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

Emergency Physician Professionalism: 360 - Degree Perceptions of Healthcare Providers and Patients in Thailand and USA Cultural Context | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Emergency Physician Professionalism: 360 - Degree Perceptions of Healthcare Providers and Patients in Thailand and USA Cultural Context Khuansiri Narajeenron, Tanawat Tarapan, Jasmina Dukovic, Krongkarn Sutham, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1710023/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version 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 4 th and 1 st 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. Emergency Physician Professionalism 360 - Degree Perceptions Healthcare providers Patients Cultural consensus Background The Accreditation Council for Graduate Medical Education (ACGME) defined professionalism as one of six new core competency requirements for medical training [ 1 ]. These competencies consist of patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice [ 1 ]. Professionalisms comprise altruism, accountability, authority, commitment, communication, honesty, service, and suspension of self-interest [ 1 , 2 ]. Medical professionalism is a crucial basis of medicine’s contract with society [ 3 ]. In emergency departments (EDs), situations involving increased time pressure and environmental forces could threaten emergency physician professionalism (EPP) [ 4 , 5 ]. Professional behaviors in focusing on emergency medicine training and practice were implicated by the Council of Emergency Medicine Residency Directors (CORD-EM) in 2002 [ 6 ]. Previous studies documented unprofessional behaviors and malpractices by emergency physicians (EPs) [ 7 , 8 ]. These led to medical errors, patient safety issues, patient mortality, and lawsuits [ 9 , 10 ]. Disruptive and unprofessional behaviors also impact on healthcare provider interrelationships [ 9 ]. Previous investigations examined medical professionalism perceptions in doctors, medical educators, medical students, allied health professionals, lay professionals, and patients [ 11 , 12 ]. In USA cohorts, we studied the definition of EPP defined from the generation perspective among healthcare providers and patients in the ED [ 13 ]. The results showed cultural consensus on EPP in millennials and Generation X overall [ 13 ]. In healthcare providers, there was consensus regarding EPP throughout all generations, but no consensus across generations in the patient group was noted [ 13 ]. There is no EPP study in ED healthcare providers and ED patients in Thailand. Therefore, the present study aimed to understand how EPP is perceived by ED healthcare providers and ED patients in different cohorts from five medical schools in Thailand and two cohorts in the USA. Using 360-degree perceptions and card-sorting techniques, we performed a study on the healthcare provider group, including attending physicians (APs), residents, nurses, MS4s, MS1s, and the patient group. The results may provide a better understanding of EPP in both countries and explicit conceptualizations of professionalism across cultural differences. We hypothesized that the study would show no absolute cultural consensus on emergency medicine professionalism among ED healthcare providers and patients. Methods Study design and setting A cross-sectional survey in multiple EDs was performed in the USA and Thailand from July 2016 to January 2017. The cultural consensus model was analyzed by using a card-sorting technique [ 13 ]. We included a total of 984 participants from two urban level 1 trauma centers in California, USA (centers A, B), and five level 1 trauma centers at university-affiliated hospitals in Thailand (centers C-G). All participants were pooled and categorized into five groups of healthcare providers and one patient group. The healthcare provider group consisted of APs, nurses, residents, and MS4s and MS1s. The participants were individuals 17 years of age or older speaking fluent English at USA centers. At Thailand centers, the Thai language was preferred. The exclusion criteria for the patient group were pregnancy, medically unstable, altered state of consciousness, handicapped, psychiatric hold, or police custody. The study was approved by the Institutional Review Boards of all institutions in the USA and the Thai Central Research Ethics Committee in Thailand [ 13 ]. Tools and procedures A card-sorting technique was described and applied in our previous study [ 13 ]. In brief, each card defined a quality or behavior of EPP within the 13 core elements [ 13 ]. In Thailand, the cards were translated from the English to Thai language by native speakers (Thai healthcare teams) to ensure proper translation. To confirm the consistency in the card interpretation, piloted studies were performed in 16 APs, 7 nurses, 5 residents, 5 MSs, and 21 patients in each country (USA and Thailand). All participants entered into the study after an informed consent agreement was signed. The data obtained during the study was kept anonymous. Participants could leave the study at any time without any consequences. Each participant received the 39 cards and ranked them in order of importance for EPP. The ranking was based on his or her opinions, with potential effects on medical professionalism, from the most to the least important. Cards were provided every time in the same sequence from 1 to 39. Afterward, the participants completed their demographic data. In the USA, demographic information from center A was collected through the Research Electronic Data Capture as an online data collection program [ 14 ]. In the other six centers (centers B-G), the data were collected as paper sheets. The total time to complete all procedures was approximately 15 minutes and the procedures were conducted by well-trained research associate teams. Each research team worked in a private room to avoid any interference from the others [ 13 ]. Statistical analysis To obtain a 0.25 agreement level based on the averaged Pearson correlation coefficients (a 0.5 competency and 95% validity), we needed at least 28 subjects in each cohort [ 13 , 15 ]. Demographic information was presented in descriptive data. The quantitative cultural consensus method was applied to inspect the existence of a shared cultural model and to determine the aggregated rankings within each group [ 13 , 15 , 16 ]. Cultural consensus analysis is a creation of statistical patterns to evaluate the degree of agreement within cohorts and the existence of “culturally shared” beliefs [ 13 ]. By the minimum-residual algorithm (no rotation), factor analysis of respondents was calculated to assess the degree of agreement within a cohort and obtain individual-level competency scores [ 13 ]. The eigenvalue ratio (ER) between the first and second indicates whether the data have a single shared dimension. ER values of 3 to 1 or greater imply a shared cultural idea within the cohort. Competency levels for individuals were estimated as the first factor loading from the factor analysis. A higher average competency level indicates a higher consensus level within the cohort. Negative competency (NC) scores indicate the presence of more than one subcultural group [ 13 ]. Cohorts with an ER equal to or greater than 3 and no NC score were considered to have an absolute cultural consensus, whereas a borderline cultural consensus presented with an ER > 3 and NC scores < 5%. The cultural consensus assumption was rejected as ER 5%. If an absolute or borderline cultural consensus was found, aggregated rankings were estimated as the first set of factor scores. The aggregated ranking among cohorts was examined by Spearman’s correlation coefficient. The FREQ, CORR, and FACTOR procedures in SAS version 9.4 [SAS Institute, Inc., 2013, SAS/ACCESS® 9.4, Cary, NC] were used to conduct all data analyses [ 13 ]. Results There were 984 participants enrolled in the study, 301 (30.59%) from the USA and 683 (69.41%) from Thailand (Table 1 ). The majority of the participants were female (55.49%) (male, 44.51%). The total numbers of APs, nurses, and residents were 89, 196, and 135, respectively. In the USA, the age of APs exhibited a wider range, varying from 30 to 68 years old, than in Thailand (29 to 49 years old). Both APs and nurses had more experience with unprofessional EPs. There were 197 in the MS4s (male 107, female 90) and 170 in the MS1s (male 89, female 81) groups. In Thailand, MS1s started medical school earlier (18 to 21 years old) than those in the USA (22 to 36 years old). Both MS4s and MS1s in the USA had more opportunities to work in healthcare before their admission to medical schools. In both countries, 197 patients were included with 73 males (37.06%) and 124 females (62.94%). All MS4s, MS1s, and patients showed a lesser extent of experience with unprofessional EP (Table 1 ). Table 1 Demographic data of participants in the USA and Thailand (n = 984) Country Site n Sex M F Age (yrs.) Year of practice Experience of unprofessional EP Yes No Experience working in healthcare Yes No AP (n = 89, 48/43 M/F) USA A 28 17 11 30-68 1-35 23 5 B 23 12 11 31-68 1-36 20 3 Thailand C 9 5 4 29-40 6-11 6 3 D 6 4 2 29-49 2-14 5 1 E 9 3 6 29-41 1-11 4 5 F 7 1 6 30-43 1-14 5 2 G 7 4 3 30-49 5-20 3 4 Nurse (n = 196, 55/141 M/F) USA A 28 14 14 25-54 1-31 18 10 B 28 9 19 27-63 3-42 14 14 Thailand C 28 4 24 25-44 1-22 10 18 D 28 12 16 23-56 1-31 20 8 E 28 2 26 24-45 1-21 20 8 F 28 3 25 22-55 1-34 22 6 G 28 11 17 23-37 1-15 17 11 Resident (n = 135, 68/67 M/F) USA A 28 15 13 26-38 1-3 13 15 B 24 16 8 26-35 1-4 14 10 Thailand C 19 8 11 26-30 1-6 7 12 D 18 7 11 25-39 1-15 5 13 E 15 8 7 26-37 1-7 9 6 F 18 8 10 26-30 2-6 7 11 G 13 6 7 27-35 2-5 1 12 MS4 (n = 197, 107/90 M/F) USA A 29 13 16 24–33 7 22 19 10 B 28 22 6 25–39 19 9 19 9 Thailand C 28 20 8 22–25 2 26 2 26 D 28 14 14 22–23 2 26 6 22 E 28 12 16 23–25 17 11 13 15 F 28 13 15 23–28 5 23 3 25 G 28 13 15 23–26 9 19 4 24 MS1 (n = 170, 89/81 M/F) USA A 29 12 17 22–36 5 24 26 3 B - - - - - - - - Thailand C 29 17 12 19–21 1 28 0 29 D 28 17 11 18–21 4 24 2 26 E 28 15 13 19–21 1 27 2 26 F 28 17 11 19–20 1 27 1 27 G 28 11 17 19–21 0 28 2 26 Patient (n = 197, 73/124 M/F) USA A 28 8 20 18–65 4 24 B 28 12 16 20–76 10 18 Thailand C 28 19 9 17–79 0 28 D 28 7 21 18–59 3 25 E 28 11 17 21–62 6 22 F 29 8 21 21–68 1 28 G 28 8 20 16–63 3 25 AP: attending physician; MS4: 4 th -year medical student; MS1: 1 st -year medical student; M: male; F: female The overall data demonstrated that the ER value was 3.07, with 3.15% negative competency (NC) (Table 2 ). These results indicated a pattern of borderline cultural consensus. In healthcare providers, the mean competency (MC) values were high (0.52 to 0.58), whereas the percentages of NC were low (0.74 to 2.04). As further analyzed in each group of healthcare providers or patients, the ER data still illustrated a borderline pattern of cultural consensus (ER: 3.13 to 3.64, Table 2 ). Both residents and MS4s had the highest cultural consensus levels (0.58). In the patient group, the data showed no cultural consensus (MC: 0.42; ER: 3.13, and NC: 7.11). When these data were combined with the healthcare provider data, the levels of MC declined (0.44 to 0.46). The NC levels were much higher (4.53 to 7.25) when combining patients with healthcare providers (Table 2 ). Table 2 Cultural consensus analysis on emergency physician professionalism in healthcare providers and patients Group n Mean competency SD competency Eigenvalue ratio % Negative competency Overall 984 0.50 0.21 3.07 3.15 AP 89 0.55 0.18 3.49 1.11 Nurse 196 0.52 0.19 3.28 2.04 Resident 135 0.58 0.14 3.64 0.74 MS4 197 0.58 0.18 3.25 1.02 MS1 170 0.57 0.19 3.56 1.78 Patient 197 0.42 0.27 3.13 7.11 Patient & AP* 286 0.44 0.25 3.11 6.97 Patient & nurse* 393 0.44 0.26 2.95 7.12 Patient & resident* 332 0.46 0.24 3.15 6.02 Patient & MS4* 394 0.46 0.24 2.42 5.84 Patient & MS1* 367 0.46 0.25 3.10 6.56 Patient & MS* 564 0.50 0.26 2.92 6.18 Patient & AP & resident* 421 0.48 0.26 3.12 7.25 Patient & AP & nurse & resident* 617 0.48 0.22 3.21 4.53 AP: attending physician; MS4: 4 th -year medical student; MS1: 1 st -year medical student; MS: all medical students; SD: standard deviation *Data pooled from multiple cohorts for cultural consensus analysis The perceptions of EPP were assessed by each group of participants and are depicted in Table 3 . All participants ranked “build excellent knowledge and procedural skills” as the most important