The potential of uncertainty tolerance measures to identify specific needs of first-year medical residents: an exploratory study
摘要
We aimed to explore 1st year residents’ responses to five different uncertainty tolerance (UT) measures, varying in their specificity to physicians and medical practice, and to compare their ability to classify residents according to their level of UT in this population.
Methods202 residents beginning training at two Norwegian hospitals in 2021–2023 completed the Physicians’ Reaction to Uncertainty (PRU), a physician-specific UT measure, as well as 4 non-specific measures: Intolerance of Uncertainty Scale (IUS-12), Tolerance for Ambiguity (TFA), Pearson’s Risk Attitude (PRA), and Ambiguity Aversion in Medicine (AAM). We described psychometric properties using exploratory factor analysis (EFA). We then applied hierarchical cluster analysis to assess the utility of the PRU and the 4 non-physician-specific measures in classifying residents.
ResultsResidents’ mean length of clinical work experience was 9.6 months (SD 7.6). 137 (68.2%) were female, 125 (62.2%) went to medical schools in Scandinavian-speaking countries. The exploratory factor analysis of all measures together revealed five factors. Factor 1 consisted of all PRU items and four items from TFA and explained 50.4% of the variance. In step 1, the cluster analysis based on PRU alone produced three stable clusters, with high (n = 58, 29%), intermediate (n = 108, 54%), or low (n = 36, 18%) UT. In step 2, a cluster analysis based on all measures produced three clusters, with high (n = 81, 40%), intermediate (n = 67, 33%), or low (n = 54, 27%) UT. Of the 58 with high UT according to PRU, three (5%) had intermediate UT using all instruments combined. Of the 36 with low UT according to PRU, 12 (33%) had high or intermediate UT using all instruments combined. Female residents and residents who studied medicine outside Scandinavia displayed lower UT.
ConclusionPRU appears to be a reliable, discriminatory, and feasible measure for identifying junior physicians who are predisposed to stress or other aversive psychological reactions to the uncertainties of clinical care. High UT measured by PRU indicates high UT according to other measures, while low UT according to PRU is less indicative. Hence, non-physician-specific UT measures appear to assess specific dimensions of UT that could assist supervisors and residents understand different responses to uncertainty.