Uncertainty: Comment to a Paper
Title: Educational Strategies to Prepare Trainees for Clinical Uncertainty
Authors: Jonathan S. Ilgen, Gurpreet Dhaliwal
Reference: N Eng J Med 2025; 393:1624-32
This is a personal summary review of some concepts in the article. No relationship with the original authors or contact has been made.
General Concepts
The authors describe clinical uncertainty as a situation where there is an incomplete control of the problem of the patient, associated with the different fields of diagnosis or therapy. They try to give some advice to teachers on how to handle this situation when they are involved with trainees. Technology is not going to resolve uncertainty, in the opinion of the authors.
How to Manage Clinical Uncertainty
The authors see clinical uncertainty as an opportunity for learning. They explain how experienced clinicians cope with uncertainty.
First, experienced clinicians give priority to safety, trying to forecast the problems that could happen in the near future with the patient. Experienced clinicians try to imagine all the problems associated with the care of the patient, and, at the end, they established a way to be in contact with the patient through a phone call and also they give advice to the patient and family about alarm symptoms or situations.
Monitoring is also a key aspect. The authors explain that experienced clinicians are able to evaluate the evolution of the patient, but with a broad range of cues, going from their own internal appreciation to the response or communication with other professionals involved in the attention of the patient, even with the opinion of the family.
Final Conclusions
Clinical uncertainty is consubstantial with the clinical work. Technology is not going to resolve this. Teachers need to see uncertainty as an opportunity for a better trainee education. Experienced clinicians develop abilities to give importance to the global safety of the patient, planning a mental control of all possible problems. Monitoring, or a sense of a continuous attention, plays a key role in the control of uncertainty.
Author: Dr. Lorenzo Alonso Carrión
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