Twelve tips for thriving in the face of clinical uncertainty

References

• Accreditation Council for Graduate Medical Education (ACGME). 2015. The Internal Medicine Milestone Group: The Internal Medicine Milestone Project. [Accessed 2018 August 24]. www.acgme.org/Portals/0/PDFs/Milestones/InternalMedicineMilestones.pdf
   Google Scholar
• Accreditation Council for Graduate Medical Education (ACGME). 2017. The Pediatrics Milestone Project: A Joint Initiative of the Accreditation Council for Gradute Medical Education and the American Board of Pediatrics. [Accessed 2018 August 24]. https://acgme.org/Portals/0/PDFs/Milestones/PediatricsMilestones.pdf
   Google Scholar
• Adams NE. 2015. Bloom’s taxonomy of cognitive learning objectives. J Med Libr Assoc. 103:152–153.
   PubMed Web of Science ®Google Scholar
• Alam R, Cheraghi-Sohi S, Panagioti M, Esmail A, Campbell S, Panagopoulou E. 2017. Managing diagnostic uncertainty in primary care: a systematic critical review. BMC Family Pract. 18:79.
   PubMed Web of Science ®Google Scholar
• Almond S, Mant D, Thompson M. 2009. Diagnostic safety-netting. Br J Gen Pract. 59:872–874.
   PubMed Web of Science ®Google Scholar
• Armstrong K. 2018. If you can’t beat it, join it: uncertainty and trust in medicine. Ann Intern Med. 168:818–819.
   PubMed Web of Science ®Google Scholar
• Arora NK. 2003. Interacting with cancer patients: the significance of physicians’ communication behavior. Soc Sci Med. 57:791–806.
   PubMed Web of Science ®Google Scholar
• Association of American Medical Colleges. 2011. MR5 - 5th Comprehensive Review of the Medical College Admission Test (MCAT): Final MCAT Recommendations. [Accessed 2018 August 24]. https://www.aamc.org/download/273766/data/finalmr5recommendations.pdf
   Google Scholar
• Balogh EP, Miller BT, Ball JR. 2016. Improving diagnosis in health care. Washington (DC), USA: National Academies Press.
   Google Scholar
• Barry MJ, Edgman-Levitan S. 2012. Shared decision making – the pinnacle of patient-centered care. New Eng J Med. 366:780–781.
   PubMed Web of Science ®Google Scholar
• Benbassat J. 2014. Role modeling in medical education: the importance of a reflective imitation. Acad Med: J Assoc Am Med Coll. 89:550–554.
   Web of Science ®Google Scholar
• Beresford EB. 1991. Uncertainty and the shaping of medical decisions. Hastings Cent Rep. 21:6–11.
   PubMed Web of Science ®Google Scholar
• Berger Z. 2015. Navigating the unknown: shared decision-making in the face of uncertainty. J Gen Intern Med. 30:675–678.
   PubMed Web of Science ®Google Scholar
• Berker AO, Rutledge RB, Mathys C, Marshall L, Cross GF, Dolan RJ, Bestmann S. 2016. Computations of uncertainty mediate acute stress responses in humans. Nature Comm. 7:10996.
   PubMed Web of Science ®Google Scholar
• Bhise V, Meyer AND, Menon S, Singhal G, Street RL, Giardina TD, Singh H. 2018b. Patient perspectives on how physicians communicate diagnostic uncertainty: an experimental vignette study. Int J Qual Health Care. 30:2–8.
   PubMed Web of Science ®Google Scholar
• Bhise V, Rajan SS, Sittig DF, Morgan RO, Chaudhary P, Singh H. 2018a. Defining and measuring diagnostic uncertainty in medicine: a systematic review. J Gen Intern Med. 33:103–115.
   PubMed Web of Science ®Google Scholar
• Bhise V, Rajan SS, Sittig DF, Vaghani V, Morgan RO, Khanna A, Singh H. 2018c. Electronic health record reviews to measure diagnostic uncertainty in primary care. J Eval Clin Pract. 24:545–551.
   PubMed Web of Science ®Google Scholar
• Blumenthal D. 2012. Performance improvement in health care-seizing the moment. N Engl J Med. 366:1953–1955.
   PubMed Web of Science ®Google Scholar
• Bowen J. 2006. Educational strategies to promote clinical diagnostic reasoning. N Engl J Med. 355:2217–2225.
   PubMed Web of Science ®Google Scholar
• Brédart A, Bouleuc C, Dolbeault S. 2005. Doctor-patient communication and satisfaction with care in oncology. Curr Opin Oncol. 17:351–354.
   PubMed Web of Science ®Google Scholar
• Bucher R, Stelling JG. 1977. Becoming professional. Oxford, England: Sage.
