Jonathan S Ilgen1, Judith L Bowen2, Anique B H de Bruin3, Glenn Regehr4, Pim W Teunissen5. 1. J.S. Ilgen is associate professor, Department of Emergency Medicine, and associate director, Center for Leadership and Innovation in Medical Education, University of Washington, Seattle, Washington; ORCID: https://orcid.org/0000-0003-4590-6570. 2. J.L. Bowen is professor, Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington; ORCID: https://orcid.org/0000-0001-6914-0413. 3. A.B.H. de Bruin is professor, Department of Educational Development and Research, School of Health Professions Education, Maastricht University, Maastricht, the Netherlands; ORCID: https://orcid.org/0000-0001-5178-0287. 4. G. Regehr is professor, Department of Surgery and Centre for Health Education Scholarship, University of British Columbia, Vancouver, British Columbia, Canada; ORCID: https://orcid.org/0000-0002-3144-331X. 5. P.W. Teunissen is professor, School of Health Professions Education, Maastricht University, Maastricht, and maternal fetal medicine specialist, Amsterdam University Medical Centers, Amsterdam, the Netherlands; ORCID: https://orcid.org/0000-0002-0930-0048.
Abstract
PURPOSE: Clinical educators often raise concerns that learners are not comfortable with uncertainty in clinical work, yet existing literature provides little insight into practicing clinicians' experiences of comfort when navigating the complex, ill-defined problems pervasive in practice. Exploring clinicians' comfort as they identify and manage uncertainty in practice could help us better support learners through their discomfort. METHOD: Between December 2018 and April 2019, the authors employed a constructivist grounded theory approach to explore experiences of uncertainty in emergency medicine faculty. The authors used a critical incident technique to elicit narratives about decision making immediately following participants' clinical shifts, exploring how they experienced uncertainty and made real-time judgments regarding their comfort to manage a given problem. Two investigators analyzed the transcripts, coding data line-by-line using constant comparative analysis to organize narratives into focused codes. These codes informed the development of conceptual categories that formed a framework for understanding comfort with uncertainty. RESULTS: Participants identified multiple forms of uncertainty, organized around their understanding of the problems they were facing and the potential actions they could take. When discussing their comfort in these situations, they described a fluid, actively negotiated state. This state was informed by their efforts to project forward and imagine how a problem might evolve, with boundary conditions signaling the borders of their expertise. It was also informed by ongoing monitoring activities pertaining to patients, their own metacognitions, and their environment. CONCLUSIONS: The authors' findings offer nuances to current notions of comfort with uncertainty. Uncertainty involved clinical, environmental, and social aspects, and comfort dynamically evolved through iterative cycles of forward planning and monitoring.
PURPOSE: Clinical educators often raise concerns that learners are not comfortable with uncertainty in clinical work, yet existing literature provides little insight into practicing clinicians' experiences of comfort when navigating the complex, ill-defined problems pervasive in practice. Exploring clinicians' comfort as they identify and manage uncertainty in practice could help us better support learners through their discomfort. METHOD: Between December 2018 and April 2019, the authors employed a constructivist grounded theory approach to explore experiences of uncertainty in emergency medicine faculty. The authors used a critical incident technique to elicit narratives about decision making immediately following participants' clinical shifts, exploring how they experienced uncertainty and made real-time judgments regarding their comfort to manage a given problem. Two investigators analyzed the transcripts, coding data line-by-line using constant comparative analysis to organize narratives into focused codes. These codes informed the development of conceptual categories that formed a framework for understanding comfort with uncertainty. RESULTS:Participants identified multiple forms of uncertainty, organized around their understanding of the problems they were facing and the potential actions they could take. When discussing their comfort in these situations, they described a fluid, actively negotiated state. This state was informed by their efforts to project forward and imagine how a problem might evolve, with boundary conditions signaling the borders of their expertise. It was also informed by ongoing monitoring activities pertaining to patients, their own metacognitions, and their environment. CONCLUSIONS: The authors' findings offer nuances to current notions of comfort with uncertainty. Uncertainty involved clinical, environmental, and social aspects, and comfort dynamically evolved through iterative cycles of forward planning and monitoring.
Authors: Paul K J Han; Tania D Strout; Caitlin Gutheil; Carl Germann; Brian King; Eirik Ofstad; Pål Gulbrandsen; Robert Trowbridge Journal: Med Decis Making Date: 2021-02-15 Impact factor: 2.583