Abstract
Although the evidence base around uncertainty and education has expanded in recent years, a lack of clarity around conceptual terms and a heterogeneity of study designs means that this landscape remains indistinct. This scoping review explores how undergraduate health professions' students learn to engage with uncertainty related to their academic practice. To our knowledge, this is the first scoping review which examines teaching and learning related to uncertainty across multiple health professions. The scoping review is underpinned by the five-stage framework of (Arksey and O'Malley in Scoping studies: Towards a methodological framework International Journal of Social Research Methodology 8(1) 19-32, 2005). We searched MEDLINE, Embase, PsychINFO, ISI Web of Science, and CINAHL and hand-searched selected health professions’ education journals. The search strategy yielded a total of 5,017 articles, of which 97 were included in the final review. Four major themes were identified: “Learners’ interactions with uncertainty”; “Factors that influence learner experiences”; “Educational outcomes”; and, “Teaching and learning approaches”. Our findings highlight that uncertainty is a ubiquitous concern in health professions’ education, with students experiencing different forms of uncertainty at many stages of their training. These experiences are influenced by both individual and system-related factors. Formal teaching strategies that directly support learning around uncertainty were infrequent, and included arts-based teaching, and clinical case presentations. Students also met with uncertainty indirectly through problem-based learning, clinical teaching, humanities teaching, simulation, team-based learning, small group learning, tactical games, online discussion of anatomy topics, and virtual patients. Reflection and reflective practice are also mentioned as strategies within the literature.
Highlights
Health professionals regularly encounter uncertainty in their work, experiencing “a subjective perception of not knowing what to think or what to do” (Sommers and Launer 2014)
These types of uncertainty arise for learners in many varied teaching and learning settings
Training for uncertainty has been described as medical education’s “most elusive ideal”28. This scoping review allows us to track down this concern, providing an overview of how health professions’ students learn to engage with uncertainty during their undergraduate training
Summary
Health professionals regularly encounter uncertainty in their work, experiencing “a subjective perception of not knowing what to think or what to do” (Sommers and Launer 2014). When confronted with complex or ambiguous situations, individuals react in different ways, often framed in terms of their cognitive, emotional and behavioural responses (Mushtaq et al 2011; Strout et al 2018). These differences, and the capacity of health professionals to manage uncertainty overall, are often referred to as “uncertainty tolerance.”. A recent review by Strout and colleagues (2018) highlighted a strong, consistent association between health professionals’ uncertainty tolerance, and their patients’ emotional well-being. This growing evidence base has encouraged the addition of uncertainty management competences to many regulatory professional frameworks (AMRC 2009; Benson et al 2015; GMC 2018; RCVS 2018)
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