aspect, whereas “wear a white coat” was the least important EPP-related issue (Table 3 ). In the respect core element, “respect patients” was in the top-ten ranked by all groups. All healthcare providers ranked “be the patients’ advocate” and “be a good team player” among the top-ten issues. The AP group was more aware of “be transparent and truthful” and “be trustworthy and dependable” than the other groups. The residents, MS4s and MS1s selected “be able to treat patients in various situations with limited resources” as their top-ten importance. The nurse group listed “respect coworkers”, while the MS4s chose “have situational awareness” and “gather data efficiently with limited time and resources” as their highest concerns. Patients listed “humanism”, “be polite and respect patients”, “listen and respond to patients’ concern”, “communicate clearly to patients”, “desire to help others”, and “take a holistic approach to patients” as their items of concern (Table 3 ). Table 3 Aggregated rankings of emergency physician professionals in healthcare providers and patients 13 core elements 39 cards Rankings AP (n = 89) Nurse (n = 196) Resident (n = 135) MS4 (n = 197) MS1 (n = 170) Patient (n = 197) Altruism 1. Be unselfish 26 20 20 23 16 18 2. Choose patients’ interests over the physician’s interest 16 10 8 12 5 13 3. Desire to help others 10 15 2 10 6 6 Accountability 4. Be the patients’ advocate 6 6 4 6 4 12 5. Be responsible to colleagues 22 14 17 17 23 34 6. Be responsible to society and the institution 30 32 29 33 32 35 Excellence 7. Be self–motivated to practice excellence by being a lifelong learner 20 26 14 19 13 16 8. Teach other medical personnel 31 29 31 29 34 31 9. Promote research to create new knowledge 35 35 35 35 35 32 Honor and integrity 10. Be transparent and truthful 7 16 15 22 17 20 11. Maintain the honor of the medical profession 28 27 26 31 29 19 12. Be trustworthy and dependable 8 17 13 20 26 17 Respect 13. Respect patients 3 5 6 8 8 2 14. Be polite 27 24 27 28 27 9 15. Respect coworkers 15 3 12 15 22 26 Communication skills 16. Communicate clearly to patients 9 9 18 14 18 5 17. Have appropriate conversations with coworkers 23 13 24 21 19 27 18. Listen and respond to patients’ concerns 4 8 11 11 11 4 Teamwork and leadership 19. Be a good team player 5 2 3 3 7 21 20. Practice good leadership 13 7 10 7 25 22 21. Practice self–control 14 4 9 4 2 14 Humanism 22. Practice compassionate patient care 2 11 5 13 9 3 23. Share the feeling of patients’ suffering (empathy) 19 18 22 24 15 7 24. Be kind 21 25 19 25 21 10 Ethics 25. Avoid any conflict of interest 32 33 33 34 28 33 26. Respect patient confidentiality and privacy 18 19 21 16 10 15 27. Adhere to doctors’ religious and moral values 36 36 36 36 36 36 Medical competence 28. Take a holistic approach to patients 25 22 28 27 14 8 29. Build excellent knowledge and procedural skills 1 1 1 1 1 1 30. Be able to treat patients in various situations with limited resources 11 12 7 2 3 11 Mindfulness and self-reflectiveness 31. Be responsive to feedback 24 23 25 18 24 24 32. Try new behaviors to promote patient care 33 31 32 32 30 25 33. Have situational awareness 12 21 16 5 12 23 Appearance 34. Wear a white coat 39 39 39 39 39 39 35. Wear professional attire 38 37 37 38 38 38 36. Practice appropriate grooming 37 38 38 37 37 37 Information management 37. Complete medical records on time 34 34 34 30 33 29 38. Document charts accurately 29 30 30 26 31 28 39. Gather data efficiently with limited time and resources 17 28 23 9 20 30 AP: attending physician; MS4: 4 th -year medical student; MS1: 1 st -year medical student Correlations of aggregated rankings by each group are detailed in Table 4 . The healthcare providers showed a high correlation between their individual groups (0.92 to 0.96). The APs and residents had the greatest agreement (0.96). When the patients’ data were analyzed with those of each healthcare provider group, the correlation values diminished (0.66 to 0.82). The least agreement was shown with MS4s (Table 4 ). Table 4 Correlations of aggregated ranking by healthcare providers and patients Group AP Nurse Resident MS4 MS1 Patient AP 1.00 Nurse 0.94 1.00 Resident 0.96 0.95 1.00 MS4 0.92 0.90 0.93 1.00 MS1 0.92 0.90 0.93 0.92 1.00 Patient 0.80 0.76 0.78 0.66 0.82 1.00 AP: attending physician; MS4: 4th -year medical student; MS1: 1st -year medical student Discussion We first demonstrated EPP perceptions in healthcare teams and patients in EDs from the USA and Thailand. The overall data illustrate 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 absolute cultural consensus among healthcare providers and patients. Previous studies examined EPP perceptions in one or a few groups of participants [ 17 – 19 ]. The present study aimed to simultaneously assess the EPP viewpoints from all related persons in EDs (healthcare providers and patients) to assess 360-degree perceptions. The data showed interesting results. All participants from different cultures (n = 984) in cohorts from both the USA and Thailand selected the same rankings of the most (excellent knowledge and procedural skills) and the least (wearing a white coat) important EPP-related issues. A recent study in the EDs (USA; n = 288) found that wearing a white coat was ranked as the last important among healthcare providers and patients from a generation perspective [ 13 ]. The present data (Thailand and the USA) also show a similar result in that wearing a white coat was the least important issue. However, the professional appearance of physicians wearing white coats was the preference from patients’ viewpoint [ 20 , 21 ]. In contrast, a study in Switzerland reported that only 34.4% of 1,637 patients considered wearing a white coat to be important [ 22 ]. This finding and our present data may indicate that wearing a white coat is no longer considered important in perceptions of physicians. Most patients highly valued aspects of EPP pertaining to “humanism”, “be polite”, “communicate clearly to patients” and “listen and respond to patients’ concern” as items of most importance to them (Table 3 ). The studies of patients’ experiences demonstrated that all participants expected the characteristics of their healthcare providers at the ED [ 23 , 24 ]. Enhanced communication skills are required to reduce the gap in perceptions between doctors and patients [ 25 , 26 ]. In addition, the present study reveals that “respect patients” was ranked most important by all groups (Table 3 ). A previous study reported that patients need to be respected in confidentiality and privacy during their ED visit [ 27 ]. Therefore, healthcare teams should place a greater emphasis on these soft skills. The APs group had a greater agreement with patients regarding EPP than those of MS4s, residents, and nurses (Table 4 ). APs have more experience and time to develop their perceptions of EPP through internal and external motivations to develop their skills and strengthen themselves to be more attuned to the needs of patients [ 28 ]. Experienced clinicians can focus more on listening to patient concerns and demonstrate their interpersonal skills [ 28 ]. Fewer experienced providers focus more on gathering essential information for differential diagnosis and management due to limitations of time and resources [ 28 ]. This may cause them to overlook their application of soft skills. Thus, teaching and evaluation of interpersonal skills should be emphasized during all levels of medical training [ 29 , 30 ]. The MS1 group had the greatest agreement with patients regarding EPP (Table 4 ), especially compared with the MS4 group. Previous studies revealed lower professional attitude scores and less empathy associated with increasing years in medical school [ 31 , 32 ]. MS4s have more experience with sleep deprivation causing physical and mental exhaustion [ 33 ]. After MSs are trained, they focus on the more complex task of building medical management skills and may forget interpersonal skills [ 34 ]. A lack of role models and mistreatment from the faculty can account for the decline in empathy during the clinical training [ 35 ]. Emergency medical educators must integrate soft skills and medicine-related skills into their teaching during clinical practice [ 36 ]. The AP group noted “be transparent and truthful” and “be trustworthy and dependable” as crucial characteristics (Table 3 ). Ethics in emergency medicine related to physician integrity, templates, and the “F” word have been described for providing medical care [ 37 ]. Health professionals are expected to tell the truth. However, each patient needs to be approached individually regarding the importance of telling the truth in all situations [ 38 ]. The ED nurses ranked “be a good team player” and “respect coworkers” among their three most important qualities for EPP (Table 3 ). A better working relationship between physicians and nurses can increase physician productivity, enhance the quality and safety of patient care, decrease ED waiting time, improve patient outcomes and satisfaction and enhance inter-professional collaboration, which is currently a requirement of the World Federation of Medical Education [ 39 – 41 ]. Teamwork among specialties directly influences the quality of ED patient care [ 42 ]. A lack of respect among coworker increases stress leading to strains in coworker relationships and teamwork [ 43 , 44 ]. Therefore, implementing instructions on teamwork during inter-professional emergency training would lead to changes in the workplaces. All cohorts in both countries agreed that having excellent knowledge and procedural skills was the most important aspect of EPP (Table 3 ). Practitioners and managers also ranked medical competency as an important aspect of medical professionalism [ 45 ]. The conventional professional image of the physician (e.g., ethics and professional reputation, dependability, integrity) and the global view (e.g., good doctor attributes, responsibility, ethics) were essential professionalism domains [ 46 ]. Two different attitudes (performance attainment and personal involvement) in terms of recognition and selection of essential values are critical for better practice in the medical profession [ 47 ]. Continuing medical education in professionalism would improve the efficiency of healthcare teams in ensuring patient safety. Conclusions The present study illustrates no absolute cultural consensus between patients and healthcare providers regarding EPP. Agreement regarding the definition of EPP is critical for ED healthcare providers and ED patients through worldwide education. Limitations Even with a large sample size, our study still has some limitations. Since there were 39 cards, the participants may have grown tired and found it difficult to rank all 39 items accurately. Although we did not test for the reliability of the card ranking, a previous study illustrated that it remains a viable research tool if there are under 40 cards involved [ 48 ]. Unfortunately, we could not measure intra-rater reliability over two separate weeks for each subject in all six cohorts due to the impracticality of follow-up. Measuring inter-rater reliability among different members of each cohort is required to determine whether the card ranking method is reliable for EPP assessment. In addition, unstable, vulnerable, or pediatric subjects were excluded from this study, and so the present data are not applicable to or representative of them. The participants in Thailand accounted for 69% of the sample, which may not accurately represent both countries. Further studies to compare the perceptions of EPP among people in Eastern and Western cultures are suggested. Of note, a factor analysis is recommended to determine the criterion validity of EPP. A prospective cohort study is also required to investigate which element can effectively predict the EPP of any EPs. A qualitative study is also required to investigate what are observable EPP behaviors from patients’ and relatives’ perspectives. Abbreviations AP: Attending physician; ED: Emergency department; EPP: Emergency physician professionalism; ER: Eigenvalue ratio; EP: Emergency physician; MS: Medical student; NC: Negative competency Declarations Ethics approval and consent to participate This study is approved by the University of California, USA (UCI, FWA 00004071, 2003), Central Research Ethics Committee (COA-CREC 008/ 2017), and the Faculty of Medicine, Chulalongkorn University, Thailand (COA No. 020/2017; IRB