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Stephens GC, Sarkar M, Lazarus MD. 'I was uncertain, but I was acting on it': A longitudinal qualitative study of medical students' responses to uncertainty. MEDICAL EDUCATION 2024; 58:869-879. [PMID: 37963570 DOI: 10.1111/medu.15269] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 10/22/2023] [Accepted: 10/24/2023] [Indexed: 11/16/2023]
Abstract
PURPOSE Uncertainty is ubiquitous within medical practice. Accordingly, how individuals respond to uncertainty, termed uncertainty tolerance (UT), is increasingly considered a medical graduate competency. Despite this, aspects of the UT construct are debated, which may relate to research focused on measuring UT, rather than understanding students' experiences. Therefore, we asked (1) how do medical students describe their responses to uncertainty, (2) how (if at all) do described responses change over time and (3) how do described responses contribute to understanding the UT construct. METHODS Engaging an interpretivist worldview, we conducted a longitudinal qualitative study throughout 2020 with 41 clinical medical students at an Australian medical school. Participants completed reflective diary entries across six in-semester time-points (n = 41, 40, 39, 38, 37 and 35) and semi-structured interviews at the end of both semesters (n = 20 per semester). We analysed data using framework analysis. RESULTS Although participants communicated accepting health care uncertainties, described cognitive appraisals of uncertainty ranged from threatening (e.g. challenging credibility) to opportunistic (e.g. for learning and growth). Emotions in response to uncertainty were predominately described in negative terms, including worry and anxiety. Participants described a range of maladaptive and adaptive behavioural responses, including avoiding versus actively engaging with uncertainty. Despite describing typically negative emotions across time, participants' cognitive and behavioural response descriptions shifted from self-doubt and avoidance, towards acceptance of, and engagement despite uncertainty. CONCLUSIONS Students' descriptions of responses to uncertainty suggest existing UT conceptualisations may not holistically reflect medical students' experiences of what it means to be uncertainty 'tolerant', especially pertaining to conceptualisations of 'tolerance' centred on emotions (e.g. stress) rather than how uncertainty is ultimately managed. Extending from this study, the field could consider redefining characteristics of uncertainty 'tolerance' to focus on adaptive cognitive and behavioural responses, rather than emotional responses as key indicators of 'tolerance'.
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Affiliation(s)
- Georgina C Stephens
- Centre for Human Anatomy Education, Monash University, Clayton, Victoria, Australia
| | - Mahbub Sarkar
- Monash Centre for Scholarship in Health Education, Monash University, Clayton, Victoria, Australia
| | - Michelle D Lazarus
- Centre for Human Anatomy Education Director and Monash Centre for Scholarship in Health Education Deputy Director, Monash University, Clayton, Victoria, Australia
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2
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Lazarus MD, Gouda-Vossos A, Ziebell A, Parasnis J, Mujumdar S, Brand G. Mapping Educational uncertainty stimuli to support health professions educators' in developing learner uncertainty tolerance. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024:10.1007/s10459-024-10345-z. [PMID: 38869782 DOI: 10.1007/s10459-024-10345-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 05/19/2024] [Indexed: 06/14/2024]
Abstract
Uncertainty is a feature of healthcare practice. In recognition of this, multiple health profession governing bodies identify uncertainty tolerance as a healthcare graduate attribute and evaluate uncertainty tolerance within new graduate cohorts. While it is clear that uncertainty tolerance development for healthcare learners is valued, gaps remain for practically addressing this within healthcare curricula. Guiding frameworks for practical approaches supporting uncertainty tolerance development in healthcare learners remains sparse, particularly outside of medicine and in certain geographical locations. As uncertainty tolerance is increasingly recognised as being, at least in part, state-based (e.g. contextually changeable)- a broader understanding of teaching practices supporting uncertainty tolerance development in diverse health professions is warranted. This study explored educators' teaching practices for purposefully stimulating learners' uncertainty tolerance. Semi-structured interviews investigated how academics at a single institution, from diverse fields and health professions, stimulate uncertainty across multiple learning contexts. Framework analysis identified three themes for stimulating uncertainty: Purposeful questioning, Forecasting uncertainty, and Placing learners in unfamiliar environments, with characterisation of these themes (and related subthemes) also described. Many of the identified themes align with aspects of existing learning theories suggesting that curricular frameworks supporting learner uncertainty tolerance development may be informed by theories beyond the boundaries of health professions education research.