   Google Scholar
• Cooke GP, Doust JA, Steele MC. 2013. A survey of resilience, burnout, and tolerance of uncertainty in Australian general practice registrars. BMC Med Educ. 13:1–6
   PubMed Web of Science ®Google Scholar
• Dalton AF, Golin CE, Esserman D, Pignone MP, Pathman DE, Lewis CL. 2015. Relationship between physicians’ uncertainty about clinical assessments and patient-centered recommendations for colorectal cancer screening in the elderly. Med Decis Making. 35:458–466.
   PubMed Web of Science ®Google Scholar
• Danczak A, Lea A. 2014. What do you do when you don’t know what to do? GP associates in training (AiT) and their experiences of uncertainty. Educ Prim Care. 25:321–326.
   PubMedGoogle Scholar
• Danczak A, Lea A. 2018. Developing expertise for uncertainty; do we rely on a baptism of fire, the mills of experience or could clinicians be trained? Educ Prim Care. 29:237–241.
   PubMed Web of Science ®Google Scholar
• Danczak A, Lea A, Murphy G. 2016. Mapping uncertainty in medicine: what do you do when you don’t know what to do? UK: Royal College of General Practitioners (RCGP) Press.
   Google Scholar
• Eva KW, Hatala RM, Leblanc VR, Brooks LR. 2007. Teaching from the clinical reasoning literature: combined reasoning strategies help novice diagnosticians overcome misleading information. Med Educ. 41:1152–1158.
   PubMed Web of Science ®Google Scholar
• Fitzgerald FT. 1999. Curiosity. Ann Intern Med. 130:70–72.
   PubMed Web of Science ®Google Scholar
• Furney SL, Orsini AN, Orsetti KE, Stern DT, Gruppen LD, Irby DM. 2001. Teaching the one-minute preceptor. A randomized controlled trial. J Gen Intern Med. 16:620–624.
   PubMed Web of Science ®Google Scholar
• Geller G. 2013. Tolerance for ambiguity: an ethics-based criterion for medical student selection. Acad Med. 88:581–584.
   PubMed Web of Science ®Google Scholar
• General Medical Council. 2018. Outcomes for Graduates 2018. [Accessed 2018 Aug 24]. https://www.gmc-uk.org/-/media/documents/dc11326-outcomes-for-graduates-2018_pdf-75040796.pdf
   Google Scholar
• Gordon GH, Joos SK, Byrne J. 2000. Physician expressions of uncertainty during patient encounters. Patient Educ Couns. 40:59–65.
   PubMed Web of Science ®Google Scholar
• Graber ML, Franklin N, Gordon R. 2005. Diagnostic error in internal medicine. Arch Intern Med. 165:1493–1499.
   PubMed Web of Science ®Google Scholar
• Ha JF, Longnecker N. 2010. Doctor-patient communication: a review. Ochsner J. 10:38–43.
   PubMedGoogle Scholar
• Hamui-Sutton A, Vives-Varela T, Gutiérrez-Barreto S, Leenen I, Sánchez-Mendiola M. 2015. A typology of uncertainty derived from an analysis of critical incidents in medical residents: A mixed methods study. BMC Med Educ. 15:198.
   PubMed Web of Science ®Google Scholar
• Han PKJ, Klein WMP, Arora NK. 2011. Varieties of uncertainty in health care: a conceptual taxonomy. Med Decis Making. 31:828–838.
   PubMed Web of Science ®Google Scholar
• Han PKJ, Schupack D, Daggett S, Holt CT, Strout TD. 2015. Temporal changes in tolerance of uncertainty among medical students: insights from an exploratory study. Med Educ Online. 20:3402.
   Web of Science ®Google Scholar
• Hsu M, Bhatt M, Adolphs R, Tranel D, Camerer CF. 2005. Neural systems responding to degrees of uncertainty in human decision-making. Science. 310:1680–1683.
   PubMed Web of Science ®Google Scholar
• Hunter DJ. 2016. Uncertainty in the era of precision medicine. N Engl J Med. 375:711–713.
   PubMed Web of Science ®Google Scholar
• John CC. 2018. The art of constructive worrying. JAMA. 319:2273–2274.
   PubMed Web of Science ®Google Scholar
• Kassirer JP, Wong JB, Kopelman R. 2009. Learning clinical reasoning. Baltimore: William & Wilkins.
   Google Scholar
• Klein G. 2007. Performing a project premortem. Harvard Business Review. [Accessed 2018 August 24]. https://hbr.org/2007/09/performing-a-project-premortem
   Google Scholar
• Kruglanski AW, Webster DM. 1996. Motivated closing of the mind: “seizing” and “freezing.” Psychol Rev.103:263–283.
   PubMed Web of Science ®Google Scholar
• Lanham HJ, Sittig DF, Leykum LK, Parchman ML, Pugh JA, McDaniel RR. 2014. Understanding differences in electronic health record (EHR) use: linking individual physicians' perceptions of uncertainty and EHR use patterns in ambulatory care. J Am Med Inform Assoc. 21:73–81.
