薬学生の臨床推論における不確実性の受容：シミュレーションベースのアプローチ

To explore whether simulation-based exposure to ambiguous patient simulations, combined with structured reflection, supports pharmacy students' clinical reasoning and ability to manage uncertainty.

Third-year PharmD students at two Canadian universities completed a two simulations over two weeks. Week 1 involved shared decision making with a standardized patient presenting with depression; Week 2 introduced an unexpected adverse outcome. Students completed structured reflections using a modified Student-Generated Reasoning Tool (SGRT) after Simulation 1, and a guided reflection after Simulation 2. Data were analyzed descriptively and through inductive thematic analysis.

A total of 259 students from two institutions engaged in the educational activity. After Simulation 1, most students reported being "more likely to change the medication" if they received new findings, making them less certain with their initial medication choice. After Simulation 2, with an unexpected outcome, students felt the most uncomfortable learning about the adverse reaction the patient experienced. The most common reason students felt comfortable after Simulation 2, was trusting in their clinical reasoning process.

Structured exposure to uncertainty reinforced that sound clinical reasoning can coexist with unpredictable outcomes. When discomfort arose, students were able to rationalize why their initial clinical reasoning and decision-making remained valid, reinforcing the concept that uncertainty and negative outcomes do not necessarily indicate flawed decision making.