Tolerancia a la incertidumbre en fisioterapeutas
implicaciones para su educación a partir de un estudio observacional
Resumen
Aunque la incertidumbre es común en el campo de la fisioterapia, se han realizado pocas investigaciones sobre el tema de la tolerancia a la incertidumbre (TI). Este estudio se basa en una investigación previa que exploró la UT en fisioterapeutas noveles e identificó sus necesidades educativas en relación con la TI utilizando el cuestionario autodesarrollado "Tolerancia a la incertidumbre en fisioterapia" (TIF). El presente trabajo pretende explorar la TI en fisioterapeutas experimentados, identificar sus necesidades educativas en relación con la gestión de la incertidumbre y compararlas con las de los fisioterapeutas noveles. Se realizó un estudio observacional cuantitativo transversal en el que participaron 40 fisioterapeutas con una experiencia laboral media de 11,9 (7,52) años. Los resultados muestran que los fisioterapeutas evaluados tenían un TI medio-alto con 51 puntos (5,99) en la escala TIF. Los años de experiencia no pudieron confirmarse como un buen predictor del TI, aunque se observó una tendencia a la mejora del TI (r= -0,075, p-valor = 0,645). Los fisioterapeutas con experiencia se mostraron menos nerviosos o ansiosos ante diagnósticos desconocidos y tuvieron menos dificultades para desconectar mentalmente. Sin embargo, coincidían con los fisioterapeutas noveles en cuanto a solicitar más pruebas diagnósticas o citas más frecuentes. Es esencial poner en marcha programas educativos para mejorar la TI durante el periodo de formación y en profesionales con experiencia.
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Almond A, Zou Y, Forbes R. Navigating diagnostic uncertainty in musculoskeletal practice: The perspectives and experiences of new graduate physiotherapists. Musculoskelet Sci Pract. 2021 ;52:102354. https://doi.org/10.1016/j.msksp.2021.102354
Han PKJ, Klein WMP, Arora NK. Varieties of Uncertainty in Health Care: A Conceptual Taxonomy. Medical Decision Making. 2011; 31(6): 828–38. http://mdm.sagepub.com/cgi/doi/10.1177/0272989X11393976
Hillen MA, Gutheil CM, Strout TD, Smets EMA, Han PKJ. Tolerance of uncertainty: Conceptual analysis, integrative model, and implications for healthcare. Soc Sci Med. 2017 May 1;180:62–75. https://doi.org/10.1016/j.socscimed.2017.03.024
Strout TD, Hillen M, Gutheil C, Anderson E, Hutchinson R, Ward H, et al. Tolerance of uncertainty: A systematic review of health and healthcare-related outcomes. Vol. 101, Patient Education and Counseling. Elsevier; 2018. p. 1518–37. https://doi.org/10.1016/j.pec.2018.03.030
Damien Ying L, Harrington A, Assi R, Thiessen C, Contessa J, Hubbard M, et al. Association for Academic Surgery Measuring Uncertainty Intolerance in Surgical Residents Using Standardized Assessments. Assessments. J Surg Res. 2020;245:145-152. doi:10.1016/j.jss.2019.07.035
Hancock J, Mattick K. Tolerance of ambiguity and psychological well‐being in medical training: A systematic review. Med Educ. 2020; 54(2):125–37. https://doi.org/10.1111/medu.14031
Kuhn G, Goldberg R, Compton S. Tolerance for Uncertainty, Burnout, and Satisfaction With the Career of Emergency Medicine. Ann Emerg Med. 2009;54:106–13. https://doi.org/10.1016/j.annemergmed.2008.12.019
Takayesu JK, Ramoska EA, Clark TR, Hansoti B, Dougherty J, Freeman W, et al. Factors Associated With Burnout During Emergency Medicine Residency. Acad Emerg Med. 2014;21(9):1031–5. https://doi/full/10.1111/acem.12464
Hall KH. Reviewing intuitive decision-making and uncertainty: The implications for medical education. Med Educ. 2002; 36(3):216–24. https://doi.org/10.1046/j.1365-2923.2002.01140.x
Patel P, Hancock J, Rogers M, Pollard SR. Improving uncertainty tolerance in medical students: A scoping review. Vol. 56, Med Educ. 2022;56(12) p. 1163–73. https://doi.org/10.1111/medu.14873
Stephens GC, Sarkar M, Lazarus MD. “A whole lot of uncertainty”: A qualitative study exploring clinical medical students’ experiences of uncertainty stimuli. Med Educ. 2022;56(7):736–46. https://doi.org/10.1111/medu.14743
Han PKJ, Strout TD, Gutheil C, Germann C, King B, Ofstad E, et al. How Physicians Manage Medical Uncertainty: A Qualitative Study and Conceptual Taxonomy. Med Decis Making. 2021;41(3):275–91. https://doi.org/10.1177/0272989x21992340
Helou MA, DiazGranados D, Ryan MS, Cyrus JW. Uncertainty in Decision Making in Medicine: A Scoping Review and Thematic Analysis of Conceptual Models. Acad Med. 2020;95(1):157–65. https://doi.org/10.1097%2FACM.0000000000002902
Stephens GC, Rees CE, Lazarus MD. Exploring the impact of education on preclinical medical students’ tolerance of uncertainty: a qualitative longitudinal study. Adv Health Sci Educ 2020;26(1):53–77. https://link.springer.com/article/10.1007/s10459-020-09971-0
