Drivers and Outcomes of Engagement in Non-Formal Special Interest Groups Among Japanese Emergency Physicians: An Activity Theory Analysis.

Objectives: Emergency medicine requires physicians to manage high uncertainty, time constraints, and diverse responsibilities. To sustain their careers, continuous professional development (CPD) and psychological well-being are crucial. While participation in formal learning is often limited by time and location, autonomous "non-formal" Special Interest Groups (SIGs) are emerging as flexible learning spaces. This study aimed to address two research questions (RQs): (1) What drives Japanese emergency physicians (EPs) to engage in non-formal SIGs? (2) What do EPs learn and gain through these activities? Methods: This qualitative study was grounded in a constructivist paradigm. We conducted semi-structured interviews with 14 EPs playing central roles within the Emergency Medicine Alliance, a non-formal SIG in Japan. Data were analyzed using Braun & Clarke's thematic analysis. Engeström's Activity Theory served as the theoretical framework, focusing on interactions between individuals and the collective, as well as systemic "contradictions". Results: For RQ1 (drivers), engagement was driven by interactions among the Subject (desire for professional development), Object (goals for transforming emergency medicine), and Community (a psychologically safe and diverse network). For RQ2 (gains), learning was mediated by Tools (means of facilitating learning and interaction), Division of Labor (transformation of roles and leadership), and Rules (norms supporting activities), leading to Outcomes (professional development and formation of social networks). A primary contradiction between mutual support and social contribution emerged as a central driver of these activities. Conclusions: Non-formal SIG activities function as a process of expansive learning, in which participants develop new practices through engagement with systemic contradictions. In particular, the tension between the initial goal of "mutual support" and the evolving goal of "social contribution" acted as a fundamental driver. The collaborative resolution of these contradictions appears central to participants' learning. These findings suggest that non-formal SIGs offer important value for CPD and the development of social capital.