Emergency Physician Professionalism: 360 - Degree Perceptions of Healthcare Providers and Patients in Thailand and USA Cultural Context

Abstract

Background: We previously demonstrated generational perspectives of emergency physician professionalism (EPP) defined by healthcare providers and patients in the USA. The present study aimed to further explore EPP perceptions among healthcare providers and patients from emergency departments in the USA and Thailand. Methods: A multicenter cross-sectional study in university-based emergency departments was performed in the USA and Thailand from July 2016 to January 2017. Participants were enrolled from seven centers (USA=2, Thailand=5). All participants were pooled and categorized into two groups: healthcare providers and patients. The former group consisted of attending physicians (APs), nurses, residents, and 4th and 1st year medical students (MS4s and MS1s, respectively). Each participant independently ranked 39 cards describing qualities of EPP. Descriptive statistics, quantitative cultural consensus, and Pearson correlation coefficients were used to assess the data. Results: The total number of participants was 984, with the majority from Thailand (n = 683; 69.41%). The groups of APs, nurses, residents, MS4s, MS1s, and patients included 89, 196, 135, 197, 170, and 197 subjects, respectively. In the USA, APs had a wider range of ages (30-68) than those in Thailand (29-49). APs and nurses had more experiences of unprofessional EPP than MS4s, MS1s, and patients. Thai MS1s started medical school earlier than students in the USA. Both MS4s and MS1s in the USA had more healthcare work-related experiences. All cohorts agreed that having excellent knowledge and procedural skills is the most important behavior for EPP, while wearing a white coat is the least important. The overall data demonstrated a pattern of borderline cultural consensus regarding EPP (eigenvalue ratio = 3.07, mean competency = 0.5, and negative competency = 3.15%), with a validity of 0.95. There was no cultural consensus among healthcare providers and patients.Conclusion: This is the first study showing EPP perceptions in healthcare teams and patients from the USA and Thailand. All participants selected the same rankings of the most and least important EPP-related issues. However, no absolute cultural consensus among healthcare providers and patients was identified. Therefore, more studies on the aspects of EPP are required.