Abstract
Background
Self‐assessment of professionals' interprofessional competency is meaningful for benchmarking oneself and helping to identify training needs. We aimed to clarify differences in self‐assessment of interprofessional competency in Japan by profession and type of facility.
Methods
We conducted a cross‐sectional study using a web survey among primary healthcare providers in Japan, especially members of the Japan Primary Care Association, between June and October 2020. After sampling using the e‐mail list, we used an exponential nondiscriminative snowball method as purposive sampling through key professional informants between November 2020 and February 2021. The questionnaire covered items including participant demographics (age, gender, years of experience as professionals, years of experience working at the current institution, attendance type (regular or part‐time work), administrative experience, profession, and facility type) and included the Japanese version of the Self‐assessment Scale of Interprofessional Competency (JASSIC). Differences between healthcare professions (physician, nurse, pharmacist, rehabilitation therapist, and social worker) and between types of facility (university hospital, medium‐sized hospital, small hospital, and clinics) were compared using the Kruskal–Wallis test.
Results
A total of 593 people responded to the survey. Their mean age was 41.2 ± 11.3 years, and 312 (52.6%) were female. JASSIC scores of physicians and social workers were significantly higher than those of rehabilitation therapists (p < 0.01). Concerning facilities, professionals working in clinics rated themselves higher than those in medium‐sized hospitals (p < 0.01).
Conclusions
We revealed that self‐assessment of interprofessional competency in Japan varied by profession and type of facility.
Keywords: interprofessional relation, professional competency, questionnaire design, self‐assessment
We clarified differences in self‐assessed interprofessional competency among health and welfare professionals in Japan in relation to profession and type of facility, using an anonymous, self‐administered questionnaire (web survey). We used the Japanese version of Self‐assessment Scale of Interprofessional Competency (JASSIC). A total of 593 people responded to this survey, which revealed higher JASSIC scores for physicians and social workers than for rehabilitation therapists.
1. INTRODUCTION
As we enter a super‐aging society, problems faced by patients and their families are becoming more complex and diverse, 1 as the medical field has to respond to these problems with limited human resources. Many of these diverse problems cannot be solved by a single profession alone, and it is necessary for multiple healthcare practitioners to collaborate and cooperate, each contributing their respective skills and expertise. 2 Because inadequate interprofessional collaboration (IPC) might adversely affect the delivery of health services and patient care, 3 , 4 bridging the gap between the current state of IPC and social needs related to health and welfare in the super‐aging society requires the promotion of education and collaborative practice related to IPC.
In 2010, WHO presented a framework for action on interprofessional education and collaborative practice to improve the quality of care for patients and their families, 5 and stated the need for competency‐based education in IPC. Since then, interprofessional competency has been addressed in various countries including Japan, 6 , 7 , 8 , 9 resulting in a gradual spread of competency‐based education. Despite the acknowledged importance of interprofessional education (IPE), however, variation in evaluation methods makes comparisons and synthesis of results problematic. 10 , 11 Several scales have been developed to evaluate IPC, focusing on, for example, readiness for interprofessional learning, 12 , 13 interprofessional attitudes, 14 and interprofessional team collaboration. 15 However, in Japan issues arise regarding the use of overseas‐developed scales to evaluate IPC, as the latter may be influenced by cultural practices, beliefs and values.
Against this background, the Japanese version of Self‐assessment Scale of Interprofessional Competency (JASSIC) was developed to take into account the cultural background of Japan, and its reliability and validity were verified. 16 Although some studies have included self‐assessment of interprofessional competency among students from multiple faculties 17 and others have compared the practice of IPC among different professions, 18 , 19 , 20 there are no reports clarifying the results of self‐assessment of interprofessional competency among different professions. One report compared IPC using demographic groups such as profession and country, but no comparison was made between the different types of facilities to which the participants belonged. 21 Therefore, by addressing these differences, this study aims not only to encourage healthcare professionals to reflect on the current situation regarding collaboration in their own professions and facilities but also to improve understanding of the differences across professions and facilities, thereby enhancing collaboration and complementarity. The purpose of this study was to compare self‐assessments of interprofessional competency among healthcare professionals in Japan by profession and by the type of facility where they work.
