Towards a medical school curriculum for uncertainty in clinical practice

Figures & data

Table 1. Correlations between clinical practice uncertainty domains and educational experiences among medical students

Clinical Practice Uncertainty Domain	Educational Experiences with Ratings Correlated to Clinical Practice Uncertainty Domain Ratings
Preparation	Clinical Team Debriefs (p = 0.04) Faculty facilitated peer reflection groups (p = 0.02) Case-Based Learning (p = 0.03)
Patient Communication	Talking about experiences (p = 0.03) Clinical Story Slams (p = 0.03) Required Scholarly Activity (p = 0.03)
Patient Relationships	Clinical Team Debriefs (p = 0.01) Small-Group Communication Skills Practice (p = 0.02) Talking about experiences (p = 0.01) Journaling experiences (p = 0.03)
Well-Being	Small-Group Communication Skills Practice (p = 0.02) Team-Problem Solving Sessions (p = 0.02) Writing Reflections and Narratives (p = 0.04) Journaling experiences (p = 0.02)

Table 2. Medical student suggestions for educational experiences that would prepare them for uncertainty in clinical practice

Theme	Number of Comments	Representative Quotes *
Experience	43	‘Being in the clinic and facing problems directly is the only way.’
Reflections	34	‘It’s okay [for attendings] to have emotions and talk about those emotions, it’s okay to have a bad day, it’s okay to acknowledge when you are stressed.’ ‘I think it is super helpful to work in a team where people say out loud that there are uncertainties and address how that makes them feel.’
Small-Group Learning	17	‘More CBL [case-based learning] or TBL [team-based learning] type cases where there ISN’T a “right” answer. Even in CBLs there is always a right answer at the end and people hang on to that.’ ‘CBL cases that don’t end with a satisfying diagnosis – include lab values that don’t tell a clear story, incorporate multiple day hospital stays where not much changes into the narrative, and ultimately have the outcome be that the patient goes home stable but without a neat and tidy ending’ ‘More clinical skills small-group sessions about uncertain scenarios.’
Simulations	17	‘I think more sim cases would teach students to get out of the multiple choice thinking process, and realize that real life is much more fluid and less concrete.’ ‘Simulations where they cannot win (stop the patient from dying), like in Star Trek’
Debriefing	16	‘My greatest benefit came with debriefing an actual event with the resident who stood alongside me.’
Demonstrating Communication	11	‘Seeing good examples of physicians explaining things to patients when they don’t know exactly in a concrete way and what they DO know and what they are going to do to work to figure it out.’
Role Modeling	14	‘Seniors who demonstrate how you can tolerate it successfully, show it is not a failure, reveal how to create relationships with patients while being uncertain.’
Storytelling	10	‘More stories from more professionals.’ ‘I’m a big fan of the faculty sharing their stories with us.’
Prioritizing Wellness	9	‘Students experience incredible distress when there is not a clear-cut-and-dry answer and they likewise approach medicine from a strictly resume-padding approach (whatever gets them to honor and match into some surgical specialty, etc.).’ ‘Less emphasis on exams, as they rot our brains and turn us into robots with canned empathy.’

* Representative quotes shared above are from different medical students

Table

	None at all (55)	A little (56)	A moderate amount (57)	A lot (58)	A great deal (59)
Case Based Learning (CBL) (1)
Clinical Skills Small Group (CSSG) (2)
TBL (17)
Clinical Experience (CE) (18)
Skills Observation and Reflection Groups (SOAR) (3)
Interprofessional programs (e.g., Health Mentors, TeamSAFE) (15)
Scholarly Inquiry (13)
Humanities (4)
Writing reflections and narratives (14)
Class lectures (16)

Q41 Please review the following electives/activities that may have been offered to you while in medical school. Indicate how the following experiences have prepared you to address uncertainty in the clinical environment.

Table

	Did not participate (46)	None at all (41)	A little (42)	A moderate amount (43)	A lot (44)	A great deal (45)
Story Slams (5)
Failing Forward (17)
Mindfulness activities (7)
Clinical team debriefs (12)
Talking about my clinical experiences with others (peer narratives) (8)
Journaling my experiences (14)
Faculty Narratives (16)

Q37 What tools or activities do you think would help students prepare for clinical uncertainty?

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