Towards a new understanding of uncertainty in medical education

Abstract

Rationale, aims, and objectives Uncertainty is a complex and constant phenomenon in clinical practice. How medical students recognize and respond to uncertainty impacts on their well‐being, career choices, and attitudes towards patients. It has been suggested that curricula should do more to prepare medical students for an uncertain world. In order to teach medical students about uncertainty, we need to understand how uncertainty has been conceptualized in the literature to date. The aim of this article is to explore existing models of uncertainty and to develop a framework of clinical uncertainty to aid medical education. Method A scoping literature review was performed to identify conceptual models of uncertainty in healthcare. Content and inductive analyses were performed to explore three dimensions of clinical uncertainty: sources of uncertainty, subjective influencers and responses to uncertainty. Results Nine hundred one references were identified using our search strategy, of which, 24 met our inclusion criteria. It was possible to classify these conceptual models using one or more of three dimensions of uncertainty; sources, subjective influencers, and responses. Exploration and further classification of these dimensions led to the development of a framework of uncertainty for medical education. Conclusion The developed framework of clinical uncertainty highlights sources, subjective influencers, responses to uncertainty, and the dynamic relationship among these elements. Our framework illustrates the different aspects of knowledge as a source of uncertainty and how to distinguish between those aspects. Our framework highlights the complexity of sources of uncertainty, especially when including uncertainty arising from relationships and systems. These sources can occur in combination. Our framework is also novel in how it describes the impact of influencers such as personal characteristics, experience, and affect on perceptions of and responses to uncertainty. This framework can be used by educators and curricula developers to help understand and teach about clinical uncertainty.

Towards a medical school curriculum for uncertainty in clinical practice

“…Section 3: Comfort with Uncertainty in Clinical Practice. To better understand medical students’ comfort with uncertainty in clinical practice, the authors focused on specific Clinical Practice Uncertainty Domains (CPUD), based on items developed by the authors, and informed by existing conceptual frameworks for uncertainty in clinical practice [ 1 , 22 ]. Survey items for this section were designed through consensus by the study investigators.…”

“…Lee et al offer an operational definition for uncertainty, and describe it as ‘the dynamic, subjective perception of not knowing what to think, feel, or do.’[ 1 ] Under this definition, three core dimensions of uncertainty in clinical practice have been described – the source of uncertainty, the subjective nature of uncertainty, and responses to uncertainty[ 1 ]. Comfort level with uncertainty, which directly links to all of these dimensions, impacts patient care.…”

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

“…2 Lee et al define uncertainty as "the dynamic, subjective perception of not knowing what to think, feel, or do." 3 To this effect, three core dimensions of uncertainty in clinical practice are described: the sources of uncertainty, the subjective nature of uncertainty, and responses to uncertainty. 3 The most common dimension in defining uncertainty is its source, which may stem from knowledge, relationships, and complex systems.…”

“…3 To this effect, three core dimensions of uncertainty in clinical practice are described: the sources of uncertainty, the subjective nature of uncertainty, and responses to uncertainty. 3 The most common dimension in defining uncertainty is its source, which may stem from knowledge, relationships, and complex systems. 3 The cognitive impact these sources of uncertainty have in practitioners, in turn, influences their respective responses and actions.…”

How to cope with uncertainty? Start by looking for patterns and emergent knowledge

“…Lee et al's 27 paper ‘ Towards a new understanding of uncertainty in medical education ’ complements Stolper's, who also emphasize the importance of addressing uncertainty as a life‐lo ng phenomenon in clinical practice. They define uncertainty in system terms ‘ as the dynamic, subjective perception of not knowing what to think, feel, or do .’ which in turn evoke interdependent responses of cognition, emotions and behaviours.…”