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

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.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.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.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.