Trainee Uncertainty around Intervening When Patients Decompensate

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.