Exploring response process validity of uncertainty tolerance scales implemented among health professions students

Uncertainty tolerance (UT) describes how individuals perceive and respond to uncertainty. Quantitative UT scales developed with physicians have been widely used in the health professions literature; however, recent studies have raised questions about their validity when implemented among students. This study explored response process validity of two commonly implemented UT scales, the Physician's Reactions to Uncertainty (PRU1995) and Tolerance for Ambiguity (TFA) scales, addressing the research question: How do health professions students conceptualize uncertainty tolerance in scale items, and what features of the scales (e.g., clarity, context, or relatability of items) influence their conceptualizations? Cognitive interviewing captured the thought processes of Australian (11) and US (22) health professions students while responding to PRU1995 or TFA items. Interviews were analyzed using a team-based approach to framework analysis. The study found that students conceptualized items in ways that were specific to the student role and context and struggled to relate to clinically contextualized scale items. Factors that moderated students' responses were identified, including limited responsibility for patient outcomes, self-reflection, and goals related to academic success. Having identified student-specific conceptualizations of the UT construct as well as issues of item relatability, context, and clarity, we caution against using the PRU1995 or TFA scales among health professions students. This work has potential for informing UT measurement in research and education and advancing theoretical models of UT in health professions students.