Cooke Georga, Tapley Amanda, Holliday Elizabeth, Morgan Simon, Henderson Kim, Ball Jean, van Driel Mieke, Spike Neil, Kerr Rohan, Magin Parker
Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
GP Synergy Ltd, Sydney, New South Wales, Australia.
Med Educ. 2017 Dec;51(12):1277-1288. doi: 10.1111/medu.13408.
Tolerance for ambiguity is essential for optimal learning and professional competence. General practice trainees must be, or must learn to be, adept at managing clinical uncertainty. However, few studies have examined associations of intolerance of uncertainty in this group.
The aim of this study was to establish levels of tolerance of uncertainty in Australian general practice trainees and associations of uncertainty with demographic, educational and training practice factors.
A cross-sectional analysis was performed on the Registrar Clinical Encounters in Training (ReCEnT) project, an ongoing multi-site cohort study. Scores on three of the four independent subscales of the Physicians' Reaction to Uncertainty (PRU) instrument were analysed as outcome variables in linear regression models with trainee and practice factors as independent variables.
A total of 594 trainees contributed data on a total of 1209 occasions. Trainees in earlier training terms had higher scores for 'Anxiety due to uncertainty', 'Concern about bad outcomes' and 'Reluctance to disclose diagnosis/treatment uncertainty to patients'. Beyond this, findings suggest two distinct sets of associations regarding reaction to uncertainty. Firstly, affective aspects of uncertainty (the 'Anxiety' and 'Concern' subscales) were associated with female gender, less experience in hospital prior to commencing general practice training, and graduation overseas. Secondly, a maladaptive response to uncertainty (the 'Reluctance to disclose' subscale) was associated with urban practice, health qualifications prior to studying medicine, practice in an area of higher socio-economic status, and being Australian-trained.
This study has established levels of three measures of trainees' responses to uncertainty and associations with these responses. The current findings suggest differing 'phenotypes' of trainees with high 'affective' responses to uncertainty and those reluctant to disclose uncertainty to patients. More research is needed to examine the relationship between clinical uncertainty and clinical outcomes, temporal changes in tolerance for uncertainty, and strategies that might assist physicians in developing adaptive responses to clinical uncertainty.
对模糊性的容忍度对于最佳学习和专业能力至关重要。全科医学实习生必须或必须学会善于应对临床不确定性。然而，很少有研究探讨该群体中对不确定性不耐受的相关因素。
本研究旨在确定澳大利亚全科医学实习生对不确定性的容忍水平，以及不确定性与人口统计学、教育和培训实践因素之间的关联。
对正在进行的多中心队列研究“注册医生培训临床接触（ReCEnT）项目”进行横断面分析。将医生对不确定性的反应（PRU）工具四个独立子量表中的三个得分作为线性回归模型的结果变量进行分析，实习生和实践因素作为自变量。
共有594名实习生在总共1209次场合中提供了数据。处于早期培训阶段的实习生在“因不确定性而焦虑”“对不良结果的担忧”和“不愿向患者透露诊断/治疗不确定性”方面得分较高。除此之外，研究结果表明在对不确定性的反应方面存在两组不同的关联。首先，不确定性的情感方面（“焦虑”和“担忧”子量表）与女性性别、开始全科医学培训前在医院的经验较少以及海外毕业有关。其次，对不确定性的适应不良反应（“不愿透露”子量表）与城市实践、学医前的健康资格、社会经济地位较高地区的实践以及澳大利亚培训有关。
本研究确定了实习生对不确定性反应的三项测量指标水平以及与这些反应的关联。目前的研究结果表明，对不确定性有高“情感”反应的实习生和不愿向患者透露不确定性的实习生存在不同的“表型”。需要更多研究来探讨临床不确定性与临床结果之间的关系、对不确定性容忍度的时间变化，以及可能帮助医生培养对临床不确定性适应性反应的策略。
