Comfort with uncertainty: reframing our conceptions of how clinicians navigate complex clinical situations
Learning to take safe and effective action in complex settings rife with uncertainty is essential for patient safety and quality care. Doing so is not easy for trainees, as they often consider certainty to be a necessary precursor for action and subsequently struggle in these settings. Understanding how skillful clinicians work comfortably when uncertain, therefore, offers an important opportunity to facilitate trainees’ clinical reasoning development. This critical review aims to define and elaborate the concept of ‘comfort with uncertainty’ in clinical settings by juxtaposing a variety of frameworks and theories in ways that generate more deliberate ways of thinking about, and researching, this phenomenon. We used Google Scholar to identify theoretical concepts and findings relevant to the topics of ‘uncertainty,’ ‘ambiguity,’ ‘comfort,’ and ‘confidence,’ and then used preliminary findings to pursue parallel searches within the social cognition, cognition, sociology, sociocultural, philosophy of medicine, and medical education literatures. We treat uncertainty as representing the lived experience of individuals, reflecting the lack of confidence one feels that he/she has an incomplete mental representation of a particular problem. Comfort, in contrast, references confidence in one’s capabilities to act (or not act) in a safe and effective manner given the situation. Clinicians’ ‘comfort with uncertainty’ is informed by a variety of perceptual, emotional, and situational cues, and is enabled through a combination of self-monitoring and forward planning. Potential implications of using ‘comfort with uncertainty’ as a framework for educational and research programs are explored.
KeywordsUncertainty Ambiguity Comfort Clinical reasoning Complexity Expertise Medical decision-making
The authors wish to thank Alisha Brown, MD, Joshua Jauregui, MD, Laura Welsh, MD, and Bjorn Watsjold, MD for their constructive critiques.
This review was supported by an award from the Society of Directors of Research in Medical Education (SDRME).
- Cassell, J. (1991). Expected miracles: Surgeons at work. Philadelphia: Temple University Press.Google Scholar
- Fox, R. (1957). Training for certainty. In R. K. Merton, G. Reader, & P. L. Kendall (Eds.), The student physician. Cambridge: Harvard University Press.Google Scholar
- Lazarus, R. S. (1991). Emotion and adaptation. New York: Oxford University Press.Google Scholar
- Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer.Google Scholar
- Mishel, M. H. (1988). Uncertainty in Illness. Image: The Journal of Nursing Scholarship, 20, 225–232.Google Scholar
- Mishel, M. H. (1990). Reconceptualization of the uncertainty in illness theory. Image: The Journal of Nursing Scholarship, 22, 256–262.Google Scholar
- Schön, D. A. (1983). The reflective practitioner: How professionals think in action. New York: Basic Books.Google Scholar
- Simpson, D. E., Dalgaard, K. A., & O’Brien, D. K. (1986). Student and faculty assumptions about the nature of uncertainty in medicine. Journal of Family Practice, 23, 468–472.Google Scholar