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      Understanding uncertainty in medicine: concepts and implications in medical education

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          Abstract

          In an era of high technology and low trust, acknowledging and coping with uncertainty is more crucial than ever. Medical uncertainty has been considered an innate feature of medicine and medical practice. An intolerance to uncertainty increases physicians’ stress and the effects of burnout and may be a potential threat to patient safety. Understanding medical uncertainty and acquiring proper coping strategies has been regarded to be a core clinical competency for medical graduates and trainees. Integrating intuition and logic and creating a culture that acknowledges medical uncertainty could be suggested ways to teach medical uncertainty. In this article, the authors describe the concepts of medical uncertainty, its influences on physicians and on medical students toward medical decision making, the role of tolerance/intolerance to uncertainty, and proposed strategies to improve coping with medical uncertainty.

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          Most cited references43

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          Toward a common taxonomy of competency domains for the health professions and competencies for physicians.

          Although health professions worldwide are shifting to competency-based education, no common taxonomy for domains of competence and specific competencies currently exists. In this article, the authors describe their work to (1) identify domains of competence that could accommodate any health care profession and (2) extract a common set of competencies for physicians from existing health professions' competency frameworks that would be robust enough to provide a single, relevant infrastructure for curricular resources in the Association of American Medical Colleges' (AAMC's) MedEdPORTAL and Curriculum Inventory and Reports (CIR) sites. The authors used the Accreditation Council for Graduate Medical Education (ACGME)/American Board of Medical Specialties six domains of competence and 36 competencies delineated by the ACGME as their foundational reference list. They added two domains described by other groups after the original six domains were introduced: Interprofessional Collaboration (4 competencies) and Personal and Professional Development (8 competencies). They compared the expanded reference list (48 competencies within eight domains) with 153 competency lists from across the medical education continuum, physician specialties and subspecialties, countries, and health care professions. Comparison analysis led them to add 13 "new" competencies and to conflate 6 competencies into 3 to eliminate redundancy. The AAMC will use the resulting "Reference List of General Physician Competencies" (58 competencies in eight domains) to categorize resources for MedEdPORTAL and CIR. The authors hope that researchers and educators within medicine and other health professions will consider using this reference list when applicable to move toward a common taxonomy of competencies.
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            Tolerance of uncertainty: Conceptual analysis, integrative model, and implications for healthcare.

            Uncertainty tolerance (UT) is an important, well-studied phenomenon in health care and many other important domains of life, yet its conceptualization and measurement by researchers in various disciplines have varied substantially and its essential nature remains unclear.
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              Varieties of uncertainty in health care: a conceptual taxonomy.

              Uncertainty is a pervasive and important problem that has attracted increasing attention in health care, given the growing emphasis on evidence-based medicine, shared decision making, and patient-centered care. However, our understanding of this problem is limited, in part because of the absence of a unified, coherent concept of uncertainty. There are multiple meanings and varieties of uncertainty in health care that are not often distinguished or acknowledged although each may have unique effects or warrant different courses of action. The literature on uncertainty in health care is thus fragmented, and existing insights have been incompletely translated to clinical practice. This article addresses this problem by synthesizing diverse theoretical and empirical literature from the fields of communication, decision science, engineering, health services research, and psychology and developing a new integrative conceptual taxonomy of uncertainty. A 3-dimensional taxonomy is proposed that characterizes uncertainty in health care according to its fundamental sources, issues, and locus. It is shown how this new taxonomy facilitates an organized approach to the problem of uncertainty in health care by clarifying its nature and prognosis and suggesting appropriate strategies for its analysis and management.

                Author and article information

                Journal
                Korean J Med Educ
                Korean J Med Educ
                KJME
                Korean Journal of Medical Education
                Korean Society of Medical Education
                2005-727X
                2005-7288
                September 2018
                27 August 2018
                : 30
                : 3
                : 181-188
                Affiliations
                Department of Medical Education, Korea University College of Medicine, Seoul, Korea
                Author notes
                Corresponding Author: Young-Mee Lee ( https://orcid.org/0000-0002-4685-9465) Department of Medical Education, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Korea Tel: +82.2.2286.1098 Fax: +82.2.928.1647 email: ymleehj@ 123456korea.ac.kr
                Author information
                http://orcid.org/0000-0002-3518-575X
                http://orcid.org/0000-0002-4685-9465
                Article
                kjme-2018-92
                10.3946/kjme.2018.92
                6127608
                30180505
                fd1525a6-2be0-493a-88c2-b44d3024dd22
                © The Korean Society of Medical Education. All rights reserved.

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 22 May 2018
                : 27 June 2018
                : 5 July 2018
                Categories
                Review Article

                uncertainty,decision making,medical education,competency-based education,heuristics

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