A randomized experimental study to assess the effect of language on medical students’ anxiety due to uncertainty

Simpkin, Arabella L; Murphy, Zachary; Armstrong, Katrina

doi:10.1515/dx-2018-0050

Cited by 7 publications

(7 citation statements)

References 26 publications

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“…Another study showed that student anxiety due to uncertainty was significantly higher in those who received the word 'hypothesis' in a patient handover compared to those who received the word 'diagnosis' for the same patient case. 26 Attenuators from the category 'Questionable' and strengtheners from the 'Focused' category comprised 61.2% of all identified modifiers discovered in this study. This seems congruent with the two current meta-theories of truth related to clinical reasoning, which complement each other: 1) knowledge is true when it contains no inconsistencies and 2) truth is communicated as empirical accuracy.…”

Section: Discussionmentioning

confidence: 71%

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Frequency of medical students' language expressing implicit uncertainty in simulated handovers

et al. 2022

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Objectives:The aim of this study was to investigate the number and type of implicit expressions of uncertainty by medical students during simulated patient handovers. Methods: Eighty-seven volunteer medical students, a convenience sample collected on a first-come, first-served basis, participated in simulated handovers. They each worked with three simulated patients who presented with different chief complaints and personal conditions. The handovers were video recorded and transcribed. A framework of implicit expressions of uncertainty was used to identify and count modifiers that attenuate or strengthen medical information using MAXQDA lexical search. We analysed the findings with respect to the patients' contexts. Results: Implicit uncertainty expressions which attenuate or strengthen information occurred in almost equal frequency, 1879 (55%) versus 1505 (45%). Attenuators were found most frequently in the category 'Questionable', 1041 (55.4%), strengtheners in the category 'Focused', 1031 (68.5%). Most attenuators and strengtheners were found in the handover of two patients with challenging personal conditions ('angry man', 434 (23.1%) versus 323 (21.5%); 'unfocused woman', 354 (19.4%) versus 322 (21.4%)) and one patient with abnormal laboratory findings ('elevated creatinine', 379 (20.2%) versus 285 (18.9%)). Conclusions: Medical students use a variety of implicit expressions of uncertainty in simulated handovers. These findings provide an opportunity for medical educators to design communication courses that raise students' awareness for content-dependent implicit expressions of uncertainty and provide strategies to communicate uncertainty explicitly.

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Frequency of medical students' language expressing implicit uncertainty in simulated handovers

et al. 2022

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“…While positive emotions can also affect reasoning [11,20], negative emotions are more frequently associated with error, which is what we see in the presence of contextual factors. As with prior studies of emotion and clinical reasoning [9,18], anxiety was common, even with physicians solving typical cases for their field. This suggests the need to be more mindful of the effects of contextual factors, including helping physicians identify and mitigate stress and anxiety during clinical encounters.…”

Section: Discussionmentioning

confidence: 91%

“…While much of the clinical reasoning literature focuses on the logical aspects of cognition, emotion (an affective state characterized by arousal that results from a specific stimulus in the environment [9]) is also an integral part of the reasoning process [9,10,18,19]. The greater the magnitude (increase in level of arousal) of the emotion, the greater the possible effect on the clinical reasoning process [11].…”

Section: Affect Cognitive Processes and Agency In Clinical Reasoningmentioning

confidence: 99%

The Linguistic Effects of Context Specificity: Exploring Affect, Cognitive Processing, and Agency in Physicians’ Think-Aloud Reflections