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Affiliation(s)
- Michelle D Lazarus
- Centre for Human Anatomy Education, Department of Anatomy and Developmental Biology, Biomedicine Discovery Institute, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
- Monash Centre for Scholarship in Health Education, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
| | - Amany Gouda-Vossos
- Centre for Human Anatomy Education, Department of Anatomy and Developmental Biology, Biomedicine Discovery Institute, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Angela Ziebell
- School of Life and Environmental Science, Deakin University, 221 Burwood Hwy, Burwood, Vic, 3125, Australia
| | - Jaai Parasnis
- Department of Economics, Monash University, Wellington Rd, Clayton, VIC, 3180, Australia
| | - Swati Mujumdar
- School of Psychological Sciences, Monash University, Wellington Road, Clayton, Vic, 3180, Australia
| | - Gabrielle Brand
- Monash Centre for Scholarship in Health Education, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- School of Nursing and Midwifery, Monash University, 47-49 Moorooduc Highway, Frankston, VIC, 3199, Australia
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3
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Appel H, Sanatkar S. Systematic Search and Scoping Review of Physicians' Intolerance of Uncertainty and Medical Decision-Making Uncertainties During the COVID-19 Pandemic: A Summary of the Literature and Directions for Future Research. J Clin Psychol Med Settings 2024; 31:338-358. [PMID: 37932520 PMCID: PMC11102404 DOI: 10.1007/s10880-023-09974-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2023] [Indexed: 11/08/2023]
Abstract
Pandemic-related uncertainties and intolerance of uncertainty (IU) could negatively affect physicians' well-being and functioning, being associated with experiences of distress and problematic decision-making processes. To summarize the available quantitative and qualitative evidence of physicians' IU and decisional uncertainty during COVID-19 and problems associated with it, a systematic search was conducted to identify all relevant articles describing physician uncertainty with regard to medical decision making and well-being in COVID-19 pandemic conditions. Medical, psychological, and preprint databases were searched. Ten articles met all eligibility criteria, with eight describing quantitative and two describing qualitative research outcomes, assessed primarily in European regions and via online surveys. Associations between IU and symptoms of poor mental health and mental health risk factors were widespread, but inconsistencies emerged. Qualitative studies emphasized decisional uncertainty as a stressor for physicians, and quantitative studies suggest it may have fostered more unproven treatment choices. While the prevalence and impact of physician uncertainty under COVID-19 conditions requires further investigation, sighting available literature indicates that IU coincided with experiences of poor mental health and, at least towards the beginning of the pandemic, with willingness to endorse unproven treatments. Efforts to reduce uncertainty-related problems for physicians seem warranted, for example, through normalizing experiences of uncertainty or reducing avoidable uncertainty through maintaining open and timely communication channels.
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Affiliation(s)
- Helmut Appel
- Clinical Psychology and Psychotherapy, University of Cologne, Cologne, Germany.
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4
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Gardner NP, Gormley GJ, Kearney GP. Learning to navigate uncertainty in primary care: a scoping literature review. BJGP Open 2024:BJGPO.2023.0191. [PMID: 38097267 DOI: 10.3399/bjgpo.2023.0191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/28/2023] [Accepted: 12/12/2023] [Indexed: 04/04/2024] Open
Abstract
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.
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Affiliation(s)
- Nick P Gardner
- Centre for Medical Education, Queen's University Belfast, Whitla Medical Building, Belfast, Northern Ireland
| | - Gerard J Gormley
- Centre for Medical Education, Queen's University Belfast, Whitla Medical Building, Belfast, Northern Ireland
| | - Grainne P Kearney
- Centre for Medical Education, Queen's University Belfast, Whitla Medical Building, Belfast, Northern Ireland
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5
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Belhomme N, Lescoat A, Dion L, Pottier P, Triby E, Pelaccia T. The culture of doubt: Do medical students really experience clinical uncertainty when they should? MEDICAL TEACHER 2024:1-3. [PMID: 38460188 DOI: 10.1080/0142159x.2024.2323181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/21/2024] [Indexed: 03/11/2024]
Abstract
Uncertainty is a fundamental aspect of medical practice, necessitating incorporation into undergraduate medical training. The integrative model of uncertainty tolerance (UT) developed by Hillen and Han serves as a comprehensive framework for exploring clinical uncertainty. While studies have extensively examined UT dimensions, including sources, responses, and moderators, the factors influencing the perception of uncertainty stimuli remain underexplored. However, students' ability to perceive uncertainty and their approach to uncertain stimuli play a crucial role in enabling them to develop adaptive responses to uncertainty, necessary for their comfort in these situations. Defining uncertainty as a metacognitive state suggests significant variability in its perception among individuals and within an individual over time. Moreover, several studies have demonstrated the substantial influence of various individual and contextual factors on how individuals perceive and respond to uncertainty. In this paper, the authors present multiple hypotheses to address the question of whether students genuinely perceive uncertainty stimuli when they should. The authors argue that students' personal relationship with their knowledge is essential in their ability to identify clinical uncertainty, particularly concerning the limits of medical knowledge. Therefore, they propose that an academic culture fostering doubt, through exposing students to a variety of perspectives, would enhance their ability to identify uncertainty zones in a clinical situation at an early stage. Drawing on Dewey's situational theory, the authors emphasize the importance of better understanding, in a work setting, the influence of contextual and situational characteristics on individual perceptions of uncertainty. In line with this idea, ethnographic studies would offer valuable insights into identifying the relationship between the students, their work environment, and their perception of clinical uncertainty.
