Advertisement

Advances in Health Sciences Education

, Volume 20, Issue 1, pp 113–130 | Cite as

Medical student and junior doctors’ tolerance of ambiguity: development of a new scale

  • Jason Hancock
  • Martin Roberts
  • Lynn Monrouxe
  • Karen Mattick
Article

Abstract

The practice of medicine involves inherent ambiguity, arising from limitations of knowledge, diagnostic problems, complexities of treatment and outcome and unpredictability of patient response. Research into doctors’ tolerance of ambiguity is hampered by poor conceptual clarity and inadequate measurement scales. We aimed to create and pilot a measurement scale for tolerance of ambiguity in medical students and junior doctors that addresses the limitations of existing scales. After defining tolerance of ambiguity, scale items were generated by literature review and expert consultation. Feedback on the draft scale was sought and incorporated. 411 medical students and 75 foundation doctors in Exeter, UK were asked to complete the scale. Psychometric analysis enabled further scale refinement and comparison of scale scores across subgroups. The pilot study achieved a 64 % response rate. The final 29 item version of the Tolerance of Ambiguity in Medical Students and Doctors (TAMSAD) scale had good internal reliability (Cronbach’s α 0.80). Tolerance of ambiguity was higher in foundation year 2 doctors than first, third and fourth year medical students (−5.23, P = 0.012; −5.98, P = 0.013; −4.62, P = 0.035, for each year group respectively). The TAMSAD scale offers a valid and reliable alternative to existing scales. Further work is required in different settings and in longitudinal studies but this study offers intriguing provisional insights.

Keywords

Ambiguity Epistemology Medical education Tolerance Uncertainty 

Notes

Acknowledgments

We would like to thank everybody who contributed towards each stage of this study. Our eight medical education colleagues who contributed towards initial item creation, the ten medical students and foundation doctors in Exeter who took part in the initial study pilot and the medical students and foundation doctors in Exeter who completed the TAMSAD questionnaire.

