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Academic Medicine:
doi: 10.1097/ACM.0b013e318257d085
Letters to the Editor

Increasing Students’ Tolerance of Ambiguity: The Need for Caution

Hancock, Jason MBChB (Hons); Mattick, Karen MSc, PhD

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Honorary university fellow, Peninsula College of Medicine and Dentistry, Exeter, Devon, United Kingdom; Jason.hancock1@pcmd.ac.uk.

Associate director of undergraduate medical studies and senior lecturer (teaching and research) in clinical education, Peninsula College of Medicine and Dentistry, Exeter, Devon, United Kingdom.

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To the Editor:

Luther and Crandall1 make a strong case for medical schools’ needing to do more to increase their students’ tolerance of ambiguity. Many medical schools already aim to do this. Yet, very little is known about tolerance of ambiguity in medical students or clinicians, and almost nothing about how it changes during a student’s time at medical school.2 We believe there are questions that need answering and assumptions that need revisiting before the conclusion—that it is beneficial to increase students’ tolerance of ambiguity—can be drawn with confidence. For example:

* Is tolerance of ambiguity context independent, as assumed by the inventories used to date?

* Is an increased tolerance of ambiguity beneficial for every clinician? Would a workforce of clinicians with varied tolerance of ambiguity be more desirable?

* If tolerance of ambiguity is linked to specialty choice (as has been suggested), could increasing it lead to an under- or oversupply of trainees in particular specialties?

Further research and debate about tolerance of ambiguity are needed to augment existing findings, such as those of Shaw et al2 and Geller et al,3 who showed that students and doctors with higher tolerance of ambiguity were more likely to go into medical specialties such as psychiatry. et al4 have already demonstrated that students with a higher tolerance of ambiguity showed a smaller reduction in their favorable attitudes toward the underserved.

Until much more is known, we urge medical educators to be alert to the possible unintended consequences that may be associated with moves toward increasing undergraduates’ tolerance of ambiguity.

Jason Hancock, MBChB (Hons)

Honorary university fellow, Peninsula College of Medicine and Dentistry, Exeter, Devon, United Kingdom; Jason.hancock1@pcmd.ac.uk.

Karen Mattick, MSc, PhD

Associate director of undergraduate medical studies and senior lecturer (teaching and research) in clinical education, Peninsula College of Medicine and Dentistry, Exeter, Devon, United Kingdom.

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References

1. Luther VP, Crandall SJ. Commentary: Ambiguity and uncertainty: Neglected elements of medical education curricula? Acad Med.. 2011;86:799–800

2. Shaw A, Lewis E, Katyal S. Factors affecting recruitment into child and adolescent psychiatry training. Acad Psychiatry.. 2010;34:183–189

3. Geller G, Faden R, Levine D. Tolerance for ambiguity among medical students: Implications for their selection, training and practice. Soc Sci Med.. 1990;31:619–624

4. Wayne S, Dellmore D, Serna L, Jerabek R, Timm C, Kalishman S. The association between intolerance of ambiguity and decline in medical students’ attitudes toward the underserved. Acad Med.. 2011;86:877–882

© 2012 Association of American Medical Colleges

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