Moving From Uncertainty to Internal Emotional Responses

We read with interest, and really enjoyed, the brief report by Taylor and colleagues, “A Pilot Study to Address Tolerance of Uncertainty among Family Medicine Residents.”1 We were pleased to learn how their restructured outpatient family medicine teaching rotations improved their residents’ abilities to attend to undifferentiated medical problems, manage ambiguity in clinical presentations, and abide moments of uncertainty.

Recently, there has been an increase in awareness around issues of self-efficacy, emotional intelligence, and mindfulness in medicine. Based on our understandings of these issues, we wonder if the factors the authors studied—behavioral responses—adequately represent the inner reality of residents’ experiences.2 Given that residency is known to be psychologically stressful,3 we encourage researchers to expand their investigative horizons and study the psychodynamic responses that commonly emerge in clinicians-in-training, including anxiety, negative dialogue, avoidance, shame, and disorientation.4 We also urge researchers to examine how residents can benefit from positive emotions so as to flourish in spite of stressful work environments. We suggest they begin exploring how we can best inculcate in our trainees confidence while dealing with complexity, habituate affirmative self-talk, encourage shared relational engagement, promote intentional practice, and develop curiosity when confronted with unknowing.5

Skilled family physicians are adept at attending to uncertainty.1 Our hope is that they and their research colleagues do not forget the “flip sides” of uncertainty—internal emotional reactions—as they work to educate new generations of physicians to do the work of family medicine with proficiency, equanimity, and authentic style.