The impact of clinical uncertainty in the graduate medical education (GME) learning environment: A mixed-methods study

Mark W. Johnson, Galina Gheihman, Horatio Thomas, Gordon Schiff, Andrew P. J. Olson, Arabella Simpkin Begin

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Background: Uncertainty is ubiquitous in medicine. Studies link intolerance of uncertainty to burnout, ineffective communication, cognitive bias, and inappropriate resource use. Little is known about how uncertainty manifests in the clinical learning environment. We aimed to explore the perceptions and experiences of uncertainty among residents and attendings. Methods: We conducted a mixed-methods study including a survey, semi-structured interviews, and ethnographic observations during rounds with residents and attendings at an academic medical center. The survey included three validated instruments: Physicians’ Reaction to Uncertainty Scale; Maslach Burnout Inventory 2-item; and Educational Climate Inventory. Results: 35/60 (58%) of eligible residents and 14/21 (67%) attendings completed the survey. Residents reported higher anxiety due to uncertainty than attendings, higher concern about bad outcomes, and greater reluctance to disclose uncertainty to patients. Residents reported increased symptoms of burnout (p <.05). Perceiving the learning environment as more competitive correlated with reluctance to disclose uncertainty (r = −0.44; p <.01). Qualitative themes included: recognizing and facing uncertainty, and consequences for the learning environment. Observations revealed senior clinicians have greater comfort acknowledging uncertainty. Conclusions: Medical curricula should be developed to promote recognition and acknowledgement of uncertainty. Greater acknowledgement of uncertainty, specifically by attendings and senior residents, may positively impact the clinical learning environment.

Original languageEnglish (US)
Pages (from-to)1100-1108
Number of pages9
JournalMedical Teacher
Issue number10
StatePublished - Oct 3 2022

Bibliographical note

Funding Information:
This study was supported by the Diagnostic Error Curriculum Fund at the University of Minnesota Foundation. Dr. G. Schiff gratefully acknowledges the support of CRICO (the Harvard Medical School Risk Management Foundation) and the Gordon and Betty Moore Foundation for work in diagnostic errors and communicating diagnostic uncertainty. The authors thank Edward Krupat, PhD for his advice regarding use of the ECI and for his review of an earlier version of this manuscript. The authors also thank the faculty and residents at the University of Minnesota for their participation in the study.

Publisher Copyright:
© 2022 Informa UK Limited, trading as Taylor & Francis Group.

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  • Journal Article


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