Implementation of a curriculum on communicating diagnostic uncertainty for clerkship-level medical students: a pseudorandomized and controlled study
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Neha Bansal Etherington
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Casey N. McQuade
Abstract
Objectives
Physicians rarely receive formal training on communicating diagnostic uncertainty to patients. Best practices in timing and educational strategies are not established. We aimed to develop, implement and assess a curriculum on communicating uncertainty for medical students.
Methods
This was a pseudorandomized and controlled study. Students on their Internal Medicine Clerkship during the study period from February to August 2023 were invited to participate and separated into control and intervention groups based on assigned rotation site. Students in the intervention group received a curriculum on communicating diagnostic uncertainty. All students completed a subscale of the Physicians’ Reaction to Uncertainty Scale (PRUS) at the beginning of their clerkship and at the end of week 4 and an Objective Structured Clinical Examination (OSCE) at the end of week 4.
Results
Fifty-four students participated in the curriculum (29 intervention, 25 control). Intervention group students scored 2.13 points higher than control group students on their skills assessment (mean OSCE for intervention group=14.3, control group=12.17, p<0.001). PRUS increased in both groups, indicating improved tolerance of uncertainty, with no significant difference in change in PRUS between groups (mean change in PRUS for intervention group=2.68, control group=4.82, p=0.33). 97.7 % of students agreed that a curriculum on uncertainty should be included in their medical training.
Conclusions
Students who participated in a curriculum on communication of uncertainty demonstrated superior skills in communicating uncertainty during their OSCE. There was a significant increase in PRUS indicating decreased stress associated with uncertainty for all students. This may reflect high levels of baseline stress associated with starting a clerkship, maturation, exposure to cases, or role-modeling by the clinical team.
Funding source: Gordon and Betty Moore Foundation
Funding source: Society to Improve Diagnosis in Medicine
Funding source: Thomas H Nimick Research Fund
Acknowledgments
The authors wish to thank Dr. Reed Van Deusen and the simulation education team at the University of Pittsburgh School of Medicine for their contributions to SP case development and implementation.
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Research ethics: The project met criteria for exemption for educational strategies and curricula by the University of Pittsburgh Institutional Review Board.
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Informed consent: Participants were informed of the study using a pre-approved script at their clerkship orientation and were given the opportunity to request that their work not be used for research purposes.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission. Neha Bansal Etherington is the first author and corresponding author. She is a board-certified internist, Associate Professor of Clinical Medicine in the Department of Medicine at the Lewis Katz School of Medicine at Temple University, and Associate Program Director for the Internal Medicine Residency Program at Temple University Hospital in Philadelphia, PA. Casey McQuade is a board-certified internist, Assistant Professor of Medicine in the Department of Medicine, and co-Lead of the Clinical Reasoning Thread for the University of Pittsburgh School of Medicine in Pittsburgh, PA. Amar Kohli is a board-certified internist, Assistant Professor of Medicine in the Department of Medicine and Clerkship Director of the Adult Inpatient Internal Medicine Clerkship at the University of Pittsburgh School of Medicine in Pittsburgh, PA. Deborah DiNardo is a board-certified internist, Associate Professor of Medicine and co-Lead of the Clinical Reasoning Thread for the University of Pittsburgh School of Medicine, and Associate Program Director for Outpatient VA Education at the University of Pittsburgh Internal Medicine Residency Program, in Pittsburgh, PA. Scott Rothenberger is a statistician and Assistant Professor of Medicine in the Department of Medicine at the University of Pittsburgh School of Medicine in Pittsburgh, PA. Eliana Bonifacino is the senior author. She is a board-certified internist and Academic Hospitalist at MedStar Washington Hospital Center in Washington, D.C.
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Use of Large Language Models, AI and Machine Learning Tools: None declared.
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Conflict of interest: The authors state no conflict of interest.
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Research funding: This project was supported by the Thomas H Nimick Research Fund and by the Society to Improve Diagnosis in Medicine.
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Data availability: The participants of this study did not give written consent for their data to be shared publicly, so due to the sensitive nature of the research supporting data is not available.
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Supplementary Material
This article contains supplementary material (https://doi.org/10.1515/dx-2025-0006).
