Perceptions of emergency physician professionalism among healthcare providers and patients: A multicenter study in Thailand and the US (California)

Abstract

Background: Universal standards for emergency physician professionalism (EPP) among different groups of healthcare workers do not exist. Objectives: This study aimed to explore the perceptions of EPP among attending physicians (APs), emergency medicine (EM) residents, first-and fourth-year medical students (MS1s and MS4s, respectively), EM nurses and emergency department (ED) patients. Methods: This multicenter, cross-sectional study was conducted at seven university-based EDs in Thailand and the United States from July 2016-to January 2018. Thirty-nine cards (13 core elements) describing behaviors derived from a global literature review were created. Subjects ranked each card from the most important to least important for EPP. Pearson correlation analysis and quantitative cultural consensus analysis were used to assess between-and within-cohort agreement in EPP perceptions. Results: We enrolled 984 subjects into six cohorts (197 ED patients, 90 APs, 135 EM residents, 169 MS1s, 197 MS4s and 196 EM nurses). The overall data demonstrated borderline cultural consensus on EPP [eigenvalue ratio (ER) = 3.1, mean competency (MC) = 0.5, and 3.2% negative competency (NC)], with a validity of 0.95. All cohorts suggested that having excellent knowledge and procedural skills was the most important behavior for EPP, whereas wearing a white coat was the least important. No consensus on EPP was found among healthcare providers and ED patients. Conclusion: The absence of consensus in EPP perceptions among healthcare providers and ED patients highlights the need for further research using qualitative methods to gain deeper insights into EPP, foster empathy between stakeholders, and bridge these gaps.