title: Cross-cultural challenges in assessing medical professionalism among emergency physicians in a Middle Eastern Country (Bahrain): feasibility and psychometric properties of multisource feedback.
abstract: BACKGROUND
  Multisource feedback (MSF) is an evaluation tool whereby surveys assessing physicians are administered among medical peers and colleagues. Such evaluations provide physicians with non-biased valuations of both their strengths and their weaknesses, offering an opportunity for improvement in their work. Studies have shown that MSF is particularly effective for emergency care physicians.
  
  
  METHODS
  The study was undertaken in a military teaching hospital in Bahrain. A total of 30 emergency physicians (the total number of emergency physicians in our hospital), 16 males and 14 females, were evaluated using multisource feedback. Each emergency physician was assessed by three groups of raters, including 4 emergency physicians, 4 referral physicians from other departments, and 4 coworkers from within the emergency department. Feasibility of the questionnaire was analyzed via response rates, average time required to complete it, and the number of raters required to produce reliable results. We used exploratory factor analysis to examine for the construct validity. Cronbach's coefficient was calculated to measure the internal consistency reliability of the instrument.
  
  
  RESULTS
  The total mean response rate was 74.2 %, and the self-reported average time needed to fill out each survey was 4.3 min, indicating a good feasibility of the questionnaire. Reliability analysis indicated that the full-scale instrument had high internal consistency (Cronbach's α 0.98). Factor analysis showed that the data on the questionnaire decomposed into three factors, which accounted for 72.6 % of the total variance: professionalism, collaboration, and communication. The generalizability coefficients (Ep(2)) were 0.76 for the surveys. Out of the 30 candidates, 26 participated in the knowledge test. The total mean score of the knowledge exam was 34.52, with scores ranging from 17 to 54.
  
  
  CONCLUSIONS
  Based on this study's results, we conclude that the instruments and procedures used have high reliability, validity, and feasibility in assessing the emergency physician in the emergency department in our clinical setting in the Middle East. The item analyses, reliability, and factor analyses all indicate that these instruments are effective in assessing emergency physicians.
authors: Department of General Surgery, Bahrain Defense Force Hospital, Off Waly Alahed Avenue, P. O. Box - 28743, West Riffa, Kingdom of Bahrain. drahmedalansari@gmail.com.|Arabian Gulf University, Manama, Bahrain. drahmedalansari@gmail.com.|Medical Education Department in the Royal College of Surgeons of Ireland in Bahrain, Adilya, Bahrain. drahmedalansari@gmail.com.
authors: Ahmed
authors: A
authors: Al Ansari
authors: Bahrain Defense Force Hospital, P. O. Box - 28743, Riffa, Kingdom of Bahrain. Almeer.ke@gmail.com.
authors: Ahmed
authors: A
authors: Al Meer
authors: Bahrain Defense Force Hospital, P. O. Box - 28743, Riffa, Kingdom of Bahrain. Althawadi89@hotmail.com.
authors: Mooza
authors: M
authors: Althawadi
authors: Department of Radiology, Bahrain Defense Force Hospital, P. O. Box - 28743, Riffa, Kingdom of Bahrain. deyarih@hotmail.com.
authors: Deyari
authors: D
authors: Henari
authors: Department of General Surgery, Bahrain Defense Force Hospital, Off Waly Alahed Avenue, P. O. Box - 28743, West Riffa, Kingdom of Bahrain. Khalid63000@gmail.com.
authors: Khalid
authors: K
authors: Al Khalifa
keywords: Emergency; Generalizability; MSF system; Validity