No.629/59), and certify that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Informed consent was obtained from all participants or, if participants are under 16, from a parent and/or legal guardian. Consent for publication Written informed consent was obtained from the participants for publication of this study and accompanying images in accordance with the journal’s participant consent policy. Availability of data and materials The datasets supporting the conclusion of this article are available in the corresponding author repository on reasonable request. Competing interests The authors have no declarations of financial or non-financial competing interests to report. Funding This research was funded by the Consortium of Thai Medical Schools through the Medical Research Network, Grant No. MRF-2560-001, and was supported in part by grant UL1 TR001414 from the National Center for Advancing Translational Sciences, National Institutes of Health (NIH), through the Biostatistics, Epidemiology and Research Design Unit. The funders did not interfere neither in the interpretation of data nor in writing the manuscript. Authors’ contributions All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Khuansiri Narajeenron, Tanawat Tarapan, Jasmina Dukovic, Krongkarn Sutham, Intanon Imsuwan, Ar-aishah Dadeh, Tanyaporn Nakornchai, Deena Bengiamin, Bharath Chakravarthy, Craig Anderson, and Wirachin Hoonpongsimanont. The first draft of the manuscript was written by Khuansiri Narajeenron, Somchit Eiam-Ong, Wirachin Hoonpongsimanont, Jasmina Dukovic, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Acknowledgements The authors would like to thank the director of the Emergency Medicine Research Associate Program and the emergency medicine team at the School of Medicine, University of California Irvine, as well as all five cohorts of university-based emergency departments in Thailand. We thank Linda S. Murphy, MLIS, University of California, Irvine, for performing literature searches and acknowledge the AJE ( www.AJE.com ) for the English language editing. References Austin M, Carra B, Casey J, Chinn S, FlottenA, Franzone J, et al. Accreditation Council for Graduate Medical Education.The Next Accreditation System:A Resident Perspective [Online].The ACGME Council of Review Committee Residents 2014. https://www.acgme.org/globalassets/pdfs/resident-services/9nasresidentsmay2014.pdf Accessed 25 Nov 2021. Emanuel EJ, Emanuel LL.What is accountability in health care? Ann Intern Med.1996; 124:229–39. ABIM Foundation, American Board of Internal Medicine, ACP-ASIM Foundation, et al.Medical professionalism in the new millennium: a physician charter.Ann Intern Med.2002;136:243–6. Feldman DS, Nowvack DH, Gracely E.Effects of managed care on physician-patient relationships, quality of care, and the ethical practice of medicine.Arch Intern Med.1998;158:1626–32. Emanuel EJ, Dubler NN.Preserving the physician-patient relationship in the era of managed care.JAMA.1995;273:323–9. Larkin GL, Binder L, Houry D, et al.Defining and evaluating professionalism: a core competency for graduate emergency medicine education.Acad Emerg Med.2002;9:1249–56. Gordon J, Sheppard LA, Anaf S.The patient experience in the emergency department: a systematic synthesis of qualitative research.Int Emerg Nurs.2010;18:80–8. Branney SW, Pons PT, Markovchick VJ, et al.Malpractice occurrence in emergency medicine: does residency training make a difference? J Emerg Med.2000;19:99–105. Rosenstein AH, Naylor B.Incidence and impact of physician and nurse disruptive behaviors in the emergency department.J Emerg Med.2012;43:139–48. Taira T, Roberts NK, Santen SA.11 defining professionalism issues among “problem residents”.Ann Emerg Med.2012;60:S167. Jha V, Bekker HL, Duffy SRG, Roberts TE.Perceptions of professionalism in medicine: a qualitative study.Med Educ.2006;40:1027–36. Wagner P, Hendrich J, Moseley G, Hudson V. Defining medical professionalism: a qualitative study.Med Educ.2007;41:288–94. Hoonpongsimanont W, Sahota PK, Chen Y, Patel M, Tarapan T, Bengiamin D, et al.Physician professionalism: definition from a generation perspective.Int J Med Educ.2018;28:246–52. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)-a metadata-driven methodology and workflow for process providing translational research informatics support.J Biomed Inform.2009;42:377–81. Weller SC.Cultural consensus theory: applications and frequently asked questions.Field Methods.2007;19:339–68. Romney AK, Weller SC, Batchelder WH.Culture as consensus: a theory of culture and informant accuracy.Am Anthropol.1986;88:313–38. Shiga T, Nakashima Y, Norisue Y, Ikegami T, Uechi T, Otaki Y, et al.Comparison of professionalism between emergency medicine resident physicians and faculty physicians: A multicenter cross-sectional study.PLoS ONE.2020;15:e0230186. Jauregui J, Gatewood M, Ilgen J, Schaninger C, Strote J. Emergency Medicine Resident Perceptions of Medical Professionalism.West J Emerg Med.2016;17:355–61. Santen SA, Hemphill RR.A Window on Professionalism in the Emergency Department Through Medical Student Narratives.Ann Emerg Med.2011;58:288–94. Tiang KW, Razack AH, Ng KL.The ‘auxiliary’ white coat effect in hospitals: perceptions of patients and doctors.Singapore Med J.2017;58:574–5. Petrilli CM, Saint S, Jennings JJ,Caruso A, Kuhn L, Snyder A, et al.Understanding patient preference for physician attire: a cross-sectional observational study of 10 academic medical centers in the USA.BMJ Open.2018;8:e021239. Sebo P, Herrmann FR, Haller DM.White coat in primary care: what do patients think today? Cross-sectional study.Swiss Med Wkly.2014;144:w14072. Swallmeh E, Byers V, Arisha A.Informing quality in emergency care: understanding patient experiences.Int J Health Care Qual Assur.2018;31:704–17. de Steenwinkel M, Juanita AH, van Berkel E, Rozema L, Rood P, Bouwhuis M. Patient satisfaction, needs, and preferences concerning information dispensation at the emergency department: a cross-sectional observational study. IJEM. 2022;15:5. Riachy CS, Nemr E.Medical professionalism in Lebanon: between doctors' perception and patients' satisfaction.Int J Med Educ.2020;11:171–2. Sari MI, Prabandari YS, Claramita M.Physicians’ professionalism at primary care facilities from patients’ perspective: The importance of doctors’ communication skills.J Family Med Prim Care.2016;5:56–60. Olsen JC, Sabin BR.Emergency Department patient perceptions of privacy and confidentiality.J Emerg Med.2003;25:329–33. Gisondi MA, Smith-Coggins R, Harter PM, Soltysik RC, Yarnold PR.Assessment of resident professionalism using high-fidelity simulation of ethical dilemmas.Acad Emerg Med.2004;11:931–7. Cruess SR, Cruess RL, Steinert Y.Supporting the development of a professional identity: General principles.Med Teach. 2019;41:641–9. Ronan-Bentle E S, Avegno J, Hegarty B, Manthey ED. Dealing with the difficult student in emergency medicine. IJEM. 2011;4:39. Santos WSD, Laros JA, Trindade EMV, Ribeiro Junior MD, da Silva DAM, Ribeiro LM.Medical professionalism: the effects of sociodemographic diversity and curricular organization on the attitudinal performance of medical students.Rev Bras Educ Med. 2017;41:594–603. Chen D, Lew R, Hershman W, Orlander J.A cross-sectional measurement of medical student empathy.J Gen Intern Med.2007;22:1434–8. Rosen IM, Gimotty PA, Shea JA, Bellini LM.Evolution of sleep quantity, sleep deprivation, mood disturbances, empathy, and burnout among interns.Acad Med. 2006;81:82–5. Chen DC, Kirshenbaum DS, Yan J, Kirshenbaum E, Aseltine RH.Characterizing changes in student empathy throughout medical school.Med Teach.2012;34:305–11. Kay J.Traumatic de-idealization and the future of medicine.JAMA.1990;263:572–3. Flowerdew L, Brown R, Vincent C, Woloshynowych M.Development and validation of a tool to assess emergency physicians' nontechnical skills.Ann Emerg Med.2012;59:376–385.e4. Musher DM, Hayward CP, Musher BL.Physician Integrity, Templates, and the ‘F’ Word.J Emerg Med.2019;57:263–5. Zolkefli Y.The Ethics of Truth-Telling in Health-Care Settings.Malays J Med Sci.2018;25:135–9. Caricati L, Guberti M, Borgognoni P, Prandi C, Spaggiari I, Vezzani E, et al.The role of professional and team commitment in nurse-physician collaboration: a dual identity model perspective.J Interprof Care.2015;29:464–8. Interprofessional Education Collaborative.Core Competencies for Interprofessional Collaborative Practice: 2016 update.Washington, DC:Interprofessional Education Collaborative; 2016. World Federation for Medical Education.Basic Medical Education. WFME Global Standards for Quality Improvement. The 2012 Revision.Copenhagen:WFME; 2003. Eisenmann D, Stroben F, Gerken Jan D, Exadaktylos AK, Machner M, Hautz WE.Interprofessional Emergency Training Leads to Changes in the Workplace.West J Emerg Med.2018;19:185–92. Oore DG, Leblanc D, Day A, Leiter MP, Spence Laschinger HK, Price SL, et al.When respect deteriorates: incivility as a moderator of the stressor-strain relationship among hospital workers.J Nurs Manag.2010;18:878–88. Sullivan C, Murano T, Comes J, Smith JL, Katz ED. Emergency medicine directors' perceptions on professionalism: a council of emergency medicine residency directors survey.Acad Emerg Med.2011;18:S97-103. Andersson H, Sundstrom BW, Nilsson K, Jakobsson Ung E.Competencies in Swedish emergency departments - the practitioners' and managers' perspective.Int Emerg Nurs.2014;22:81–7. Reimer D, Russell R, Khallouq BB,Kauffman C, Hernandez C, Cendán J, et al.Pre-clerkship medical students’ perceptions of medical professionalism.BMC Med Educ.2019;19:239. Minicuci N, Giorato C, Rocco I, Lloyd-Sherlock P, Avruscio G, Cardin F.Survey of doctors’ perception of professional values.PLoS One.2020;15:e0244303. Design at IBM.Card sorting:a powerful, simple research method-design at IBM-medium.2018. https://medium.com/design-ibm/card-sorting-a-powerful-simple-research-method-9d1566be9b62ch-method-9d1566be9b62 . Accessed 25 Nov 2021. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1710023","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":110667584,"identity":"7f186744-8a99-4f2c-8f7e-00c7fbc81027","order_by":0,"name":"Khuansiri Narajeenron","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8klEQVRIiWNgGAWjYBACCQkIxcDGwMD4gLGBQQYqcYAoLcwGQC08EPEEglrAgE2CKC2Ss3sMPxf8scjnY+A9VvFzx2Ee/gbmhx8Yf9zBqUVa5oyx9Mw2Ccs2Br60m71nDvNIHGAzlmBIeIZTi5xEjoE0b4OEARsDj9ltxrbDPECPmwEddhifFuPfPH8gWopBWuQPsH/Dq0VaIsdMmocNooUZpMXgAA9+WyRnpJVZ87YBtTDzGEv2tqXzGB7mKZZISMOtReJG8ubbPH/qDOTbeww//GyzlpM73r7xwwcb3FoQgBmZkUCEhlEwCkbBKBgFuAEAOzBF7xMnkXoAAAAASUVORK5CYII=","orcid":"","institution":"Chulalongkorn University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Khuansiri","middleName":"","lastName":"Narajeenron","suffix":""},{"id":110667585,"identity":"70f2965a-379e-4a76-a62e-3779d1592fcc","order_by":1,"name":"Tanawat Tarapan","email":"","orcid":"","institution":"Chulalongkorn University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Tanawat","middleName":"","lastName":"Tarapan","suffix":""},{"id":110667586,"identity":"6e2fd452-706a-4cd3-9661-2493f8837f7f","order_by":2,"name":"Jasmina Dukovic","email":"","orcid":"","institution":"University of California, Irvine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jasmina","middleName":"","lastName":"Dukovic","suffix":""},{"id":110667587,"identity":"14669f8e-1de6-4100-9489-71bfc5fa2f00","order_by":3,"name":"Krongkarn Sutham","email":"","orcid":"","institution":"Chiang Mai University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Krongkarn","middleName":"","lastName":"Sutham","suffix":""},{"id":110667588,"identity":"0880f2d0-7d19-4885-962c-cc76d28e5ee8","order_by":4,"name":"Intanon Imsuwan","email":"","orcid":"","institution":"Thammasat University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Intanon","middleName":"","lastName":"Imsuwan","suffix":""},{"id":110667589,"identity":"e1f07c7b-8d28-4375-97af-a6c171c3194e","order_by":5,"name":"Ar-aishah Dadeh","email":"","orcid":"","institution":"Prince of Songkla University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ar-aishah","middleName":"","lastName":"Dadeh","suffix":""},{"id":110667592,"identity":"1b5f77ac-d4a2-4012-9822-534cc1303a67","order_by":6,"name":"Tanyaporn Nakornchai","email":"","orcid":"","institution":"Mahidol University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Tanyaporn","middleName":"","lastName":"Nakornchai","suffix":""},{"id":110667593,"identity":"1c46a772-806d-491c-8eec-0de19ff865c8","order_by":7,"name":"Deena