Premium
Responses to clinical uncertainty in Australian general practice trainees: a cross‐sectional analysis
Author(s) -
Cooke Georga,
Tapley Amanda,
Holliday Elizabeth,
Morgan Simon,
Henderson Kim,
Ball Jean,
Driel Mieke,
Spike Neil,
Kerr Rohan,
Magin Parker
Publication year - 2017
Publication title -
medical education
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.776
H-Index - 138
eISSN - 1365-2923
pISSN - 0308-0110
DOI - 10.1111/medu.13408
Subject(s) - competence (human resources) , anxiety , cross sectional study , psychology , context (archaeology) , cohort , workload , clinical psychology , medical education , clinical practice , medicine , family medicine , social psychology , psychiatry , paleontology , pathology , biology , operating system , computer science
Context Tolerance for ambiguity is essential for optimal learning and professional competence. General practice trainees must be, or must learn to be, adept at managing clinical uncertainty. However, few studies have examined associations of intolerance of uncertainty in this group. Objectives The aim of this study was to establish levels of tolerance of uncertainty in Australian general practice trainees and associations of uncertainty with demographic, educational and training practice factors. Methods A cross‐sectional analysis was performed on the Registrar Clinical Encounters in Training (Re CE nT) project, an ongoing multi‐site cohort study. Scores on three of the four independent subscales of the Physicians' Reaction to Uncertainty ( PRU ) instrument were analysed as outcome variables in linear regression models with trainee and practice factors as independent variables. Results A total of 594 trainees contributed data on a total of 1209 occasions. Trainees in earlier training terms had higher scores for ‘Anxiety due to uncertainty’, ‘Concern about bad outcomes’ and ‘Reluctance to disclose diagnosis/treatment uncertainty to patients’. Beyond this, findings suggest two distinct sets of associations regarding reaction to uncertainty. Firstly, affective aspects of uncertainty (the ‘Anxiety’ and ‘Concern’ subscales) were associated with female gender, less experience in hospital prior to commencing general practice training, and graduation overseas. Secondly, a maladaptive response to uncertainty (the ‘Reluctance to disclose’ subscale) was associated with urban practice, health qualifications prior to studying medicine, practice in an area of higher socio‐economic status, and being Australian‐trained. Conclusions This study has established levels of three measures of trainees’ responses to uncertainty and associations with these responses. The current findings suggest differing ‘phenotypes’ of trainees with high ‘affective’ responses to uncertainty and those reluctant to disclose uncertainty to patients. More research is needed to examine the relationship between clinical uncertainty and clinical outcomes, temporal changes in tolerance for uncertainty, and strategies that might assist physicians in developing adaptive responses to clinical uncertainty.