Presented By: Sarah Lerchenfeldt, Oakland University William Beaumont School of Medicine
Co-Authors: Suzan Kamel-ElSayed, Oakland University William Beaumont School of Medicine
Simon Keep, Oakland University William Beaumont School of Medicine
Gustavo Patino, Western Michigan University Homer Stryker M.D. School of Medicine

Purpose
Healthcare providers are often expected to make important decisions when well-defined answers are not available. Despite the widespread recognition of the importance of medical uncertainty, formal preparation for navigating such ambiguity is lacking in medical school curricula. Team-Based Learning (TBL) clinical application exercises (AEs) present a potential avenue for educating students on acknowledging and responding to medical uncertainty. This study aims to determine if TBL AEs enhance medical students' ability to address uncertainty and help students develop appropriate management strategies when faced with difficult decisions.

Methods 
This investigation employed exploratory qualitative research, conducting a series of six focus group sessions. Each session comprised medical students or alumni of a program with extensive use of TBL, including ungraded AEs. Participants were interviewed through semi-structured interviews to gather their perspectives on medical uncertainty, including its relationship to TBL. The interviews were transcribed, and independent reviewers conducted thematic analysis on the responses.

Results 
A total of 5 first-year students, 12 second-year students, 2 fourth-year students, and 4 alumni (residents and attendings) participated in the focus groups, revealing three primary themes. The first theme highlighted the evolving definition of medical uncertainty over time, influenced by the TBL process and increased exposure to content. The second theme emphasized the significance of exposure to medical uncertainty, and whether this exposure occurred during clerkship or pre-clerkship stages. In the third theme, clinical cases emerged as crucial for encountering medical uncertainty in TBL application exercises, stressing the necessity for team discussion, open-ended real-life examples, and thoughtful reasoning behind answers.

Conclusion 
TBL application exercises may offer a valuable opportunity to learn about medical uncertainty for learners. As the perception of medical uncertainty evolves over time, an initial exposure to clinical cases in TBL may be pivotal in fostering an understanding of medical uncertainty.