A question I was often asked during fellowship interviews was "Tell me about a weakness of yours." Most trainees attempt spinning a weakness into a veiled strength, but I was advised to be genuine and honest instead. I admitted that I have had trouble handling ambiguous situations at crucial points of medical training. Through feedback from interviewers, I was told many trainees struggle with my predicament. This could be due to the multifaceted nature of medical exams and the ambiguous nature of the Match process. Both contribute to overthinking and analyzing ways to align a computerized algorithm toward a desired outcome. While seemingly pragmatic, it reflects a more significant issue: feeling uncomfortable with uncertainty and the need to address it.
The American Psychological Association defines tolerance of ambiguity (TOA) as the degree to which one can accept and function without distress or disorientation in conflicting or multiple interpretations.
Medical trainees have an ingrained need to strive for perfection, often extending into decreased tolerance of ambiguity. A study on medical students found that their TOA quotient as measured on standardized scales decreased post clerkships. This was attributed to frequent schedule and rotation changes. It was also noted that medical students' TOA changes over time, and a positive change was also associated with more empathy and openness to diversity.
Some experts opine that medical schools should consider strategies to assess TOA in their admissions process. Inculcating TOA throughout the curriculum and learning process will likely improve medical trainees' psychological well-being. It would help foster creativity and innovative thinking.
This need for ambiguity tolerance also extends to the art of patient care. We battle knowledge limitations and complexities of treatment options. We develop a provisional diagnosis and management plan, knowing that it might have to be altered dramatically based on the uncertainty of the patient's clinical response and eventual outcome.
For instance, my patient admitted with pulmonary embolism was found to have incidental liver lesions, which may have been malignant. I pushed to get an inpatient MRI to evaluate further, but my attending explained that it was better pursued outpatient. This taught me to balance uncertainty with other values, such as health care costs and patient comfort.
In patients with heart failure exacerbations who are fully compliant with medications and dietary restrictions, I often couldn’t uncover what triggered their decompensation. We still did our best to manage them using the same guidelines as those with an identifiable cause. I learned to be satisfied with a successful treatment plan, even when some questions lingered.
What are some ways in which we can better handle ambiguity? I developed a few strategies over the years that may benefit residents and fellows. Firstly, when applying through the Match, zoom in to each actionable step without a looming "bigger picture." This could be having each recommendation letter uploaded or finalizing your rank list. Treat each of them as a short-term goal and reward yourself for accomplishing them without wondering how it will impact your outcome.
Beyond the Match, there are a few approaches. Start by asking yourself what type of ambiguity you’re dealing with. Is it goal ambiguity on what you wish to achieve through a task/project, outcome ambiguity, or method ambiguity on resources or steps needed toward your desired end point? Allow yourself to give into scenario planning but recognize that it will never be 100% perfect. You will find yourself growing comfortable with not instantaneously having the right solution but staying flexible enough to figure it out with changing circumstances, and understand that the best outcome is only a matter of interpretation.
The beauty of uncertainty is infinite possibility.
How would you rank your ambiguity tolerance?
Sneha is a third-year internal medicine resident at Albert Einstein College of Medicine in New York City. She enjoys reading mystery novels, trying new restaurants, and swimming. She believes in the power of effective communication and, in the future, hopes to create a far-reaching platform for trainees to share experiences and personal stories. Twitter handle: @snehanandy26
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