How does creative enquiry enable us to deal with uncertainty?

Uncertainty is an inherent and pervasive feature of medical practice. Here, uncertainty refers to the subjective perception and affective experience encountered by medical students and clinicians. Difficulties in managing uncertainty are associated with impaired communication in shared decision-making and may contribute to clinical burnout. Despite longstanding recognition of its importance, including recent UK curricular reforms focused on "managing uncertainty," it remains insufficiently addressed in medical practice. This study seeks to address this gap by examining how creative enquiry may support both learners and clinicians in engaging with uncertainty in practice.

We undertook a qualitative study using semi-structured interviews with ten participants (five medical students; five clinicians, comprising four general practitioners and one infectious disease specialist) with prior experience of creative enquiry. Participants were recruited through convenience sampling from a creative-enquiry student-selected component (SSC) and clinician networks. Interviews were conducted online, audio-recorded, and transcribed verbatim. Data were analysed inductively using Braun and Clarke's reflexive thematic analysis, supported by NVivo 14. Student participants had completed the SSC in preclinical years and were interviewed during clinical training. Creative enquiry activities included engagement with patient-generated creative work, arts-based practices (e.g. photography, collage, creative writing, sculpture), and facilitated group dialogue.

Three analytically related dimensions were generated: Issues, Processes, and Effects. Participants described uncertainty as intensified by binary epistemic cultures and the marginalisation of emotional experience. Creative enquiry involved engagement with indeterminate processes characterised by the absence of singular correct outcomes and the unpredictability of creative production. These processes enabled emotional processing, supporting participants to "digest" affective responses, and fostered a stance of "permission to play," legitimising experimentation and imperfection. Repeated engagement contributed to the normalisation of uncertainty, with parallels drawn to exposure. Reported effects included restoration of voice and recognition, reduction in the emotional burden of uncertainty, and enhanced reflexivity. Participants described an expanded capacity for perspective-taking and more complex conceptualisations of practice ("seeing medicine in three dimensions").

This study extends current understandings of uncertainty in medical education by identifying creative enquiry as a practice that integrates epistemic and affective engagement. We propose a Personal, Protective, and Embracing (PPE) framework, through which creative enquiry supports (i) articulation and emotional processing (Personal), (ii) containment and respite (Protective), and (iii) acceptance and constructive engagement with uncertainty (Embracing). These findings contribute to the operationalisation of "managing uncertainty" as a curricular competency and support further theoretically informed and empirical investigation of creative pedagogies in medical education.