Learning Objectives: Managing uncertainty represents a significant source of stress for clinicians and trainees. Self-compassion is a strategy to help individuals cope with stress. The objective of this study is to determine the relationship between intolerance of uncertainty and self-compassion in medical students.

Background: For clinicians, higher scores on the Intolerance of Uncertainty Scale (IUS) have been linked with failure to comply with evidence-based guidelines and higher likelihood of burnout. In contrast, higher self-compassion scores are correlated with decreased stress and burnout. A negative correlation between self-compassion and intolerance of uncertainty has been demonstrated in college students and general population. This relationship has not been examined in medical students and provides a possible curricular aim for addressing stress as they transition to clinical learning environments during clerkships.

Objectives: The goal of our study is to determine if there is a correlation between intolerance of uncertainty and self-compassion in medical students.

Methods: Third-year medical students (n=273) completed the IUS short version and the Self-Compassion Short Form (SCSF) through an online survey. Data was de-identified and a linear regression analysis was conducted to predict IUS based on SCSF. Pearson correlation was also calculated.

Results: Response rate was 95% (259/273). IUS and SCSF scores were treated as continuous variables and analyzed parametrically. Mean scores for IUS and SCSF in medical students did not differ from previously reported means (p=0.14 and p=0.43 respectively). A significant regression equation was found (F(1,256) = 48.372, p<0.0001) with an R2 of 0.159. Pearson correlation was calculated at r = 0.399 (moderate effect size).

Conclusion: A significant negative correlation was found between intolerance of uncertainty and self-compassion (p<0.0001). While findings suggest that self-compassion predicts intolerance of uncertainty, future studies should examine its implications on the role of curriculum in preparing learners for clinical uncertainty.

Learning Objectives: Our study aims to describe how emergency medicine physicians engage in and rely on informal and incidental learning when working through the uncertainty of clinical practice.

Background: Informal learning is implicit, organic, and unstructured. Opportunities for informal learning arise in ill-structured, unstable environments where established processes may fail to provide a means of understanding situations or to develop strategies to problem-solve. We examined the Marsick and Watkins Model of Informal and Incidental Learning (IIL) as a framework to describe how physicians learn in the clinical environment, particularly when working through heightened uncertainty.

Objective: Our study aims to describe how emergency medicine physicians engage in and rely on informal and incidental learning when working through the uncertainty of clinical practice.

Methods: A qualitative deductive analysis of physicians’ narratives using the critical incident technique was conducted to gain an understanding of the components of IIL. Six frontline emergency medicine and six critical care physicians who worked during the height of the pandemic (March-June 2020) were interviewed. Investigators shortened narratives from recorded, transcribed interviews into cohesive, chronological stories using participants’ words. We applied codes from the IIL Model and engaged in constant comparative analysis to identify categories, patterns, and sequences of IIL.

Results: Data suggest that the IIL Model and its components serve as an explanatory framework to describe physicians’ learning during uncertainty (Table 1). Consistent with previous research from the non-healthcare sector, the complexity of IIL is captured as cyclical, non-linear, non-sequential and highly intertwined with patient care.

Conclusions: Data from physicians’ critical incidents clarifies understanding of IIL when working through clinical uncertainty. The Marsick and Watkins Model offers an explanatory framework for how IIL may guide educational programming that links to stages of IIL to prime students for the learning they will engage in when in clinical practice.

Learning Objectives: Identify and compare the lessons students learn from participating in peer role-play as either physician, patient, or observer.

Background: Communication Skills Training (CST) is an important part of undergraduate medical training, with instructional modalities including peer role-play (RP) and simulated patients (SP). Research comparing effectiveness of RP and SP is mixed, with some evidence suggesting RP may better develop empathy. Unlike with SP CST, students participating in RP CST spend time portraying patients. The impact of this patient role-play has not been explored.

Methods: We developed a virtual RP case in which a physician communicates diagnostic uncertainty to a patient being discharged from the emergency department. We scripted three roles: physician, patient, and observer. Third-year medical students complete the RP, then enter small-group break-out rooms (10 students) for facilitated debriefing, which we transcribe. Each session included only students from a single role. Qualitative analysis began with generation of inductive codes. Pairs of researchers developed preliminary codebooks for each role, testing codes against several transcriptions. We integrated these codebooks into a master codebook to be used on all transcriptions.

Results: 273 students participated, yielding 24 transcriptions with >85,000 words. Preliminary analysis revealed themes that differed between roles. Students playing the physician tend to emphasize useful lessons they gleaned, whereas those playing patients discussed empathy and the emotional impact of decisions by the physician role.

Conclusion: Initial results indicate that role-playing as patient may support learning in ways that playing as physician does not. Educators should utilize RP with an eye towards these benefits, emphasizing engagement when playing the role of the patient.