How to say “I don’t know”: development and evaluation of workshops for medical students and surgical residents on communicating uncertainty using the ADAPT framework

Abstract

Purpose Uncertainty, or the conscious awareness of having doubts, is pervasive in medicine, from differential diagnoses and the sensitivity of diagnostic tests, to the absence of a single known recovery path. While openness about uncertainty is necessary for shared decision-making and is a pillar of patient-centered care, it is a challenge to do so while preserving patient confidence. The authors’ aim was to develop, pilot, and evaluate an uncertainty communication curriculum to prepare medical students and residents to confidently navigate such conversations. Methods The authors developed ADAPT , a mnemonic framework to improve student comprehension and recall of the important steps in uncertainty disclosure: assess the patient’s knowledge, disclose uncertainty directly, acknowledge patient emotions, plan next steps, and temper expectations. Using this framework, the authors developed, piloted, and evaluated an uncertainty communications course as part of an ongoing communication curriculum for second year medical students in 2020 and with surgical residents in 2021. Results Learner confidence in uncertainty communication skills significantly increased post-class. Resident confidence in disclosing uncertainty was significantly correlated with observer ratings of their related communication skills during simulation. Students expressed positive experiences of the class, noting particular appreciation for the outline of steps included in the ADAPT framework, and the ability to observe a demonstration prior to practice. Conclusions The ADAPT communication curriculum was effective at increasing learner confidence and performance in communicating uncertainty. More rigorous evaluation of the ADAPT protocol will be important in confirming its generalizability. Supplementary Information The online version contains supplementary material available at 10.1007/s44186-022-00075-4.

The Italian Epistemic Disclaimer Non so [I Don’t Know] in a Corpus of Gynaecological Interactions

“…In other words, dealing with uncertainty and the limits of knowledge should be a medical competence to be included in training curricula, i.e., the ability to communicate uncertain or unknown content during interactions with patients should become a skill taught as part of specific training courses and curricula aimed at preparing doctors, and more generally, healthcare professionals, to handle such conversations with confidence (e.g., Ledford et al 2015;Moffett et al 2022;Duval et al 2022), also during shared decisionmaking processes (Berger 2015). It is clear that for a "shift in mentality" (Menichetti et al 2021) to occur, patients must also be willing to acknowledge the limitations of doctors' knowledge and have realistic expectations towards medical treatment (Gordon et al 2000).…”

Decision making among residents in training of obstetrics and gynecology: A qualitative exploration in Pakistani context

“…For instance, in a recent study, the authors developed ADAPT, a mnemonic framework to improve medical students’ and surgical residents’ comprehension and recall of important steps in uncertainty disclosure which is pervasive in medicine from sensitivity of diagnostic tests and differential diagnoses to the absence of a single path of recovery for the patient. This helped residents’ in the assessment of patients’ temper expectations, acknowledging patients’ emotions, knowledge, disclosure of uncertainty, and planning the next steps [ 35 ].…”