Centre for Human Anatomy Education, Monash University, Clayton, Victoria, Australia.
Monash Centre for Scholarship in Health Education, Monash University, Clayton, Victoria, Australia.
Med Educ. 2024 Jul;58(7):869-879. doi: 10.1111/medu.15269. Epub 2023 Nov 14.
Uncertainty is ubiquitous within medical practice. Accordingly, how individuals respond to uncertainty, termed uncertainty tolerance (UT), is increasingly considered a medical graduate competency. Despite this, aspects of the UT construct are debated, which may relate to research focused on measuring UT, rather than understanding students' experiences. Therefore, we asked (1) how do medical students describe their responses to uncertainty, (2) how (if at all) do described responses change over time and (3) how do described responses contribute to understanding the UT construct.
Engaging an interpretivist worldview, we conducted a longitudinal qualitative study throughout 2020 with 41 clinical medical students at an Australian medical school. Participants completed reflective diary entries across six in-semester time-points (n = 41, 40, 39, 38, 37 and 35) and semi-structured interviews at the end of both semesters (n = 20 per semester). We analysed data using framework analysis.
Although participants communicated accepting health care uncertainties, described cognitive appraisals of uncertainty ranged from threatening (e.g. challenging credibility) to opportunistic (e.g. for learning and growth). Emotions in response to uncertainty were predominately described in negative terms, including worry and anxiety. Participants described a range of maladaptive and adaptive behavioural responses, including avoiding versus actively engaging with uncertainty. Despite describing typically negative emotions across time, participants' cognitive and behavioural response descriptions shifted from self-doubt and avoidance, towards acceptance of, and engagement despite uncertainty.
Students' descriptions of responses to uncertainty suggest existing UT conceptualisations may not holistically reflect medical students' experiences of what it means to be uncertainty 'tolerant', especially pertaining to conceptualisations of 'tolerance' centred on emotions (e.g. stress) rather than how uncertainty is ultimately managed. Extending from this study, the field could consider redefining characteristics of uncertainty 'tolerance' to focus on adaptive cognitive and behavioural responses, rather than emotional responses as key indicators of 'tolerance'.
医学实践中存在着不确定性。因此，个体对不确定性的反应，即不确定性容忍度（UT），越来越被认为是医学毕业生的一项能力。尽管如此，UT 结构的某些方面仍存在争议，这可能与侧重于测量 UT 的研究有关，而不是与理解学生的经验有关。因此，我们提出了以下三个问题：（1）医学生如何描述他们对不确定性的反应；（2）描述性反应是否随时间变化（如果有的话）；（3）描述性反应如何有助于理解 UT 结构。
我们秉持解释主义世界观，在澳大利亚一所医学院进行了一项纵向定性研究，研究对象为 41 名临床医学专业学生。参与者在六个学期内完成了反思性日记条目（n=41、40、39、38、37 和 35），并在两个学期结束时进行了半结构化访谈（n=20 个学期）。我们使用框架分析法分析数据。
尽管参与者表示接受医疗不确定性，但对不确定性的认知评估范围从威胁性（如挑战可信度）到机会性（如学习和成长）不等。对不确定性的反应情绪主要以负面术语描述，包括担忧和焦虑。参与者描述了一系列适应不良和适应良好的行为反应，包括避免不确定性和积极应对不确定性。尽管随着时间的推移描述了通常的负面情绪，但参与者对认知和行为反应的描述从自我怀疑和回避转变为对不确定性的接受和应对。
学生对不确定性反应的描述表明，现有的 UT 概念化可能不能全面反映医学生对成为“能够容忍不确定性”的意义的体验，特别是关于以情绪（如压力）为中心而不是以最终如何管理不确定性为中心的“容忍”概念化。从这项研究中可以进一步考虑重新定义不确定性“容忍”的特征，将重点放在适应性认知和行为反应上，而不是将情绪反应作为“容忍”的关键指标。