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Affiliation(s)
- N Belhomme
- Service de Médecine Interne et Immunologie Clinique, CHU Rennes, Rennes, France
- Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)-UMR_S 1085, Rennes, France
- Laboratoire Interuniversitaire des Sciences de l'Education et de la Communication, LISEC_UR2310, Université de Strasbourg, Strasbourg, France
| | - A Lescoat
- Service de Médecine Interne et Immunologie Clinique, CHU Rennes, Rennes, France
- Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)-UMR_S 1085, Rennes, France
| | - L Dion
- Service de Gynécologie, CHU Rennes Hôpital Sud, Rennes, France
- Irset - Inserm UMR_S 1085, Rennes, France
| | - P Pottier
- Service de Médecine Interne et Immunologie Clinique, CHU Nantes, Nantes, France
- Faculté de Médecine-Pôle Santé, Nantes Université, Nantes, France
| | - E Triby
- Laboratoire Interuniversitaire des Sciences de l'Education et de la Communication, LISEC_UR2310, Université de Strasbourg, Strasbourg, France
| | - T Pelaccia
- Laboratoire Interuniversitaire des Sciences de l'Education et de la Communication, LISEC_UR2310, Université de Strasbourg, Strasbourg, France
- Service d'Urgences (SAMU 67), CHU Strasbourg, Strasbourg, France
- Centre de Formation et de Recherche en Pédagogie des Sciences de la Santé, faculté de Médecine, Université de Strasbourg, Strasbourg, France
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Syed A, Jacob MS. Languaging psychopathology: neurobiology and metaphor. Front Psychiatry 2024; 15:1320771. [PMID: 38374980 PMCID: PMC10875027 DOI: 10.3389/fpsyt.2024.1320771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 01/12/2024] [Indexed: 02/21/2024] Open
Abstract
Explanatory models of the mind inform our working assumptions about mental illness with direct implications for clinical practice. Neurobiological models assert that the mind can be understood in terms of genetics, chemistry, and neuronal circuits. Growing evidence suggests that clinical deployment of neurobiological models of illness may have unintended adverse effects on patient attitudes, public perception, provider empathy, and the effectiveness of psychiatric treatment. New approaches are needed to find a better language for describing (let alone explaining) the experience of mental illness. To address this gap, we draw upon interdisciplinary sources and semiotic theory to characterize the role of metaphor in the conceptualization and communication of psychopathology. We examine the metaphors recruited by contemporary neurobiological models and metaphor's role in facilitating descriptive clarity or evocative creativity, depending on intention and context. These multiple roles reveal the implications of metaphorical reasoning in clinical practice, including cognitive flexibility, personalized communication, and uncertainty tolerance. With this analysis, we propose a clinical approach that embraces the meta-process of ongoing novel metaphor generation and co-elaboration, or languaging metaphors of psychopathology. Our goal is to bring attention to the value of employing ever-evolving, shapeable metaphorical depictions of psychiatric illness: metaphors that enable a capacity for change in individuals and society, reduce stigma, and nurture recovery.
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Affiliation(s)
- Adnan Syed
- Mental Health Service, San Francisco Veterans Affairs (VA) Medical Center, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Michael S. Jacob
- Mental Health Service, San Francisco Veterans Affairs (VA) Medical Center, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
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Guilding C, White PJ, Cunningham M, Kelly-Laubscher R, Koenig J, Babey AM, Tucker S, Kelly JP, Gorman L, Aronsson P, Hawes M, Ngo SNT, Mifsud J, Werners AH, Hinton T, Khan F, Aljofan M, Angelo T. Defining and unpacking the core concepts of pharmacology: A global initiative. Br J Pharmacol 2024; 181:375-392. [PMID: 37605852 DOI: 10.1111/bph.16222] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/11/2023] [Accepted: 08/08/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND AND PURPOSE Development of core concepts in disciplines such as biochemistry, microbiology and physiology have transformed teaching. They provide the foundation for the development of teaching resources for global educators, as well as valid and reliable approaches to assessment. An international research consensus recently identified 25 core concepts of pharmacology. The current study aimed to define and unpack these concepts. EXPERIMENTAL APPROACH A two-phase, iterative approach, involving 60 international pharmacology education experts, was used. The first phase involved drafting definitions for core concepts and identifying key sub-concepts via a series of online meetings and asynchronous work. These were refined in the second phase, through a 2-day hybrid workshop followed by a further series of online meetings and asynchronous work. KEY RESULTS The project produced consensus definitions for a final list of 24 core concepts and 103 sub-concepts of pharmacology. The iterative, discursive methodology resulted in modification of concepts from the original study, including change of 'drug-receptor interaction' to 'drug-target interaction' and the change of the core concept 'agonists and antagonists' to sub-concepts of drug-target interaction. CONCLUSIONS AND IMPLICATIONS Definitions and sub-concepts of 24 core concepts provide an evidence-based foundation for pharmacology curricula development and evaluation. The next steps for this project include the development of a concept inventory to assess acquisition of concepts, as well as the development of case studies and educational resources to support teaching by the global pharmacology community, and student learning of the most critical and fundamental concepts of the discipline.
