Tolerance of uncertainty and reflection ability among medical students in Germany

With growing recognition of uncertainty tolerance (UT) and reflection ability (RA) as core competencies for healthcare professionals, targeted promotion of these skills has become increasingly important in medical education. However, research on the associations between UT and RA and students' individual characteristics, such as age and gender, remains limited, and existing findings are inconsistent. Addressing this gap, the present study assesses UT and RA among medical students at entry to medical school, examines their associations with age and gender, and explores implications for the tailored design of educational interventions.

All first-year medical students at Ludwig Maximilian University and the Technical University of Munich were invited to participate in the survey during a compulsory joint course, Introduction to Clinical Medicine. The questionnaire, administered via EvaSys, included the Groningen Reflection Ability Scale, the Uncertainty Tolerance Scale, and demographic data.

A total of 761 participants were included in the analysis. The age could be determined for 384 participants, and the gender for 493 participants. Measuring UT resulted in a mixed picture: while students reported openness toward novel experiences, they simultaneously expressed a preference for predictability and routine. Linear regression analysis revealed no significant association between overall UT scores and age or gender (all p > 0.05). However, statistically significant gender differences emerged at the item level, with female students reporting lower tolerance of uncertainty. Regarding RA, linear regression analysis similarly revealed no significant association between overall GRAS scores and age or gender (R² = 0.002; all p > 0.05). However, statistically significant gender differences were identified at the item level, with female students reporting a higher level of self-underestimation and self-doubt.

Although overall UT and RA scores were not significantly associated with gender or age, exploratory item-level analysis suggested gender-specific differences in certain aspects of both constructs. Given the high proportion of female students, these differences may warrant further investigation and consideration in curriculum development to promote equitable opportunities and optimally prepare all students for clinical practice.