SUMMARY
The skill of managing clinical uncertainty is fundamental to the practice of family medicine, and can be celebrated as a strength of our specialty. It is a teachable skill, best learned through reflective case discussion and by observing one’s teachers and mentors explicitly managing their own uncertainty.
TAKE AWAY TIDBITS
- Label uncertainty when you and your learner encounter it
- Explicitly review strategies for dealing with uncertainty with learners
- Address the feelings associated with uncertainty
- Model how to handle uncertainty explicitly
SUMMARY
Teaching Strategies for Managing Clinical Uncertainty
- The skill of managing clinical uncertainty is fundamental to the practice of family medicine, and can be celebrated as a strength of our specialty. It is a teachable skill, best learned through reflective case discussion and by observing one’s teachers and mentors explicitly managing their own uncertainty.
- Identify the concept of uncertainty right up front at the beginning of any clinical rotation
- Model managing uncertainty: faculty willingness to disclose gaps in their own knowledge, and then demonstrate how to find answers to questions, has been shown to be an independent predictor of effective teaching
- Use of “SNAPPS “– learner centered presentation technique that can increase learners expressions of uncertainty thus transforming private thoughts about uncertainty to discussable teaching opportunities.
- Random case review, using “what if” questions.
- Specifically identify in and out of appointment strategies
Strategies within Patient Encounters
- Expect uncertainty
- Allow the patient to control initial data collection with open ended questions
- Gather sufficient data
- Slow down clinical reasoning
- Identify the patient’s agenda (FIFE, ICE)
- Sick/not sick?
- What is most likely, and rule out the serious
- Clinical decision tools
- Introduce the possibility of emotional distress contributing to symptoms early on
- Clinical pause
Strategies Outside Patient Encounters
- Present case to preceptor, colleague
- Reflect on cases while charting or at the end of the day, give yourself a “second opinion”
- Check in with self and acknowledge feelings – be able to forgive yourself and others when managing the unexpected
RESOURCES
Managing uncertainty in general practice supervisor guide
General Practice supervisors Australia
Primary Care Knowledge Boost Podcast ”Dealing with Uncertainty”
https://www.pckb.org/e/dealing-with-uncertainty-1602494023/
Wolpaw T, Coˆte ́ L, Papp KK, Bordage G. Student uncertainties drive teaching during case presentations: more so with SNAPPS. Acad Med. 2012;87(9):1210–1217.