Merrill J M, Camacho Z, Laux L F, Lorimor R, Thornby J I, Vallbona C
Department of Community Medicine, Baylor College of Medicine, Houston, Texas 77030.
Med Educ. 1994 Jul;28(4):316-22. doi: 10.1111/j.1365-2923.1994.tb02719.x.
To develop psychometric measures specific to the ambiguities encountered in medicine and determine their value in predicting medical students' attitudes towards patients and their choice of residency, we administered to senior and first-year medical students a 25-item Likert-type questionnaire to assess their intolerance of ambiguity (ITA). Factor analysis yielded two dimensions that were converted to scales: 'Aversion to uncertainties in clinical medicine' (ITA1) and 'Preference for highly structured training environs' (ITA2). First-year students scored higher on ITA1 and lower on ITA2 than seniors. An excessive reliance on high-technology medicine, a negative orientation toward psychological problems, and Machiavellianism predicted ITA1. ITA1 was the best predictor of senior medical students' negative attributional style toward hypochondriac, geriatric and chronic pain patients. The following rank order of seniors' career choice was predicted by ITA1 scores: internal medicine, psychiatry and family medicine (lowest); radiology, surgery and anaesthesiology (highest). And by ITA2 scores: surgery, obstetrics and gynaecology, and surgical subspecialties (lowest); radiology, psychiatry and anaesthesiology (highest). We concluded that personality traits and role characteristics which predict 'Aversion to uncertainties in clinical medicine' are maladaptive to managing many primary care patients, and this mismatch is reflected in seniors' residency choice.
为了开发针对医学中遇到的模糊性的心理测量方法，并确定它们在预测医学生对患者的态度及其住院医师选择方面的价值，我们对高年级和一年级医学生进行了一项包含25个条目的李克特式问卷，以评估他们对模糊性的不耐受性（ITA）。因子分析产生了两个维度，并将其转换为量表：“对临床医学中不确定性的厌恶”（ITA1）和“对高度结构化培训环境的偏好”（ITA2）。一年级学生在ITA1上得分高于高年级学生，在ITA2上得分低于高年级学生。对高科技医学的过度依赖、对心理问题的消极态度和权谋主义预测了ITA1。ITA1是高年级医学生对疑病症、老年病和慢性疼痛患者的负面归因风格的最佳预测指标。ITA1得分预测了高年级学生职业选择的以下排名顺序：内科、精神病学和家庭医学（最低）；放射科、外科和麻醉科（最高）。而ITA2得分预测的排名顺序为：外科、妇产科和外科亚专业（最低）；放射科、精神病学和麻醉科（最高）。我们得出结论，预测“对临床医学中不确定性的厌恶”的人格特质和角色特征不利于管理许多初级保健患者，这种不匹配反映在高年级学生的住院医师选择上。