Bengiamin","email":"","orcid":"","institution":"University of California San Francisco","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Deena","middleName":"","lastName":"Bengiamin","suffix":""},{"id":110667595,"identity":"b5c1fdc0-281b-4d5c-ba74-b04eea3c88e9","order_by":8,"name":"Bharath Chakravarthy","email":"","orcid":"","institution":"University of California, Irvine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Bharath","middleName":"","lastName":"Chakravarthy","suffix":""},{"id":110667596,"identity":"06f1a14e-7f37-4b1e-bdc0-1b494411a797","order_by":9,"name":"Craig Anderson","email":"","orcid":"","institution":"University of California, Irvine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Craig","middleName":"","lastName":"Anderson","suffix":""},{"id":110667598,"identity":"810d9a53-f43f-4a29-994a-550b3f57f917","order_by":10,"name":"Somchit Eiam-Ong","email":"","orcid":"","institution":"Chulalongkorn University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Somchit","middleName":"","lastName":"Eiam-Ong","suffix":""},{"id":110667601,"identity":"3088ee59-ae72-494f-b3a2-f61cb54d0756","order_by":11,"name":"Wirachin Hoonpongsimanont","email":"","orcid":"","institution":"Eisenhower Medical Center","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Wirachin","middleName":"","lastName":"Hoonpongsimanont","suffix":""}],"badges":[],"createdAt":"2022-05-31 04:14:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1710023/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1710023/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":31063531,"identity":"5d062482-7dd7-4dbd-a4f2-15981ad6e167","added_by":"auto","created_at":"2023-01-04 02:59:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":343813,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1710023/v1/c6f6d757-9a58-433c-a91d-e1849f9d3a8a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Emergency Physician Professionalism: 360 - Degree Perceptions of Healthcare Providers and Patients in Thailand and USA Cultural Context","fulltext":[{"header":"Background","content":"\u003cp\u003eThe Accreditation Council for Graduate Medical Education (ACGME) defined professionalism as one of six new core competency requirements for medical training [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. These competencies consist of patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Professionalisms comprise altruism, accountability, authority, commitment, communication, honesty, service, and suspension of self-interest [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Medical professionalism is a crucial basis of medicine\u0026rsquo;s contract with society [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In emergency departments (EDs), situations involving increased time pressure and environmental forces could threaten emergency physician professionalism (EPP) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Professional behaviors in focusing on emergency medicine training and practice were implicated by the Council of Emergency Medicine Residency Directors (CORD-EM) in 2002 [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePrevious studies documented unprofessional behaviors and malpractices by emergency physicians (EPs) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. These led to medical errors, patient safety issues, patient mortality, and lawsuits [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Disruptive and unprofessional behaviors also impact on healthcare provider interrelationships [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Previous investigations examined medical professionalism perceptions in doctors, medical educators, medical students, allied health professionals, lay professionals, and patients [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In USA cohorts, we studied the definition of EPP defined from the generation perspective among healthcare providers and patients in the ED [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The results showed cultural consensus on EPP in millennials and Generation X overall [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In healthcare providers, there was consensus regarding EPP throughout all generations, but no consensus across generations in the patient group was noted [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. There is no EPP study in ED healthcare providers and ED patients in Thailand. Therefore, the present study aimed to understand how EPP is perceived by ED healthcare providers and ED patients in different cohorts from five medical schools in Thailand and two cohorts in the USA. Using 360-degree perceptions and card-sorting techniques, we performed a study on the healthcare provider group, including attending physicians (APs), residents, nurses, MS4s, MS1s, and the patient group. The results may provide a better understanding of EPP in both countries and explicit conceptualizations of professionalism across cultural differences. We hypothesized that the study would show no absolute cultural consensus on emergency medicine professionalism among ED healthcare providers and patients.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003ch2\u003eStudy design and setting\u003c/h2\u003e\n\u003cp\u003eA cross-sectional survey in multiple EDs was performed in the USA and Thailand from July 2016 to January 2017. The cultural consensus model was analyzed by using a card-sorting technique [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e]. We included a total of 984 participants from two urban level 1 trauma centers in California, USA (centers A, B), and five level 1 trauma centers at university-affiliated hospitals in Thailand (centers C-G). All participants were pooled and categorized into five groups of healthcare providers and one patient group. The healthcare provider group consisted of APs, nurses, residents, and MS4s and MS1s. The participants were individuals 17 years of age or older speaking fluent English at USA centers. At Thailand centers, the Thai language was preferred. The exclusion criteria for the patient group were pregnancy, medically unstable, altered state of consciousness, handicapped, psychiatric hold, or police custody. The study was approved by the Institutional Review Boards of all institutions in the USA and the Thai Central Research Ethics Committee in Thailand [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\n\u003c/div\u003e\n\u003ch2\u003eTools and procedures\u003c/h2\u003e\n\u003cp\u003eA card-sorting technique was described and applied in our previous study [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e]. In brief, each card defined a quality or behavior of EPP within the 13 core elements [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e]. In Thailand, the cards were translated from the English to Thai language by native speakers (Thai healthcare teams) to ensure proper translation. To confirm the consistency in the card interpretation, piloted studies were performed in 16 APs, 7 nurses, 5 residents, 5 MSs, and 21 patients in each country (USA and Thailand). All participants entered into the study after an informed consent agreement was signed. The data obtained during the study was kept anonymous. Participants could leave the study at any time without any consequences. Each participant received the 39 cards and ranked them in order of importance for EPP. The ranking was based on his or her opinions, with potential effects on medical professionalism, from the most to the least important. Cards were provided every time in the same sequence from 1 to 39. Afterward, the participants completed their demographic data. In the USA, demographic information from center A was collected through the Research Electronic Data Capture as an online data collection program [\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e]. In the other six centers (centers B-G), the data were collected as paper sheets. The total time to complete all procedures was approximately 15 minutes and the procedures were conducted by well-trained research associate teams. Each research team worked in a private room to avoid any interference from the others [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n\u003ch2\u003eStatistical analysis\u003c/h2\u003e\n\u003cp\u003eTo obtain a 0.25 agreement level based on the averaged Pearson correlation coefficients (a 0.5 competency and 95% validity), we needed at least 28 subjects in each cohort [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e]. Demographic information was presented in descriptive data. The quantitative cultural consensus method was applied to inspect the existence of a shared cultural model and to determine the aggregated rankings within each group [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e]. Cultural consensus analysis is a creation of statistical patterns to evaluate the degree of agreement within cohorts and the existence of \u0026ldquo;culturally shared\u0026rdquo; beliefs [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eBy the minimum-residual algorithm (no rotation), factor analysis of respondents was calculated to assess the degree of agreement within a cohort and obtain individual-level competency scores [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e]. The eigenvalue ratio (ER) between the first and second indicates whether the data have a single shared dimension. ER values of 3 to 1 or greater imply a shared cultural idea within the cohort. Competency levels for individuals were estimated as the first factor loading from the factor analysis. A higher average competency level indicates a higher consensus level within the cohort. Negative competency (NC) scores indicate the presence of more than one subcultural group [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eCohorts with an ER equal to or greater than 3 and no NC score were considered to have an absolute cultural consensus, whereas a borderline cultural consensus presented with an ER\u0026thinsp;\u0026gt;\u0026thinsp;3 and NC scores\u0026thinsp;\u0026lt;\u0026thinsp;5%. The cultural consensus assumption was rejected as ER\u0026thinsp;\u0026lt;\u0026thinsp;3 or NC scores\u0026thinsp;\u0026gt;\u0026thinsp;5%. If an absolute or borderline cultural consensus was found, aggregated rankings were estimated as the first set of factor scores. The aggregated ranking among cohorts was examined by Spearman\u0026rsquo;s correlation coefficient. The FREQ, CORR, and FACTOR procedures in SAS version 9.4 [SAS Institute, Inc., 2013, SAS/ACCESS\u0026reg; 9.4, Cary, NC] were used to conduct all data analyses [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThere were 984 participants enrolled in the study, 301 (30.59%) from the USA and 683 (69.41%) from Thailand (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). The majority of the participants were female (55.49%) (male, 44.51%). The total numbers of APs, nurses, and residents were 89, 196, and 135, respectively. In the USA, the age of APs exhibited a wider range, varying from 30 to 68 years old, than in Thailand (29 to 49 years old). Both APs and nurses had more experience with unprofessional EPs. There were 197 in the MS4s (male 107, female 90) and 170 in the MS1s (male 89, female 81) groups. In Thailand, MS1s started medical school earlier (18 to 21 years old) than those in the USA (22 to 36 years old). Both MS4s and MS1s in the USA had more opportunities to work in healthcare before their admission to medical schools. In both countries, 197 patients were included with 73 males (37.06%) and 124 females (62.94%). All MS4s, MS1s, and patients showed a lesser extent of experience with unprofessional EP (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003ctable border=\"1\" width=\"0\"\u003e\n \u003ccaption\u003e\n \u003cp\u003eTable 1\u003c/p\u003e\n \u003cp\u003eDemographic data of participants in the USA and Thailand (n = 984)\u003c/p\u003e\n \u003c/caption\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"133\"\u003e\n \u003cp\u003eCountry\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003eSite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"72\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eM \u0026nbsp; \u0026nbsp;F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003cp\u003e(yrs.