Tolerance for Uncertainty, Personality Traits and Specialty Choice Among Medical Students

On the Construct of Subjective Risk Intelligence and Its Relationships with Personality, Emotional Intelligence and Coping Strategies: A Comparison between Adolescents and Adults

The complexity of today's scenario has made it necessary to investigate the need for individuals to make choices that entail increasing exposure to risk and uncertainty. Among the individual resources that could help people to cope with situations of uncertainty, the new construct of subjective risk intelligence (SRI), known as a person's ability to effectively weigh the pros and cons of a decision in situations where not all the outcomes are foreseen, would seem to play a prominent role. Considering that personality and coping strategies have been shown to be significantly related in previous research, the present study investigates the relationships between subjective risk intelligence, emotional intelligence, personality traits and coping strategies in both adults and adolescents. This cross-sectional study was conducted on 1390 Italian people, divided into two subsamples of 641 adolescents and 749 adults. The results showed that SRI mediated the roles that personality traits and emotional intelligence have in coping strategies differently in the adult sample, in which the mediating role of SRI was found for avoidance coping, and in the adolescent sample, in which SRI influenced all of the antecedents analysed in the study for almost all of the identified coping strategies. In light of these findings, subjective risk intelligence could be activated to deal with uncertain and risky situations, influencing the choice of effective or ineffective strategies in both adults and adolescents.

Learning to navigate uncertainty in primary care: a scoping literature review

BACKGROUND

Clinical practice occurs in the context of uncertainty. Primary care is a clinical environment that accepts and works with uncertainty differently from secondary care. Recent literature reviews have contributed to understanding how clinical uncertainty is taught in educational settings and navigated in secondary care, and, to a lesser extent, by experienced GPs. We do not know how medical students and doctors in training learn to navigate uncertainty in primary care.

AIM

To explore what is known about primary care as an opportunity for learning to navigate uncertainty.

DESIGN & SETTING

Scoping review of articles written in English.

METHOD

Using a scoping review methodology, Embase, MEDLINE, and Web of Science databases were searched, with additional articles obtained through citation searching. Studies were included in this review if they: (a) were based within populations of medical students and/or doctors in training; and (b) considered clinical uncertainty or ambiguity in primary care or a simulated primary care setting. Study findings were analysed thematically.

RESULTS

Thirty-six studies were included from which the following three major themes were developed: uncertainty contributes to professional identity formation (PIF); adaptive responses; and maladaptive behaviours. Relational and social factors that influence PIF were identified. Adaptive responses included adjusting epistemic expectations and shared decision making (SDM).

CONCLUSION

Educators can play a key role in helping learners navigate uncertainty through socialisation, discussing primary care epistemology, recognising maladaptive behaviours, and fostering a culture of constructive responses to uncertainty.

An acute care surgeon's dilemma: Operative vs. non-operative management of emergency general surgery conditions in patients with recent colorectal cancer treatment

BACKGROUND

This comparative effectiveness study examined outcomes of operative vs. non-operative management for emergency general surgery (EGS) conditions in patients with recent cancer treatment (RT).

METHODS

Medicare beneficiaries with a history of colorectal cancer hospitalized for an EGS condition (2016-2018) were identified. RT was defined as chemotherapy/radiation within 3 months prior to admission. Instrumental variable analysis assessed the impact of management on mortality and readmissions among survivors (30d, 60d, and 90d), for patients in whom there was clinical equipoise regarding optimal management strategy.

RESULTS

Of 26,097 patients, 13% had undergone RT. In both the RT and non-RT groups, the optimal management strategy was uncertain in 14%. Operative management conferred increased risk of mortality but not readmission in patients with RT compared to those without (90d mortality:+43%, p ​= ​0.03; 90d readmission:+7.1%, p ​= ​0.776).

CONCLUSIONS

In patients with RT for whom there is clinical equipoise regarding EGS management, operative intervention increases risk of mortality.

The stability of physicians' risk attitudes across time and domains

Risk attitude is known to influence physicians' decision-making under uncertainty. Research on the risk attitudes of physicians is therefore important in facilitating a better understanding of physicians' decisions. However, little is known about the stability of physicians' risk attitudes across domains. Using five waves of data from a prospective panel study of Australian physicians from 2013 to 2017, we explored the stability of risk attitudes over a four-year period and examined the association between negative life events and risk attitudes among 4417 physicians. Further, we tested the stability of risk attitude across three domains most relevant to a physician's career and clinical decision-making (financial, career and clinical). The results showed that risk attitude was stable over time at both the mean and individual levels but the correlation between domains was modest. There were no significant associations between negative life events and risk attitude changes in all three domains. These findings suggest that risk attitude can be assumed to be constant but domain-specificity needs to be considered in analyses of physician decision-making.

Fostering uncertainty tolerance in anatomy education: Lessons learned from how humanities, arts and social science (HASS) educators develop learners' uncertainty tolerance

Uncertainty tolerance, individuals' perceptions/responses to uncertain stimuli, is increasingly recognized as critical to effective healthcare practice. While the Covid-19 pandemic generated collective uncertainty, healthcare-related uncertainty is omnipresent. Correspondingly, there is increasing focus on uncertainty tolerance as a health professional graduate "competency," and a concomitant interest in identifying pedagogy fostering learners' uncertainty tolerance. Despite these calls, practical guidelines for educators are lacking. There is some initial evidence that anatomy education can foster medical students' uncertainty tolerance (e.g., anatomical variation and dissection novelty), however, there remains a knowledge gap regarding robust curriculum-wide uncertainty tolerance teaching strategies. Drawing upon humanities, arts and social sciences (HASS) educators' established uncertainty tolerance pedagogies, this study sought to learn from HASS academics' experiences with, and teaching practices related to, uncertainty pedagogy using a qualitative, exploratory study design. Framework analysis was undertaken using an abductive approach, wherein researchers oscillate between inductive and deductive coding (comparing to the uncertainty tolerance conceptual model). During this analysis, the authors analyzed ~386 min of data from purposively sampled HASS academics' (n = 14) discussions to address the following research questions: (1) What teaching practices do HASS academics' perceive as impacting learners' uncertainty tolerance, and (2) How do HASS academics execute these teaching practices? The results extend current understanding of the moderating effects of education on uncertainty tolerance and supports prior findings that the anatomy learning environment is ripe for supporting learner uncertainty tolerance development. This study adds to growing literature on the powerful moderating effect education has on uncertainty tolerance and proposes translation of HASS uncertainty tolerance teaching practices to enhance anatomy education.

Medical Students' Personalities: A Critical Factor for Doctor-Patient Communication

The aim of this study was to assess the level of creativity and personality traits and their mutual influence on medical students using the DECAS and BWAS. We performed a prospective descriptive study on 119 medical students from Târgu Mureș, Romania between November 2020 and July 2021, who answered questions relating to the BWAS and DECAS scales to evaluate their creativity and personality traits. Our findings pointed out a reverse correlation between age and both the original and revised BWAS (r = −0.2037, p = 0.0263; r = −0.1931, p = 0.0354). In terms of extraversion, we found a significant positive correlation for both openness (r = 0.3032, p = 0.0008) and emotional stability (r = 0.2868, p = 0.0016) and a negative correlation between extraversion and agreeability (r = −0.2394, p = 0.0087). Regarding creativity, we found positive correlations between emotional stability and both the original and revised BWAS (r = 0.20, p = 0.0279; r = 0.20, p = 0.0245). Medical students’ creativity might be positively influenced by emotional stability and seems to decrease with age. Higher extraversion scores could be related to increased openness and emotional stability as well as decreased agreeability.