Tolerance of ambiguity in doctors-in-training and links with psychological well-being

Abstract

There is a high prevalence of psychological morbidity in doctors-in-training (medical students and trainee doctors) with a subsequent impact on delivery of healthcare. The practice of medicine involves inherent ambiguity leading to uncertainty, and there is growing evidence that reduced tolerance of ambiguity in doctors-in-training may be associated with reduced psychological well-being. However research into this important construct is hampered by a lack of conceptual clarity relating to the underpinning constructs, and a lack of validated measurement tools. Furthermore, it remains unclear if tolerance of ambiguity, in medical students, doctors and similar professional groups, such as vets, is a dynamic state that can be influenced by medical education interventions. The aim of this thesis is to develop understanding and approaches to measurement of the tolerance of ambiguity construct in doctors-in-training, using veterinary trainees as a comparison group, and to improve understanding of the potential association between tolerance of ambiguity and psychological well-being. This thesis describes the development of a high quality Tolerance of Ambiguity in Medical Students and Doctors (TAMSAD) measurement scale. Variants of the scale were used to compare tolerance of ambiguity in medical and veterinary students. Existing literature was assessed to determine if there is an association between tolerance of ambiguity and psychological well-being in the medical population. A conceptual model is proposed relating to the tolerance of ambiguity construct, and the mediating and moderating factors that may influence the relationship with psychological well-being. The broader ambition of this thesis is to support development and evaluation of future educational interventions which will ultimately improve psychological well-being of doctors-in-training, and support improved workforce sustainability and high quality patient care.