Highlighting a curricular need: Uncertainty, COVID‐19, and health systems science

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has illuminated the gap in training students in the health professions to function in environments of both certainty and uncertainty. Medical students are typically presented with facts, associations, and algorithms, and are later assessed through methods that either has a single correct answer or a series of acceptable answers with a single meaning (eg, multiple-choice examinations and objective structured clinical examinations). 1 The transition from the classroom to the clinical learning environment poses medical students with significant struggles. These may include struggles with diagnosis, management, communication, patient care, and care coordination. To date, formal training and assessment to enhance comfort with and management of uncertainty in clinical practice are lacking in many training programs. 1 A curriculum in Health Systems Science (HSS) can specifically acknowledge and address the uncertainty intrinsic to modern medical care and, in doing so, better prepare students for the transition to the clinical environment, the intrinsic complexity of the healthcare system, and the uncertainty of professional clinical practice.

Bridging Human Resource Development and Health Professions Education Through Action Learning

“…When considering current health systems, our argument for bridging the two fields becomes evident. Current healthcare systems are full of uncertainties, and HPE is required to develop healthcare providers who can function amidst such uncertainties (Papanagnou et al, 2021). Traditionally, HPE, such as medical education programs, was based on two major disciplines, basic science, and clinical science, dating back to the Flexner report in 1910 that first introduced the traditional two-by-two model for training: two years of basic science training followed by two years of clinical training.…”

Navigating Uncertainty in Clinical Practice: A Workshop to Prepare Medical Students to Problem-Solve During Complex Clinical Challenges

“…One way to help address the uncertainty of clinical practice is to recognize its overlap and integration with HSS and to blend educational strategies in these areas. 2 …”

“…Issues can be sorted into four main contexts: simple, complicated, complex, or chaotic. 2 , 4 , 5 In a dynamic clinical environment, physicians can use these four decision-making contexts to better understand their experiences and act accordingly. The simple (known knowns) and complicated (known unknowns) domains are more ordered; cause and effect are easily identifiable, and physicians can determine next steps by reviewing the data and facts presented to them.…”

“…The simple (known knowns) and complicated (known unknowns) domains are more ordered; cause and effect are easily identifiable, and physicians can determine next steps by reviewing the data and facts presented to them. 2 , 4 , 5 The complex (unknown unknowns) and chaotic (unclear cause and effect) domains are more disordered and require physicians to engage in experimentation to develop new data and solutions. 2 , 4 , 5 The COVID-19 pandemic is a timely example of physicians navigating the uncertainty of the clinical environment and working through the chaotic and complex domains.…”

Being explicit about the uncertainty of clinical practice in training

“…Other “uncertainty” curricula have successfully integrated complexity science, humanities programs, and patient‐centered narratives into the formal curriculum, which have been shown to improve learners’ abilities to think abductively 16 . Supporting discussions on the “philosophy of medicine” within clinical coursework, for example, may increase a given trainee's fluency in articulating the experiences surrounding uncertainty and competency to navigate dilemmas in clinical practice 17 …”