2. METHODS
2.1. Research design
This was a cross‐sectional study using an anonymous, self‐administered questionnaire (web survey).
2.2. Participants and methods
Participants were primary healthcare providers in Japan, especially members of the Japan Primary Care Association (JPCA). They were solicited from among recipients on the JPCA e‐mail list between June and October 2020. After sampling using the e‐mail list, as purposive sampling we directly asked key professional informants to encourage their peers and other local professionals to participate between November and December 2020, because the number of responses from nurses, pharmacists, and rehabilitation therapists was low. In addition, we recruited more pharmacists through key professional informants in January and February 2021. Sample size was not calculated for this study, due to its exploratory nature and untested feasibility.
JPCA was established in 2010 by the merger of three academic societies in primary care, and it represents primary care in Japan. As of September 30, 2020, 10,019 physicians, 735 pharmacists, 271 nurses, 49 dentists, and 304 other health professionals were registered as members. 22
2.3. Content of the survey
Based on previous work, 20 the survey included questions on age, gender, years of experience as a professional, years of experience working at the current institution, attendance type, administrative experience, professions, and facilities, as attributes that the authors considered to be associated with JASSIC. JASSIC is a 5‐domain measurement scale based on Interprofessional Competency in Japan 6 (Domain 1: Patient‐/Client‐/Family‐/Community‐Centered, Domain 2: Interprofessional Communication, Domain 3: Role Contribution, Domain 4: Facilitation Relationship, Domain 5: Reflection, and Domain 6: Understanding for Others). Each domain consists of three items, for a total of 18 items (Table S1). Each item is answered on a 5‐point Likert scale, with total scores ranging from 18 to 90. On the JASSIC scale, a higher score indicates a more positive self‐assessment of interprofessional competency. The scale has been validated in previous research. 16
2.4. Statistical analysis
Participants' demographics and JASSIC total and domain‐specific scores were described. In addition, to explore differences in JASSIC scores across diverse professions and facilities in primary healthcare, we conducted comparisons among the top five professions (i.e., the five professions most often engaged in medical institutions: physician, nurse, pharmacist, rehabilitation therapist, and social worker) and top four types of facility (i.e., based on Japanese hospital size standards: university hospitals, medium hospitals (100‐499‐beds), small hospitals (20‐99‐beds), and clinics) with sufficiently large sample sizes. Differences between professions and between types of facilities were compared using the Kruskal–Wallis test. Multiple comparisons were also performed using the Mann–Whitney U test and adjusted by Bonferroni correction. Thus, the significance level for comparisons between professions was set at 0.005% (0.05/10) and, for comparisons between types of facilities, at 0.008% (0.05/6). This survey was designed so that anyone who did not give consent was not allowed to respond, and those who did consent were required to answer all questions; this meant that there were no missing data in the final dataset. SPSS (Statistical Package for the Social Sciences), Windows version 27.0, was used to run the statistical analyses.
3. RESULTS
3.1. Attributes of the subjects
A total of 593 people responded to the survey (Figure 1). Their mean age was 41.2 ± 11.3 years, and 312 (52.6%) were female. The mean number of years of experience as a professional was 16.4 ± 9.7, and years of experience working at the current institution was 9.2 ± 8.3. In decreasing order of number of participants, the professions were as follows: nurse, doctor, social worker, rehabilitation therapist, and pharmacist. The types of facilities in which respondents worked were medium‐sized hospital, clinic, university hospital, and small hospital, in that order (Table 1).
FIGURE 1.
Participant flow chart.
Table 1.
