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A typology of uncertainty derived from an analysis of critical incidents in medical residents: A mixed methods study.

Hamui-Sutton A, Vives-Varela T, Gutiérrez-Barreto S, Leenen I, Sánchez-Mendiola M - BMC Med Educ (2015)

Bottom Line: The model considers the final resolution at each of three levels: the patient, the health system, and the physician's personal level.This study gives insight into how medical residents make decisions under different types of uncertainty, giving account of the context in which the interactions take place and of the strategies used to resolve the incidents.These insights may guide the development of organizational policies that reduce uncertainty and stress in residents during their clinical training.

View Article: PubMed Central - PubMed

Affiliation: Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico. lizhamui@gmail.com.

ABSTRACT

Background: Medical uncertainty is inherently related to the practice of the physician and generally affects his or her patient care, job satisfaction, continuing education, as well as the overall goals of the health care system. In this paper, some new types of uncertainty, which extend existing typologies, are identified and the contexts and strategies to deal with them are studied.

Methods: We carried out a mixed-methods study, consisting of a qualitative and a quantitative phase. For the qualitative study, 128 residents reported critical incidents in their clinical practice and described how they coped with the uncertainty in the situation. Each critical incident was analyzed and the most salient situations, 45 in total, were retained. In the quantitative phase, a distinct group of 120 medical residents indicated for each of these situations whether they have been involved in the described situations and, if so, which coping strategy they applied. The analysis examines the relation between characteristics of the situation and the coping strategies.

Results: From the qualitative study, a new typology of uncertainty was derived which distinguishes between technical, conceptual, communicational, systemic, and ethical uncertainty. The quantitative analysis showed that, independently of the type of uncertainty, critical incidents are most frequently resolved by consulting senior physicians (49 % overall), which underscores the importance of the hierarchical relationships in the hospital. The insights gained by this study are combined into an integrative model of uncertainty in medical residencies, which combines the type and perceived level of uncertainty, the strategies employed to deal with it, and context elements such as the actors present in the situation. The model considers the final resolution at each of three levels: the patient, the health system, and the physician's personal level.

Conclusions: This study gives insight into how medical residents make decisions under different types of uncertainty, giving account of the context in which the interactions take place and of the strategies used to resolve the incidents. These insights may guide the development of organizational policies that reduce uncertainty and stress in residents during their clinical training.

No MeSH data available.


Related in: MedlinePlus

“Conceptual model of the different elements that interact when medical residents face uncertainty in clinical practice”. Uncertainty on critical incidents takes place within the clinical context and may be of different types, where distinct strategies may be activated to evaluate, decide and resolve the event. Stress and uncertainty may rise to different levels of intensity and the resolution may respond to diverse issues: patient health, resident’s learning and satisfaction, and health system goals
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Fig1: “Conceptual model of the different elements that interact when medical residents face uncertainty in clinical practice”. Uncertainty on critical incidents takes place within the clinical context and may be of different types, where distinct strategies may be activated to evaluate, decide and resolve the event. Stress and uncertainty may rise to different levels of intensity and the resolution may respond to diverse issues: patient health, resident’s learning and satisfaction, and health system goals

Mentions: Based upon the critical incidents in the qualitative study, together with the responses obtained from the questionnaires in the quantitative phase, we built a conceptual model, which represents the process faced and the trajectory followed by a resident when he/she is confronted with an extraordinary clinical situation that generates uncertainty (see Fig. 1). This model is relevant because it includes the interactions with different actors implied in the situations, which generally affect the strategies, decisions and actions taken in the situation and, in turn, may intensify the stress and uncertainty experienced by the resident. The context in which these actions take place is explicitly taken into account by reference to human and material resources, the prevailing norms in the hospital, and the patient’s expectancies and necessities. Furthermore, the model incorporates the effects in relevant domains, including the patient’s health, the organization of the system, and the satisfaction and learning experience of the resident. We now discuss each of the components of the model in light of the qualitative and quantitative results in the present study and, where appropriate, relate them to results from similar studies on medical uncertainty.Fig. 1


A typology of uncertainty derived from an analysis of critical incidents in medical residents: A mixed methods study.

