Abstract
BackgroundMedical uncertainty is inherently related to the practice of the physician and generally affects his or her patient care, job satisfaction, continuing education, as well as the overall goals of the health care system. In this paper, some new types of uncertainty, which extend existing typologies, are identified and the contexts and strategies to deal with them are studied.MethodsWe carried out a mixed-methods study, consisting of a qualitative and a quantitative phase. For the qualitative study, 128 residents reported critical incidents in their clinical practice and described how they coped with the uncertainty in the situation. Each critical incident was analyzed and the most salient situations, 45 in total, were retained. In the quantitative phase, a distinct group of 120 medical residents indicated for each of these situations whether they have been involved in the described situations and, if so, which coping strategy they applied. The analysis examines the relation between characteristics of the situation and the coping strategies.ResultsFrom the qualitative study, a new typology of uncertainty was derived which distinguishes between technical, conceptual, communicational, systemic, and ethical uncertainty. The quantitative analysis showed that, independently of the type of uncertainty, critical incidents are most frequently resolved by consulting senior physicians (49 % overall), which underscores the importance of the hierarchical relationships in the hospital. The insights gained by this study are combined into an integrative model of uncertainty in medical residencies, which combines the type and perceived level of uncertainty, the strategies employed to deal with it, and context elements such as the actors present in the situation. The model considers the final resolution at each of three levels: the patient, the health system, and the physician’s personal level.ConclusionsThis study gives insight into how medical residents make decisions under different types of uncertainty, giving account of the context in which the interactions take place and of the strategies used to resolve the incidents. These insights may guide the development of organizational policies that reduce uncertainty and stress in residents during their clinical training.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-015-0459-2) contains supplementary material, which is available to authorized users.
Highlights
Medical uncertainty is inherently related to the practice of the physician and generally affects his or her patient care, job satisfaction, continuing education, as well as the overall goals of the health care system
We applied a qualitative methodology to identify coping strategies applied by medical residents to deal with critical incidents and to develop a questionnaire to measure these strategies in typical uncertainty situations
Qualitative phase We describe three types of results obtained from the qualitative phase: (a) the typology of uncertainty derived from the critical incident reports, (b) the relation between the critical incidents and some context and perception variables derived from the reports, and (c) the final version of the questionnaire with selected typical situations and responses, which allows to quantitatively investigate the coping strategies employed by physicians faced with medical uncertainty
Summary
Medical uncertainty is inherently related to the practice of the physician and generally affects his or her patient care, job satisfaction, continuing education, as well as the overall goals of the health care system. And from an outer perspective, it is commonly believed that physicians manage any clinical situation without doubts; everyday medical decisions are typically made under conditions of uncertainty. Residents may experience fear of causing errors, anxiety, stress, frustration, and insecurity During his or her training, the physician tends to develop personal strategies that take the health and safety of the patient into account and which, in turn, affect his or her education and personal satisfaction, together with the goals at the institutional level [2,3,4,5,6]. Beresford [9] explicitly considered uncertainty in a clinical context and distinguished three types: technical (i.e., lack of knowledge to understand the situation), conceptual
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