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Situational certainty, not individual traits, better predicts trainee decisions on invasive procedures for decompensating patients. Understanding context improves clinical actions and supervision seeking.

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Area of Science:

  • Medical Education
  • Acute Care Medicine
  • Clinical Decision-Making

Background:

  • Trainees in acute care face uncertainty when deciding on invasive procedures for unstable patients.
  • Individual psychological and cultural perceptions of uncertainty influence trainee actions.
  • The role of situational context versus trainee traits in managing uncertainty is underexplored.

Purpose of the Study:

  • To explore trainee actions in managing decompensating patients.
  • To assess if invasive intervention and supervision seeking depend on situational certainty or individual uncertainty perceptions.

Main Methods:

  • 41 internal medicine residents completed surveys on anxiety related to uncertainty (Physicians' Reactions to Uncertainty - PRU) and uncertainty avoidance (Values Survey Module - VSM).
  • Residents responded to 14 emergency scenarios with varying diagnostic certainty.
  • Mixed multivariable modeling analyzed the relationship between interventions, situational uncertainty, and trait-based perceptions.

Main Results:

  • Situational certainty was a stronger predictor of upfront intervention (OR, 30.5) than PRU (OR, 1.22) or VSM (OR, 1.73).
  • Situational certainty also predicted reduced supervision seeking (OR, 0.20) more strongly than PRU (OR, 2.03) or VSM (P not significant).
  • Trainees' initial actions were appropriate in 60% of cases.

Conclusions:

  • Situation-specific certainty, not individual trainee traits, more strongly correlates with invasive intervention decisions.
  • Improving trainee actions and supervision seeking may be more effective by focusing on contextual understanding of risk-benefit ratios.