College of Medicine and Health, University of Exeter, Exeter, UK.
Med Educ. 2022 Dec;56(12):1163-1173. doi: 10.1111/medu.14873. Epub 2022 Jul 18.
Uncertainty is an inevitable part of medical practice. An ability to tolerate uncertainty is viewed as a key competency across many health-care systems. Poor uncertainty tolerance (UT) has been linked to negative outcomes including reduced psychological well-being in medical students. A variety of medical education interventions have been developed with the intention of increasing medical students' UT. However, there is no synthesis of these studies available to inform education and research practice. Our aim was to conduct a scoping review of medical education interventions that evaluate their impact on UT.
Medline, PsycInfo, Embase and ERIC databases were searched for articles published from inception to December 2020. An extensive supplementary search was conducted and both quantitative and qualitative evaluations were included. For each intervention, we categorised the stimulus of uncertainty (ambiguity, complexity and/or probability) and mapped the students' reported cognitive, behavioural, and/or emotional response(s) to uncertainty onto an existing conceptual framework.
Twenty-two of 24 included studies reported a positive impact on medical student UT in at least one domain (cognitive, behavioural or emotional). Interventions included problem based learning-based curricula, medical humanities, simulation, reflection and assessment. We found in four studies that a negative response in the emotional domain was reported despite positive responses also being reported in the cognitive and/or behavioural domains.
We identified a range of medical education interventions which report a positive impact on medical student UT. Further research is required to understand why a single intervention may stimulate a negative emotional response alongside a positive cognitive or behavioural response. In turn, this could support stakeholders such as policymakers and institutions to adapt the medical curriculum to better prepare their medical students for practice by enhancing their UT.
不确定性是医学实践中不可避免的一部分。在许多医疗保健系统中，能够容忍不确定性被视为一项关键能力。较差的不确定性容忍度（UT）与包括医学生心理健康状况下降在内的负面结果有关。已经开发了各种医学教育干预措施，旨在提高医学生的 UT。然而，目前还没有这些研究的综合信息来为教育和研究实践提供信息。我们的目的是对评估 UT 影响的医学教育干预措施进行范围界定审查。
从成立到 2020 年 12 月，在 Medline、PsycInfo、Embase 和 ERIC 数据库中搜索已发表的文章。进行了广泛的补充搜索，并包括定量和定性评估。对于每项干预措施，我们将不确定性的刺激因素（模糊性、复杂性和/或概率）进行分类，并将学生对不确定性的报告认知、行为和/或情感反应映射到现有的概念框架上。
22 项研究报告称，至少在一个领域（认知、行为或情感）对医学生 UT 产生了积极影响。干预措施包括基于问题的学习课程、医学人文、模拟、反思和评估。我们在四项研究中发现，尽管在认知和/或行为领域也报告了积极反应，但在情感领域报告了负面反应。
我们确定了一系列对医学生 UT 产生积极影响的医学教育干预措施。需要进一步研究以了解为什么单一干预措施可能会引发负面的情感反应，同时也会引发积极的认知或行为反应。反过来，这可以支持政策制定者和机构等利益相关者通过增强 UT 来调整医学课程，从而更好地为医学生的实践做好准备。
