G.C. Stephens is a PhD student, Centre for Human Anatomy Education, Monash University, Melbourne, Australia; ORCID: https://orcid.org/0000-0001-9695-7592 .
M.N. Karim is a lecturer, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; ORCID: https://orcid.org/0000-0003-2604-9649 .
Acad Med. 2022 Sep 1;97(9):1413-1422. doi: 10.1097/ACM.0000000000004641. Epub 2022 Mar 1.
Uncertainty tolerance (UT) is a construct describing individuals' perceptions of, and responses to, uncertainty across their cognition, emotion, and behavior. Various UT scales have been designed for physician and medical student populations. However, links between UT and other variables (e.g., training stages) are inconsistent, raising concerns about scale reliability and validity. As reliability is a precondition for validity, a necessary first step in assessing UT scales' efficacy is evaluating their reliability. Accordingly, the authors conducted a meta-analysis of the reliability of UT scales designed for, and implemented among, physician and medical student populations.
In 2020, the authors searched 4 electronic databases alongside a citation search of previously identified UT scales. They included English-language, peer-reviewed studies that implemented UT scales in physician and/or medical student populations and reported reliability evidence. A meta-analysis of studies' Cronbach's alphas evaluated aggregated internal consistency across studies; subgroup analyses evaluated UT scales by named scale, population, and item characteristics.
Among 4,124 records screened, 35 studies met the inclusion criteria, reporting 75 Cronbach's alphas. Four UT scales appeared in at least 3 included studies: Physicians' Reactions to Uncertainty scale 1990 (PRU1990) and 1995 (PRU1995) versions, Tolerance for Ambiguity scale (TFA), and Tolerance of Ambiguity in Medical Students and Doctors scale (TAMSAD). The scores from these scales ranged in reliability from very good (PRU1990: 0.832, PRU1995: 0.818) to respectable (TFA: 0.761, TAMSAD: 0.711). Aggregated internal consistency was significantly higher ( P < .001) among physicians (0.797) than medical students (0.711).
UT scales generally demonstrated respectable internal consistency when administered among physicians and medical students, yet the reliability among medical students was significantly lower. The authors caution against using UT scores for decision-making purposes (e.g., applicant selection, program evaluation), especially among medical student populations. Future research should explore the reasons underlying these observed population differences.
不确定性容忍度（UT）是一个描述个体在认知、情感和行为层面感知和应对不确定性的结构。已经设计了各种 UT 量表用于医生和医学生群体。然而，UT 与其他变量（例如，培训阶段）之间的联系并不一致，这引发了对量表可靠性和有效性的关注。由于可靠性是有效性的前提，因此评估 UT 量表效能的必要第一步是评估其可靠性。因此，作者对针对医生和医学生群体设计并实施的 UT 量表的可靠性进行了荟萃分析。
2020 年，作者搜索了 4 个电子数据库，并对之前确定的 UT 量表进行了引文搜索。他们纳入了实施 UT 量表且报告了可靠性证据的以英语发表的同行评审研究，研究对象为医生和/或医学生。对研究的 Cronbach's alpha 的荟萃分析评估了研究间的综合内部一致性；亚组分析根据命名量表、人群和项目特征评估了 UT 量表。
在筛选出的 4124 条记录中，有 35 项研究符合纳入标准，报告了 75 个 Cronbach's alpha 值。有 4 个 UT 量表出现在至少 3 项纳入研究中：医生对不确定性的反应量表 1990 年（PRU1990）和 1995 年（PRU1995）版本、模糊容忍度量表（TFA）和医学生和医生对模糊的容忍度量表（TAMSAD）。这些量表的分数在可靠性方面的范围从非常好（PRU1990：0.832，PRU1995：0.818）到尚可（TFA：0.761，TAMSAD：0.711）。在医生中，综合内部一致性显著更高（P<.001，0.797），而在医学生中，综合内部一致性显著更低（0.711）。
当在医生和医学生中使用 UT 量表时，它们通常表现出尚可的内部一致性，但医学生的可靠性明显更低。作者警告说，不要将 UT 分数用于决策目的（例如，申请人选择、项目评估），尤其是在医学生群体中。未来的研究应探索观察到的人群差异的原因。
