불확실성에 대한 내성 측정: 1학년부터 6학년까지 단면연구(BMC Family Practice, 2014)

불확실성에 대한 내성 측정: 1학년부터 6학년까지 단면연구(BMC Family Practice, 2014)

Measuring the ambiguity tolerance of medical students: a cross-sectional study from the first to sixth academic years

Anne Weissenstein1*, Sandra Ligges2, Britta Brouwer3, Bernhard Marschall4 and Hendrik Friederichs3

배경

Background

버너 (Budner, 1962)는 모호성에 대한 불내성을 "모호한 상황을 위협의 원천으로 인식하는 경향"으로,  모호함에 대한 내성을 "모호한 상황을 바람직한 것으로 인식하는 경향"으로 정의한다 [1]. 모호함이란, '결과의 확률'이 알려지지 않은 위험의 한 유형이다 [2].

Budner (1962) defines intolerance of ambiguity as “the tendency to perceive ambiguous situations as sources of threat” and tolerance of ambiguity as the tendency to “perceive ambiguous situations as desirable” [1]. Ambiguity is a type of risk, in that the probability of the outcome is unknown [2].

• 모호성의 내성은 독창성과 새로운 아이디어에 대한 개방성 등 몇 가지 긍정적 인 특성과 관련되어 있습니다. 

• 대조적으로 모호함의 불내성은 낮은 정신적 유연성 뿐만 아니라, 정신적 강직, 순응, 민족적 편견과 같은 다른 부정적인 성격 특성과 관련되어있다 [1,3,4].

• Tolerance of ambiguity has been associated with several positive traits, such as originality and openness to new ideas [3]. 

• In contrast, intolerance of ambiguity has been associated with lower mental flexibility as well as other negative personality traits, such as mental rigidity, conformity, and ethnic prejudice [1,3,4].

보건 의료 산업에서의 고용은 진기함, 복잡성, 때로는 불용성으로 특징 지어진다. 따라서 의사들은 매우 복잡한 상황에 직면 할 수 있습니다. 왜냐하면 환자 진료란 광범위한 모호성을 반영하는 경향이 있기 때문입니다. Geller (2013)가 요약 한 바와 같이, 모호함에 대한 내성이 낮은 의사는 

• 유방 X 선 사진을 리콜할 가능성이 높고, 

• 환자에게 더 많은 비용을 청구하며, 

• 부정적인 유전자 검사 결과를 보류하고, 

• 의료 사고로 인한 소송을 두려워하고, 그 결과 방어적 진료를 하고, 

• 죽음과 슬픔의 맥락에서의 경험을 불편해하고 [10], 

• 더 검사를 내는 경향이 더 높으며, 

• 증거 기반 가이드 라인을 따르지 못하는 것을 보여줍니다 [11].

Employment in the health care industry is characterized by novelty, complexity, and sometimes insolubility [5]. Thus, physicians may encounter very complex situations, as they tend to patients whose treatments and diagnoses reflect a wide continuum of ambiguity. As Geller (2013) summarized, physicians who have a low tolerance of ambiguity are more likely to recall mammograms [6], increase patient charges [7], withhold negative genetic test results [8], fear malpractice litigation, and thus engage in defensive practice [9], experience discomfort in the context of death and grief [10], exhibit greater test-ordering tendencies, and demonstrate failure to comply with evidence-based guidelines [11].

모호성에 대한 내성은 의대생의 태도와 행동에 중요한 역할을합니다. 다음과 같은 특성들은 이 집단에서 모호성의 낮은 내성과 관련이있다 : 

• 취약집단에 대한 부정적인 태도 [12,13] 

• 실수를하는 것에 대한 두려움 [14]. 

반대로, 모호성에 대한 높은 내성은 

• 의대생의 리더십 능력의 향상과 

• 농촌 지역에서의 의료실천에 대한 의지의 증가와 관련이있다 [16,17]. 

학생들이 모호성을 다루는 방식이 malleable할  수 있습니다 [18].

Tolerance for ambiguity also plays an important role on the attitudes and behaviors of medical students. the following traits have been associated with a low tolerance of ambiguity in this population: negative attitudes toward the underserved [12,13] and fear of making mistakes [14]. Conversely, higher tolerance of ambiguity has been associated with greater leadership abilities in medical students [15] as well as increased willingness to practice in rural areas [16,17]. It is possible that the way students deal with ambiguity is malleable [18].

겔러 (Geller, 2013)는 그 이유를 설명하려고 시도했다. 의과대학에 입학하는 학생들은 불확실성으로 특징지어지는 의학의 특성에 끌려서 들어오는 것이고, 따라서 모호성과 관련된 의사 소통 및 의사 결정 기술을 발전시킬 기회를 더 많이 얻는다. 그러면 (이것이 선순환이 되어) 모호성 관련 커뮤니케이션 및 의사 결정 기술을 더욱 발전시킬 수있는 기회를 갖게됩니다. 이러한 결과는 모호함의 내성이 만들어내는 긍정적 피드백 루프입니다 [5]. 마찬가지로, 모호함에 대한 내성이 낮은 학생들에게는 부정적 피드백 루프가 작동 할 수 있는데, 모호한 상황을 피할수록 더욱 모호함에 대한 내성이 낮아지는 경향이 있기 때문이다.