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Affiliation(s)
- Clare Guilding
- School of Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Paul J White
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Margaret Cunningham
- Strathclyde Institute for Pharmacy and Biomedical Sciences (SIPBS), University of Strathclyde, Glasgow, UK
| | - Roisin Kelly-Laubscher
- Department of Pharmacology and Therapeutics, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Jennifer Koenig
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Anna-Marie Babey
- Faculty of Medicine and Health, University of New England, Armidale, New South Wales, Australia
| | - Steve Tucker
- School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK
| | - John P Kelly
- Department of Pharmacology and Therapeutics, School of Medicine, University of Galway, Galway, Ireland
| | - Laurel Gorman
- Department of Medical Education, University of Central Florida College of Medicine, Orlando, Florida, USA
- Department of Biomedical Education, Temple University, Lewis Katz School of Medicine, Philadelphia, Pennsylvania, USA
| | - Patrik Aronsson
- Department of Pharmacology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Martin Hawes
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, University of Surrey, Guildford, UK
| | - Suong N T Ngo
- School of Animal and Veterinary Science, Faculty of Sciences, Engineering and Technology, The University of Adelaide, Adelaide, South Australia, Australia
| | - Janet Mifsud
- Department of Clinical Pharmacology and Therapeutics, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Arend H Werners
- School of Veterinary Medicine, St. George's University, True Blue, Grenada
| | - Tina Hinton
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Fouzia Khan
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Mohamad Aljofan
- Department of Biomedical Science, School of Medicine Nazarbayev University, Astana, Kazakhstan
| | - Tom Angelo
- University of North Carolina, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA
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8
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Salava A. Teaching uncertainty in dermatology: The role of philosophical categories. J Eur Acad Dermatol Venereol 2024; 38:e137-e138. [PMID: 37641850 DOI: 10.1111/jdv.19480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/23/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Alexander Salava
- Department of Dermatology, Venereology and Allergology, University Hospital Helsinki, University of Helsinki, Helsinki, Finland
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9
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Stephens GC, Lazarus MD. Twelve tips for developing healthcare learners' uncertainty tolerance. MEDICAL TEACHER 2024:1-9. [PMID: 38285073 DOI: 10.1080/0142159x.2024.2307500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 01/16/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Uncertainty is pervasive throughout healthcare practice. Uncertainty tolerance (i.e. adaptively responding to perceived uncertainty) is considered to benefit practitioner wellbeing, encourage person-centred care, and support judicious healthcare resource utilisation. Accordingly, uncertainty tolerance development is increasingly referenced within training frameworks. Practical approaches to support healthcare learners' uncertainty tolerance development, however, are lacking. AIMS Drawing on findings across the literature, and the authors' educational experiences, twelve tips for promoting healthcare learners' uncertainty tolerance were developed. RESULTS Tips are divided into 1. Tips for Learners, 2. Tips for Educators and Supervisors, and 3. Tips for Healthcare Education Institutions and Systems. Each tip summarises relevant research findings, alongside applications to educational practice. CONCLUSIONS Approaches to developing uncertainty tolerance balance factors supporting learners through uncertain experiences, with introducing challenges for learners to further develop uncertainty tolerance. These tips can reassure healthcare education stakeholders that developing learner uncertainty tolerance, alongside core knowledge, is achievable.
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Affiliation(s)
- Georgina C Stephens
- Centre for Human Anatomy Education, Monash University, Clayton, Victoria, Australia
| | - Michelle D Lazarus
- Centre for Human Anatomy Education, Monash University, Clayton, Victoria, Australia
- Monash Centre for Scholarship in Health Education, Monash University, Clayton, Victoria, Australia
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10
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Gormley GJ, Carr D, Murphy P, Tallentire VR, Smith SE. Unlocking the learning potential of simulation-based education. Br J Hosp Med (Lond) 2023; 84:1-8. [PMID: 38153022 DOI: 10.12968/hmed.2023.0353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
Simulation is ubiquitous in the training of hospital-based doctors worldwide, often focusing on an individual level in traditional 'skills and drills'-based training. However, there has been an expansion in the use of simulation in healthcare practice and training. Simulation is being adopted into many disciplines that traditionally have not used this form of experiential learning. Moreover, simulation is increasingly being harnessed to enhance team and organisational learning in hospital-based practice. This article shares some insights into simulation-based education and makes the 'familiar unfamiliar' about this important method of learning. The aim is to broaden readers' outlook about what simulation has to offer beyond the classic notion of skills and drills-based training.
