Developing and defining core climate and environmental epidemiology competencies for field epidemiology training programs in the Eastern Mediterranean Region: a Delphi study.

BACKGROUND: Climate change, environmental degradation, and chemical hazards increasingly shape population health risks, particularly in the Eastern Mediterranean Region (EMR), where water scarcity, rapid urbanization, conflict, and fragile health systems amplify vulnerability. Despite these growing threats, Field Epidemiology Training Programs (FETPs) lack systematically defined competencies in climate change and environmental epidemiology. This study aimed to identify, prioritize, and validate a core set of practice-oriented competencies for integrating climate change and environmental epidemiology into FETPs, with particular relevance to the EMR. METHODS: We conducted a three-round modified Delphi study. Round 1 used a qualitative online survey to elicit expert input on essential competencies, priority areas, and implementation considerations. In Round 2, experts rated synthesized competencies using a 5-point Likert scale to assess importance and curricular inclusion. Round 3 consisted of a multidisciplinary expert workshop to validate and refine the competencies, clarify their applicability across FETP levels (Basic, Intermediate, Advanced), and translate them into applied learning modalities, including teaching case studies and structured fieldwork activities. RESULTS: Consensus was achieved on a comprehensive set of competencies spanning foundational knowledge; environmental exposures and risk assessment; epidemiological and analytical skills; climate-informed environmental public health surveillance; environmental incident and event response; vulnerability, adaptation, and preparedness; policy and governance; risk communication and community engagement; and One Health and multisectoral collaboration. The highest-rated competencies extended core field epidemiology functions-particularly surveillance, outbreak and environmental event investigation, and data analysis-into climate and environmental contexts. Workshop validation confirmed the relevance, clarity, and feasibility of all competency domains and emphasized tiered implementation and integration within existing FETP curricula. CONCLUSION: This study presents a consensus-based, practice-oriented competency framework for integrating climate change and environmental epidemiology into FETPs. By combining Delphi consensus with expert validation and operationalization, the framework offers a feasible and scalable approach to strengthening climate-resilient field epidemiology capacity, particularly in vulnerable regions such as the EMR.