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Adv Health Sci Educ Theory Pract. 2018 Nov 2. doi: 10.1007/s10459-018-9859-5. [Epub ahead of print]

Comfort with uncertainty: reframing our conceptions of how clinicians navigate complex clinical situations.

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Department of Emergency Medicine and Center for Leadership and Innovation in Medical Education, University of Washington School of Medicine, Seattle, WA, USA.
Department of Medicine and Centre for Health Education Scholarship, University of British Columbia, Vancouver, BC, Canada.
Department of Educational Development and Research, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands.
Department of Medicine and Office of Applied Scholarship and Education Science, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
Department of Surgery and Centre for Health Education Scholarship, University of British Columbia, Vancouver, BC, Canada.


Learning to take safe and effective action in complex settings rife with uncertainty is essential for patient safety and quality care. Doing so is not easy for trainees, as they often consider certainty to be a necessary precursor for action and subsequently struggle in these settings. Understanding how skillful clinicians work comfortably when uncertain, therefore, offers an important opportunity to facilitate trainees' clinical reasoning development. This critical review aims to define and elaborate the concept of 'comfort with uncertainty' in clinical settings by juxtaposing a variety of frameworks and theories in ways that generate more deliberate ways of thinking about, and researching, this phenomenon. We used Google Scholar to identify theoretical concepts and findings relevant to the topics of 'uncertainty,' 'ambiguity,' 'comfort,' and 'confidence,' and then used preliminary findings to pursue parallel searches within the social cognition, cognition, sociology, sociocultural, philosophy of medicine, and medical education literatures. We treat uncertainty as representing the lived experience of individuals, reflecting the lack of confidence one feels that he/she has an incomplete mental representation of a particular problem. Comfort, in contrast, references confidence in one's capabilities to act (or not act) in a safe and effective manner given the situation. Clinicians' 'comfort with uncertainty' is informed by a variety of perceptual, emotional, and situational cues, and is enabled through a combination of self-monitoring and forward planning. Potential implications of using 'comfort with uncertainty' as a framework for educational and research programs are explored.


Ambiguity; Clinical reasoning; Comfort; Complexity; Expertise; Medical decision-making; Uncertainty


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