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Affiliation(s)
- Gerard J Gormley
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
- InterSim, Faculty of Medicine, Health and Life Sciences, Queens' University Belfast, Belfast, UK
| | - Davina Carr
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
| | - Paul Murphy
- Drama Studies, School of Arts, English and Languages, Queen's University Belfast, Belfast, UK
| | | | - Samantha E Smith
- Scottish Centre for Simulation and Clinical Human Factors, NHS Forth Valley, Larbert, UK
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Poço PCE, Collares CF, Haydar A, de Oliveira VB, de Arruda Martins M, Tempski PZ. Measurement of uncertainty tolerance revisited. CLINICAL TEACHER 2023; 20:e13619. [PMID: 37608765 DOI: 10.1111/tct.13619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 07/10/2023] [Indexed: 08/24/2023]
Abstract
INTRODUCTION Uncertainty tolerance (UT) is attracting increasing attention in medical education due to the numerous challenges associated with uncertainty in professional life. Inconsistencies in analysing the relationship between UT and moderators may arise from inadequate measurement methods. Most instruments were formulated before the most widely accepted framework was published. Our aim was to investigate the validity of an UT scale using an actual framework to corroborate with better and accurate instruments. METHODS A total of 1052 students were invited. Various psychometric methods were used to explore validity of the TAMSAD scale in light of actual framework. Classic exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed. Secondly, content item classification was triangulated with exploratory graph analysis (EGA), and the new EFA, CFA, and cognitive diagnostic modelling (CDM) analysis were conducted. The reliability was calculated using Cronbach's alpha and McDonald's omega. RESULTS A total of 694 students (65.9%) responded to the questionnaire. The reliability of the TAMSAD scale was 0.782. The initial EFA revealed no clear interpretable dimensions. The TAMSAD scale items can be classified into sources of uncertainty. The EGA has three dimensions, and the new EFA led to a 17-item TAMSAD scale with the following three dimensions: ambiguity, complexity, and probability. These dimensions lead to better adjustment fit indices in the new CFA and CDM analyses. CONCLUSION We found evidence that the TAMSAD scale can be considered a multidimensional scale, organised in terms of sources of uncertainty.
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Affiliation(s)
- Paula Cristina Eiras Poço
- Faculdade São Leopoldo Mandic, Campinas, Brazil
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Ahmed Haydar
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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12
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Xu X, Yan X, Zhang Q, Xu C, Li M. The chain mediating role of psychological resilience and neuroticism between intolerance of uncertainty and perceived stress among medical university students in Southwest China. BMC Psychiatry 2023; 23:861. [PMID: 37990205 PMCID: PMC10664673 DOI: 10.1186/s12888-023-05345-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/02/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Medical university students are confronted with unprecedented uncertainty and stress compared with their peers. Research has explored the effect of intolerance of uncertainty on perceived stress, but little attention was paid to investigate the mediating mechanisms behind this relationship, especially among medical university students. The aim of this study was to examine whether psychological resilience and neuroticism played a mediating role between medical university students' intolerance of uncertainty and perceived stress. METHODS A total of 717 medical university students from Chongqing in Southwest China were recruited to participate in our study and completed demographic information, Intolerance of Uncertainty Scale Short Version (IUS-12), Chinese Version of Perceived Stress Scale (CPSS), Connor-Davidson Resilience Scale-10 (CD-RISC-10) and Eysenck Personality Questionnaire (EPQ). RESULTS (1) Significant correlations between intolerance of uncertainty, perceived stress, psychological resilience and neuroticism were found. (2) Intolerance of uncertainty affected medical university students' perceived stress via three paths: the mediating effect of psychological resilience, the mediating effect of neuroticism, and the chain mediating effect of both psychological resilience and neuroticism. CONCLUSIONS Intolerance of uncertainty could directly affect the perceived stress of medical university students, and also affected perceived stress through the mediating roles of psychological resilience and neuroticism, as well as through the chain mediating role of these two variables.
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Affiliation(s)
- Xiaoxiao Xu
- Department of Military Psychology, Faculty of Medical Psychology, Army Medical University (Third Military Medical University), Chongqing, 400038, China
- Department of Basic Psychology, Faculty of Medical Psychology, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Xiaofan Yan
- Department of Military Psychology, Faculty of Medical Psychology, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Qianhui Zhang
- Department of Foreign Languages, College of Basic Medical Sciences, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Chen Xu
- Department of Military Psychology, Faculty of Medical Psychology, Army Medical University (Third Military Medical University), Chongqing, 400038, China.
| | - Min Li
- Department of Military Psychology, Faculty of Medical Psychology, Army Medical University (Third Military Medical University), Chongqing, 400038, China.
