Exploring conceptions of medical unprofessionalism in Japan and the UK: a Q-methodology study

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  • Stanyon Maham
    Center for Medical Education and Career Development, Fukushima Medical University
  • Shikama Yayoi
    Center for Medical Education and Career Development, Fukushima Medical University
  • Horsburgh Jo
    Medical Education Innovation Research Centre, Imperial College London Centre for Higher Education Research and Scholarship, Imperial College London
  • Parekh Ravi
    Medical Education Innovation Research Centre, Imperial College London
  • Benoy Gautham
    Medical Education Innovation Research Centre, Imperial College London
  • Oikawa Sayaka
    Department of Innovative and Digitalized Medical Education, Akita University Graduate School of Medicine
  • Yasuda Megumi
    Center for Medical Education and Career Development, Fukushima Medical University
  • Moula Zoe
    Department of Care in Long-term Conditions, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings College London
  • Otani Koji
    Center for Medical Education and Career Development, Fukushima Medical University

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<p>Western professionalism frameworks dominate medical education yet cause translational and ethical challenges when applied across cultures.　Increasing globalisation brings an impetus to examine these perspectives in non-dominating cultures, with a cultural understanding about what constitutes unprofessional behaviour urgently needed.　In the absence of comparative data from dominating and non-dominating cultures, we sought to use Q-methodology to examine perceptions of unprofessional behaviour amongst stakeholders in Japan and the UK.</p><p>Statements describing 48 unprofessional behaviours were sorted according to perceived severity by 58 Japanese and UK students, clinical educators, and administrators.　Factor analysis using judgemental rotation flagging factors at p<0.05 was performed.　Follow-up questionnaire responses were coded and supported the interpretation of factors.</p><p>A four-factor solution showing four distinct constructs of unprofessional behaviour was extracted: clinical responsibility (international factor), relational responsibility (Japanese-only factor), moral responsibility (UK-dominant factor), and personal responsibility (Japanese-dominant factor).　Japanese-only constructs identified behaviours disrupting personal and group relationships as more unprofessional, whereas the UK factor focused on personal motivation and ethical reasoning.</p><p>Our multi-stakeholder data provides empirical evidence into the contrasting conceptualisations of unprofessional behaviour that co-exist in practice.　We identify culturally constructed perspectives unique to both contexts, which warrant recognition and integration in local teaching and national guidelines.</p>

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