Wegwarth Odette, Pfoch Moritz, Spies Claudia, Möckel Martin, Schaller Stefan J, Wehler Markus, Giese Helge
Heisenberg Chair for Medical Risk Literacy and Evidence-Based Decisions, Charité Universitätsmedizin Berlin, Berlin, Germany.
Center for Adaptive Rationality, Max Planck Institute for Human Development, Berlin, Germany.
Med Educ. 2025 Jan 23. doi: 10.1111/medu.15610.
In 1962, the idea emerged that medical students' tolerance of uncertainty could determine their specialty choice. While some studies supported this claim, others refuted it, often using independently developed instruments. We explored whether the reported link between specialty choice and uncertainty tolerance is more myth than evidence by employing established instruments to investigate whether specialty choice could be explained by variance in uncertainty tolerance.
We conducted a cross-sectional online survey at two periods of time. From February to June 2023, we queried 563 final-year medical students from 34 German medical universities (1) on their uncertainty tolerance using three validated tools (the modified tolerance for ambiguity scale, the physicians' reaction to uncertainty scale and the uncertainty intolerance scenario method) and (2) on their intended specialty choice. In a follow-up 1 year later (May to June 2024), 263 of those medical students responded to our query on their final specialty choice and again on their uncertainty tolerance.
Participants' (N = 563) median age was 26.0 years (mean: 27.2; SD = 3.8), and 70% (n = 396) were female. Originally reported differences and rank orders in uncertainty tolerance among medical students with different intended specialty choices could not be replicated for any of the three scales. Instead, our results suggest different rank orders of uncertainty tolerance by different tools, as well as nonsignificant differences between intended medical specialties. Intercorrelation coefficient analyses demonstrated that, depending on the scale, only 0.3% to 1.5% of the variance in uncertainty tolerance could be attributed to specialty choice. Follow-up data using actual instead of intended medical choices left findings unchanged.
Our findings suggest that the presumed link between uncertainty tolerance and specialty choice is more myth than evidence. Instead of teaching this link or using it as an admissions criterion, medical schools should equip students with the skills needed to navigate uncertainty across their careers.
1962年，有观点认为医学生对不确定性的容忍度可能决定他们的专业选择。虽然一些研究支持这一说法，但其他研究则予以反驳，且往往使用自行开发的工具。我们通过使用既定工具来调查专业选择是否可以由不确定性容忍度的差异来解释，从而探讨所报道的专业选择与不确定性容忍度之间的联系是否更多是一种误解而非证据。
我们在两个时间段进行了横断面在线调查。2023年2月至6月，我们使用三种经过验证的工具（改良的模糊容忍度量表、医生对不确定性的反应量表和不确定性不耐受情景法）询问了来自34所德国医学院的563名医学专业最后一年的学生：（1）他们对不确定性的容忍度，以及（2）他们打算选择的专业。在一年后的随访中（2024年5月至6月），其中263名医学生回应了我们关于他们最终专业选择以及再次关于他们不确定性容忍度的询问。
参与者（N = 563）的年龄中位数为26.0岁（平均：27.2；标准差 = 3.8），70%（n = 396）为女性。最初报道的不同预期专业选择的医学生在不确定性容忍度方面的差异和排名顺序，在这三个量表中均无法重现。相反，我们的结果表明不同工具得出的不确定性容忍度排名顺序不同，以及预期医学专业之间差异不显著。相互关联系数分析表明，根据量表不同，不确定性容忍度差异中只有0.3%至1.5%可归因于专业选择。使用实际而非预期医学选择的随访数据使研究结果保持不变。
我们的研究结果表明，不确定性容忍度与专业选择之间的假定联系更多是一种误解而非证据。医学院校不应讲授这种联系或将其用作录取标准，而应培养学生在整个职业生涯中应对不确定性所需的技能。