© 2025 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- Frontmatter
- Reviews
- Accuracy of pulse wave velocity for screening coronary artery disease: a systematic review and meta-analysis
- Prenatal screening for genetic disorders: updated guidelines, proposed counseling, a holistic approach for primary health care providers in developing countries
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- Opinion Papers
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- Original Articles
- Implementation of a curriculum on communicating diagnostic uncertainty for clerkship-level medical students: a pseudorandomized and controlled study
- A synthesized differential diagnosis is associated with fewer diagnostic errors compared to an inventorial list
- Equity-Driven Diagnostic Excellence framework: An upstream approach to minimize risk of diagnostic inequity
- Two decades of autopsy-detected diagnostic errors in Japan
- Does management reasoning display context specificity? An exploration of sleep loss and other distracting situational (contextual) factors in clinical reasoning
- Cognitive biases in osteopathic diagnosis: a mixed study among French osteopaths
- Racial and ethnic disparities in pediatric emergency department patients with missed opportunities for diagnostic excellence
- Diagnostic accuracy of non-mydriatic fundus photography as a triage and telemedicine tool for patients with vision loss
- “Innumerable” lesion burden on brain MRI ‒ a diagnostic approach
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- Analytical performance and user-friendliness of four point-of-care measuring systems for monitoring prothrombin time international normalized ratio in the hands of the intended users
- Fetal hematological phenotypes of various hemoglobinopathies and demonstration of embryonic hemoglobins on capillary electrophoresis: a large cohort data from prenatal screening program
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- Short Communications
- Using language to evaluate curricular impact: a novel approach in assessing clinical reasoning curricula
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- Letters to the Editor
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Artikel in diesem Heft
- Frontmatter
- Reviews
- Accuracy of pulse wave velocity for screening coronary artery disease: a systematic review and meta-analysis
- Prenatal screening for genetic disorders: updated guidelines, proposed counseling, a holistic approach for primary health care providers in developing countries
- A scoping review of fever of unknown origin with normal serum C-reactive protein
- Mini Review
- Overview of dengue diagnostic limitations and potential strategies for improvement
- Opinion Papers
- Demystifying cognitive bias in the diagnostic process for frontline clinicians and educators; new words for old ideas
- Physicians’ prism: illuminating history with structured expertise
- Original Articles
- Implementation of a curriculum on communicating diagnostic uncertainty for clerkship-level medical students: a pseudorandomized and controlled study
- A synthesized differential diagnosis is associated with fewer diagnostic errors compared to an inventorial list
- Equity-Driven Diagnostic Excellence framework: An upstream approach to minimize risk of diagnostic inequity
- Two decades of autopsy-detected diagnostic errors in Japan
- Does management reasoning display context specificity? An exploration of sleep loss and other distracting situational (contextual) factors in clinical reasoning
- Cognitive biases in osteopathic diagnosis: a mixed study among French osteopaths
- Racial and ethnic disparities in pediatric emergency department patients with missed opportunities for diagnostic excellence
- Diagnostic accuracy of non-mydriatic fundus photography as a triage and telemedicine tool for patients with vision loss
- “Innumerable” lesion burden on brain MRI ‒ a diagnostic approach
- Factors associated with positive findings of deep infection on computed tomography among patients with extremity cellulitis
- Exploring emergency department providers’ uncertainty in neurological clinical reasoning
- Analytical performance and user-friendliness of four point-of-care measuring systems for monitoring prothrombin time international normalized ratio in the hands of the intended users
- Fetal hematological phenotypes of various hemoglobinopathies and demonstration of embryonic hemoglobins on capillary electrophoresis: a large cohort data from prenatal screening program
- Development and assessment of autoverification system for routine coagulation assays in inpatient and outpatient settings of tertiary care hospital: algorithm performance and impact on laboratory efficiency
- Validation of new, circulating biomarkers for gliomas
- Short Communications
- Using language to evaluate curricular impact: a novel approach in assessing clinical reasoning curricula
- Comparative evaluation of routine coagulation testing on Stago sthemO 301 and Werfen ACL TOP 750
- Letters to the Editor
- Reversible systemic vasoconstriction syndrome: a new diagnostic family of generalized vasospasm in multiple organs
- The value of designating symptoms as “vague” in diagnosis
- Immunoglobulin E in an inverted skin-prick test for rapid detection of cutaneous antigens
