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- Title
Warning bells: How clinicians leverage their discomfort to manage moments of uncertainty.
- Authors
Ilgen, Jonathan S.; Teunissen, Pim W.; Bruin, Anique B. H.; Bowen, Judith L.; Regehr, Glenn
- Abstract
Objectives: It remains unclear how medical educators can more effectively bridge the gap between trainees' intolerance of uncertainty and the tolerance that experienced physicians demonstrate in practice. Exploring how experienced clinicians experience, appraise and respond to discomfort arising from uncertainty could provide new insights regarding the kinds of behaviours we are trying to help trainees achieve. Methods: We used a constructivist grounded theory approach to explore how emergency medicine faculty experienced, managed and responded to discomfort in settings of uncertainty. Using a critical incident technique, we asked participants to describe case‐based experiences of uncertainty immediately following a clinical shift. We used probing questions to explore cognitive, emotional and somatic manifestations of discomfort, how participants had appraised and responded to these cues, and how they had used available resources to act in these moments of uncertainty. Two investigators coded the data line by line using constant comparative analysis and organised transcripts into focused codes. The entire research team discussed relationships between codes and categories, and developed a conceptual framework that reflected the possible relationships between themes. Results: Participants identified varying levels of discomfort in their case descriptions. They described multiple cues alerting them to problems that were evolving in unexpected ways or problems with aspects of management that were beyond their abilities. Discomfort served as a trigger for participants to monitor a situation with greater attention and to proceed more intentionally. It also served as a prompt for participants to think deliberately about the types of human and material resources they might call upon strategically to manage these uncertain situations. Conclusions: Discomfort served as a dynamic means to manage and respond to uncertainty. To be 'tolerant' of uncertainty thus requires clinicians to embrace discomfort as a powerful tool with which to grapple with the complex problems pervasive in clinical practice. The authors report how practicing clinicians experience, appraise, and respond to discomfort arising from uncertainty, describing it as a trigger for instigating strategic management of uncertainty.
- Subjects
ABILITY; ATTENTION; CLINICAL competence; CLINICAL medicine; COMPARATIVE studies; CONCEPTUAL structures; GROUNDED theory; LEARNING strategies; PSYCHOLOGY of medical students; PHYSICIANS; PROBLEM solving; SCHOOL environment; STUDENT attitudes; UNCERTAINTY; TRAINING; THEMATIC analysis; PROMPTS (Psychology); DESCRIPTIVE statistics
- Publication
Medical Education, 2021, Vol 55, Issue 2, p233
- ISSN
0308-0110
- Publication type
Article
- DOI
10.1111/medu.14304