“A whole lot of uncertainty”: A longitudinal qualitative study exploring clinical medical students’ experiences of uncertainty

Introduction: Uncertainty Tolerance (UT), a construct describing individuals’ responses to uncertainty, is recognised as impacting healthcare outcomes, including medical students’/doctors’ psychological wellbeing. Presently, little is understood about how medical students experience uncertainty, nor factors that may impact this. Thus, our research question was “How do medical students, in their clinical years, experience and manage (i.e. “tolerate”) uncertainty?”
Methods: Through a social constructionist approach, we conducted a longitudinal qualitative study of medical students transitioning from preclinical years to clinical placements (n=23), and to practice (n=18). Data were collected across the 2020 academic year, with students completing reflective diary entries during semesters (n=230, totalling 178,308 words), and end of semester semi-structured interviews (n=40). Data were analysed by framework analysis, using an abductive approach based on the integrative UT model from Hillen et al. (Soc Sci Med 180:62–75, 2017).
Results: Participants described a variety of uncertainty stimuli: Some related to clinical medicine, others extended to professional and personal uncertainties. Multiple factors (“moderators”) appeared to impact students’ UT, including: People, past experience, sense of purpose, personal characteristics, guiding clinical information, educational structures and reflective learning. Responses to uncertainty ranged from negative (e.g. anxiety, avoidance) to positive (e.g. interest, action). Longitudinally, the dominant pattern across student data was for negative responses. By contrast, students’ responses to uncertainty upon reflection demonstrated a dominant positive pattern, including: Identifying learning opportunities, gratitude, and developing resilience.
Discussion: Our results improve the definition of the UT construct within a clinical learner population. Participants identified that reflective diary engagement served to moderate experiences of uncertainty, suggesting that repeated, formative reflective learning may assist students to develop UT.
Conclusions: UT in medical students is dynamic, complex and extends beyond clinical uncertainties previously described. Reassuringly, this research identifies multiple factors that may impact UT, with possible avenues for educational interventions.