Geller (2013) has attempted to explain why: medical students with a high tolerance of ambiguity entering medical school are drawn to uncertainties characterized by medicine and thus have the opportunity to further develop their ambiguity related communication and decision-making skills. These students would then have the opportunity to further develop their ambiguity-related communication and decision-making skills. The result is a positive feedback loop in which the tolerance of ambiguity increases in these students [5]. In a similar manner, a negative feedback loop may operate for students with a low ambiguity tolerance, as they may tend to avoid ambiguous situations and thus become even less tolerant [5].

방법

Methods

연구 설계 및 참가자

Study design and participants

Our study was conducted in the summer semester of 2013 at the medical school of the Westphalian Wilhelms University in Muenster, Germany. We used a crosssectional design to evaluate ambiguity tolerance in 622 medical students from the first to the sixth academic years, as well as 30 general practitioners.

성과 척도 및 측정 도구

Outcome measures and measuring instrument

Measurements were conducted using the Inventory for measuring ambiguity tolerance (IMA) by Reis (1997, Additional file 1) [21]. The IMA comprises 40 items, divided into the following five areas:

다음에 대한 모호함에 대한 내성을 측정 

Ambiguity tolerance with respect to:

• 명백하게 해결 불가능한 문제들 apparently insoluble problems (PR)

• 사회적 갈등 social conflicts (SC)

• 부모의 이미지 parental image (PI)

• 역할 고정관념 role stereotypes (RS) 

• 새로운 경험에 대한 개방성 openness to new experiences (OE). ## Critical thinking

As our aim was to conduct a survey in the context of an academic profession, we shortened the sections of the IMA that addressed parental image and role stereotypes. For the remaining three areas, the Cronbach’s alpha values ranged from .78 to .86, indicating acceptable levels of reliability.

Ambiguity tolerance was assessed for the three scales regarding 

• openness to new experiences (OE, eight questions in total), 

• social conflicts (SC, six questions in total), and 

• apparently insoluble problems (PR, six questions in total).

자료 분석

Data analysis

결과

Results

Figure 1 shows the scores for each of the three scales with respect to academic year together with the results from the general practitioners.

학년 간 유의한 점수 차이 없음.

We found no significant differences between 

• the scores (95% confidence interval) obtained by the general practitioners (OE score 20.5 (19.2–21.7), SC score 23.6 (21.8–25.3), PR score 15.3 (13.4–17.2)), and 

• those obtained by the medical students (p = .111 for OE score, p = .8 for SC score and p = .404 for PR score).

Discussion

우리의 연구 결과에 의하면 의대생은 새로운 경험에 대한 개방성과 명백하게 해결불가능한 문제에 대한 접근 방식에 대해 매우 낮은 수준의 모호성 내성을 가지고 있음을 나타냅니다. 여기서 우리는 새로운 경험과 사회적 갈등에 대한 개방성과 관련하여 성별에 따른 차이가 서로 다르다는 것을 발견했습니다. 

• 새로운 경험에 대한 개방성의 성별 차이는 거의 없었다 (남녀 모두 평균은 1 ~ 10 %였다). 

• 사회적 갈등에 대한 접근 방식의 차이 (여성 학생의 평균은 71-80 % 밴드 였고 남성 학생의 평균은 61-70 % 밴드 였음)는 사회적으로 바람직하게 여겨지는 행동에 대한 편향 때문일 수 있습니다. 

여러 학년 사이의 차이는 Reis (1997)가 제안한 기준 그룹과 관련하여 유의하지 않았다. 일반 의사는 높은 수준의 모호한 내성을 갖고 있다고 여겨지지만, Reis (1997)가 제시 한 참조 그룹과 우리의 표본 사이에 임상적으로 관련된 비 유사성을 발견하지 못했습니다.

The results of our study indicate that medical students have a very low level of ambiguity tolerance regarding openness to new experiences and in their approach to apparently insoluble problems. Here, we detected gender-specific differences with respect to openness to new experiences and social conflicts. However, the gender-based differences in openness to new experiences were minimal (the average for both female and male students was in the 1–10% band). The observed differences in approach to social conflicts (average for female students was in the 71–80% band and the average for male students was in the 61–70% band) may have been due to a behavioral response bias regarding social desirability. Although we observed differences between the various academic years, these differences were not significant with respect to the reference groups suggested by Reis (1997). Although general practitioners are thought to possess a higher level of ambiguity tolerance, we did not detect any clinically relevant dissimilarities between our sample and the reference groups suggested by Reis (1997).

