Presented By: Jennifer Eastwood, Rush University
Co-Authors: Melanie Farlie, Monash University
Michelle Lazarus, Monash University
Georgina Stephens, Monash University
Adam Wilson, Rush University

Purpose
Uncertainty tolerance (UT) describes how individuals perceive and respond to uncertainty. Studies purporting to measure UT with quantitative scales have associated doctors' responses with outcomes related to patient care and well-being. Such scales are used for programmatic measure of medical schools, however, there appear to be important questions about the validity of these scales implemented among students. This study explores response process validity of two commonly implemented UT scales, Tolerance for Ambiguity (TFA) and Physician's Reaction to Uncertainty (PRU), with the aim of understanding whether students' conceptualizations of items align with those intended by scale developers.

Methods
Cognitive interviewing captured the thought processes of Australian (9) and US (22) medical and health professions students. Participants thought-aloud as they responded to TFA or PRU items. Probing questions clarified students' understanding of items, response challenges, and item relatability. Interviews were recorded, transcribed, and analyzed using framework analysis.

Results
Participants generally reported understanding scale items, despite identifying several issues related to clarity and specificity. Participants struggled to contextualize items situated in clinical practice contexts due to lack of relevant experience. Participants often referenced academic experiences or imagined clinical scenarios to guide their responses. Participants also indicated that their limited responsibility as students influenced how they responded to uncertainty in relation to items.

Conclusions
Aspects of the student role pose unique challenges to the content validity of the TFA and PRU scales. These scales may not be measuring the UT construct in students in the same way they are thought to measure the construct in practicing doctors. Thus, we caution against using the TFA and PRU scales amongst medical students. By identifying salient factors in students' conceptions and responses to uncertainty, this work also helps to reframe UT measurement, and potentially advance theoretical models of UT in medical and health professions students.