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66\"\u003e\n \u003cp\u003eYear of practice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" width=\"102\"\u003e\n \u003cp\u003eExperience of unprofessional\u003c/p\u003e\n \u003cp\u003eEP\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; Yes \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" width=\"84\"\u003e\n \u003cp\u003eExperience working in healthcare\u003c/p\u003e\n \u003cp\u003eYes \u0026nbsp; \u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"133\"\u003e\n \u003cp\u003eAP\u003c/p\u003e\n \u003cp\u003e(n = 89, 48/43 M/F)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" width=\"133\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003eA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e30-68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66\"\u003e\n \u003cp\u003e1-35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e31-68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66\"\u003e\n \u003cp\u003e1-36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" width=\"133\"\u003e\n \u003cp\u003eThailand\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003eC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e29-40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66\"\u003e\n \u003cp\u003e6-11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003eD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e29-49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66\"\u003e\n \u003cp\u003e2-14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003eE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e29-41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66\"\u003e\n \u003cp\u003e1-11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e30-43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66\"\u003e\n \u003cp\u003e1-14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003eG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e30-49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66\"\u003e\n \u003cp\u003e5-20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\" width=\"499\"\u003e\n \u003cp\u003eNurse\u003c/p\u003e\n \u003cp\u003e(n = 196, 55/141 M/F)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" width=\"133\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003eA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e25-54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66\"\u003e\n \u003cp\u003e1-31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e27-63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66\"\u003e\n \u003cp\u003e3-42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" width=\"133\"\u003e\n \u003cp\u003eThailand\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003eC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e25-44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66\"\u003e\n \u003cp\u003e1-22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003eD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e23-56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66\"\u003e\n \u003cp\u003e1-31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003eE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e24-45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66\"\u003e\n \u003cp\u003e1-21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e22-55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66\"\u003e\n \u003cp\u003e1-34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003eG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e23-37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66\"\u003e\n \u003cp\u003e1-15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\" width=\"499\"\u003e\n \u003cp\u003eResident\u003c/p\u003e\n \u003cp\u003e(n = 135, 68/67 M/F)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" width=\"133\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003eA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e26-38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66\"\u003e\n \u003cp\u003e1-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e26-35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66\"\u003e\n \u003cp\u003e1-4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" width=\"133\"\u003e\n \u003cp\u003eThailand\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003eC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e26-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66\"\u003e\n \u003cp\u003e1-6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003eD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e25-39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66\"\u003e\n \u003cp\u003e1-15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003eE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e26-37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66\"\u003e\n \u003cp\u003e1-7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e26-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66\"\u003e\n \u003cp\u003e2-6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003eG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e27-35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66\"\u003e\n \u003cp\u003e2-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable border=\"1\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\" width=\"493\"\u003e\n \u003cp\u003eMS4\u003cbr\u003e(n = 197, 107/90 M/F)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" width=\"133\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003eA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e24\u0026ndash;33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e25\u0026ndash;39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" width=\"133\"\u003e\n \u003cp\u003eThailand\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003eC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e22\u0026ndash;25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003eD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e22\u0026ndash;23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003eE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e23\u0026ndash;25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e23\u0026ndash;28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003eG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e23\u0026ndash;26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\" width=\"493\"\u003e\n \u003cp\u003eMS1\u003cbr\u003e(n = 170, 89/81 M/F)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" width=\"133\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003eA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e22\u0026ndash;36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" width=\"133\"\u003e\n \u003cp\u003eThailand\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003eC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e19\u0026ndash;21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003eD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e18\u0026ndash;21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003eE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e19\u0026ndash;21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e19\u0026ndash;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003eG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e19\u0026ndash;21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\" width=\"493\"\u003e\n \u003cp\u003ePatient\u003cbr\u003e(n = 197, 73/124 M/F)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" width=\"133\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003eA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e18\u0026ndash;65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e20\u0026ndash;76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" width=\"133\"\u003e\n \u003cp\u003eThailand\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003eC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e17\u0026ndash;79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003eD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e18\u0026ndash;59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003eE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e21\u0026ndash;62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e21\u0026ndash;68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003eG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e16\u0026ndash;63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAP: attending physician; MS4: 4\u003csup\u003eth\u003c/sup\u003e-year medical student; MS1: 1\u003csup\u003est\u003c/sup\u003e-year medical student;\u003c/p\u003e\n\u003cp\u003eM: male; F: female\u003c/p\u003e\n\u003cp\u003eThe overall data demonstrated that the ER value was 3.07, with 3.15% negative competency (NC) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). These results indicated a pattern of borderline cultural consensus. In healthcare providers, the mean competency (MC) values were high (0.52 to 0.58), whereas the percentages of NC were low (0.74 to 2.04). As further analyzed in each group of healthcare providers or patients, the ER data still illustrated a borderline pattern of cultural consensus (ER: 3.13 to 3.64, Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). Both residents and MS4s had the highest cultural consensus levels (0.58). In the patient group, the data showed no cultural consensus (MC: 0.42; ER: 3.13, and NC: 7.11). When these data were combined with the healthcare provider data, the levels of MC declined (0.44 to 0.46). The NC levels were much higher (4.53 to 7.25) when combining patients with healthcare providers (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable border=\"1\" id=\"Tab2\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCultural consensus analysis on emergency physician professionalism in healthcare providers and patients\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean competency\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSD competency\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eEigenvalue ratio\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e% Negative competency\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOverall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e984\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e196\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eResident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e135\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMS4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e197\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMS1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e170\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePatient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e197\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePatient \u0026amp; AP*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e286\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.97\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePatient \u0026amp; nurse*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e393\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePatient \u0026amp; resident*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e332\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePatient \u0026amp; MS4*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e394\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePatient \u0026amp; MS1*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e367\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePatient \u0026amp; MS*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e564\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePatient \u0026amp; AP \u0026amp; resident*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e421\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePatient \u0026amp; AP \u0026amp; nurse \u0026amp; resident*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e617\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003eAP: attending physician; MS4: 4\u003csup\u003eth\u003c/sup\u003e-year medical student; MS1: 1\u003csup\u003est\u003c/sup\u003e-year medical student; MS: all medical students; SD: standard deviation\u003c/p\u003e\n \u003cp\u003e*Data pooled from multiple cohorts for cultural consensus analysis\u003c/p\u003e\n \u003cp\u003eThe perceptions of EPP were assessed by each group of participants and are depicted in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e. All participants ranked \u0026ldquo;build excellent knowledge and procedural skills\u0026rdquo; as the most important aspect, whereas \u0026ldquo;wear a white coat\u0026rdquo; was the least important EPP-related issue (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). In the respect core element, \u0026ldquo;respect patients\u0026rdquo; was in the top-ten ranked by all groups. All healthcare providers ranked \u0026ldquo;be the patients\u0026rsquo; advocate\u0026rdquo; and \u0026ldquo;be a good team player\u0026rdquo; among the top-ten issues. The AP group was more aware of \u0026ldquo;be transparent and truthful\u0026rdquo; and \u0026ldquo;be trustworthy and dependable\u0026rdquo; than the other groups. The residents, MS4s and MS1s selected \u0026ldquo;be able to treat patients in various situations with limited resources\u0026rdquo; as their top-ten importance. The nurse group listed \u0026ldquo;respect coworkers\u0026rdquo;, while the MS4s chose \u0026ldquo;have situational awareness\u0026rdquo; and \u0026ldquo;gather data efficiently with limited time and resources\u0026rdquo; as their highest concerns. Patients listed \u0026ldquo;humanism\u0026rdquo;, \u0026ldquo;be polite and respect patients\u0026rdquo;, \u0026ldquo;listen and respond to patients\u0026rsquo; concern\u0026rdquo;, \u0026ldquo;communicate clearly to patients\u0026rdquo;, \u0026ldquo;desire to help others\u0026rdquo;, and \u0026ldquo;take a holistic approach to patients\u0026rdquo; as their items of concern (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n \u003ctable border=\"1\" width=\"0\"\u003e\n \u003ccaption\u003e\n \u003cp\u003eTable 3\u003c/p\u003e\n \u003cp\u003eAggregated rankings of emergency physician professionals in healthcare providers and patients\u003c/p\u003e\n \u003c/caption\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" width=\"114\"\u003e\n \u003cp\u003e13 core elements\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"240\"\u003e\n \u003cp\u003e39 cards\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" width=\"324\"\u003e\n \u003cp\u003eRankings\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41\"\u003e\n \u003cp\u003eAP\u003cbr\u003e(n = 89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003eNurse\u003cbr\u003e(n = 196)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"72\"\u003e\n \u003cp\u003eResident\u003cbr\u003e(n = 135)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003eMS4\u003cbr\u003e(n = 197)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003eMS1\u003cbr\u003e(n = 170)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61\"\u003e\n \u003cp\u003ePatient\u003cbr\u003e(n = 197)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" width=\"114\"\u003e\n \u003cp\u003eAltruism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"240\"\u003e\n \u003cp\u003e1. Be unselfish\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"72\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"240\"\u003e\n \u003cp\u003e2. Choose patients\u0026rsquo; interests over the physician\u0026rsquo;s interest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"72\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"240\"\u003e\n \u003cp\u003e3. Desire to help others\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"72\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" width=\"114\"\u003e\n \u003cp\u003eAccountability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"240\"\u003e\n \u003cp\u003e4. Be the patients\u0026rsquo; advocate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"72\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"240\"\u003e\n \u003cp\u003e5. Be responsible to colleagues\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"72\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"240\"\u003e\n \u003cp\u003e6. Be responsible to society and the institution\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"72\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" width=\"114\"\u003e\n \u003cp\u003eExcellence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"240\"\u003e\n \u003cp\u003e7. Be self\u0026ndash;motivated to practice excellence by being a lifelong learner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"72\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"240\"\u003e\n \u003cp\u003e8. Teach other medical personnel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"72\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"240\"\u003e\n \u003cp\u003e9. Promote research to create new knowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"72\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" width=\"114\"\u003e\n \u003cp\u003eHonor and integrity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"240\"\u003e\n \u003cp\u003e10. Be transparent and truthful\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"72\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"240\"\u003e\n \u003cp\u003e11. Maintain the honor of the medical profession\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"72\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"240\"\u003e\n \u003cp\u003e12. Be trustworthy and dependable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"72\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" width=\"114\"\u003e\n \u003cp\u003eRespect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"240\"\u003e\n \u003cp\u003e13. Respect patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"72\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"240\"\u003e\n \u003cp\u003e14. Be polite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"72\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"240\"\u003e\n \u003cp\u003e15. Respect coworkers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"72\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" width=\"114\"\u003e\n \u003cp\u003eCommunication skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"240\"\u003e\n \u003cp\u003e16. Communicate clearly to patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"72\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"240\"\u003e\n \u003cp\u003e17. Have appropriate conversations with coworkers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"72\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"240\"\u003e\n \u003cp\u003e18. Listen and respond to patients\u0026rsquo; concerns\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"72\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" width=\"114\"\u003e\n \u003cp\u003eTeamwork and leadership\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"240\"\u003e\n \u003cp\u003e19. Be a good team player\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"72\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"240\"\u003e\n \u003cp\u003e20. Practice good leadership\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"72\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"240\"\u003e\n \u003cp\u003e21. Practice self\u0026ndash;control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"72\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" width=\"114\"\u003e\n \u003cp\u003eHumanism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"240\"\u003e\n \u003cp\u003e22. Practice compassionate patient care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"72\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"240\"\u003e\n \u003cp\u003e23. Share the feeling of patients\u0026rsquo; suffering (empathy)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"72\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"240\"\u003e\n \u003cp\u003e24. Be kind\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"72\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" width=\"114\"\u003e\n \u003cp\u003eEthics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"240\"\u003e\n \u003cp\u003e25. Avoid any conflict of interest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"72\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"240\"\u003e\n \u003cp\u003e26. Respect patient confidentiality and privacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"72\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"240\"\u003e\n \u003cp\u003e27. Adhere to doctors\u0026rsquo; religious and moral values\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"72\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" width=\"114\"\u003e\n \u003cp\u003eMedical competence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"240\"\u003e\n \u003cp\u003e28. Take a holistic approach to patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"72\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"240\"\u003e\n \u003cp\u003e29. Build excellent knowledge and procedural skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"72\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"240\"\u003e\n \u003cp\u003e30. Be able to treat patients in various situations with limited resources\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"72\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" width=\"114\"\u003e\n \u003cp\u003eMindfulness and self-reflectiveness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"240\"\u003e\n \u003cp\u003e31. Be responsive to feedback\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"72\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"240\"\u003e\n \u003cp\u003e32. Try new behaviors to promote patient care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"72\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"240\"\u003e\n \u003cp\u003e33. Have situational awareness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"72\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" width=\"114\"\u003e\n \u003cp\u003eAppearance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"240\"\u003e\n \u003cp\u003e34. Wear a white coat\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"72\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"240\"\u003e\n \u003cp\u003e35. Wear professional attire\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"72\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"240\"\u003e\n \u003cp\u003e36. Practice appropriate grooming\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"72\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" width=\"114\"\u003e\n \u003cp\u003eInformation management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"240\"\u003e\n \u003cp\u003e37. Complete medical records on time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"72\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"240\"\u003e\n \u003cp\u003e38. Document charts accurately\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"72\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"240\"\u003e\n \u003cp\u003e39. Gather data efficiently with limited time and resources\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"72\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003eAP: attending physician; MS4: 4\u003csup\u003eth\u003c/sup\u003e-year medical student; MS1: 1\u003csup\u003est\u003c/sup\u003e-year medical student\u003c/p\u003e\n \u003cp\u003eCorrelations of aggregated rankings by each group are detailed in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e. The healthcare providers showed a high correlation between their individual groups (0.92 to 0.96). The APs and residents had the greatest agreement (0.96). When the patients\u0026rsquo; data were analyzed with those of each healthcare provider group, the correlation values diminished (0.66 to 0.82). The least agreement was shown with MS4s (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable border=\"1\" id=\"Tab3\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCorrelations of aggregated ranking by healthcare providers and patients\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAP\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNurse\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eResident\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMS4\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMS1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePatient\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eResident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMS4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMS1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePatient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003eAP: attending physician; MS4: 4th -year medical student; MS1: 1st -year medical student\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eWe first demonstrated EPP perceptions in healthcare teams and patients in EDs from the USA and Thailand. The overall data illustrate a pattern of borderline cultural consensus regarding EPP (eigenvalue ratio\u0026thinsp;=\u0026thinsp;3.07, mean competency\u0026thinsp;=\u0026thinsp;0.5, and negative competency\u0026thinsp;=\u0026thinsp;3.15%), with a validity of 0.95. There was no absolute cultural consensus among healthcare providers and patients. Previous studies examined EPP perceptions in one or a few groups of participants [\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e]. The present study aimed to simultaneously assess the EPP viewpoints from all related persons in EDs (healthcare providers and patients) to assess 360-degree perceptions. The data showed interesting results. All participants from different cultures (n\u0026thinsp;=\u0026thinsp;984) in cohorts from both the USA and Thailand selected the same rankings of the most (excellent knowledge and procedural skills) and the least (wearing a white coat) important EPP-related issues.