How we teach us medical students to negotiate uncertainty in clinical care: A Cera study

Background And Objectives: The patient relies on the physician to help negotiate medical evidence, particularly when experts disagree. For shared decision making to be most effective, the physician must disclose personal uncertainty. This study proposes to describe how uncertainty management is intentionally and systematically taught to medical students.

Methods: A cross-sectional survey was administered to all family medicine clerkship directors (FM CDs) at US allopathic medical schools. Items evaluated the teaching of uncertainty in two domains (instruction and modeling).

Results: Eighty-six of 134 (64.18%) FM CDs surveyed completed the survey. Overall, an average of 2.6 hours was devoted to learning about clinical guidelines. The teaching objective addressed least by this sample was discussing uncertainty with the patient. Most curricula do not engage the medical students in how to discuss uncertainty with patients. Hypothesis testing revealed that the clerkship’s general attitude toward the importance of teaching students how to deal with competing medical evidence is associated with both instruction and modeling behavior.

Discussion: FM CDs demonstrate a positive attitude toward teaching students how to deal with competing evidence. Clerkships do provide students with the opportunity to see faculty engage in uncertainty discussions with patients. Opportunities exist to improve medical student competence in discussing uncertainty in a productive manner. Clerkship directors influence curriculum development and implementation but through their attitude also construct a culture that can be positively aligned with teaching medical students how to negotiate uncertainty in clinical care.