Reliability of Uncertainty Tolerance Scales Implemented Among Physicians and Medical Students: A Systematic Review and Meta-Analysis

Abstract

Purpose Uncertainty tolerance (UT) is a construct describing individuals’ perceptions of, and responses to, uncertainty across their cognition, emotion, and behavior. Various UT scales have been designed for physician and medical student populations. However, links between UT and other variables (e.g., training stages) are inconsistent, raising concerns about scale reliability and validity. As reliability is a precondition for validity, a necessary first step in assessing UT scales’ efficacy is evaluating their reliability. Accordingly, the authors conducted a meta-analysis of the reliability of UT scales designed for, and implemented among, physician and medical student populations. Method In 2020, the authors searched 4 electronic databases alongside a citation search of previously identified UT scales. They included English-language, peer-reviewed studies that implemented UT scales in physician and/or medical student populations and reported reliability evidence. A meta-analysis of studies’ Cronbach’s alphas evaluated aggregated internal consistency across studies; subgroup analyses evaluated UT scales by named scale, population, and item characteristics. Results Among 4,124 records screened, 35 studies met the inclusion criteria, reporting 75 Cronbach’s alphas. Four UT scales appeared in at least 3 included studies: Physicians’ Reactions to Uncertainty scale 1990 (PRU1990) and 1995 (PRU1995) versions, Tolerance for Ambiguity scale (TFA), and Tolerance of Ambiguity in Medical Students and Doctors scale (TAMSAD). The scores from these scales ranged in reliability from very good (PRU1990: 0.832, PRU1995: 0.818) to respectable (TFA: 0.761, TAMSAD: 0.711). Aggregated internal consistency was significantly higher (P < .001) among physicians (0.797) than medical students (0.711). Conclusions UT scales generally demonstrated respectable internal consistency when administered among physicians and medical students, yet the reliability among medical students was significantly lower. The authors caution against using UT scores for decision-making purposes (e.g., applicant selection, program evaluation), especially among medical student populations. Future research should explore the reasons underlying these observed population differences.

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“…To the Editor: We appreciate Stephens and colleagues' article on the reliability of uncertainty tolerance (UT) scales among physicians and medical students for contributing to the understanding of UT-an important construct "describing individuals' perceptions of, and responses to, uncertainty across their cognition, emotion, and behavior." 1 Although the conceptual basis of UT is still being unraveled, we suspect a focus on reliability alone can only give a partial view.…”

“…Respectable internal consistency (i.e., ≥ 0.700; with Tolerance of Ambiguity in Medical Students and Doctors scale (TAMSAD) = 0.711 per our findings) is typically acceptable for general instrument use, presuming additional validity evidence is sufficient and complementary. 1 Fully exploring the development and validity testing of UT scales was the focus of our subsequent work. 2 Typical meta-analytic processes require judgments for determining whether studies are similar enough to make metaanalysis sensible.…”