Ndoja Silvio, Chahine Saad, Saklofske Donald H, Lanting Brent
Schulich School of Medicine & Dentistry, University of Western Ontario, 1151 Richmond St, London, ON, N6A 5C1, Canada.
Faculty of Education, Queen's University, Duncan McArthur Hall, 511 Union St W, Kingston, ON, K7M 5R7, Canada.
BMC Med Educ. 2020 Nov 10;20(1):417. doi: 10.1186/s12909-020-02345-5.
Medicine is a field that is simultaneously factual and ambiguous. Medical students have their first exposure to full time clinical practice during clerkship. While studies have examined medical trainees' tolerance of ambiguity (TOA), the extent to which TOA is affected by clinical experiences and its association with perfectionism is unknown. The aim of this study was to evaluate the effect of clerkship experience on TOA and perfectionism in medical students.
This was a multiple sampling, single cohort study of students in their first year of clinical clerkship which is comprised of 6 core rotations. Consenting students completed an online anonymous survey assessing their tolerance of ambiguity (TOA) and perfectionism in their first (pre) and last (post) 12 weeks of their clinical clerkship year. Tolerance of Ambiguity in Medical Students and Doctors (TAMSAD) and The Big Three perfectionism scale-short form (BTPS-SF) were used to assess TOA and perfectionism respectively. Pre-Post mean comparisons of TOA and perfectionism were assessed via t-tests.
From a cohort of 174 clinical clerkship students, 51 students responded to pre-survey, 62 responded to post-survey. Clerkship was associated with a significant decrease in TOA (p < 0.00) with mean pre-TOA scores of 59.57 and post TOA of 43.8. Perfectionism scores were not significantly different over time (p > 0.05). There was a moderate inverse correlation between TOA and perfectionism before clerkship (r = 0.32) that increased slightly after clerkship (r = 0.39). Those preferring primary care specialties had significantly lower rigid and total perfectionism scores in pre-clerkship than those choosing other specialties, but this difference was not found post-clerkship.
Exposure to clerkship decreased TOA while perfectionism remained stable in medical students. These results were not expected as exposure has been previously shown to increase TOA. The frequency of rotation changes maintaining a cycle of anxiety may be an underlying factor accounting for these results. Overall these results require further investigation to better characterize the role of clinical exposure on TOA.
医学是一个既基于事实又存在模糊性的领域。医学生在临床实习期间首次接触全职临床实践。虽然已有研究考察了医学实习生对模糊性的容忍度（TOA），但TOA受临床经验影响的程度及其与完美主义的关联尚不清楚。本研究的目的是评估临床实习经历对医学生TOA和完美主义的影响。
这是一项对临床实习第一年学生进行的多阶段抽样单队列研究，该年包括6个核心轮转科室。同意参与的学生在临床实习年的前12周（实习前）和后12周（实习后）完成了一项在线匿名调查，评估他们对模糊性的容忍度（TOA）和完美主义。分别使用医学生和医生对模糊性的容忍度（TAMSAD）和三大完美主义量表简版（BTPS-SF）来评估TOA和完美主义。通过t检验评估TOA和完美主义的实习前后均值比较。
在174名临床实习学生队列中，51名学生回复了实习前调查，62名学生回复了实习后调查。临床实习与TOA显著降低相关（p < 0.00），实习前TOA平均得分为59.57，实习后为43.8。完美主义得分随时间无显著差异（p > 0.05）。实习前TOA与完美主义之间存在中度负相关（r = 0.32），实习后略有增加（r = 0.39）。比起选择其他专业的学生，倾向于初级保健专业的学生在实习前的严格和总体完美主义得分显著更低，但实习后未发现这种差异。
接触临床实习降低了医学生的TOA，而完美主义保持稳定。这些结果出乎意料，因为之前的研究表明接触会增加TOA。维持焦虑循环的轮转变化频率可能是导致这些结果的一个潜在因素。总体而言，这些结果需要进一步研究，以更好地描述临床接触对TOA的作用。
