Tolerating Uncertainty in the context of the MLA

Educator workshop 

2024-09-04

This workshop provided an overview of the new Medical Licensing Assessment (MLA), a national exam for medical students. A key feature of the MLA is its emphasis on preparing students to handle 'uncertainty' in clinical practice, highlighting this as an important area of focus.

Interesting themes/ideas from discussions 

1. Adaptive Expertise and Vulnerable Leadership

   • The concept of adaptive expertise emphasises being able to adjust and innovate in unfamiliar or uncertain situations.

   • Vulnerable leadership encourages leaders to be open about uncertainty—expressing "I don’t know" and thinking aloud with peers and patients. This fosters a culture of openness and collaborative problem-solving.

2. Experiencing and Managing Uncertainty

   • Tutors discussed the value of immersing learners in real-world uncertainty—akin to “throwing them in the deep end”—to build adaptive thinking.

   • Learning through uncertainty allows clinicians to grow by experiencing it

3. Emotional Impact of Uncertainty

   • Clinicians often feel pressured to provide a diagnosis, which may lead to discomfort when no definitive answer is apparent. It’s important to acknowledge and work through these feelings rather than avoid them.

   • The challenge of feeling like "I haven’t done anything" after a consultation can be difficult for both clinicians and students, but this discomfort is an important part of the learning process. 

   • Bringing patients back for follow-ups can help manage uncertainty and improve shared decision-making.

4. Incorporating Uncertainty into Medical Education

   • Recognising uncertainty as part of the curriculum, rather than a failure or knowledge gap, is essential.

   • This approach helps in developing the ability to tolerate and accept uncertainty.

   • Uncertainty should be presented as an opportunity for learning, fostering skills like reflection, seeking information, and lifelong learning—a cycle of curiosity.

5. Strategies for Managing Uncertainty

   • The group discussed how communication and shared decision-making are key tools for handling uncertainty. These approaches help involve the patient in the diagnostic and treatment process, easing some of the clinician’s burden of always providing clear answers.

   • The MLA will include OSCEs (Objective Structured Clinical Examinations) that have elements of uncertainty. Tutors wanted examples of these cases to support students. 

6. Assessing Students’ Ability to Handle Uncertainty

   • Assessing how students manage uncertain situations in clinical practice remains a challenge.