   PubMed Web of Science ®Google Scholar
• Logan RL, Scott PJ. 1996. Uncertainty in clinical practice: implications for quality and costs of health care. Lancet. 347:595–598.
   PubMed Web of Science ®Google Scholar
• Luther VP, Crandall SJ. 2011. Commentary: ambiguity and uncertainty: neglected elements of medical education curricula? Acad Med. 86:799–800.
   PubMed Web of Science ®Google Scholar
• Merriam-Webster, Inc (Ed.). 2004. The Merriam-Webster dictionary. Springfield, Mass: Merriam-Webster.
   Google Scholar
• Mlodinow L. 2009. The drunkard’s walk: how randomness rules our lives. 1st Vintage Books ed. New York, USA: Pantheon Books.
   Google Scholar
• Neher JO, Gordon KC, Meyer B, Stevens N. 1992. A five-step “microskills model of clinical teaching.” J Am Board Fam Pract. 5:419–424.
   PubMedGoogle Scholar
• Pascoe JM, Nixon J, Lang VJ. 2015. Maximizing teaching on the wards: review and application of the One-Minute Preceptor and SNAPPS models. J Hosp Med. 10:125–130.
   PubMed Web of Science ®Google Scholar
• Politi MC, Légaré F. 2010. Physicians’ reactions to uncertainty in the context of shared decision making. Patient Educ Couns. 80:155–157.
   PubMed Web of Science ®Google Scholar
• Ranjan P, Kumari A, Chakrawarty A. 2015. How can doctors improve their communication skills? J Clin and Diag Res. 9:JE01–JE04.
   PubMed Web of Science ®Google Scholar
• Rencic J. 2011. Twelve tips for teaching expertise in clinical reasoning. Med Teach. 33:887–892.
   PubMed Web of Science ®Google Scholar
• Rosen MA, DiazGranados D, Dietz AS, Benishek LE, Thompson D, Pronovost P, Weaver SJ. 2018. Teamwork in healthcare: key discoveries enabling safer, high-quality care. Am Psychol. 73:433–450.
   PubMed Web of Science ®Google Scholar
• Schwartzstein RM, Roberts DH. 2017. Saying goodbye to lectures in medical school - paradigm shift or passing fad? N Engl J Med. 377:605–607.
   PubMed Web of Science ®Google Scholar
• Simpkin AL, Khan A, West DC, Garcia BM, Sectish TC, Spector ND, Landrigan CP. 2018. Stress from uncertainty and resilience among depressed and burned out residents: a cross-sectional study. Acad Ped. 18:698–704.
   PubMed Web of Science ®Google Scholar
• Simpkin AL, Schwartzstein RM. 2016. Tolerating uncertainty - the next medical revolution? N Engl J Med. 375:1713–1715.
   PubMed Web of Science ®Google Scholar
• Simpkin AL, Vyas JM, Armstrong KA. 2017. Diagnostic reasoning: an endangered competency in internal medicine training. Ann Intern Med. 167:507–508.
   PubMed Web of Science ®Google Scholar
• Starmer AJ, Spector ND, Srivastava R, West DC, Rosenbluth G, Allen AD, Noble EL, Tse LL, Dalal AK, Keohane CA, et al. 2014. Changes in medical errors after implementation of a handoff program. N Engl J Med. 371:1803–1812.
   PubMed Web of Science ®Google Scholar
• Strout TD, Hillen M, Gutheil C, Anderson E, Hutchinson R, Ward H, Kay H, Mills GJ, Han PKJ. 2018. Tolerance of uncertainty: a systematic review of health and healthcare-related outcomes. Patient Educ Couns. 101:1518–1537.
   PubMed Web of Science ®Google Scholar
• Trowbridge RL. 2008. Twelve tips for teaching avoidance of diagnostic errors. Med Teach. 30:496–500.
   PubMed Web of Science ®Google Scholar
• Tversky A, Kahneman D. 1974. Judgment under uncertainty: heuristics and biases. Science. 185:1124–1131.
   PubMed Web of Science ®Google Scholar
• Vanderbilt AA, Perkins SQ, Muscaro MK, Papadimos TJ, Baugh RF. 2017. Creating physicians of the 21st century: assessment of the clinical years. Adv Med Educ Pract. 8:395–398.
   PubMed Web of Science ®Google Scholar
• Wenzel RP. 2017. Medical education in the era of alternative facts. N Engl J Med. 377:607–609.
   PubMed Web of Science ®Google Scholar
• Wolpaw TM, Wolpaw DR, Papp KK. 2003. SNAPPS: a learner-centered model for outpatient education. Acad Med. 78:893–898.
   PubMed Web of Science ®Google Scholar