‘Visiting uncertainty’: an immersive primary care simulation to explore decision-making when there is clinical uncertainty

Carr, Davina; Gormley, Gerard

doi:10.1080/14739879.2022.2070867

Cited by 2 publications

(3 citation statements)

References 21 publications

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“…Shared decision-making (SDM) was a finding in nine studies. (10,26,32,43,44,45,46,47,48) Often viewed as a "middle ground", SDM is a consultation model found midway between paternalism and informed choice with an emphasis on involving patients in decision-making, (45) and can be considered a "functional" adaptation to clinical uncertainty in GP trainees, helping both the doctor and the patient. (32) Guenter et al (43) encourage GP trainees "to think out loud with the patient about the analytical process" when navigating uncertainty.…”

Section: Adaptive Responsesmentioning

confidence: 99%

“…Ten studies (23,32,35,39,43,45,47,51,52,53) identified the presence of maladaptive behaviours in medical students and GP trainees. These behaviours took two forms: premature closure of diagnostic reasoning associated with actions (admitting, referring, investigating, or prescribing) motivated at imposing certainty too early, and reluctance to disclose uncertainty.…”

Section: Maladaptive Behavioursmentioning

confidence: 99%

“…Trainees admitted that they used referrals as "a way of absolving themselves of uncertainty", (52) without considering the negative consequences this could have. Carr and Gormley (47) also identified this affective stimulus in medical students, whose decisions to investigate patients were "influenced significantly by the discomfort that they experienced whilst 'holding the risk' associated with clinical uncertainty." One study (23) showed greater reluctance to disclose uncertainty to patients was associated with burnout in GP trainees.…”

Section: Maladaptive Behavioursmentioning

confidence: 99%

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Learning to navigate uncertainty in primary care: a scoping literature review

Gardner,

Gormley,

Kearney

2023

BJGP Open

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BackgroundClinical 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 don’t know how medical students and doctors in training learn to navigate uncertainty in primary care.AimIn this scoping review, we asked the question: What is known about primary care as an opportunity for learning to navigate uncertainty?Design & settingScoping review of articles written in English.MethodUsing 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.ResultsThirty-six studies were included from which 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.ConclusionEducators 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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Section: Adaptive Responsesmentioning

confidence: 99%

Section: Maladaptive Behavioursmentioning

confidence: 99%

Section: Maladaptive Behavioursmentioning

confidence: 99%

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Learning to navigate uncertainty in primary care: a scoping literature review

Gardner,

Gormley,

Kearney

2023

BJGP Open

Self Cite

View full text Add to dashboard Cite

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Unlocking the learning potential of simulation-based education

Gormley,

Carr,

Murphy

et al. 2023

Br J Hosp Med

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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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‘Visiting uncertainty’: an immersive primary care simulation to explore decision-making when there is clinical uncertainty

Cited by 2 publications

References 21 publications

Learning to navigate uncertainty in primary care: a scoping literature review

Learning to navigate uncertainty in primary care: a scoping literature review

Unlocking the learning potential of simulation-based education

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