Preparing Medical Students for Uncertainty in Clinical Practice

Uncertainty abounds in the clinical environment. Medical students, however, are not explicitly prepared for situations of uncertainty in clinical practice, which can result in students’ anxiety and impact their well-being. To address this gap, we aimed to provide recommendations that would better inform a curriculum that prepares students to acknowledge and navigate uncertainty in clinical practice. We sought to: (1) capture students’ general self-efficacy and intolerance to uncertainty, (2) describe perceived comfort with uncertainty encountered during clerkships, (3) identify curricular elements that best prepare students for these situations. This is an observational cross-sectional study of third-year medical students from an urban medical school surveyed at the end of core clerkships. The survey consisted of the General Self-Efficacy (GSE) Scale and Intolerance of Uncertainty Scale (IUS). Additional items asked students to rate preparedness, confidence, and comfort with uncertainty in clinical practice. Items on curricular programs asked students to identify training that prepared them for uncertainty in clerkships and examined correlations with specific clinical practice uncertainty domains (CPUDs): preparing for uncertainty, communicating with patients during times of uncertainty, building relationships with patients during times of uncertainty, and overall well-being. Spearman’s rank-order correlation, chi-square test, and ANOVA were used to analyze quantitative data. Open responses were analyzed using Braun and Clarke’s Framework. Response rate was 98.9% (287/290). GSE was inversely correlated with IUS (P < .001). GSE was positively correlated with all CPUDs (P < .005). IUS had an inverse correlation with all CPUDs (P < .005). Curricular pedagogies with statistically significant relationships with preparing students for uncertainty, communicating and building relationships with patients during times of uncertainty, and overall well-being included: team debriefs, interprofessional role plays, case- and team-based learning, story slams, and sharing narratives with peers and faculty (P < .05). Qualitatively, students appreciated storytelling, role modeling of communication strategies, debriefing, and simulations. Strategically immersing specific educational formats into medical school curricula may help cultivate skills needed to prepare students for uncertainty in clinical practice. Clinical debriefs, role plays, simulations, communications skills training, instructor emotional vulnerability, storytelling, and peer-to-peer conversations may have the most impact. Further study is required to evaluate their longitudinal impact

Clinical Practice · Curriculum · Family medicine · Medical education · Observational study · Pedagogy · Preparedness · Clinical Reasoning and Diagnostic Skills · Empathy and Medical Education · Innovations in Medical Education · Medicine · Psychology