Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA.
Department of Medicine, University of California-San Francisco, San Francisco, CA, USA.
Diagnosis (Berl). 2022 Sep 12;10(1):13-18. doi: 10.1515/dx-2022-0045. eCollection 2023 Feb 1.
As we increasingly acknowledge the ubiquitous nature of uncertainty in clinical practice (Meyer AN, Giardina TD, Khawaja L, Singh H. Patient and clinician experiences of uncertainty in the diagnostic process: current understanding and future directions. Patient Educ Counsel 2021;104:2606-15; Han PK, Klein WM, Arora NK. Varieties of uncertainty in health care: a conceptual taxonomy. Med Decis Making 2011;31:828-38) and strive to better define this entity (Lee C, Hall K, Anakin M, Pinnock R. Towards a new understanding of uncertainty in medical education. J Eval Clin Pract 2020; Bhise V, Rajan SS, Sittig DF, Morgan RO, Chaudhary P, Singh H. Defining and measuring diagnostic uncertainty in medicine: a systematic review. J Gen Intern Med 2018;33:103-15), as educators we should also design, implement, and evaluate curricula addressing clinical uncertainty. Although frequently encountered, uncertainty is often implicitly referred to rather than explicitly discussed (Gärtner J, Berberat PO, Kadmon M, Harendza S. Implicit expression of uncertainty - suggestion of an empirically derived framework. BMC Med Educ 2020;20:83). Increasing explicit discussion of - and comfort with -uncertainty has the potential to improve diagnostic reasoning and accuracy and improve patient care (Dunlop M, Schwartzstein RM. Reducing diagnostic error in the intensive care unit. Engaging. Uncertainty when teaching clinical reasoning. Scholar;1:364-71). Discussion of both diagnostic and prognostic uncertainty with patients is central to shared decision-making in many contexts as well, (Simpkin AL, Armstrong KA. Communicating uncertainty: a narrative review and framework for future research. J Gen Intern Med 2019;34:2586-91) from the outpatient setting to the inpatient setting, and from undergraduate medical education (UME) trainees to graduate medical education (GME) trainees. In this article, we will explore the current status of how the science of uncertainty is taught from the UME curriculum to the GME curriculum, and describe strategies how uncertainty can be explicitly discussed for all levels of trainees.
在临床实践中，我们越来越多地认识到不确定性无处不在（Meyer AN、Giardina TD、Khawaja L 和 Singh H. 患者和临床医生在诊断过程中对不确定性的体验：当前的理解和未来的方向。患者教育与咨询 2021；104:2606-15；Han PK、Klein WM 和 Arora NK. 医疗保健中的不确定性种类：概念分类。医学决策 2011；31:828-38），并努力更好地定义这一实体（Lee C、Hall K、Anakin M 和 Pinnock R. 对医学教育中不确定性的新理解。评估临床实践 2020；Bhise V、Rajan SS、Sittig DF、Morgan RO、Chaudhary P 和 Singh H. 定义和衡量医学中的诊断不确定性：系统评价。普通内科医学 2018；33:103-15），因此作为教育者，我们还应该设计、实施和评估针对临床不确定性的课程。尽管经常遇到，但不确定性通常是隐含的而不是明确讨论的（Gärtner J、Berberat PO、Kadmon M 和 Harendza S. 不确定性的隐含表达-基于实证得出的框架建议。BMC 医学教育 2020；20:83）。增加对不确定性的明确讨论和接受度有可能改善诊断推理和准确性，并改善患者护理（Dunlop M 和 Schwartzstein RM. 减少重症监护室的诊断错误。吸引。在教授临床推理时不确定。学者；1:364-71）。与患者讨论诊断和预后不确定性也是许多情况下共享决策的核心，从门诊到住院，从 UME 受训者到 GME 受训者（Simpkin AL 和 Armstrong KA. 沟通不确定性：综述和未来研究框架。普通内科医学 2019；34:2586-91）。在本文中，我们将探讨从 UME 课程到 GME 课程如何教授不确定性科学的现状，并描述如何为所有层次的受训者明确讨论不确定性的策略。
