Tolerating ambiguity as a Foundation doctor

In our study we are looking at the work doctors do, and using a range of measures related to wellbeing, including stress and burnout. In this post Dr Jason Hancock (Consultant Liaison Psychiatrist, Devon Partnership Trust & Honorary Clinical Lecturer, University of Exeter Medical School) writes about another of our key measures which may play an important role in wellbeing.


As part of this study we are collecting data on how interim F1 doctors respond to ambiguity in clinical practice. Both ambiguity and uncertainty are inherent within the practice of medicine. I recall when I was a foundation doctor even seemingly simple tasks, such as prescribing Warfarin, would be associated with significant uncertainty. For example it was often unclear what the patient’s usual Warfarin prescription was, why they were taking Warfarin, what their target INR should be, how much Warfarin they had actually been taking before admission, and if any changes to other medications since admission would be impacting on the metabolism of Warfarin. While some of the challenges associated with the prescription of Warfarin may have now reduced with the rise of new anticoagulant medications, the issue of managing and tolerating uncertainty remains. 

One of the challenges with research into this field to date has been the interchangeable use of the terms ambiguity and uncertainty. When we refer to ambiguity we mean a clinical situation where there is imprecise, missing, or conflicting information. When we refer to uncertainty we mean a clinical situation where we are consciously aware that we do not know what the outcome will be. This can be caused by many things including ambiguity or complexity. 

As a psychiatrist I am particularly interested in how our ability as doctors to tolerate ambiguity or uncertainty may be linked to our own psychological well-being, and his has been the focus of my research to date. 

To help evaluate how tolerant of ambiguity medical students and junior doctors are within clinical practice we developed the TAMSAD (Tolerance of Ambiguity in Medical Students and Doctors) scale. This scale was initially developed and validated in a population of medical students and foundation doctors in Exeter, and has since been used in a wide range of populations including veterinary students. 

Through taking part in this research and completing the TAMSAD, alongside other measures, you will help us understand how an ability to tolerate ambiguity may be linked to your own psychological well-being as doctors. It will also provide us with valuable information about the how doctors working in rapidly developed and novel roles such as yours tolerate ambiguity, and how practising within the context of a global pandemic can impact on your own ability to tolerate ambiguity and uncertainty in clinical practice.

Through better understanding these potential associations we hope to be better placed to develop educational interventions to help newly qualified doctors, such as you, tolerate and practice within an ambiguous and uncertainty clinical world. 

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