Making decisions "in the dark": Learning through uncertainty in clinical practice during Covid-19

Area of Science:

• Medical Education
• Clinical Learning Environments
• Physician Decision-Making

Background:

• The COVID-19 pandemic created unprecedented uncertainty in clinical learning environments.
• Frontline physicians faced complex challenges in decision-making and learning.

Purpose of the Study:

• To explore decision-making and informal and incidental learning (IIL) in the clinical learning environment during the pandemic.
• To understand IIL among physicians navigating uncertainty.
• To inform the creation of medical student experiences simulating IIL and using uncertainty as a learning catalyst.

Main Methods:

• Modified constructivist, grounded theory approach.
• Critical incident technique with virtual interviews of 12 physicians (ED and ICU).
• Inductive, comparative analysis of transcribed and restoried interviews.

Main Results:

• Decision-making was influenced by physical, emotional, relational, and situational contexts.
• Decision-making patterns included simplifying problems using prior knowledge, pattern recognition, and team consultation.
• IIL patterns involved trial and error, experimentation, consulting diverse information sources, and exploring clinical peripheries.

Conclusions:

• Decision-making patterns and IIL approaches observed can be integrated into formal medical curricula.
• Explicitly addressing and practicing navigation of uncertainty can better prepare learners for clinical practice.