et al. 2020

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BackgroundThe literature suggests that affect, higher-level cognitive processes (e.g. decision-making), and agency (the capacity to produce an effect) are important for reasoning; however, we do not know how these factors respond to context. Using situated cognition theory as a framework, and linguistic tools as a method, we explored the effects of context specificity [a physician seeing two patients with identical presentations (symptoms and findings), but coming to two different diagnoses], hypothesizing more linguistic markers of cognitive load in the presence of contextual factors (e.g. incorrect diagnostic suggestion).MethodsIn this comparative and exploratory study, 64 physicians each completed one case with contextual factors and one without. Transcribed think-aloud reflections were coded by Linguistic Inquiry and Word Count (LIWC) software for markers of affect, cognitive processes, and first-person pronouns. A repeated-measures multivariate analysis of variance was used to inferentially compare these LIWC categories between cases with and without contextual factors. This was followed by exploratory descriptive analysis of subcategories.ResultsAs hypothesized, participants used more affective and cognitive process markers in cases with contextual factors and more I/me pronouns in cases without. These differences were statistically significant for cognitive processing words but not affective and pronominal words. Exploratory analysis revealed more negative emotions, cognitive processes of insight, and third-person pronouns in cases with contextual factors.ConclusionsThis study exposes linguistic differences arising from context specificity. These results demonstrate the value of a situated cognition view of patient encounters and reveal the utility of linguistic tools for examining clinical reasoning.

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“…A shift in culture could be facilitated by using a different way of speaking, e.g. by stating "hypotheses" rather than "diagnoses" [22]. Medical students should exercise as early as possible in using language and reasoning skills to recognize, evaluate, and mitigate uncertainty when they encounter it [23].…”

Section: Introductionmentioning

confidence: 99%

Implicit expression of uncertainty – suggestion of an empirically derived framework

et al. 2020

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Background: Uncertainty occurs in physicians' daily work in almost every clinical context and is also present in the clinical reasoning process. The way physicians communicate uncertainty in their thinking process during handoffs is crucial for patient safety because uncertainty has diverse effects on individuals involved in patient care. Dealing with uncertainty and expressing uncertainty are important processes in the development of professional identity of undergraduate medical students. Many studies focused on how to deal with uncertainty and whether uncertainty is explicitly expressed. Hardly any research has been done regarding implicit expression of uncertainty. Therefore, we studied the ways in which medical students in the role of beginning residents implicitly express uncertainty during simulated handoffs. Methods: Sixty-seven advanced undergraduate medical students participated in a simulated first day of residency including a consultation hour, a patient management phase with interprofessional interaction, and a patient handoff. We transcribed the videographed handoffs verbatim and extracted language with respect to expression of uncertainty using a grounded theory approach. Text sequences expressing patient related information were analyzed and coded with respect to language aspects which implicitly modified plain information with respect to increasing or decreasing uncertainty. Concepts and categories were developed and discussed until saturation of all aspects was reached. Results: We discovered a framework of implicit expressions of uncertainty regarding diagnostic and treatment-related decisions within four categories: "Statement", "Assessment", "Consideration", and "Implication". Each category was related to either the subcategory "Actions" or "Results" within the diagnostic or therapeutic decisions. Within each category and subcategory, we found a subset of expressions, which implicitly attenuated or strengthened plain information thereby increasing uncertainty or certainty, respectively. Language that implicitly attenuated plain information belonged to the categories questionable, incomplete, alterable, and unreliable while we could ascribe implicit strengtheners to the categories assertive, adequate, focused, and reliable. Conclusions: Our suggested framework of implicit expression of uncertainty may help to raise the awareness for expression of uncertainty in the clinical reasoning process and provide support for making uncertainty explicit in the teaching process. This may lead to more transparent communication processes among health care professionals and eventually to improved patient safety.

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A randomized experimental study to assess the effect of language on medical students’ anxiety due to uncertainty

Cited by 7 publications

References 26 publications

Frequency of medical students' language expressing implicit uncertainty in simulated handovers

Frequency of medical students' language expressing implicit uncertainty in simulated handovers

The Linguistic Effects of Context Specificity: Exploring Affect, Cognitive Processing, and Agency in Physicians’ Think-Aloud Reflections

Implicit expression of uncertainty – suggestion of an empirically derived framework

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