\u003c/p\u003e\n\u003cp\u003eA recent study in the EDs (USA; n\u0026thinsp;=\u0026thinsp;288) found that wearing a white coat was ranked as the last important among healthcare providers and patients from a generation perspective [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e]. The present data (Thailand and the USA) also show a similar result in that wearing a white coat was the least important issue. However, the professional appearance of physicians wearing white coats was the preference from patients\u0026rsquo; viewpoint [\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e]. In contrast, a study in Switzerland reported that only 34.4% of 1,637 patients considered wearing a white coat to be important [\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e]. This finding and our present data may indicate that wearing a white coat is no longer considered important in perceptions of physicians.\u003c/p\u003e\n\u003cp\u003eMost patients highly valued aspects of EPP pertaining to \u0026ldquo;humanism\u0026rdquo;, \u0026ldquo;be polite\u0026rdquo;, \u0026ldquo;communicate clearly to patients\u0026rdquo; and \u0026ldquo;listen and respond to patients\u0026rsquo; concern\u0026rdquo; as items of most importance to them (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). The studies of patients\u0026rsquo; experiences demonstrated that all participants expected the characteristics of their healthcare providers at the ED [\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e]. Enhanced communication skills are required to reduce the gap in perceptions between doctors and patients [\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e]. In addition, the present study reveals that \u0026ldquo;respect patients\u0026rdquo; was ranked most important by all groups (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). A previous study reported that patients need to be respected in confidentiality and privacy during their ED visit [\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e]. Therefore, healthcare teams should place a greater emphasis on these soft skills.\u003c/p\u003e\n\u003cp\u003eThe APs group had a greater agreement with patients regarding EPP than those of MS4s, residents, and nurses (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e). APs have more experience and time to develop their perceptions of EPP through internal and external motivations to develop their skills and strengthen themselves to be more attuned to the needs of patients [\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e]. Experienced clinicians can focus more on listening to patient concerns and demonstrate their interpersonal skills [\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e]. Fewer experienced providers focus more on gathering essential information for differential diagnosis and management due to limitations of time and resources [\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e]. This may cause them to overlook their application of soft skills. Thus, teaching and evaluation of interpersonal skills should be emphasized during all levels of medical training [\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eThe MS1 group had the greatest agreement with patients regarding EPP (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e), especially compared with the MS4 group. Previous studies revealed lower professional attitude scores and less empathy associated with increasing years in medical school [\u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e32\u003c/span\u003e]. MS4s have more experience with sleep deprivation causing physical and mental exhaustion [\u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e]. After MSs are trained, they focus on the more complex task of building medical management skills and may forget interpersonal skills [\u003cspan class=\"CitationRef\"\u003e34\u003c/span\u003e]. A lack of role models and mistreatment from the faculty can account for the decline in empathy during the clinical training [\u003cspan class=\"CitationRef\"\u003e35\u003c/span\u003e]. Emergency medical educators must integrate soft skills and medicine-related skills into their teaching during clinical practice [\u003cspan class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eThe AP group noted \u0026ldquo;be transparent and truthful\u0026rdquo; and \u0026ldquo;be trustworthy and dependable\u0026rdquo; as crucial characteristics (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). Ethics in emergency medicine related to physician integrity, templates, and the \u0026ldquo;F\u0026rdquo; word have been described for providing medical care [\u003cspan class=\"CitationRef\"\u003e37\u003c/span\u003e]. Health professionals are expected to tell the truth. However, each patient needs to be approached individually regarding the importance of telling the truth in all situations [\u003cspan class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eThe ED nurses ranked \u0026ldquo;be a good team player\u0026rdquo; and \u0026ldquo;respect coworkers\u0026rdquo; among their three most important qualities for EPP (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). A better working relationship between physicians and nurses can increase physician productivity, enhance the quality and safety of patient care, decrease ED waiting time, improve patient outcomes and satisfaction and enhance inter-professional collaboration, which is currently a requirement of the World Federation of Medical Education [\u003cspan class=\"CitationRef\"\u003e39\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e41\u003c/span\u003e]. Teamwork among specialties directly influences the quality of ED patient care [\u003cspan class=\"CitationRef\"\u003e42\u003c/span\u003e]. A lack of respect among coworker increases stress leading to strains in coworker relationships and teamwork [\u003cspan class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e44\u003c/span\u003e]. Therefore, implementing instructions on teamwork during inter-professional emergency training would lead to changes in the workplaces.\u003c/p\u003e\n\u003cp\u003eAll cohorts in both countries agreed that having excellent knowledge and procedural skills was the most important aspect of EPP (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). Practitioners and managers also ranked medical competency as an important aspect of medical professionalism [\u003cspan class=\"CitationRef\"\u003e45\u003c/span\u003e]. The conventional professional image of the physician (e.g., ethics and professional reputation, dependability, integrity) and the global view (e.g., good doctor attributes, responsibility, ethics) were essential professionalism domains [\u003cspan class=\"CitationRef\"\u003e46\u003c/span\u003e]. Two different attitudes (performance attainment and personal involvement) in terms of recognition and selection of essential values are critical for better practice in the medical profession [\u003cspan class=\"CitationRef\"\u003e47\u003c/span\u003e]. Continuing medical education in professionalism would improve the efficiency of healthcare teams in ensuring patient safety.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe present study illustrates no absolute cultural consensus between patients and healthcare providers regarding EPP. Agreement regarding the definition of EPP is critical for ED healthcare providers and ED patients through worldwide education.\u003c/p\u003e "},{"header":"Limitations","content":"\u003cp\u003eEven with a large sample size, our study still has some limitations. Since there were 39 cards, the participants may have grown tired and found it difficult to rank all 39 items accurately. Although we did not test for the reliability of the card ranking, a previous study illustrated that it remains a viable research tool if there are under 40 cards involved [\u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e]. Unfortunately, we could not measure intra-rater reliability over two separate weeks for each subject in all six cohorts due to the impracticality of follow-up. Measuring inter-rater reliability among different members of each cohort is required to determine whether the card ranking method is reliable for EPP assessment.\u003c/p\u003e\n\u003cp\u003eIn addition, unstable, vulnerable, or pediatric subjects were excluded from this study, and so the present data are not applicable to or representative of them. The participants in Thailand accounted for 69% of the sample, which may not accurately represent both countries. Further studies to compare the perceptions of EPP among people in Eastern and Western cultures are suggested. Of note, a factor analysis is recommended to determine the criterion validity of EPP. A prospective cohort study is also required to investigate which element can effectively predict the EPP of any EPs. A qualitative study is also required to investigate what are observable EPP behaviors from patients\u0026rsquo; and relatives\u0026rsquo; perspectives.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAP: Attending physician; ED: Emergency department; EPP: Emergency physician professionalism; ER: Eigenvalue ratio; EP: Emergency physician; MS: Medical student; NC: Negative competency\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is approved by the University of California, USA (UCI, FWA 00004071, 2003), Central Research Ethics Committee (COA-CREC 008/ 2017), and the Faculty of Medicine, Chulalongkorn University, Thailand (COA No. 020/2017; IRB No.629/59), and certify that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Informed consent was obtained from all participants or, if participants are under 16, from a parent and/or legal guardian.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the participants for publication of this study and accompanying images in accordance with the journal\u0026rsquo;s participant consent policy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets supporting the conclusion of this article are available in the corresponding author repository on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no declarations of financial or non-financial competing interests to report.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was funded by the Consortium of Thai Medical Schools through the Medical Research Network, Grant No. MRF-2560-001, and was supported in part by grant UL1 TR001414 from the National Center for Advancing Translational Sciences, National Institutes of Health (NIH), through the Biostatistics, Epidemiology and Research Design Unit.\u0026nbsp;The funders did not interfere neither in the interpretation of data nor in writing the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors\u0026rsquo; contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Khuansiri Narajeenron, Tanawat Tarapan, Jasmina Dukovic, Krongkarn Sutham, Intanon Imsuwan, Ar-aishah Dadeh, Tanyaporn Nakornchai, Deena Bengiamin, Bharath Chakravarthy, Craig Anderson, and Wirachin Hoonpongsimanont. The first draft of the manuscript was written by Khuansiri Narajeenron, Somchit Eiam-Ong, Wirachin Hoonpongsimanont, Jasmina Dukovic, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank the director of the Emergency Medicine Research Associate Program and the emergency medicine team at the School of Medicine, University of California Irvine, as well as all five cohorts of university-based emergency departments in Thailand. We thank Linda S. Murphy, MLIS, University of California, Irvine, for performing literature searches and acknowledge the AJE (\u003ca href=\"http://www.AJE.com\"\u003ewww.AJE.com\u003c/a\u003e) for the English language editing.