The 50 Shades of Gray's Anatomy: Anatomy Education as a Primer for Student Development of Tolerance of Ambiguity

Medical students often perceive anatomy as a “dead” science, one that is both complete and certain. Authentic anatomy, however, is comprised of variations, unknowns and ambiguities. Given that ambiguity is also inherent within clinical practice across the spectrum of patient care, anatomy education may afford ripe opportunities to prepare students for developing tolerance of ambiguity (ToA). ToA is a construct describing an individual’s response to ambiguous stimuli; in the healthcare environment, low ToA (sometimes “intolerance” of ambiguity) is linked to negative outcomes such as over testing of patients and clinician burnout. Following ethics approval, we explored the impact of anatomy education on medical student ToA using an inductive longitudinal qualitative study. Data collected from online discussion forums during semester and interviews at the end of semesters were analaysed using framework analysis. Stimuli of ambiguity, student responses to ambiguity and factors impacting/moderating students’ ToA were all identified within the anatomy education context. Anatomical variation was described as a stimulus for ambiguity in relation to learning from donor dissection and prosections. Appreciation of anatomical variation, however, was more clearly tied to student descriptions of donor dissection, with students describing this as a key difference between learning from donors and learning from textbooks. Some students furthered this discussion by linking anatomical variation with implications for their future clinical practice. Interestingly, anatomy educators impacted student ToA, with didactic teaching approaches having negative impacts. Alternatively, educators highlighting and discussing anatomy-related uncertainties positively impacted students’ ToA. Although some students struggled with the concept of ambiguity early in their anatomy studies, over time acceptance of ToA as a clinical competency improved. This research suggests that anatomy education, which highlights inherent ambiguities and variations, has a potentially important role in fostering medical student ToA, and facilitating students’ preparedness for practice.