Abstract
-
Purpose
This study aimed to identify core shared competencies required for effective physician–nurse collaboration in primary care.
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Methods
A three-round Delphi survey was conducted from November 2024 to February 2025 with 30 experts (12 physicians, 18 nurses), including family medicine professors, primary care physicians, nursing professors, and practicing nurses. Experts evaluated the importance and roles of interprofessional team approaches using online questionnaires. Quantitative analyses included mean, standard deviation, and content validity ratio (CVR).
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Results
The first round confirmed the necessity of interprofessional teamwork in cases such as chronic disease management, rehabilitation, elderly care, and mental health. Essential team members were physicians, nurses, and social workers, with additional professionals engaged as needed. Through iterative consensus, six shared competencies were derived: (1) patient-centered integrated care, (2) treatment plan development and implementation, (3) communication and collaboration, (4) professional development as a team member, (5) Evaluation and feedback on service outcomes, and (6) disease prevention and health promotion. All items met consensus criteria (CVR ≥0.34).
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Conclusion
These findings clarify physician-nurse shared competencies in primary care and provide a foundation for developing competency-based interprofessional curricula and training programs to enhance collaborative care quality and patient outcomes.
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Key Words: Delphi technique, Interprofessional relations, Patient care team, Professional competence
Introduction
Primary care represents the essential healthcare service responsible for public health at the frontline of the healthcare system. The World Health Organization defines it as “a whole-of-society approach that aims for the highest possible level and equitable distribution of health and well-being, encompassing the full spectrum from health promotion to treatment, rehabilitation, and palliative care, delivered as close to people’s everyday environment as possible” [
1]. The Institute of Medicine similarly defines primary care as “the provision of integrated, accessible healthcare services by clinicians who are accountable for addressing a large majority of personal healthcare needs, developing a sustained partnership with patients, and practicing in the context of family and community” [
2].
A multidisciplinary team approach involving physicians and nurses is essential to achieving these functions. In today’s healthcare environment marked by growing chronic diseases and multimorbidity, the efforts of individual specialists are insufficient to address patients’ complex needs, highlighting the importance of team-based care [
1]. Interprofessional collaboration has been shown to improve clinical outcomes compared with individual practice [
3].
However, several barriers hinder the implementation of team-based care. Fee-for-service payment models reduce incentives for collaboration and interprofessional education (IPE), while a lack of role clarity and hierarchical culture among healthcare professionals can result in communication breakdowns, inefficiency, and potential patient safety risks [
4]. Therefore, role clarity, effective communication, and IPE are recognized as key enablers of collaboration [
5].
Before identifying profession-specific competencies, it is necessary to define shared competencies that physicians and nurses must both possess to ensure effective primary care. Yet, most prior research has focused on individual professional competencies, with limited systematic exploration of shared ones. Establishing shared competencies provides a common foundation of skills, knowledge, and values essential for interprofessional collaboration [
6]. Although previous studies have proposed communication, teamwork, leadership, and patientcenteredness as core shared competencies [
7], research tailored to the domestic primary care environment remains scarce. In particular, the role ambiguity and hierarchical culture identified as major barriers in Korean primary care are expected to be mitigated through the shared competencies derived in this study. These competencies can help clarify professional roles, promote horizontal communication, and foster a culture of mutual respect among team members. Therefore, this study aims to systematically derive core shared competencies that physicians and nurses should possess for effective collaboration in primary care. The specific research questions are as follows: (1) What are the importance and roles of interprofessional team approaches in primary care? (2) What are the core shared competencies that primary care physicians and nurses should possess?
Methods
1. Expert panel
A total of 30 experts, including physicians and nurses, participated in the Delphi panel to develop a community primary care competency scale for future healthcare professionals. The panel was composed of domestic experts representing various regions. The physician group (n=12) included six family medicine professors and six primary care physicians (family or internal medicine), with an average of 13.3 years of clinical experience and over six instances of clinical supervision. Eleven were male and one female. The nurse group (n=18) included nine nursing professors and nine nurses working in primary care institutions, all female, with an average of 20.8 years of experience and about 15 supervision experiences.