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e\u003cspan\u003eAustin M, Carra B, Casey J, Chinn S, FlottenA, Franzone J, et al. Accreditation Council for Graduate Medical Education.The Next Accreditation System:A Resident Perspective [Online].The ACGME Council of Review Committee Residents 2014.\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.acgme.org/globalassets/pdfs/resident-services/9nasresidentsmay2014.pdf\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan\u003eAccessed 25 Nov 2021.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eEmanuel EJ, Emanuel LL.What is accountability in health care? Ann Intern Med.1996; 124:229\u0026ndash;39.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eABIM Foundation, American Board of Internal Medicine, ACP-ASIM Foundation, et al.Medical professionalism in the new millennium: a physician charter.Ann Intern Med.2002;136:243\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eFeldman DS, Nowvack DH, Gracely E.Effects of managed care on physician-patient relationships, quality of care, and the ethical practice of medicine.Arch Intern Med.1998;158:1626\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eEmanuel EJ, Dubler NN.Preserving the physician-patient relationship in the era of managed care.JAMA.1995;273:323\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eLarkin GL, Binder L, Houry D, et al.Defining and evaluating professionalism: a core competency for graduate emergency medicine education.Acad Emerg Med.2002;9:1249\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eGordon J, Sheppard LA, Anaf S.The patient experience in the emergency department: a systematic synthesis of qualitative research.Int Emerg Nurs.2010;18:80\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eBranney SW, Pons PT, Markovchick VJ, et al.Malpractice occurrence in emergency medicine: does residency training make a difference? J Emerg Med.2000;19:99\u0026ndash;105.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eRosenstein AH, Naylor B.Incidence and impact of physician and nurse disruptive behaviors in the emergency department.J Emerg Med.2012;43:139\u0026ndash;48.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eTaira T, Roberts NK, Santen SA.11 defining professionalism issues among \u0026ldquo;problem residents\u0026rdquo;.Ann Emerg Med.2012;60:S167.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eJha V, Bekker HL, Duffy SRG, Roberts TE.Perceptions of professionalism in medicine: a qualitative study.Med Educ.2006;40:1027\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eWagner P, Hendrich J, Moseley G, Hudson V. Defining medical professionalism: a qualitative study.Med Educ.2007;41:288\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eHoonpongsimanont W, Sahota PK, Chen Y, Patel M, Tarapan T, Bengiamin D, et al.Physician professionalism: definition from a generation perspective.Int J Med Educ.2018;28:246\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eHarris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)-a metadata-driven methodology and workflow for process providing translational research informatics support.J Biomed Inform.2009;42:377\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eWeller SC.Cultural consensus theory: applications and frequently asked questions.Field Methods.2007;19:339\u0026ndash;68.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eRomney AK, Weller SC, Batchelder WH.Culture as consensus: a theory of culture and informant accuracy.Am Anthropol.1986;88:313\u0026ndash;38.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eShiga T, Nakashima Y, Norisue Y, Ikegami T, Uechi T, Otaki Y, et al.Comparison of professionalism between emergency medicine resident physicians and faculty physicians: A multicenter cross-sectional study.PLoS ONE.2020;15:e0230186.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eJauregui J, Gatewood M, Ilgen J, Schaninger C, Strote J. Emergency Medicine Resident Perceptions of Medical Professionalism.West J Emerg Med.2016;17:355\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eSanten SA, Hemphill RR.A Window on Professionalism in the Emergency Department Through Medical Student Narratives.Ann Emerg Med.2011;58:288\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eTiang KW, Razack AH, Ng KL.The \u0026lsquo;auxiliary\u0026rsquo; white coat effect in hospitals: perceptions of patients and doctors.Singapore Med J.2017;58:574\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003ePetrilli CM, Saint S, Jennings JJ,Caruso A, Kuhn L, Snyder A, et al.Understanding patient preference for physician attire: a cross-sectional observational study of 10 academic medical centers in the USA.BMJ Open.2018;8:e021239.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eSebo P, Herrmann FR, Haller DM.White coat in primary care: what do patients think today? Cross-sectional study.Swiss Med Wkly.2014;144:w14072.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eSwallmeh E, Byers V, Arisha A.Informing quality in emergency care: understanding patient experiences.Int J Health Care Qual Assur.2018;31:704\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003ede Steenwinkel M, Juanita AH, van Berkel E, Rozema L, Rood P, Bouwhuis M. Patient satisfaction, needs, and preferences concerning information dispensation at the \u003cspan\u003eemergency department: a cross-sectional observational study. IJEM. 2022;15:5.\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eRiachy CS, Nemr E.Medical professionalism in Lebanon: between doctors\u0026apos; perception and patients\u0026apos; satisfaction.Int J Med Educ.2020;11:171\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eSari MI, Prabandari YS, Claramita M.Physicians\u0026rsquo; professionalism at primary care facilities from patients\u0026rsquo; perspective: The importance of doctors\u0026rsquo; communication skills.J Family Med Prim Care.2016;5:56\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eOlsen JC, Sabin BR.Emergency Department patient perceptions of privacy and confidentiality.J Emerg Med.2003;25:329\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eGisondi MA, Smith-Coggins R, Harter PM, Soltysik RC, Yarnold PR.Assessment of resident professionalism using high-fidelity simulation of ethical dilemmas.Acad Emerg Med.2004;11:931\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eCruess SR, Cruess RL, Steinert Y.Supporting the development of a professional identity: General principles.Med Teach. 2019;41:641\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eRonan-Bentle E S, Avegno J, Hegarty B, Manthey ED. Dealing with the difficult student in emergency medicine. IJEM. 2011;4:39.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eSantos WSD, Laros JA, Trindade EMV, Ribeiro Junior MD, da Silva DAM, Ribeiro LM.Medical professionalism: the effects of sociodemographic diversity and curricular organization on the attitudinal performance of medical students.Rev Bras Educ Med. 2017;41:594\u0026ndash;603.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eChen D, Lew R, Hershman W, Orlander J.A cross-sectional measurement of medical student empathy.J Gen Intern Med.2007;22:1434\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eRosen IM, Gimotty PA, Shea JA, Bellini LM.Evolution of sleep quantity, sleep deprivation, mood disturbances, empathy, and burnout among interns.Acad Med. 2006;81:82\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eChen DC, Kirshenbaum DS, Yan J, Kirshenbaum E, Aseltine RH.Characterizing changes in student empathy throughout medical school.Med Teach.2012;34:305\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eKay J.Traumatic de-idealization and the future of medicine.JAMA.1990;263:572\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eFlowerdew L, Brown R, Vincent C, Woloshynowych M.Development and validation of a tool to assess emergency physicians\u0026apos; nontechnical skills.Ann Emerg Med.2012;59:376\u0026ndash;385.e4.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eMusher DM, Hayward CP, Musher BL.Physician Integrity, Templates, and the \u0026lsquo;F\u0026rsquo; Word.J Emerg Med.2019;57:263\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eZolkefli Y.The Ethics of Truth-Telling in Health-Care Settings.Malays J Med Sci.2018;25:135\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eCaricati L, Guberti M, Borgognoni P, Prandi C, Spaggiari I, Vezzani E, et al.The role of professional and team commitment in nurse-physician collaboration: a dual identity model perspective.J Interprof Care.2015;29:464\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eInterprofessional Education Collaborative.Core Competencies for Interprofessional Collaborative Practice: 2016 update.Washington, DC:Interprofessional Education Collaborative; 2016.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eWorld Federation for Medical Education.Basic Medical Education. WFME Global Standards for Quality Improvement. The 2012 Revision.Copenhagen:WFME; 2003.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eEisenmann D, Stroben F, Gerken Jan D, Exadaktylos AK, Machner M, Hautz WE.Interprofessional Emergency Training Leads to Changes in the Workplace.West J Emerg Med.2018;19:185\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eOore DG, Leblanc D, Day A, Leiter MP, Spence Laschinger HK, Price SL, et al.When respect deteriorates: incivility as a moderator of the stressor-strain relationship among hospital workers.J Nurs Manag.2010;18:878\u0026ndash;88.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eSullivan C, Murano T, Comes J, Smith JL, Katz ED. Emergency medicine directors\u0026apos; perceptions on professionalism: a council of emergency medicine residency directors survey.Acad Emerg Med.2011;18:S97-103.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eAndersson H, Sundstrom BW, Nilsson K, Jakobsson Ung E.Competencies in Swedish emergency departments - the practitioners\u0026apos; and managers\u0026apos; perspective.Int Emerg Nurs.2014;22:81\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eReimer D, Russell R, Khallouq BB,Kauffman C, Hernandez C, Cend\u0026aacute;n J, et al.Pre-clerkship medical students\u0026rsquo; perceptions of medical professionalism.BMC Med Educ.2019;19:239.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eMinicuci N, Giorato C, Rocco I, Lloyd-Sherlock P, Avruscio G, Cardin F.Survey of doctors\u0026rsquo; perception of professional values.PLoS One.2020;15:e0244303.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eDesign at IBM.Card sorting:a powerful, simple research method-design at IBM-medium.2018. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://medium.com/design-ibm/card-sorting-a-powerful-simple-research-method-9d1566be9b62ch-method-9d1566be9b62\u003c/span\u003e\u003c/span\u003e. Accessed 25 Nov 2021.\u003c/span\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Emergency Physician Professionalism, 360 - Degree Perceptions, Healthcare providers, Patients, Cultural consensus ","lastPublishedDoi":"10.21203/rs.3.rs-1710023/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1710023/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: 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. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: 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 4\u003csup\u003eth\u003c/sup\u003e and 1\u003csup\u003est\u003c/sup\u003e 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. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: 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.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: 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.\u0026nbsp;\u003c/p\u003e","manuscriptTitle":"Emergency Physician Professionalism: 360 - Degree Perceptions of Healthcare Providers and Patients in Thailand and USA Cultural Context","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-06-09 16:03:13","doi":"10.21203/rs.3.rs-1710023/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"713616c2-5654-4955-ac9b-7af226ade43f","owner":[],"postedDate":"June 9th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-01-04T02:59:14+00:00","versionOfRecord":[],"versionCreatedAt":"2022-06-09 16:03:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1710023","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1710023","identity":"rs-1710023","version":["v1"]},"buildId":"FbvkV6FR0MCFSLy54lSbu","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}