Perceptions of Family Medicine Residents on the Role of Clinical Uncertainty in Learning to Become Competent Family Physicians

Abstract

As the first point of patient care, Family physicians are known to experience greater levels of uncertainty in decision-making. Little is known about how Family Medicine residents perceive and experience uncertainty in their dual roles as learners and healthcare providers. While there is research to suggest that uncertainty can be productive for learning medical practice, no study has examined the role of uncertainty in resident learning. The purpose of this study was to explore how Family Medicine residents view, experience, and manage uncertainty while learning through practice. A qualitative design was used to explore residents’ emotions, thoughts, opinions, and attitudes regarding their lived experiences of uncertainty. Over a two-week period, nine Family Medicine residents from one academic institution participated in individual, semi-structured interviews. Following verbatim transcription and member checking of interview summaries, the data was thematically analyzed to identify patterns in participants’ views and experiences of uncertainty. Results showed that uncertainty was a common and potentially uncomfortable experience for participating residents. Over time, the residents recalled their uncertainty subsiding and changing in character as they gained confidence and comfort with uncertainty in their decision-making. Despite viewing uncertainty as integral to lifelong professional learning, the residents in this study recalled censoring their expressions of uncertainty based on their perceptions of how they thought their patients and supervisors would react. In conclusion, the findings of this study suggest a need for medical education culture to be more accepting of residents’ uncertainty. A culture of acceptance towards uncertainty, in which residents and supervisors could speak freely about their professional limitations, has the potential to enhance patient safety as well as the quality and scope of clinical teaching and learning. Teaching medical learners to reflect in practice, by noticing uncertainty and suspending judgment, may help develop their ability to recognize professional weaknesses, self-limit practice in areas of limited competence, identify what must be learned, and locate external resources to resolve gaps in competence.