Balancing Parts: Integrating Uncertainty/Ambiguity into Anatomy Education

Abstract

Tolerance of Uncertainty/Ambiguity (ToU/A) is a construct describing individuals’ responses to ambiguous stimuli. ToA is recognised as impacting healthcare outcomes, however, little is known about whether education may impact students’ ToA, and if so, how we can develop pedagogy to improve students’ ToU/A. Framework analysis of longitudinal qualitative data, collected via online discussions and semi‐structured interviews from 207 undergraduate medical students across three semesters of anatomy, identified anatomy pedagogy which either fostered or hindered students’ ToU/A. Anatomy curricula which integrates opportunities for students to distribute responsibility for knowledge (i.e. working in teams) and/or provide anonymity for those conveying knowledge (i.e. online anonymous discussion forums) appear to foster students’ ToU/A, while didactic educator approaches (suggesting that knowledge is finite and knowable) appear to hinder students’ ToU/A. Thematic analysis across time‐points suggest that active learning approaches can be effective stimuli for students’ ToU/A development. Active learning approaches within our study balanced communication of anatomy discipline knowledge with clinical applications, so that the context of knowledge became the stimulus of uncertainty. Exemplar anatomy curricula fostering ToU/A include “choose your own adventure” chest pain team‐based learning, where students elect which patient information they receive and in which order, engaging anatomical knowledge through the “adventure”. Another approach is using short clinical case scenarios wherein more than one underlying anatomical deficit may explain symptoms described in the scenario. Despite evidence that students develop ToA/U in their cognition and behaviour (e.g. through acknowledgement of the clinical importance of ToU/ToA, and perseverance when faced with ambiguous/unknown knowledge), student talk in this study suggests that emotionally, students remain negative about ToU/A (e.g. feeling overwhelmed, fearing errors). Together our data and examples illustrate that foundational science knowledge education can be balanced with effective student development of ToU/A, but student feedback may remain negative; an important consideration in evaluating effective curricula. Future work will focus on whether students’ negative emotions change with time and clinical exposure.Support or Funding InformationResearch supported by Monash Education Academy, Faculty of Medicine, Nursing and Health Sciences (Monash University) and a Medical Education Travel Fellowship