References

  1. American Educational Research Association, American Psychological Association, National Council on Measurement in Education. (1999). Standards for educational and psychological testing. Washington, DC: American Educational Research Association.Google Scholar
  2. Benbassat, J., Baumal, R., Chan, S., & Nirel, N. (2011). Sources of distress during medical training and clinical practice: Suggestions for reducing their impact. Medical Teacher, 33(6), 486–490.CrossRefGoogle Scholar
  3. Bovier, P., & Perneger, T. (2007). Stress from uncertainty from graduation to retirement—a population-based study of Swiss physicians. Journal of General Internal Medicine, 22(5), 632–638.CrossRefGoogle Scholar
  4. Budner, S. (1962). Intolerance of ambiguity as a personality variable. Journal of Personality, 30(1), 29–50.CrossRefGoogle Scholar
  5. Cohen, J. (1988). Statistical power analysis for the behavioural sciences. London: Lawrence Erlbaum Associates.Google Scholar
  6. Cooke, G., Doust, J., & Steele, M. (2013). A survey of resilience, burnout, and tolerance of uncertainty in Australian general practice registrars. BMC Medical Education, 13, 2.CrossRefGoogle Scholar
  7. Deforge, B., & Sobal, J. (1991). Intolerance of ambiguity among family practice residents. Family Medicine, 23(6), 466–468.Google Scholar
  8. Downing, S. (2003). Validity: On the meaningful interpretation of assessment data. Medical Education, 37, 830–837.CrossRefGoogle Scholar
  9. Field, A. (2005). Discovering statistics using SPSS (2nd ed.). Beverley Hills, CA: Sage.Google Scholar
  10. Furnham, A., & Ribchester, T. (1995). Tolerance of ambiguity: A review of the concept, its measurement and applications. Current Psychology, 14(3), 179.CrossRefGoogle Scholar
  11. Geller, G. (2013). Tolerance for ambiguity: An ethics-based criterion for medical student selection. Academic Medicine, 88(5), 581–584.CrossRefGoogle Scholar
  12. Geller, G., Faden, R., & Levine, D. (1990). Tolerance for ambiguity among medical students: Implications for their selection, training and practice. Social Science and Medicine, 31(5), 619–624.CrossRefGoogle Scholar
  13. Geller, G., Tambor, E., Chase, G., & Holtzmann, N. (1993). Measuring physicians’ tolerance for ambiguity and its relationship to their reported practices regarding genetic testing. Medical Care, 31(11), 989–1001.CrossRefGoogle Scholar
  14. Gerrity, M. S., DeVellis, R. F., & Earp, J. A. (1990). Physicians’ reactions to uncertainty in patient care. A new measure and new insights. Medical Care, 28(8), 724–736.CrossRefGoogle Scholar
  15. Greco, V., & Roger, D. (2002). Uncertainty, stress and health. Personality and Individual Differences, 34(6), 1057–1068.CrossRefGoogle Scholar
  16. Hammer, D., & Elby, A. (2002). On the form of a personal epistemology. In B. Hofer & P. Pintrich (Eds.), Personal epistemology: The psychology of beliefs about knowledge and knowing (pp. 169–190). Mahwah, NJ: Erlbaum.Google Scholar
  17. Hancock, J., & Mattick, K. (2012). Increasing students’ tolerance of ambiguity: The need for caution. Academic Medicine, 87(7), 834.CrossRefGoogle Scholar
  18. Knight, L., & Mattick, K. (2006). When I first came here, I thought medicine was black and white: Making sense of medical students’ ways of knowing. Social Science and Medicine, 63(4), 1084–1096.CrossRefGoogle Scholar
  19. Lim, M. (2003). Who is being difficult? Addressing the determinants of difficult patient-physician relationships. Virtual Mentor, 5(4). Retrieved June 13, 2013, from http://virtualmentor.ama-assn.org/003/04/jdsc-0304.html.
  20. Luther, V. P., & Crandall, S. J. (2011). Commentary: Ambiguity and uncertainty: Neglected elements of medical education curricula? Academic Medicine, 86(7), 799–800.CrossRefGoogle Scholar
  21. Norton, R. (1975). Measurement of ambiguity tolerance. Journal of Personality Assessment, 39(6), 607–619.CrossRefGoogle Scholar
  22. Oppenheim, A. N. (2008). Questionnaire design, interviewing and attitude measurement. London: Continuum.Google Scholar
  23. Perry, W. (1968). Forms of intellectual and ethical development in the college years—a scheme. New York: Holt, Rinehart and Winston.Google Scholar
  24. Polanyi, M. (1966). The tacit dimension. London: Routledge.Google Scholar
  25. Royal College Psychiatrists. (2013). CT1 personal specification. Retrieved March 24, 2013, from; http://www.rcpsych.ac.uk/pdf/CT1%20Psych-person%20spec-August%202013-approved.pdf.
  26. Sidanius, J. (1988). Intolerance of ambiguity, conservatism and racism: Whose fantasy, whose reality? A reply to Ray. Political Psychology, 9, 309–316.CrossRefGoogle Scholar
  27. Stanley, J. (1971). Educational measurement (2nd edn). Washington, DC: American Council on Education.Google Scholar
  28. TAMSAD recruitment video. Retrieved June 13, 2013, from; http://www.youtube.com/watch?v=uQEANkFzfq4&feature=youtu.be.
  29. Wayne, S., Dellmore, D., Serna, L., Jerabek, R., Timm, C., & Kalishman, S. (2011). The association between intolerance of ambiguity and decline in medical students attitudes toward the underserved. Academic Medicine, 86(7), 877–882.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  • Jason Hancock
    • 1
  • Martin Roberts
    • 2
  • Lynn Monrouxe
    • 3
  • Karen Mattick
    • 1
  1. 1.University of Exeter Medical SchoolExeterUK
  2. 2.Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA)Plymouth University Peninsula Schools of Medicine and DentistryPlymouthUK
  3. 3.School of MedicineCardiff UniversityCardiffUK

Personalised recommendations