[01] Ang Jia You, Faculty of Medicine, Manipal University College Malaysia, Manipal Academy of Higher Education (MAHE), Melaka, Malaysia. [02] Najihah Binti Mohamad Shajhan, Faculty of Medicine, Manipal University College Malaysia, Manipal Academy of Higher Education (MAHE), Melaka, Malaysia. [03] Sharvveen Paskaran, Faculty of Medicine, Manipal University College Malaysia, Manipal Academy of Higher Education (MAHE), Melaka, Malaysia. [04] Lavnea Ramis, Faculty of Medicine, Manipal University College Malaysia, Manipal Academy of Higher Education (MAHE), Melaka, Malaysia. [05] Aminath Sheeneez, Faculty of Medicine, Manipal University College Malaysia, Manipal Academy of Higher Education (MAHE), Melaka, Malaysia.

Medical students go through self-doubt and uncertainties every single day. We have been in these positions personally, experiencing fear and second guessing. The study was aimed to understand how most medical students think in these situations and how much they were able to get through it, also what factors led these medical students to second guess themselves, such as gender, family background, clinical training and the awareness of medical negligence. A cross sectional study was conducted among the clinical phase medical students of Manipal University College Malaysia. An online questionnaire was distributed and a total of 126 participants responded. The data was statistically analyzed using Epi Info version 7.2.4.0. The independent and dependent variables were all calculated with frequency and percentage, and Chi Square Test was chosen to study the associations between them. Odds Ratio was also calculated to explore the associations between the independent variables and tolerance of uncertainty along with fear of making mistakes among clinical year medical students. Findings revealed that the number of students tolerating uncertainty quite well were about 70 (55.6%) compared to tolerating uncertainty poorly which was 51 (40.5%). 5 students were found tolerating uncertainty well (4.0%). Students who belong to a low socioeconomic status were found to be 5.38 times more likely to tolerate uncertainty poorly as compared to those from a high socioeconomic status family (95% C1 for OR 1.70-17.06; P-value 0.003). It was also observed that students from a moderate socioeconomic status family were 2.93 times more likely to tolerate uncertainty poorly than those from a high socioeconomic status family (95% CI for OR 1.31 to 6.57; P-value: 0.008). All other variables were found to be insignificant. In summary it was seen that students coming from low or moderate socioeconomic backgrounds were more likely to tolerate uncertainty poorly compared to others. While we assume that most of these students have a fear of making mistakes when carrying out their doctor work, most of them were willing to acknowledge the mistakes made by providing an explanation to their patients, supervisor and their working community rather than trying to hide their mistakes. Our future medical care and efficiency is dependent on these medical students, further studies are needed to help medical students overcome their tolerance of uncertainty and fear of making mistakes.

Tolerance of Uncertainty, Fear of Making Mistakes, Clinical Year Medical Students, Cross-Sectional Study, Malaysia