어린 학생이 나이가 많은 학생보다 모호함에 대한 내성이 떨어진다는D eForge (1989) 및 Tatzel (1980)의 연구와 대조적으로, 우리는 집단 별 차이점을 발견하지 못했다. 모호함 내성이 청소년기부터 중년까지 안정적으로 유지되고 50 세가 될 때까지 변하지 않는다는 Reis (1997)의 발견을 뒷받침 해 주면서, 우리는 의대 학년간의 모호성에 대한 내성에 차이가 없음을 발견했다 . 일반적으로, 우리 학생집단은 Reis [21]에 의해 연구 된 것보다 모호함에 대한 내성이 떨어지는 것처럼 보였다. 우리의 연구 결과는 의대생이 Reis의 연구 이후 수년간 모호성 관용의 측면에서 변화했다는 것을 나타냅니다

In contrast with DeForge (1989) and Tatzel (1980), who found younger students to be more intolerant of ambiguity than older students [3,24], we did not detect cohort-specific differences. Corroborating the findings of Reis (1997), who stated that ambiguity tolerance tends to remain stable from adolescence to middle age, and does not change until around age 50 [21], we found no differences in ambiguity tolerance between the academic years of medical school. In general, our student population appeared to be more intolerant of ambiguity than those studied by Reis [21]. Our findings may indicate that medical students have changed in terms of their ambiguity tolerance in the years since Reis’ study

DeForge는 1970 년대 학생들이 1950 년대의 학생들보다 불확실성을 더 잘 처리 할 수 ​​있다고 밝힌 폭스 (Fox [25])연구에서의 경향에도 불구하고, 기술에 대한 의존도가 높아짐에 따라 오늘날보다 많은 구조화를 추구할 수 있으며, 그 결과로 그들의 선배의사보다 모호함을 더 위협으로 인식하는 경향이 있을 수 있다. 모호성에 내성이 강한 의대생은 가정의학과 같은 덜 구조화된 전공을 선택하는 경향이 있기 때문에, GP들이 학생들보다 모호성에 대한 더 높은 내성을 가질 것으로 예상됩니다. 그러나 들어오는 의대생의 의학 전문화 선호도에 따라 모호성 편협성에 차이가 없다는 것을 발견 한 DeForge와 마찬가지로 GP와 의대생간에 임상적으로 관련된 차이를 발견하지 못했습니다 [24, 27].

Despite the trend described by Fox [25], who perceived students in the 1970s as being more capable of dealing with uncertainty than those in the 1950s, DeForge hypothesized that, owing to their increasing dependence on technology, students today may be seeking more structure than their predecessors, and thus may perceive ambiguity as more of a threat [24]. As medical students who are more tolerant of ambiguity tend to choose more unstructured specialties, such as family practice [1,26], we expected that general practitioners would have a higher ambiguity tolerance than students. However, like DeForge, who found no differences in ambiguity intolerance based on the medical specialization preferences of incoming medical students, we found no clinically relevant differences between general practitioners and medical students [24,27].

일반 의사가 의대생과는 다른 수준의 모호한 내성을 보이는다면 이는 (학생들에게 진단 기술을 가르치려는 노력과 함께) 중요한 교육적 고려 사항이 될 수 있습니다. 이는 결국 정확성과 세심한 배려가 학문적, 직업적 성공에 핵심적인 역할을 할 것이다.

If general practitioners do exhibit a different level of ambiguity tolerance to medical students, this may be an important educational consideration, alongside the efforts to train students to have sound diagnostic skills, in which accuracy and attention to detail play a central role in academic and professional success [28].

Conclusions

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BMC Fam Pract. 2014 Jan 9;15:6. doi: 10.1186/1471-2296-15-6.

Measuring the ambiguity tolerance of medical students: a cross-sectional study from the first to sixth academic years.

Weissenstein A1, Ligges S, Brouwer B, Marschall B, Friederichs H.

Author information

1

Department of Gastroenterology and Hepatology, University Hospital of Cologne, Kerpener Strasse 62, Cologne, 50937 Germany. anne.weissenstein@gmail.com.

Abstract

BACKGROUND:

Tolerance of ambiguity, or the extent to which ambiguous situations are perceived as desirable, is an important component of the attitudes and behaviors of medical students. However, few studies have compared this trait across the years of medical school. General practitioners are considered to have a higher ambiguity tolerance than specialists. We compared ambiguity tolerance between general practitioners and medical students.

METHODS:

We designed a cross-sectional study to evaluate the ambiguity tolerance of 622 medical students in the first to sixth academicyears. We compared this with the ambiguity tolerance of 30 general practitioners. We used the inventory for measuring ambiguity tolerance(IMA) developed by Reis (1997), which includes three measures of ambiguity tolerance: openness to new experiences, social conflicts, and perception of insoluble problems.

RESULTS:

We obtained a total of 564 complete data sets (return rate 90.1%) from medical students and 29 questionnaires (return rate 96.7%) from general practitioners. In relation to the reference groups defined by Reis (1997), medical students had poor ambiguity toleranceon all three scales. No differences were found between those in the first and the sixth academic years, although we did observe gender-specific differences in ambiguity tolerance. We found no differences in ambiguity tolerance between general practitioners and medicalstudents.

CONCLUSIONS:

The ambiguity tolerance of the students that we assessed was below average, and appeared to be stable throughout the course of their studies. In contrast to our expectations, the general practitioners did not have a higher level of ambiguity tolerance than the students did.

PMID:

 

24405525

 

PMCID:

 

PMC3897997

 

DOI:

 

10.1186/1471-2296-15-6