Geller G, Faden R R, Levine D M
Johns Hopkins School of Public Health, Baltimore, MD 21205.
Soc Sci Med. 1990;31(5):619-24. doi: 10.1016/0277-9536(90)90098-d.
The practice of medicine has always been characterized by uncertainty. Yet, attempts to study tolerance for uncertainty in medicine have been few, and limited to its influence on specialty preferences and test-ordering behavior. In particular, studies have not investigated how the process of socialization into the medical profession affects tolerance for uncertainty. Based on the assumption that uncertainty and ambiguity are related concepts, a modified version of a tolerance for ambiguity scale was used to study Johns Hopkins medical students' (N = 386) tolerance for ambiguity (TFA) through 4 yr of medical school. In addition, using alcoholism as an example of a clinically ambiguous condition, the association between students' tolerance for ambiguity and their perceived role in diagnosing and treating alcoholism was also investigated. Results indicate that tolerance for ambiguity (1) does not change throughout medical school, (2) is lower among men, whites and students who are younger when they begin medical school, (3) is higher among prospective psychiatrists than surgeons, and (4) is lower among students who do not feel responsible for diagnosing and treating alcoholism. These findings suggest that tolerance for ambiguity may, indeed, affect practitioners' career choices and performance and that selection of medical students may be more important than medical training per se in influencing students' tolerance for ambiguity. If medical schools admitted students who possess a high tolerance for ambiguity, quality of care for ambiguous conditions might improve, imbalances in physician supply and practice patterns might be reduced, and the increasing ambiguity in medical practice might be better acknowledge and accepted.
医学实践一直以来都具有不确定性的特点。然而，对医学领域不确定性耐受性的研究却很少，并且仅限于其对专业偏好和检查医嘱行为的影响。特别是，尚未有研究探讨医学专业社会化过程如何影响对不确定性的耐受性。基于不确定性和模糊性是相关概念的假设，我们使用了一个经过修改的模糊耐受性量表版本，来研究约翰·霍普金斯大学医学院4年期间386名医学生的模糊耐受性（TFA）。此外，以酒精中毒作为临床模糊病症的一个例子，我们还研究了学生的模糊耐受性与他们在酒精中毒诊断和治疗中所感知的角色之间的关联。结果表明，模糊耐受性：（1）在医学院学习期间不会改变；（2）在男性、白人以及医学院入学时年龄较小的学生中较低；（3）未来想成为精神科医生的学生比想成为外科医生的学生更高；（4）在那些认为自己对酒精中毒诊断和治疗没有责任的学生中较低。这些发现表明，模糊耐受性可能确实会影响从业者的职业选择和表现，并且在影响学生的模糊耐受性方面，医学院学生的选拔可能比医学培训本身更重要。如果医学院录取那些对模糊性具有高耐受性的学生，那么对于模糊病症的护理质量可能会提高，医生供应和执业模式的不平衡可能会减少，并且医学实践中日益增加的模糊性可能会得到更好的认识和接受。