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Vaid U, Lundgren H, Watkins KE, Ziring D, Alcid GA, Marsick VJ, Papanagnou D. Making decisions "in the dark": Learning through uncertainty in clinical practice during Covid-19. AEM EDUCATION AND TRAINING 2023; 7:e10909. [PMID: 37791137 PMCID: PMC10543116 DOI: 10.1002/aet2.10909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/27/2023] [Accepted: 08/24/2023] [Indexed: 10/05/2023]
Abstract
Purpose The purpose of this study was to explore how decision making and informal and incidental learning (IIL) emerged in the clinical learning environment (CLE) during the height of the Covid-19 pandemic. The authors' specific interest was to better understand the IIL that took place among frontline physicians who had to navigate a CLE replete with uncertainty and complexity with the future goal of creating experiences for medical students that would simulate IIL and use uncertainty as a catalyst for learning. Method Using a modified constructivist, grounded theory approach, we describe physicians' IIL while working during times of heightened uncertainty. Using the critical incident technique, we conducted 45-min virtual interviews with seven emergency department (ED) and five intensive care unit (ICU) physicians, who worked during the height of the pandemic. The authors transcribed and restoried each interview before applying inductive, comparative analysis to identify patterns, assertions, and organizing themes. Results Findings showed that the burden of decision making for physicians was influenced by the physical, emotional, relational, and situational context of the CLE. The themes that emerged for decision making and IIL were interdependent. Prominent among the patterns for decision making were ways to simplify the problem by applying prior knowledge, using pattern recognition, and cross-checking with team members. Patterns for IIL emerged through trial and error, which included thoughtful experimentation, consulting alternative sources of information, accumulating knowledge, and "poking at the periphery" of clinical practice. Conclusions Complexity and uncertainty are rife in clinical practice and this study made visible decision-making patterns and IIL approaches that can be built into formal curricula. Making implicit uncertainty explicit by recognizing it, naming it, and practicing navigating it may better prepare learners for the uncertainty posed by the clinical practice environment.
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Affiliation(s)
- Urvashi Vaid
- Division of Pulmonary and Critical Care MedicineSidney Kimmel Medical College at Thomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Henriette Lundgren
- Human Resource Development, Department of Organization and LeadershipTeachers College at Columbia UniversityNew YorkNew YorkUSA
| | - Karen E. Watkins
- Department of Lifelong Education, Administration, and PolicyUniversity of GeorgiaAthensGeorgiaUSA
| | - Deborah Ziring
- Department of MedicineSidney Kimmel Medical College at Thomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Grace A. Alcid
- Adult Learning and Leadership Program, Department of Organization and LeadershipTeachers College at Columbia UniversityNew YorkNew YorkUSA
| | - Victoria J. Marsick
- Department of Organization and LeadershipTeachers College at Columbia UniversityNew YorkNew YorkUSA
| | - Dimitrios Papanagnou
- Department of Emergency MedicineSidney Kimmel Medical College at Thomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
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14
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Patel P, Hancock J. Uncertainty tolerance scales: Weighing up the research. MEDICAL EDUCATION 2023; 57:787-789. [PMID: 37157928 DOI: 10.1111/medu.15114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/17/2023] [Accepted: 04/20/2023] [Indexed: 05/10/2023]
Abstract
Patel and Hancock explore the uncertainty tolerance literature to determine how it ties in with quantitive scales developed to measure uncertainty tolerance.
