Greater tolerance of uncertainty facilitates thriving in doctors entering postgraduate training

Background: Medical curricula increasingly emphasise the need to prepare graduates to manage uncertainty. Uncertainty is an inevitable consequence of the complex nature of human health and illness but may be stressful for clinicians less able to tolerate it. Although work-related stress is prevalent in healthcare services, not all clinicians struggle under the pressures they face. Indeed, some thrive, experiencing success and development, observed through the joint experience of high levels of wellbeing and perceived performance. Therefore, this study aimed to explore relationships between tolerance of uncertainty, perceived stress, and performance and wellbeing (i.e., human thriving) in doctors entering UK foundation training.

Methods: Sixty-six doctors entering UK foundation training completed validated self-report measures to assess tolerance of uncertainty, perceived stress, wellbeing and performance. Multiple linear regression analyses were used to investigate relationships between tolerance of uncertainty, perceived stress, and human thriving. Mediation analysis was then undertaken to explore whether the observed relationship between tolerance of uncertainty and thriving was mediated by perceived stress.

Results: Tolerance of uncertainty and perceived stress predicted a significant proportion of variance in thriving, independently of sex, lifetime stress, and adverse childhood experiences (model adjusted R2 = 0.51). Additionally, tolerance of uncertainty accounted for a significant proportion of variance in perceived stress after controlling for covariates (model adjusted R2 = 0.43). Furthermore, the effect of tolerance of uncertainty on thriving was partially mediated by perceived stress.

Conclusions: Tolerance of uncertainty may represent a novel enabler of thriving and act, at least in part, by reducing perceived stress. Medical educators should consider how best to equip doctors in training to face uncertainty in clinical practice. Further research is required to examine whether interventions can optimise tolerance of uncertainty, or reduce perceived stress in uncertain situations, to facilitate thriving in early career doctors.