[01] Kim K, Lee YM. Understanding uncertainty in medicine: concepts and implications in medical education. Korean journal of medical education. 2018 Sep; 30 (3): 181. [02] Stephens GC, Rees CE, Lazarus MD. Exploring the impact of education on preclinical medical students’ tolerance of uncertainty: a qualitative longitudinal study. Advances in Health Sciences Education. 2021 Mar; 26 (1): 53-77. [03] Hillen MA, Gutheil CM, Strout TD, Smets EM, Han PK. Tolerance of uncertainty: Conceptual analysis, integrative model, and implications for healthcare. Social Science & Medicine. 2017 May 1; 180: 62-75. [04] Nevalainen M, Kuikka L, Sjöberg L, Eriksson J, Pitkälä K. Tolerance of uncertainty and fears of making mistakes among fifth-year medical students. Family Medicine-Kansas City. 2012 Apr 1; 44 (4): 240. [05] Stanley Budner NY. Intolerance of ambiguity as a personality variable 1. Journal of personality. 1962 Mar; 30 (1): 29-50. [06] WEST M, O'DONNELL M. Personality type and curriculum preference in primary care. Medical education. 1982 Mar; 16 (2): 94-6. [07] Eagle PF, Marcos LR. Factors in medical students' choice of psychiatry. The American journal of psychiatry. 1980 Apr. [08] Weisman CS, Levine DM, Steinwachs DM, Chase GA. Male and female physician career patterns: specialty choices and graduate training. Journal of Medical Education. 1980 Oct 1; 55 (10): 813-25. [09] Nieman LZ, Holbert D, Bremer CC. Career preferences and decision-making habits of first-year medical students. Journal of medical education. 1986 Aug 1; 61 (8): 644-53. [10] Geller G, Faden RR, Levine DM. Tolerance for ambiguity among medical students: implications for their selection, training and practice. Social science & medicine. 1990 Jan 1; 31 (5): 619-24. [11] Radcliffe C, Lester H. Perceived stress during undergraduate medical training: a qualitative study. Medical education. 2003 Jan; 37 (1): 32-8. [12] Carrier ER, Reschovsky JD, Katz DA, Mello MM. High physician concern about malpractice risk predicts more aggressive diagnostic testing in office-based practice. Health Affairs. 2013 Aug 1; 32 (8): 1383-91. [13] Carrier ER, Reschovsky JD, Mello MM, Mayrell RC, Katz D. Physicians’ fears of malpractice lawsuits are not assuaged by tort reforms. Health affairs. 2010 Sep 1; 29 (9): 1585-92. [14] Pinto A, Brunese L, Pinto F, Reali R, Daniele S, Romano L. The concept of error and malpractice in radiology. InSeminars in Ultrasound, CT and MRI 2012 Aug 1 (Vol. 33, No. 4, pp. 275-279). WB Saunders. [15] Bartlett G, Blais R, Tamblyn R, Clermont RJ, MacGibbon B. Impact of patient communication problems on the risk of preventable adverse events in acute care settings. Cmaj. 2008 Jun 3; 178 (12): 1555-62. [16] Bernard A, Whitaker M, Ray M, Rockich A, Barton-Baxter M, Barnes SL, Boulanger B, Tsuei B, Kearney P. Impact of language barrier on acute care medical professionals is dependent upon role. Journal of Professional Nursing. 2006 Nov 1; 22 (6): 355-8. [17] Carleton, R. Nicholas. "The intolerance of uncertainty construct in the context of anxiety disorders: Theoretical and practical perspectives." Expert Review of Neurotherapeutics 12.8 (2012): 937-947. [18] Sharif, Farkhondeh, and Sara Masoumi. "A qualitative study of nursing student experiences of clinical practice." BMC nursing 4.1 (2005): 1-7. [19] Kong, Fanzhu, Lily Zhao, and Cheng-Hung Tsai. "The relationship between entrepreneurial intention and action: The effects of fear of failure and role model." Frontiers in psychology 11 (2020). [20] Vincent CA, Coulter A. Patient safety: what about the patient?. BMJ Quality & Safety. 2002 Mar 1; 11 (1): 76-80. [21] Kuzel AJ, Woolf SH, Gilchrist VJ, Engel JD, LaVeist TA, Vincent C, Frankel RM. Patient reports of preventable problems and harms in primary health care. The Annals of Family Medicine. 2004 Jul 1; 2 (4): 333-40. [22] Azoulay E, Chevret S, Leleu G, Pochard F, Barboteu M, Adrie C, Canoui P, Le Gall JR, Schlemmer B. Half the families of intensive care unit patients experience inadequate communication with physicians. Critical care medicine. 2000 Aug 1; 28 (8): 3044-9. [23] Green CA, Pope CR. Gender, psychosocial factors and the use of medical services: a longitudinal analysis. Social science & medicine. 1999 May 1; 48 (10): 1363-72. [24] Hoffman JM, Yorkston KM, Shumway-Cook A, Ciol MA, Dudgeon BJ, Chan L. Effect of Communication Disability on Satisfaction With Health Care. [25] Sheu, Sheila, Huey-Shyan Lin, and Shiow-Li Hwang. "Perceived stress and physio-psycho-social status of nursing students during their initial period of clinical practice: the effect of coping behaviors." International journal of nursing studies 39.2 (2002): 165-175. [26] Nevalainen M, Kuikka L, Pitkälä K. Medical errors and uncertainty in primary healthcare: a comparative study of coping strategies among young and experienced GPs. Scandinavian journal of primary health care. 2014 Jun 1; 32 (2): 84-9. [27] Wu AW, Folkman S, McPhee SJ, Lo B. Do house officers learn from their mistakes?. Jama. 1991 Apr 24; 265 (16): 2089-94. [28] Nakhostin-Ansari A, Maghbouli N, Shayestefar M. Ambiguity tolerance among medical students and its relationship with personality and participation in the mentoring program: A cross-sectional study. Annals of Medicine and Surgery. 2021 Feb 1; 62: 425-30. [29] DeForge BR, Sobal J. Intolerance of ambiguity in students entering medical school. Social Science & Medicine. 1989 Jan 1; 28 (8): 869-74. [30] Katz DA, Williams GC, Brown RL, Aufderheide TP, Bogner M, Rahko PS, Selker HP. Emergency physicians' fear of malpractice in evaluating patients with possible acute cardiac ischemia. Annals of emergency medicine. 2005 Dec 1; 46 (6): 525-33. [31] Muller D, Ornstein K. Perceptions of and attitudes towards medical errors among medical trainees. Medical education. 2007 Jul; 41 (7): 645-52. [32] Cheng G, Zhang D, Ding F. Self-esteem and fear of negative evaluation as mediators between family socioeconomic status and social anxiety in Chinese emerging adults. International journal of social psychiatry. 2015 Sep; 61 (6): 569-76. [33] Firth-Cozens J. Effects of gender on performance in medicine. [34] Shabani MB. Levels and Sources of Language Anxiety and Fear of Negative Evaluation among Iranian EFL Learners. Theory & practice in language studies. 2012 Nov 1; 2 (11).