2. Study procedure
A three-round Delphi survey was conducted online from November 2024 to February 2025 to identify shared competencies in primary care. All 30 experts participated in Round 1 (100% response rate), and 29 in Rounds 2 and 3 (97%). Each questionnaire was revised based on prior feedback through researcher consensus. The process is summarized in
Fig. 1. In Round 1, experts were asked to respond to open-ended questions regarding the roles and importance of interprofessional collaboration in primary care (RQ1), and the key themes derived from their responses were transformed into shared competency items for evaluation and consensus in Rounds 2 and 3 (RQ2).
Open-ended and structured questions were used to gather expert opinions, and subsequent rounds refined items based on previous results. Mean, standard deviation (SD), and content validity ratio (CVR) were calculated. Following the criteria by Lawshe [
8], minimum CVR thresholds were 0.33 (n=30) and 0.34 (n=29). Items with means ≤4.0 or SD ≥0.8 were excluded. Item selection considered both quantitative results and qualitative feedback. Expert opinions collected through open-ended responses in Round 1 were reviewed to identify recurring themes and overlapping concepts. These were consolidated through internal discussion and agreement within the research team and subsequently used to formulate the items for Rounds 2 and 3. All surveys were conducted anonymously, and consensus was reached through iterative feedback. This study received approval from the Institutional Review Board (IRB) of Gachon University prior to the start of the research (IRB approval no., 1044396-202410-HR-170-01).
Results
1. Delphi round 1: Importance and roles of interprofessional team approaches in primary care
In the first Delphi round, 30 panel members including 12 physicians and 18 nurses responded regarding the importance of interprofessional team approaches in primary care, team composition, representative cases, and profession-specific roles. Physicians emphasized the necessity of attending physician-centered collaboration and flexible team composition according to patient conditions, while nurses mentioned the importance of collaboration for providing integrated and continuous care to chronic disease patients, elderly individuals, and vulnerable populations. It was suggested that team leadership can be adjusted according to situations, and various professions other than physicians can assume leadership roles. All experts emphasized that team approaches are essential in various cases including patients with multiple chronic diseases, rehabilitation, end-of-life elderly care, and mental health management. It was commonly noted that physicians are responsible for treatment planning, nurses for monitoring and coordination, social workers for resource linkage, and nutritionists and therapists for dietary management and rehabilitation therapy, respectively. Essential team members included physicians, nurses, and social workers, with nutritionists, physical therapists, pharmacists, and psychological counselors potentially included depending on circumstances. The derived roles of each profession are presented in
Table 1. Sixteen competencies were derived by converging opinions on shared competencies between physicians and nurses, leading to the second Delphi round.
1) Delphi round 2
In the second Delphi round, the importance and validity of 16 items regarding physician and nurse roles derived from the first Delphi were evaluated (
Table 2). As a result, all items showed means of 4.03–4.86 and standard deviations of 0.38–0.93, with importance scores above 4.0. After meeting the minimum CVR criterion (0.34), three items (‘nutrition and exercise counseling and prescription,’ ‘provision of psychological support,’ ‘therapeutic mediation with caregivers’) were deleted due to SDs above 0.8, and 13 items were integrated and refined. The deleted items were excluded not only due to high SDs but also because they were considered less relevant to the shared physician–nurse collaborative roles and conceptually overlapped with other items. Considering the conceptual similarities and functional relationships among items, several were integrated into higher-level categories; for instance, “team collaboration” and “communication with team members” were combined into “communication and collaboration,” and “diagnosis and treatment direction” was restructured as “treatment plan development and management.”
2) Delphi round 3
In the third round, similar items from the second round were integrated and refined into six items (
Table 2). Patient-centered integrated care (mean=4.90, CVR=1.00), treatment plan development and implementation (mean=4.72, CVR=1.00), communication and collaboration (mean=4.76, CVR=1.00), professional development as a team member (mean=4.45, CVR=0.79), evaluation and feedback on service outcomes (mean=4.57, CVR=0.79), and disease prevention and health promotion (mean=4.76, CVR=0.86) were included. All final six items met the consensus criteria (stability ≤0.2, convergence ≤0.5, agreed ≥70%), and the derived shared role competencies can be presented as foundational data for establishing primary care professional competency models.
