Blissett Sarah, Skinner Jamila, Banner Harrison, Cristancho Sayra, Taylor Taryn
Division of Cardiology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Adv Simul (Lond). 2024 Feb 12;9(1):8. doi: 10.1186/s41077-024-00281-8.
Residents struggle to express clinical uncertainty, often exhibiting negative cognitive, behavioral, and emotional responses to uncertainty when engaging with patients or supervisors. However, the Integrative Model of Uncertainty Tolerance posits that individuals may have positive or negative responses to perceived uncertainty. Situational characteristics, such as interactions with other health professionals, can impact whether the response is positive or negative. The team context in which residents interact with resident peers and supervisors could represent varying situational characteristics that enable a spectrum of responses to uncertainty. Understanding the situational characteristics of multidisciplinary teams that allow residents to display positive responses to perceived uncertainty could inform strategies to foster positive responses to uncertainty in other contexts. We explored resident responses to perceived uncertainty in a simulated multidisciplinary team context.
A simulation-primed qualitative inquiry approach was used. Fourteen residents from Cardiology and Obstetrics and Gynecology participated in simulation scenarios involving pregnant patients with heart disease. We incorporated epistemic fidelity through the deliberate inclusion of ambiguity and complexity to prompt uncertainty. Audio recordings of debriefing sessions were analyzed using directed content analysis.
Residents recognized that uncertainty is unavoidable, and positive responses to uncertainty are crucial to team dynamics and patient safety. While residents had positive responses to expressing uncertainty to peers, they had predominantly negative responses to expressing uncertainty to supervisors. Predominant negative response to supervisors related to judgement from supervisors, and impacts on perceived trustworthiness or independence. Although residents recognized expressing uncertainty to a supervisor could identify opportunities for learning and resolve their uncertainty, the negative responses overshadowed the positive responses. Residents highly valued instances in which supervisors were forthcoming about their own uncertainty.
Through participation in simulations with epistemic fidelity, residents reflected on how they perceive and respond to uncertainty in multidisciplinary teams. Our findings emphasize the role of situational characteristics, particularly peers and supervisors, in moderating responses to perceived uncertainty. The productive discussions around responses to uncertainty in debriefing sessions suggest further studies of multidisciplinary simulations could enhance our understanding of how uncertainty is expressed, and potentially be used as an instructional intervention to promote positive responses to uncertainty.
住院医师难以表达临床不确定性，在与患者或上级交流时，面对不确定性往往表现出消极的认知、行为和情绪反应。然而，不确定性容忍度综合模型认为，个体对感知到的不确定性可能会有积极或消极的反应。情境特征，如与其他医护人员的互动，会影响这种反应是积极还是消极。住院医师与住院医师同伴及上级互动的团队环境可能代表了不同的情境特征，从而产生一系列对不确定性的反应。了解多学科团队中能让住院医师对感知到的不确定性表现出积极反应的情境特征，可为在其他情境中促进对不确定性的积极反应提供策略依据。我们在模拟的多学科团队环境中探究了住院医师对感知到的不确定性的反应。
采用模拟引导的定性探究方法。来自心脏病学和妇产科的14名住院医师参与了涉及患有心脏病的孕妇的模拟场景。我们通过刻意引入模糊性和复杂性以引发不确定性，从而纳入认知保真度。使用定向内容分析法对汇报环节的录音进行分析。
住院医师认识到不确定性是不可避免的，对不确定性的积极反应对团队动态和患者安全至关重要。虽然住院医师对向同伴表达不确定性有积极反应，但对向上级表达不确定性则主要表现出消极反应。对上级的主要消极反应与上级的评判以及对感知到的可信度或独立性的影响有关。尽管住院医师认识到向上级表达不确定性可以发现学习机会并解决他们的不确定性，但消极反应掩盖了积极反应。住院医师高度重视上级坦率承认自身不确定性的情况。
通过参与具有认知保真度的模拟，住院医师反思了他们在多学科团队中如何感知和应对不确定性。我们的研究结果强调了情境特征，特别是同伴和上级，在调节对感知到的不确定性的反应中的作用。汇报环节中围绕对不确定性的反应进行的富有成效的讨论表明，对多学科模拟的进一步研究可以加深我们对不确定性如何表达的理解，并有可能用作促进对不确定性的积极反应的教学干预措施。