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Affiliation(s)
| | - Jason Hancock
- University of Exeter Medical School, College of Medicine and Health, Exeter, UK
- Devon Partnership Trust, Exeter, UK
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15
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Jones D, McCalla M, Beverly EA. Measuring grit, self-efficacy, curiosity, and intolerance of uncertainty in first-generation college and first-generation osteopathic medical students. BMC MEDICAL EDUCATION 2023; 23:190. [PMID: 36978030 PMCID: PMC10043857 DOI: 10.1186/s12909-023-04181-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 03/21/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Medical school is a challenging time, with many medical students reporting symptoms of burnout, depression, anxiety, suicidal ideation, and psychological distress during pre-clinical and clinical years. First-generation college and first-generation medical students may be two groups of students at increased risk for the negative psychosocial effects of medical school. Importantly, grit, self-efficacy, and curiosity are protective factors against the negative psychosocial effects of medical school, whereas intolerance of uncertainty is a risk factor. Thus, research examining the associations among grit, self-efficacy, curiosity, and intolerance of uncertainty in first-generation college and first-generation medical students is needed. METHODS We conducted a cross-sectional, descriptive study to assess medical students' grit, self-efficacy, curiosity, and intolerance of uncertainty. We conducted independent samples t-tests and regression analyses using SPSS statistical software version 28.0. RESULTS A total of 420 students participated in the study for a response rate of 51.5%. One-fifth of participants (21.2%, n = 89) identified as first-generation students, 38.6% (n = 162) participants reporting having a physician relative, and 16.2% (n = 68) reported having a physician parent. Grit, self-efficacy, and curiosity and exploration scores did not differ by first-generation college status, physician relative(s), or physician parent(s). However, total intolerance of uncertainty scores differed by physician relative(s) (t= -2.830, p = 0.005), but not by first-generation status, or physician parent(s). Further, subscale scores for prospective intolerance of uncertainty differed by physician relative(s) (t= -3.379, p = 0.001) and physician parent(s) (t= -2.077, p = 0.038), but not by first-generation college student status. In the hierarchical regression models, first-generation college student status and first-generation medical student status were not predictive of grit, self-efficacy, curiosity and exploration, or intolerance of uncertainty, although statistical trends were observed with students with physician relative(s) predicting lower intolerance of uncertainty scores (B= -2.171, t= -2138, p = 0.033) and lower prospective intolerance of uncertainty (B= -1.666, t= -2.689, p = 0.007). CONCLUSIONS These findings suggest that first-generation college students did not differ by grit, self-efficacy, curiosity, or intolerance of uncertainty. Similarly, first-generation medical students did not differ by grit, self-efficacy, or curiosity; however, first-generation medical students showed statistical trends in higher total intolerance of uncertainty and higher prospective intolerance of uncertainty. Additional research needs to confirm these findings in first-generation medical students.
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Affiliation(s)
- DeWitt Jones
- Department of Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH, 45701, USA
| | - Monet McCalla
- Department of Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH, 45701, USA
| | - Elizabeth A Beverly
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Athens, OH, 45701, USA.
- The Diabetes Institute, Ohio University, Athens, OH, 45701, USA.
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16
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Ogle M, Papanagnou D, Reopelle K, Rusnack F, Feingold-Link J, Poluch M, Ankam N. Intolerance of uncertainty and attitudes towards persons living with disabilities in medical students: Is there a correlation? Front Public Health 2023; 11:1149725. [PMID: 37033010 PMCID: PMC10079984 DOI: 10.3389/fpubh.2023.1149725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 03/10/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction Patients living with a disability experience an illness trajectory that may be uncertain. While navigating clinical uncertainty has been well-researched, health professionals' intolerance of uncertainty for patients living with disabilities has yet to be explored. We examined the relationship between medical students' intolerance of uncertainty with their attitudes towards people living with disabilities to better inform curricular efforts. Methods We employed a survey-based design consisting of the Intolerance of Uncertainty Scale (IUS) and Disability Attitudes in Healthcare (DAHC) Scale to medical students upon completion of core clerkships (end of third-year of training). Data were de-identified. Mean DAHC and IUS scores were compared with published values via t-test. Linear regression was used to examine IUS/DAHC scores for anonymized students. Pearson correlation coefficient was calculated to assess correlation between IUS and DAHC scores. Results Response rate was 97% (268/275 students). Mean IUS score did not differ from previously cited medical student scores, but mean DAHC score was significantly higher than previously cited scores. We observed a statistically-significant relationship between IUS and DAHC scores. Students with greater intolerance of uncertainty had lower scores for disability attitudes [F(1,243) = 8.05, value of p < 0.01], with an R 2-value of 0.032, suggesting that 3% of DAHC score variance can be explained by IUS score changes. Conclusion We identified a weak negative correlation between IUS and DAHC scores in medical students. Further research is needed to clarify findings and identify best practices that equip trainees with skills to care for patients with uncertain illness trajectories and patients living with disabilities.
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17
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Belhomme N, Lescoat A, Launey Y, Jégo P, Cavalin C, Pottier P. [Tolerating uncertainty: Towards a competence-based approach]. Rev Med Interne 2023; 44:27-30. [PMID: 36371326 DOI: 10.1016/j.revmed.2022.10.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/16/2022] [Accepted: 10/20/2022] [Indexed: 11/11/2022]
Abstract
Uncertainty in inherent to every aspects of medical practice. As the concept of uncertainty in healthcare is still to explore, deciphering the determinants and the roots of this uncertainty would benefit from the insights of various disciplines, such as epistemology, sociology, mathematics, or philosophy. The urgent need to improve physician's ability to cope with uncertainty, has been recently highlighted by the COVID-19 pandemic. Besides, the concept of uncertainty tolerance has been proposed, and could serve as a relevant basis for approaching uncertainty, in medical education. Thus, we propose at first to discuss the uncertainty tolerance framework from Hillen et al. Then, from an educational perspective, we outline some avenues regarding how uncertainty tolerance could be thought, in a competence-based approach, and discuss several educational activities, which have proven efficient in promoting uncertainty tolerance among medical practitioners abroad.