Discussion
This study identified six core shared competencies between physicians and nurses in primary care through a Delphi survey of 30 experts.
The findings confirmed that team-based approaches are essential for managing patients with chronic diseases, rehabilitation, end-of-life care, and mental health conditions. Core team members include physicians, nurses, and social workers, with additional professionals such as nutritionists, physical therapists, pharmacists, and psychological counselors involved as needed. These results align with previous studies emphasizing multidisciplinary collaboration in primary care [
9]. Physicians are primarily responsible for diagnosis, treatment, and overall clinical management, while nurses play key roles in chronic disease management, patient education, and care coordination [
9]. Regardless of setting, all team members should possess shared competencies beyond their individual professional skills, and role clarity remains fundamental to effective integration.
Based on expert consensus, six shared competencies were identified: (1) patient-centered integrated care, (2) treatment plan development and implementation, (3) communication and collaboration, (4) professional development as team members, (5) evaluation and feedback on service outcomes, and (6) disease prevention and health promotion. These competencies are essential for addressing the complex demands of primary care and for ensuring coordinated, patient-centered care. Effective collaboration requires mutual understanding of roles, shared communication skills [
10], and patient-centeredness [
11]. In particular, the emphasis on patient-centered integrated care reflects Korea’s ongoing shift toward community-based chronic care management. Meanwhile, the focus on treatment plan implementation highlights the need for more effective coordination among physicians, nurses, and other professionals within Korea’s traditionally physician-led healthcare system. Furthermore, the inclusion of professional development as team members underscores the importance of fostering mutual role understanding and collaboration to enhance interprofessional practice in Korean primary care.
Integrating these shared competencies into IPE is critical to preparing future healthcare professionals for collaborative practice. IPE provides structured opportunities for learners from different disciplines to develop communication, teamwork, and problem-solving skills together. Embedding the identified competencies into undergraduate and postgraduate curricula can foster early appreciation of each profession’ s roles, strengthen interprofessional relationships, and reduce hierarchical barriers in clinical settings. Moreover, continuous IPE-based training in healthcare institutions can enhance collaborative readiness, promote role flexibility, and improve care coordination across the continuum of care.
The significance of this study lies in its contribution to establishing a foundation for interprofessional collaboration between physicians and nurses in primary care. By clarifying their shared roles and competencies, the findings support role delineation, facilitate teamwork, and promote more efficient and holistic care delivery. This competency framework can guide the design of education programs, clinical evaluation tools, and continuing professional development, thereby enhancing collaborative practice and patient safety within the primary care system. Several limitations must be noted. First, the panel was imbalanced in terms of profession and gender, which may have influenced the consensus outcomes. Qualitative feedback was researcher-interpreted, posing a risk of bias. The identified competencies also require future empirical validation in educational and clinical contexts.
Acknowledgements
None.
Funding
This study was supported by the Ministry of Education of the Republic of Korea and National Research Foundation of Korea (grant number: NRF-2024S1A5C3A01043098).
Conflicts of interest
So Jung Yune and Kwi Hwa Park serve as an Editorial Board members of the Korean Journal of Medical Education but have no role in the decision to publish this article. Except for that, no potential conflict of interest relevant to this article was reported.
Author contributions
Conceptualization: JYL, YHM, JY, KHP, SJY. Formal analysis: JYL, YHM, JY, KHP, SJY. Data curation: JYL, JY, KHP, SJY. Funding acquisition: KHP. Methodology: KHP, SJY. Writing–original draft: JYL. Writing–review & editing: KHP, SJY. Final approval of the version to be published: all authors.
Fig. 1.
Delphi Process for Driving Core Shared Competencies
CVR: Content validity ratio, M: Mean, SD: Standard deviation.