Kerr AM, Thompson CM. Medical Students’ Reactions to Uncertainty During Clinical Rotations. Fam Med 2022;54(4):285–9. https://journals.stfm.org/familymedicine/2022/april/kerr-2021-0081/
Lawton R, Robinson O, Harrison R, Mason S, Conner M, Wilson B. Are more experienced clinicians better able to tolerate uncertainty and manage risks? A vignette study of doctors in three NHS emergency departments in England. BMJ Qual Saf. 2019;28:382–8. http://dx.doi.org/10.1136/bmjqs-2018-008390
Nevalainen M, Kuikka L, Pitkälä K. Medical errors and uncertainty in primary healthcare: A comparative study of coping strategies among young and experienced GPs. Scand J Prim Health Care. 2014;32(2):84–9. https://doi.org/10.3109%2F02813432.2014.929820
Escourrou E, Bergeaut M, Gimenez L, Durliat I, Stillmunkés A, Oustric S, et al. Evolution of reactions to uncertainty among residents to during a clinical rotation. Fam Med. 2020 May 1;52(5):339–45. https://doi.org/10.22454/fammed.2020.403807
Geller G, Grbic D, Andolsek KM, Caulfield M, Roskovensky L. Tolerance for Ambiguity among Medical Students: Patterns of Change during Medical School and Their Implications for Professional Development. Acad Med. 2021;96(7):1036–42. https://doi.org/10.1097/acm.0000000000003820
Lee C, Hall K, Anakin M, Pinnock R. Towards a new understanding of uncertainty in medical education. J Eval Clin Pract. 2020;jep.13503. https://onlinelibrary.wiley.com/doi/10.1111/jep.13503
Luther VP, Crandall SJ. Commentary: Ambiguity and uncertainty: Neglected elements of medical education curricula? Acad Med. 2011; 86(7): 799–800. https://journals.lww.com/academicmedicine/Fulltext/2011/07000/Commentary__Ambiguity_and_Uncertainty__Neglected.7.aspx
Stephens GC, Sarkar M, Lazarus MD. Medical Student Experiences of Uncertainty Tolerance Moderators: A Longitudinal Qualitative Study. Front Med (Lausanne). 2022;9:864141. https://doi.org/10.3389/fmed.2022.864141
Colegio Oficial de Fisioterapeutas de Canarias [Internet]. 2023 [cited 2023 Dec 7]. https://fisiocanarias.org/. https://fisiocanarias.org/transparencia/memorias-anuales
Infante Guedes, A, Quintana Montesdeoca, MP, Etopa Bitata, MP. Educational Needs for Coping with Clinical Uncertainty in Physiotherapy. Educ. Sci. 2023;13(7):657. https://doi.org/10.3390/educsci13070657
jamovi. The jamovi project. Retrieved from https://www.jamovi.org 2022.
R Core Team. R: A Language and environment for statistical computing. https://cran.r-project.org . (R packages retrieved from MRAN snapshot 2022-01-01); 2021.
Jan van Eck N, Waltman L. Software survey: VOSviewer, a computer program for bibliometric mapping. www.cs.sandia.gov/*smartin/software.html
Simmonds MJ, Derghazarian T, Vlaeyen JW. Physiotherapists' knowledge, attitudes, and intolerance of uncertainty influence decision making in low back pain. Clin J Pain. 2012 Jul;28(6):467-74. https://doi.org/10.1097/AJP.0b013e31825bfe65
Han PKJ, Schupack D, Daggett S, Holt CT, Strout TD. Temporal changes in tolerance of uncertainty among medical students: Insights from an exploratory study. Med Educ Online. 2015;20(1). https://doi.org/10.3402/meo.v20.28285
Begin AS, Hidrue M, Lehrhoff S, del Carmen MG, Armstrong K, Wasfy JH. Factors Associated with Physician Tolerance of Uncertainty: an Observational Study. J Gen Intern Med. 2022;37(6):1415–21. https://doi.org/10.1007/s11606-021-06776-8
Scott IA, Doust JA, Keijzers GB, Wallis KA. Coping with uncertainty in clinical practice: a narrative review. Med J Aust. 2023;218(9):418–25. https://pubmed.ncbi.nlm.nih.gov/37087692/
Ingram S, Stenner R, May S. The experiences of uncertainty amongst musculoskeletal physiotherapists in first contact practitioner roles within primary care. Musculoskeletal Care. 2023;21(3):644–54. https://onlinelibrary-wiley-com.accedys2.bbtk.ull.es/doi/full/10.1002/msc.1735
Simpkin AL, Schwartzstein RM. Tolerating Uncertainty — The Next Medical Revolution? New England Journal of Medicine. 2016;375(18):1713–5. https://doi.org/10.1056/NEJMp1606402
Iannello P, Mottini A, Tirelli S, Riva S, Antonietti A. Ambiguity and uncertainty tolerance, need for cognition, and their association with stress. A study among Italian practicing physicians. Med Educ Online. 2017;22(1). https://doi.org/10.1080/10872981.2016.1270009
Katz J. Why Doctors Don’t Disclose Uncertainty. Hastings Cent Rep. 1984;14(1):35.
Reis-Dennis S, Gerrity MS, Geller G. Tolerance for Uncertainty and Professional Development: a Normative Analysis. J Gen Intern Med. 2021;36(8):13. https://doi.org/10.1007/s11606-020-06538-y
Medendorp NM, Stiggelbout AM, Aalfs CM, Han PKJ, Smets EMA, Hillen MA. A scoping review of practice recommendations for clinicians’ communication of uncertainty. Health Expectations. 2021;24(4):1025–43. https://doi.org/10.1111/hex.13255
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