Attributes of participants
| (n = 593) | |
|---|---|
| Age (years) | 41.2 ± 11.3 |
| Gender (female) | 312 (52.6) |
| Years of experience as professional | 16.4 ± 9.7 |
| Years of experience working at the current institution | 9.2 ± 8.3 |
| Attendance type (regular) | 557 (93.9) |
| Administrative experience (yes) | 303 (51.1) |
| Profession (including duplicates) | |
| Physician | 128 (21.6) |
| Public health nurse or nurse | 133 (22.4) |
| Pharmacist | 59 (9.9) |
| Rehabilitation therapist | 113 (19.1) |
| Care manager | 25 (4.2) |
| Social worker | 120 (20.2) |
| Psychiatric social worker | 22 (3.7) |
| Care worker | 14 (2.4) |
| Others | 35 (5.9) |
| Facilities | |
| University hospital (over 500 beds) | 55 (9.3) |
| Medium hospital (100–499 beds) | 238 (40.1) |
| Small hospital (20–99 beds) | 43 (7.3) |
| Clinic | 99 (16.7) |
| Home‐visit nursing station | 23 (3.9) |
| Pharmacy | 26 (4.4) |
| Administrative agency | 10 (1.7) |
| Nursing home | 28 (4.7) |
| Others | 71 (12.0) |
3.2. Comparison of JASSIC score across professions
Median JASSIC total scores were 72.5 (69–80) for physicians, 72 (66–78) for nurses, 70 (62–77.5) for pharmacists, 70 (64–74) for rehabilitation therapists, and 72 (69–80) for social workers (Kruskal–Wallis test: H = 21.507, df = 4, p < 0.001). Multiple comparisons revealed significant differences between physicians and rehabilitation therapists (p = 0.004) and between social workers and rehabilitation therapists (p = 0.001) (Figure 2). The scores for each domain of interprofessional competency are presented in Table 2.
FIGURE 2.
Comparison of JASSIC scores across professions. *Mann–Whitney U test, adjusted by Bonferroni correction (significance level of 0.005%).
TABLE 2.
Scores for each domain of JASSIC across professions and facilities
| Professions | Facilities | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Physician | Nurse | Pharmacist | Rehabilitation therapist | Social worker | University hospital | Medium hospital (100–499 beds) | Small hospital (20–99 beds) | Clinic | |
| Patient‐/Client‐/Family‐/Community‐Centered | 12 (12–14) | 12 (11–14) | 12 (10–13.5) | 12 (11–13) | 12 (12–14) | 12 (12–14) | 12 (11–13) | 12 (12–13) | 12 (12–14) |
| Interprofessional communication | 12 (12–14) | 12 (12–14) | 12 (11–13) | 12 (11–13) | 12 (12–14) | 12 (12–13) | 12 (11–13) | 12 (12–14) | 13 (12–14) |
| Role contribution | 12 (12–14) | 12 (11–13) | 12 (10–13) | 12 (11–13) | 12 (12–14) | 12 (11–13) | 12 (11–13) | 12 (11–13) | 12 (12–14) |
| Facilitation relationship | 12 (11–13) | 12 (10–13) | 11 (10–13) | 11 (9–12) | 12 (10–12) | 11 (10–13) | 11 (10–12) | 11 (10–12) | 12 (11–13) |
| Reflection | 12 (12–15) | 12 (11–14) | 12 (11–14) | 12 (11–13) | 12 (12–13) | 12 (12–14) | 12 (11–13) | 12 (12–14) | 12 (12–15) |
| Understanding of others | 12 (11–13) | 12 (10–12) | 11 (9–12) | 11 (9–12) | 12 (11–13) | 12 (11–12) | 11 (10–12) | 12 (10–12) | 12 (11–13) |
3.3. Comparison of JASSIC score across facilities
Median JASSIC total scores were 73 (68–78.5) for university hospitals, 71 (64–75.75) for medium hospitals, 71 (68–75.5) for small hospitals, and 75 (70–81) for clinics (Kruskal–Wallis test: H = 20.596, df = 3, p < 0.001). Multiple comparisons showed a significant difference between medium‐sized hospitals and clinics (p < 0.001) (Figure 3). The scores for each domain of interprofessional competency are presented in Table 2.
FIGURE 3.
Comparison of JASSIC scores across facilities. *Mann–Whitney U test, adjusted by Bonferroni correction (significance level of 0.008%).
4. DISCUSSION
Self‐assessments of interprofessional competency were conducted by healthcare professionals in Japan, for comparison by profession and facility. The results showed that self‐assessed interprofessional competency of physicians and social workers was higher than that of rehabilitation therapists. In addition, the self‐assessment of professionals working in clinics was higher than those working in medium hospitals. As IPC will become even more important as the population continues to age and complex social problems multiply, these findings on the current state of interprofessional competency and differences by profession and type of facility provide a valuable basis for individuals to better understand other professions and confirm their own position within the multiprofessional setting.