Table 1.Roles and Responsibilities of Healthcare Professionals in Primary Care Teams
Table 1.
|
Physician |
Roles and responsibilities |
|
Nurse |
Medical team leader, diagnosis and treatment planning, building trust relationships with patients and families |
|
Profession |
Patient assessment, monitoring, implementation of treatment plans, education, team coordination, linking with community resources |
|
Social worker |
Medical expense support, resource connection, socioeconomic and psychological support, administrative support for long-term care, and so forth |
|
Dietitian |
Nutritional assessment, meal planning, dietary education, nutrition management for chronic diseases |
|
Physical therapist, occupational therapist |
Rehabilitation, exercise prescription, disease prevention and management, prevention and control of degenerative arthritis |
|
Pharmacist |
Management of drug side effects, polypharmacy management, medication counseling |
|
Psychological counselor |
Stress management, psychological counseling |
|
Volunteer, clergy |
Caregiving support, emotional and spiritual support |
|
Others |
Additional professionals as needed, such as dental hygienists, clinical laboratory technicians, care coordinators, and so forth |
Table 2.Delphi Survey Results for Core Roles of Primary Care Healthcare Professionals
Table 2.
|
Round |
Roles for physicians and nurses |
Validity
|
Revision
status |
Notes |
|
Mean±SD |
CVR |
|
2 round |
1. Team leader and coordinator |
4.79±0.41 |
1 |
Revised |
Merged into 3rd round item 3 |
|
2. Diagnosis and treatment direction |
4.83±0.38 |
1 |
Revised |
Merged into 3rd round item 2 |
|
3. Development and management of treatment plans |
4.79±0.41 |
1 |
Revised |
Merged into 3rd round item 2 |
|
4. Communication and collaboration with team members |
4.76±0.51 |
0.93 |
Revised |
Merged into 3rd round item 3 |
|
5. Patient-centered integrated care |
4.59±0.50 |
1 |
Retained |
- |
|
6. Leadership in disease prevention and health promotion |
4.24±0.79 |
0.72 |
Revised |
Merged into 3rd round item 6 |
|
7. Support for professional development of the healthcare team |
4.52±0.57 |
0.93 |
Revised |
Merged into 3rd round item 4 |
|
8. Patient monitoring and status evaluation |
4.86±0.44 |
0.93 |
Revised |
Merged into 3rd round item 5 (reframed as outcome evaluation) |
|
9. Support and management of treatment plan implementation |
4.72±0.53 |
0.93 |
Revised |
Merged into 3rd round item 5 (reframed as outcome evaluation) |
|
10. Team collaboration and coordination |
4.83±0.47 |
0.93 |
Revised |
Merged into 3rd round item 3 |
|
11. Nutrition and exercise counseling and prescription |
4.03±0.91 |
0.52 |
Deleted |
Low mean (4.03) and high SD (0.91) |
|
12. Connection with community resources |
4.24±0.79 |
0.72 |
Revised |
Merged into 3rd round item 1 |
|
13. Provision of psychological support |
4.31±0.89 |
0.72 |
Deleted |
High SD (0.89), inconsistent consensus |
|
14. Therapeutic mediation with caregivers |
4.17±0.93 |
0.59 |
Deleted |
Low mean (4.17) and very high SD (0.93) |
|
15. Support for chronic disease management and prevention |
4.59±0.78 |
0.79 |
Revised |
Merged into 3rd round item 6 |
|
16. Patient education and health promotion counseling |
4.66±0.61 |
0.86 |
Revised |
Merged into 3rd round item 6 |
|
3 round |
1. Patient-centered integrated care |
4.90±0.31 |
1 |
Retained |
Integrated from 2nd round items 5 and 12 |
|
2. Treatment plan development and implementation |
4.72±0.45 |
1 |
Retained |
Integrated from 2nd round items 2, 3, and 9 |
|
3. Communication and collaboration |
4.76±0.44 |
1 |
Retained |
Integrated from 2nd round items 1, 4 and 10 |
|
4. Professional development as a team member |
4.45±0.69 |
0.79 |
Retained |
Rephrased from 2nd round item 7 |
|
5. Evaluation and feedback on service outcomes |
4.57±0.74 |
0.79 |
Retained |
Integrated from 2nd round items 8 and 9 |
|
6. Disease prevention and health promotion |
4.76±0.58 |
0.86 |
Retained |
Integrated from 2nd round items 6, 15, and 16 |
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