Temporal Changes in Tolerance of Uncertainty Among Medical Students: Insights from an Exploratory Study

Overview

Journal Med Educ Online

Specialty Medical Education

Date 2015 Sep 11

PMID 26356230

Citations 17

Authors

Paul K J Han

Daniel Schupack

Susannah Daggett

Christina T Holt

Tania D Strout

Affiliations

Soon will be listed here.

Abstract

Background: Physicians' tolerance of uncertainty (TU) is a trait potentially associated with desirable outcomes, and emerging evidence suggests it may change over time. Past studies of TU, however, have been cross-sectional and have not measured tolerance of the different, specific types of uncertainty that physicians confront. We addressed these limitations in a longitudinal exploratory study of medical students.

Methods: At the end of medical school (Doctor of Medicine degree) Years 1 and 4, a cohort of 26 students at a US medical school completed measures assessing tolerance of different types of uncertainty: 1) complexity (uncertainty arising from features of information that make it difficult to comprehend); 2) risk (uncertainty arising from the indeterminacy of future outcomes); and 3) ambiguity (uncertainty arising from limitations in the reliability, credibility, or adequacy of information). Change in uncertainty-specific TU was assessed using paired t-tests.

Results: Between Years 1 and 4, there was a significant decrease in tolerance of ambiguity (t=3.22, p=0.004), but no change in students' tolerance of complexity or risk.

Conclusions: Tolerance of ambiguity--but not other types of uncertainty--decreases during medical school, suggesting that TU is a multidimensional, partially mutable state. Future studies should measure tolerance of different uncertainties and examine how TU might be improved.

Citing Articles

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Evolution of ambiguity tolerance research a scientometric and bibliometric analysis.

Rubiales-Nunez J, Rubio A, Araya-Castillo L, Moraga-Flores H Front Psychol. 2024; 15:1356992.

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The Effect of Uncertainty Training on the Improvement of Diagnostic Ability in Chinese Medical Students.

Xia X, Zeng Y, Pi P, Wu X, Fang X, Chen J J Med Educ Curric Dev. 2024; 11:23821205241226818.

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The effect of the attitude towards risk/ambiguity on examination grades: cross-sectional study in a Portuguese medical school.

Leite-Mendes F, Delgado L, Ferreira A, Severo M Adv Health Sci Educ Theory Pract. 2024; 29(4):1309-1321.

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Intolerance of Uncertainty and Attitudes towards Vaccination Impact Vaccinal Decision While Perceived Uncertainty Does Not.

Brun C, Akinyemi A, Houtin L, Zerhouni O, Monvoisin R, Pinsault N Vaccines (Basel). 2022; 10(10).

PMID: 36298607 PMC: 9609034. DOI: 10.3390/vaccines10101742.

References

Han P, Williams A, Haskins A, Gutheil C, Lucas F, Klein W . Individual differences in aversion to ambiguity regarding medical tests and treatments: association with cancer screening cognitions. Cancer Epidemiol Biomarkers Prev. 2014; 23(12):2916-23. PMC: 4257853. DOI: 10.1158/1055-9965.EPI-14-0872. View

Han P, Klein W, Arora N . Varieties of uncertainty in health care: a conceptual taxonomy. Med Decis Making. 2011; 31(6):828-38. PMC: 3146626. DOI: 10.1177/0272989x11393976. View

Gerrity M, DeVellis R, Earp J . Physicians' reactions to uncertainty in patient care. A new measure and new insights. Med Care. 1990; 28(8):724-36. DOI: 10.1097/00005650-199008000-00005. View

Geller G, Faden R, Levine D . Tolerance for ambiguity among medical students: implications for their selection, training and practice. Soc Sci Med. 1990; 31(5):619-24. DOI: 10.1016/0277-9536(90)90098-d. View

DeForge B, Sobal J . Intolerance of ambiguity among family practice residents. Fam Med. 1991; 23(6):466-8. View

Merrill J, Camacho Z, Laux L, Lorimor R, Thornby J, VALLBONA C . Uncertainties and ambiguities: measuring how medical students cope. Med Educ. 1994; 28(4):316-22. DOI: 10.1111/j.1365-2923.1994.tb02719.x. View

Pearson S, Goldman L, Orav E, Guadagnoli E, Garcia T, Johnson P . Triage decisions for emergency department patients with chest pain: do physicians' risk attitudes make the difference?. J Gen Intern Med. 1995; 10(10):557-64. DOI: 10.1007/BF02640365. View

Allison J, Kiefe C, Cook E, Gerrity M, Orav E, Centor R . The association of physician attitudes about uncertainty and risk taking with resource use in a Medicare HMO. Med Decis Making. 1998; 18(3):320-9. DOI: 10.1177/0272989X9801800310. View

Knight L, Mattick K . 'When I first came here, I thought medicine was black and white': making sense of medical students' ways of knowing. Soc Sci Med. 2006; 63(4):1084-96. DOI: 10.1016/j.socscimed.2006.01.017. View

10.

McKibbon K, Fridsma D, Crowley R . How primary care physicians' attitudes toward risk and uncertainty affect their use of electronic information resources. J Med Libr Assoc. 2007; 95(2):138-46, e49-50. PMC: 1852627. DOI: 10.3163/1536-5050.95.2.138. View

11.

Han P, Reeve B, Moser R, Klein W . Aversion to ambiguity regarding medical tests and treatments: measurement, prevalence, and relationship to sociodemographic factors. J Health Commun. 2009; 14(6):556-72. PMC: 4205160. DOI: 10.1080/10810730903089630. View

12.

Luther V, Crandall S . Commentary: ambiguity and uncertainty: neglected elements of medical education curricula?. Acad Med. 2011; 86(7):799-800. DOI: 10.1097/ACM.0b013e31821da915. View

13.

Yeh V, Schnur J, Margolies L, Montgomery G . Dense breast tissue notification: impact on women's perceived risk, anxiety, and intentions for future breast cancer screening. J Am Coll Radiol. 2015; 12(3):261-6. PMC: 4352389. DOI: 10.1016/j.jacr.2014.11.001. View

14.

Hancock J, Mattick K . Increasing students' tolerance of ambiguity: the need for caution. Acad Med. 2012; 87(7):834. DOI: 10.1097/ACM.0b013e318257d085. View

15.

Geller G . Tolerance for ambiguity: an ethics-based criterion for medical student selection. Acad Med. 2013; 88(5):581-4. DOI: 10.1097/ACM.0b013e31828a4b8e. View

16.

Hamilton J, Hutson S, Moser R, Kobrin S, Frohnmayer A, Alter B . Sources of uncertainty and their association with medical decision making: exploring mechanisms in Fanconi anemia. Ann Behav Med. 2013; 46(2):204-16. DOI: 10.1007/s12160-013-9507-5. View

17.

Weissenstein A, Ligges S, Brouwer B, Marschall B, Friederichs H . Measuring the ambiguity tolerance of medical students: a cross-sectional study from the first to sixth academic years. BMC Fam Pract. 2014; 15:6. PMC: 3897997. DOI: 10.1186/1471-2296-15-6. View

18.

Hancock J, Roberts M, Monrouxe L, Mattick K . Medical student and junior doctors' tolerance of ambiguity: development of a new scale. Adv Health Sci Educ Theory Pract. 2014; 20(1):113-30. DOI: 10.1007/s10459-014-9510-z. View