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Affiliation(s)
- N Belhomme
- Service de médecine interne et immunologie clinique, CHU de Rennes, université Rennes 1, Rennes, France; Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France.
| | - A Lescoat
- Service de médecine interne et immunologie clinique, CHU de Rennes, université Rennes 1, Rennes, France; Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | - Y Launey
- Réanimation chirurgicale, département d'anesthésie-réanimation-médecine Périopératoire, CHU de Rennes, université Rennes 1, Rennes, France
| | - P Jégo
- Service de médecine interne et immunologie clinique, CHU de Rennes, université Rennes 1, Rennes, France; Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | - C Cavalin
- IRISSO, UMR CNRS-INRAE 7170-1427, Université Paris-Dauphine, PSL, Paris, France; Laboratoire interdisciplinaire d'évaluation des politiques publiques (LIEPP), Sciences Po, Paris, France; Centre d'études de l'emploi et du travail (CEET, CNAM), Noisy-le-Grand, France
| | - P Pottier
- Service de médecine interne et immunologie clinique, CHU Nantes, Nantes, France; Faculté de médecine-pôle santé, Nantes Université, Nantes, France
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18
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Moffett J, Cassidy D, Collins N, Illing J, de Carvalho Filho MA, Bok H. Exploring Medical Students' Learning Around Uncertainty Management Using a Digital Educational Escape Room: A Design-based Research Approach. PERSPECTIVES ON MEDICAL EDUCATION 2023; 12:86-98. [PMID: 36969324 PMCID: PMC10038110 DOI: 10.5334/pme.844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 03/07/2023] [Indexed: 05/05/2023]
Abstract
Introduction Medical professionals meet many transitions during their careers, and must learn to adjust rapidly to unfamiliar workplaces and teams. This study investigated the use of a digital educational escape room (DEER) in facilitating medical students' learning around managing uncertainty in transitioning from classroom to clinical placement. Methods We used design-based research to explore the design, build, and test of a DEER, as well as gain insight into how these novel learning environments work, using Community of Inquiry (CoI) as a guiding conceptual framework. This study represented a mixed methods pilot test of a prototype DEER. Twenty-two medical students agreed to participate, and data were collected through qualitative (i.e., focus groups, game-play observations) and quantitative (i.e., questionnaires) methods. Results Eighty-two per cent of participants agreed or strongly agreed that the DEER supported their learning around uncertainty. Participants offered diverse examples of how the game had facilitated new insights on, and approaches to, uncertainty. With respect to the learning environment, multiple indicators and examples of the three domains of CoI - cognitive, teaching and social presence - were observed. Discussion Our findings suggested that DEERs offer a valuable online learning environment for students to engage with complex and emotion-provoking challenges, such as those experienced at transitions. The study also suggested that CoI can be applied to the design, implementation, and evaluation of DEER learning environments, and we have proposed a set of design principles that may offer guidance here.
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Affiliation(s)
- Jenny Moffett
- HPEC Health Professions’ Education Centre, RCSI University of Medicine and Health Sciences, 123 St. Stephen’s Green, Dublin, Ireland
| | - Dara Cassidy
- HPEC Health Professions’ Education Centre, RCSI University of Medicine and Health Sciences, 123 St. Stephen’s Green, Dublin, Ireland
| | - Naoise Collins
- Department of Visual and Human-Centred Computing, Dundalk Institute of Technology, Dublin Rd, Marshes Upper, Dundalk, Ireland
| | - Jan Illing
- HPEC Health Professions’ Education Centre, RCSI University of Medicine and Health Sciences, 123 St. Stephen’s Green, Dublin, Ireland
| | - Marco Antonio de Carvalho Filho
- Wenckebach Institute, Health Profession Education Research, Faculty of Medical Sciences, University Medical Center Groningen, Groningen, The Netherlands
| | - Harold Bok
- Department of Population Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
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Haas M, Stojan JN. Uncertainty about uncertainty tolerance: The elephants in the room. MEDICAL EDUCATION 2022; 56:1152-1154. [PMID: 35980941 DOI: 10.1111/medu.14926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/03/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Mary Haas
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
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20
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Ilgen JS, Watsjold BK, Regehr G. Is uncertainty tolerance an epiphenomenon? MEDICAL EDUCATION 2022; 56:1150-1152. [PMID: 36124815 DOI: 10.1111/medu.14938] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Jonathan S Ilgen
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Bjorn K Watsjold
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Glenn Regehr
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Education Scholarship, University of British Columbia, Vancouver, British Columbia, Canada
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