Department of Paediatric Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland.
School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland.
Perspect Med Educ. 2024 Oct 22;13(1):527-539. doi: 10.5334/pme.1394. eCollection 2024.
While healthcare practice is inherently characterised by uncertainty, there is a paucity of formal curricular training to support comfort with uncertainty (CWU) in postgraduate training. Indeed, some evidence suggests medical training inherently conflicts with CWU in emphasizing pedagogies focussing on "fixing" the problem. While referral patterns increase significantly, dealing with uncertainty has direct implications for patient referral rates and use of valuable healthcare resources.
Paediatricians in Ireland were invited to participate. Face-to-face interviews were conducted after participants watched videos of varied clinician-patient interactions.. Two researchers independently analysed the collected data using thematic analysis. Triangulation and member checking was performed to ensure validity of findings. A reflection journal documented the research journey.
Thirty four paediatricians participated. Five themes were identified: the interplay between quality of information, uncertainty and decision-making, confidence in clinical assessment and first-hand patient evaluation, anxiety and fear experienced by medical professionals when dealing with complex and serious conditions, strategies employed by medical professionals in managing their own uncertainty and the impact of societal and parental expectations on medical decision-making. These are moderated by a number of factors, most significantly the child's caregivers' comfort with doctors reassurance (CDR). Enacted management will diverge from the consultant's clinical plan when the caregiver's CDR cannot be satisfactorily supported.
Clinician CWU in the paediatric context is inextricably linked to caregiver CDR. The complexities and central importance of social context in understanding CWU has important implications for how we develop educational activities to support clinician CWU and patient/care-giver CDR. This may translate to efficient use of limited resources in healthcare settings.
尽管医疗保健实践本质上具有不确定性，但在研究生培训中，缺乏正式的课程培训来支持对不确定性的适应（CWU）。事实上，一些证据表明，医学培训在强调“解决”问题的教学法方面与 CWU 本质上存在冲突。虽然转诊模式显著增加，但处理不确定性直接影响患者转诊率和宝贵医疗资源的利用。
邀请爱尔兰的儿科医生参与。参与者观看了不同临床医生-患者互动的视频后，进行了面对面的访谈。两名研究人员使用主题分析独立分析收集的数据。进行了三角测量和成员检查，以确保研究结果的有效性。研究日志记录了研究过程。
34 名儿科医生参与了研究。确定了五个主题：信息质量、不确定性和决策之间的相互作用、对临床评估和第一手患者评估的信心、医疗专业人员在处理复杂和严重疾病时感到的焦虑和恐惧、医疗专业人员在管理自己的不确定性时采用的策略以及社会和父母期望对医疗决策的影响。这些主题受到许多因素的调节，最重要的是孩子照顾者对医生保证的舒适度（CDR）。当照顾者的 CDR 无法得到满意支持时，实施的管理将与顾问的临床计划有所不同。
儿科环境中临床医生的 CWU 与照顾者的 CDR 密切相关。理解 CWU 中社会背景的复杂性和核心重要性对我们如何开展支持临床医生 CWU 和患者/照顾者 CDR 的教育活动具有重要意义。这可能会转化为在医疗保健环境中有效利用有限资源。
