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Characterizing Personal Clinical Cognitive Uncertainty and Its Association With Clinical Judgment.

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This study explored personal clinical cognitive uncertainty in medical learners, finding it impacts clinical judgment. Understanding and teaching uncertainty tolerance can improve clinical decision-making and patient outcomes.

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Area of Science:

  • Medical Education
  • Cognitive Psychology
  • Clinical Decision Making

Background:

  • Clinical uncertainty is often studied in relation to scenarios or personal traits, but the interplay between context and individual characteristics is underexplored.
  • Personal and cognitive aspects of clinical uncertainty may operate at various cognitive levels, influencing judgment and training.
  • Understanding these nuances is crucial for improving medical training and practice.

Purpose of the Study:

  • To characterize and quantify different facets of personal clinical cognitive uncertainty.
  • To examine the associations between these uncertainty measures and clinical judgment.
  • To identify potential targets for improving medical education and clinical performance.

Main Methods:

  • 120 learners and 24 supervisors were recruited from the Centre hospitalier de l'Université de Montréal.
  • Learners completed 15 vignettes, rating their uncertainty, and their characteristics and supervisor-rated clinical judgment were recorded.
  • Five measures of uncertainty were quantified, and correlations and regressions were used to analyze associations with demographics, test scores, and clinical judgment.

Main Results:

  • Higher degrees of clinical uncertainty correlated with lower test scores, lower training levels, and being female.
  • Self-reported general uncertainty related to higher clinical uncertainty but lower calibration, while higher test scores correlated with better calibration.
  • Lower self-reported general uncertainty, lower degree of uncertainty, and higher relative/absolute calibrations were associated with better clinical judgment.

Conclusions:

  • Five distinct measures of personal clinical cognitive uncertainty were identified, each showing differential links to clinical judgment and knowledge.
  • Emphasizing the understanding and teaching of personal clinical cognitive uncertainty may enhance clinicians' tolerance for ambiguity.
  • Improved tolerance to uncertainty has the potential to enhance clinical judgment and ultimately improve patient outcomes.