Differences in JASSIC scores might reflect the influence of experiences in training courses and clinical practice. 23 Although some reports have compared IPC between two professions, 18 , 19 few have compared IPC among multiple professions. The comparison in this study revealed higher scores for physicians and social workers. One possible reason for this could be that physicians have been aware of the need for leadership in the healthcare team since medical school 24 and have developed their leadership identity through pregraduate education and clinical practice. 25 , 26 , 27 Meanwhile, social workers focus on the wholeness of the patient and family 28 and serve as a link between patients, families, professionals, and the community. 29 Accordingly, physicians, who demonstrate leadership in the multiprofessional team, and social workers, who are the hub with various stakeholders, highly value interprofessional competency due to identity formation from their training and recognition of the role of their own profession through clinical experience. On the contrary, although a team approach may be the best way to provide rehabilitation for the elderly, 30 rehabilitation therapists in Japan often provide individual training to patients in a hospital or at home. This means that, due to spending a lot of time with patients and their families, they may lack opportunities to get involved with colleagues and other professionals. In addition, similarly to rehabilitation students, who tended to have a low opinion of IPC, 31 even clinically experienced rehabilitation therapists assessed their interprofessional competency lower than other professions. Therefore, it may be advantageous for rehabilitation therapists to recognize that one of their roles is to communicate rehabilitation information to other professionals and involve them in implementing rehabilitation.
Differences emerged in JASSIC scores related to the type of facility in which participants worked. These differences may be explained with reference to organizational structure and roles across medical institutions. 32 In large university hospitals with many functions and employees in diverse professions, for example, the specialties and roles of each profession are clear, and the entire organization functions by each person fulfilling the role of their own profession. By contrast, clinics have fewer functions and professionals. However, each profession in a clinic may rate their interprofessional competency as higher because under this organizational structure, each profession can have a bird's‐eye view of the entire organization and maintain the functions of the clinic by playing multiple roles concurrently. Professionals working in medium‐sized hospitals, however, assessed their interprofessional competency lower than those working in clinics. Unlike the case in university hospitals, where professionals are abundant and their roles are clear, and clinics, where mutual roles are easily visible, the roles of professionals in medium‐sized hospitals may be more ambiguous. 33 , 34 Furthermore, role ambiguity tends to cause conflicts and confusion within organizations, 35 and decreases job satisfaction and professional performance. 34 , 36 Therefore, professionals working in medium‐sized hospitals may self‐assess as having relatively low interprofessional competency. As reflective practice interventions have been reported to be effective in improving IPC, 37 greater reflection on the role of one's own profession within the organization and working on the relationship with other professions could conceivably lead to improving IPC.
There are several limitations in this study. First, because the main participants were members of the JPCA e‐mailing list, a degree of sampling bias is present. Therefore, the study may have limited generalizability and the results should be interpreted with due caution. Second, it is possible that many people who responded to the survey were highly interested in IPC, which in turn could have led to a higher JASSIC score than might be obtained from a more general population. Finally, the self‐assessment of interprofessional competency used in the study does not measure actual collaboration ability. Nonetheless, the results may help lead to better IPC, including greater complementarity across different professional roles and types of facility.
5. CONCLUSIONS
Self‐assessment of interprofessional competency among healthcare professionals in Japan showed that physicians and social workers were more likely to score higher than rehabilitation therapists and that those working in clinics were more likely to score higher than those working in medium hospitals. It is hoped that the results of this study will contribute toward better mutual understanding among professionals by increasing awareness of differences between, for example, professions and facilities.
ETHICS APPROVAL STATEMENT
This study was approved by the Ethics Committee of the Faculty of Medicine, University of Tsukuba (approval number: 1483).
CONFLICT OF INTEREST
The authors have stated explicitly that there are no conflicts of interest in connection with this article.
PATIENT CONSENT STATEMENT
None.
CLINICAL TRIAL REGISTRATION
None.
Supporting information
Table S1
ACKNOWLEDGMENT
This study was supported by the Interprofessional Collaboration Committee of the Japan Primary Care Association.
Goto R, Haruta J. Current status of interprofessional competency among healthcare professions in Japan: A cross‐sectional web‐based survey. J Gen Fam Med. 2023;24:119–125. 10.1002/jgf2.601
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Supplementary Materials
Table S1