Navigating uncertainty in patient care: a closer look at emergency medicine residents in Brazil.

BACKGROUND

In emergency care, inexperience and case complexity can generate uncertainty and stress among physicians, impairing decision-making and impacting patients and the healthcare system. Despite its relevance, little is known about uncertainty among Emergency Medicine residents (EMRs).

AIM

To investigate decision-making uncertainty among EMRs, identifying the most affected dimensions and the influence of sociodemographic and academic profiles.

METHODS

This cross-sectional study included EMRs in Brazil, regardless of residency year. Data were collected via snowball sampling using an anonymous electronic form distributed through virtual groups and email. Information on sociodemographic/academic characteristics, as well as the Physicians' Reactions to Uncertainty (PRU) questionnaire, was obtained.

RESULTS

A total of 124 EMRs participated (median age 28 years; 52% female). The majority of the participants were first-year residents (49%), with no prior residency experience (92%) or other healthcare degrees (94%). The Southeast region was most represented (38%). The median PRU score was 49.0 (IQR: 41.0-57.0), with the highest scores observed in anxiety due to uncertainty (21.0) and reluctance to disclose uncertainty to patients (13.0). Cluster analysis identified three groups: high (43%), moderate (35%), and low (22%) uncertainty. Male and third-year residents had significantly lower total PRU scores, especially in anxiety ( = 0.023 and  = 0.017). Previous healthcare training or residency did not significantly affect uncertainty levels.

CONCLUSION

EMRs show substantial uncertainty in decision-making, particularly in anxiety and reluctance to disclose uncertainty to patients. First-year residents and those without prior healthcare training or residency are more affected. Male and more experienced residents report lower uncertainty, especially regarding anxiety. These findings suggest that targeted interventions-such as enhanced training and structured support-could help EMRs manage uncertainty, improving both decision-making and well-being in emergency settings.