Navigating uncertainty should be a core training milestone

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The article argues that medical training should prepare clinicians to acknowledge and manage uncertainty rather than treating definitive answers as the only sign of competence. It cites research linking difficulty tolerating uncertainty with stress, reduced resilience, depression, and burnout among clinicians, and discusses its relationship to diagnostic decisions.

Chris Whitty is right to call for doctors to be better trained in holding and managing risk.1 But this requires a foundational capacity that medicine has historically struggled to cultivate: the ability to work well with uncertainty.Uncertainty is intrinsic to clinical practice, yet medical training has traditionally rewarded definitive answers. A decade ago, Richard Schwartzstein and I argued in the New England Journal of Medicine that medicine’s reluctance to acknowledge uncertainty left doctors poorly prepared for clinical practice.2 When uncertainty feels associated with ignorance or incompetence, it is unsurprising that clinicians may seek to suppress or deny it rather than learn to work productively within it.My subsequent research with colleagues has explored why this matters. Among paediatric trainees, greater stress from uncertainty was strongly associated with lower resilience, as well as depression and burnout.3 Among 217 primary care physicians, tolerance of uncertainty was associated with differences in diagnostic test ordering...