Medical education, simulation and uncertainty.

Area of Science:

• Medical Education
• Clinical Skills Training
• Patient Simulation

Background:

• Foundation doctors frequently report feeling unprepared for clinical uncertainty in acute settings.
• Traditional patient simulations often simplify cases, potentially hindering preparedness for complex, nuanced clinical scenarios.
• This study investigates final-year medical students' experiences with clinical uncertainty during a complex simulated patient encounter.

Purpose of the Study:

• To explore final-year medical students' perceptions of clinical uncertainty.
• To assess the impact of an 'authentically' complex simulated patient scenario on student learning.
• To identify challenges and effective strategies for managing uncertainty in medical training.

Main Methods:

• An adapted simulation scenario was designed to replicate clinical uncertainty, featuring a patient with a confused history and unclear diagnosis.
• Students participated in debriefings using the 'Diamond Approach' (advocacy and enquiry) facilitated by researchers.
• Transcripts of debriefings were thematically coded and analyzed.

Main Results:

• Students perceived the 'uncertainty' simulation as more challenging than standard simulations.
• Participants expressed frustration when a clear diagnosis was not immediately apparent and described task fixation or inaction.
• Difficulties were noted in seeking senior support and defining their role in managing complex cases.

Conclusions:

• The simulation prompted valuable discussions among students regarding reactions to clinical uncertainty.
• The approach was generally perceived as useful for developing coping strategies.
• Providing reflective space and strategies for managing uncertainty can better prepare future foundation doctors for complex patient care.