Comfort with uncertainty: reframing our conceptions of how clinicians navigate complex clinical situations

Ilgen, Jonathan S.; Eva, Kevin W.; Bruin, Anique B. H. de; Cook, David A.; Regehr, Glenn

doi:10.1007/s10459-018-9859-5

Cited by 98 publications

(120 citation statements)

References 67 publications

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“…For example, participants implied that not knowing the correct answer and being uncertain should be acceptable, but that contextual factors, such as not wanting to waste faculty staff time and wanting to manage image around faculty members and peers, might force one to hide uncertainty. Medicine's values for certainty and objectivity in knowledge claims are undoubtedly apparent in our study and prior studies . Such values are concerning as they can run counter to quality learning .…”

Section: Discussionsupporting

confidence: 51%

‘There shouldn't be anything wrong with not knowing’: epistemologies in simulation

Kangasjarvi

Lorello

et al. 2019

Medical Education

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Context Medical education embraces simulation‐based education (SBE). However, key SBE features purported to support learning, such as learner safety and learning through experience and error, may not align with the dominant culture of medicine, in which portraying confidence and certainty about one's knowledge prevails. Misaligned conceptions about knowledge and learning may produce unintended negative effects, including the suboptimal implementation of SBE, which could consequently compromise SBE and its outcomes. Methods To uncover the epistemological beliefs of students experiencing SBE, we conducted a theory‐informed analysis of interviews with 24 pre‐clerkship medical students following their participation in an SBE training study. Our analysis borrowed from coding methods common in constructivist grounded theory and used Hofer and Pintrich's four dimensions of epistemology as sensitising concepts. Results Participants subscribed to a dominant view of knowledge as consisting of concrete facts, derived from external sources. By contrast, they described but did not prioritise a conception of building their own knowledge through different learning experiences. Participants positioned experts (i.e. teaching faculty members) as the ultimate knowledge validators through their presence and feedback. Participants also noted that faculty staff could counter medicine's pressures to perform with certainty and confidence at all times by instead embodying and modelling an authentic appreciation of learning through experiences, errors and discovery. Conclusions Medicine's tendency to idealise the objective pursuit of singular truths may compromise the purported culture of SBE as a space for learning many wide‐ranging aspects of medicine, including how and when to innovate and deviate from norms. Explicit attempts to bridge the epistemological beliefs of medicine and SBE may better enable the realisation of safe experiential learning. Faculty members are positioned to play key roles in enabling this bridging.

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Section: Discussionsupporting

confidence: 51%

‘There shouldn't be anything wrong with not knowing’: epistemologies in simulation

Kangasjarvi

Lorello

et al. 2019

Medical Education

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“…Another review examined trainees’ ‘comfort with uncertainty’, that is, ‘the phenomenological lived experience of having the confidence to act on a problem (or wait and observe) in the absence of full confidence in one's understanding of the underlying cause of the issue’, which increased with experience and analysing different options for patient care (Ilgen et al . : 4). Although medical educators’ interest in uncertainty is too recent to have influenced trainees’ learning to manage uncertainty yet, it may affect the continuity of this process in the future.…”

Section: Resultsmentioning

confidence: 95%

“…As medical educators are starting to discuss training for uncertainty (Ilgen et al . , Simpkin and Armstrong , Tonelli and Upshur ), studying supervisors’ strategies to develop such training would be helpful. Finally, as this research focused on interactions between healthcare professionals, we did not analyse how uncertainty manifested in relationships with patients.…”

Section: Resultsmentioning

confidence: 99%

Learning to manage uncertainty: supervision, trust and autonomy in residency training

Bochatay

Bajwa

2020

Sociology Health & Illness

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Sociologists have debated whether and how medical trainees are socialised to deal with uncertainty for decades. Recent changes in the structure of medical education, however, have likely affected the ways that resident physicians learn to manage uncertainty. Through ethnographic case studies of academic medical centres in Switzerland and the United States, this article provides new insights into the processes through which residents learnt to manage uncertainty. These processes included working under supervision, developing relationships of trust with supervisors and gaining autonomy to practise independently. As a result, residents developed different attitudes towards uncertainty. Residents at the Swiss medical centre tended to develop a more pragmatic attitude and viewed uncertainty as something to be addressed and controlled. On the other hand, residents at the American medical centre tended to develop an acceptive attitude towards uncertainty. More broadly, residents learnt to reproduce their supervisors’ attitudes towards uncertainty. This article therefore provides new perspectives on continuity and the reproduction of social phenomena in medical education.

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“…And indeed, while junior physicians often aim for certainty as a prerequisite for action, more experienced physicians are more confident in the appropriateness of their actions even in situations where they do not (yet) fully understand a patient’s problem 12 13. Experts become more ‘comfortable with not knowing.’ Ilgen and colleagues recently reviewed the concepts of ‘comfort with uncertainty’ and suggested that skilful clinicians can be comfortable in their management plan and at the same time be not completely confident about their diagnosis 14. The reason for this is that skilful clinicians rely on their experience to be confident about having ruled out all conditions that require immediate action.…”

Section: Making Decisions While Acknowledging Uncertaintymentioning

confidence: 99%

Bridging the gap between uncertainty, confidence and diagnostic accuracy: calibration is key

Zwaan

Hautz

2019

BMJ Qual Saf

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Comfort with uncertainty: reframing our conceptions of how clinicians navigate complex clinical situations

Cited by 98 publications

References 67 publications

‘There shouldn't be anything wrong with not knowing’: epistemologies in simulation

‘There shouldn't be anything wrong with not knowing’: epistemologies in simulation

Learning to manage uncertainty: supervision, trust and autonomy in residency training

Bridging the gap between uncertainty, confidence and diagnostic accuracy: calibration is key

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