Hamui-Sutton A, Vives-Varela T, Gutiérrez-Barreto S, Leenen I, Sánchez-Mendiola M - BMC Med Educ (2015)

“Conceptual model of the different elements that interact when medical residents face uncertainty in clinical practice”. Uncertainty on critical incidents takes place within the clinical context and may be of different types, where distinct strategies may be activated to evaluate, decide and resolve the event. Stress and uncertainty may rise to different levels of intensity and the resolution may respond to diverse issues: patient health, resident’s learning and satisfaction, and health system goals
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4634904&req=5

Fig1: “Conceptual model of the different elements that interact when medical residents face uncertainty in clinical practice”. Uncertainty on critical incidents takes place within the clinical context and may be of different types, where distinct strategies may be activated to evaluate, decide and resolve the event. Stress and uncertainty may rise to different levels of intensity and the resolution may respond to diverse issues: patient health, resident’s learning and satisfaction, and health system goals
Mentions: Based upon the critical incidents in the qualitative study, together with the responses obtained from the questionnaires in the quantitative phase, we built a conceptual model, which represents the process faced and the trajectory followed by a resident when he/she is confronted with an extraordinary clinical situation that generates uncertainty (see Fig. 1). This model is relevant because it includes the interactions with different actors implied in the situations, which generally affect the strategies, decisions and actions taken in the situation and, in turn, may intensify the stress and uncertainty experienced by the resident. The context in which these actions take place is explicitly taken into account by reference to human and material resources, the prevailing norms in the hospital, and the patient’s expectancies and necessities. Furthermore, the model incorporates the effects in relevant domains, including the patient’s health, the organization of the system, and the satisfaction and learning experience of the resident. We now discuss each of the components of the model in light of the qualitative and quantitative results in the present study and, where appropriate, relate them to results from similar studies on medical uncertainty.Fig. 1

Bottom Line: The model considers the final resolution at each of three levels: the patient, the health system, and the physician's personal level.This study gives insight into how medical residents make decisions under different types of uncertainty, giving account of the context in which the interactions take place and of the strategies used to resolve the incidents.These insights may guide the development of organizational policies that reduce uncertainty and stress in residents during their clinical training.

View Article: PubMed Central - PubMed

Affiliation: Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico. lizhamui@gmail.com.

ABSTRACT

Background: Medical uncertainty is inherently related to the practice of the physician and generally affects his or her patient care, job satisfaction, continuing education, as well as the overall goals of the health care system. In this paper, some new types of uncertainty, which extend existing typologies, are identified and the contexts and strategies to deal with them are studied.

Methods: We carried out a mixed-methods study, consisting of a qualitative and a quantitative phase. For the qualitative study, 128 residents reported critical incidents in their clinical practice and described how they coped with the uncertainty in the situation. Each critical incident was analyzed and the most salient situations, 45 in total, were retained. In the quantitative phase, a distinct group of 120 medical residents indicated for each of these situations whether they have been involved in the described situations and, if so, which coping strategy they applied. The analysis examines the relation between characteristics of the situation and the coping strategies.

Results: From the qualitative study, a new typology of uncertainty was derived which distinguishes between technical, conceptual, communicational, systemic, and ethical uncertainty. The quantitative analysis showed that, independently of the type of uncertainty, critical incidents are most frequently resolved by consulting senior physicians (49 % overall), which underscores the importance of the hierarchical relationships in the hospital. The insights gained by this study are combined into an integrative model of uncertainty in medical residencies, which combines the type and perceived level of uncertainty, the strategies employed to deal with it, and context elements such as the actors present in the situation. The model considers the final resolution at each of three levels: the patient, the health system, and the physician's personal level.

Conclusions: This study gives insight into how medical residents make decisions under different types of uncertainty, giving account of the context in which the interactions take place and of the strategies used to resolve the incidents. These insights may guide the development of organizational policies that reduce uncertainty and stress in residents during their clinical training.

No MeSH data available.


Related in: MedlinePlus