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Academic Medicine:
doi: 10.1097/ACM.0b013e3182586bdd
Letters to the Editor

Increasing Students’ Tolerance of Ambiguity: The Need for Caution

Wayne, Sharon MPH; Dellmore, Deborah MD; Kalishman, Summers PhD

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Associate scientist, Office of Program Evaluation, Education and Research, University of New Mexico School of Medicine, Albuquerque, New Mexico; swayne@salud.unm.edu.

Associate professor and director, Medical Student Education, Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, New Mexico.

Assistant professor and director, Office of Program Evaluation, Education and Research, University of New Mexico School of Medicine, Albuquerque, New Mexico.

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In Reply:

We agree with Hancock and Mattick that the topic of tolerance of ambiguity has not been fully studied in medical students. And we are aware that change is often accompanied by unintended consequences. However, to wait for definitive evidence that proposed changes have the desired effect and are free of major unintended consequences is probably not possible. Most change is instituted based on a reasonable assumption that it will be beneficial. It is our contention that the topic of ambiguity in medicine, which was once a part of the curriculum, should be reemphasized.

We’d like to clarify that we did not recommend that an effort be made to increase students’ tolerance of ambiguity. There is some evidence that the trait is a fixed one and not easily changed.1 Rather, we want to increase students’ awareness of the amount of ambiguity in medicine and its potential for causing distress. By so doing, we hope to reduce the number of instances in which students experience ambiguity as threatening. This approach may also allow students to make more informed specialty choices based on their own tolerance levels.

We have observed that the ambiguity inherent in treating the underserved is often analogous to an “elephant in the room,” something that is obvious but ignored. We hope that by acknowledging the distress caused by highly ambiguous situations, anxiety may be reduced and more thoughtful choices can be made.

Sharon Wayne, MPH

Associate scientist, Office of Program Evaluation, Education and Research, University of New Mexico School of Medicine, Albuquerque, New Mexico; swayne@salud.unm.edu.

Deborah Dellmore, MD

Associate professor and director, Medical Student Education, Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, New Mexico.

Summers Kalishman, PhD

Assistant professor and director, Office of Program Evaluation, Education and Research, University of New Mexico School of Medicine, Albuquerque, New Mexico.

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Reference

1. Budner S. Intolerance of ambiguity as a personality variable. J Pers.. 1962;30:29–50

© 2012 Association of American Medical Colleges

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