Purpose
Tolerance for ambiguity (TFA), the ability to navigate uncertainty, is crucial in medicine. As medical training requires processing ambiguous information, higher TFA may contribute to improved performance while facing uncertainty. This study explores trends in TFA among medical students as they progress through their undergraduate medical education. It aims to provide insights into how medical school influences TFA at different phases and identify trends that may impact the development of clinical skills and decision-making.

Methods
Cohorts 2022 to 2027 from the KKSOM at UNLV had TFA scores collected from the AAMC’s Matriculating Student Questionnaire at the conclusion of each phase of medical school. A Kruskal-Wallis test with a Dunn posthoc analysis was used to evaluate differences between the average TFA scores at four time points (matriculation and the end of several phases).

Results
The analysis revealed a decline in TFA scores from the baseline (matriculation) to three later phases of medical education. Average TFA scores decreased notably during the first phase of medical school, with slight increases observed in subsequent phases: baseline (24.87 ± 5.88), preclinical (22.55 ± 5.84), clinical (22.79 ± 6.43), and fourth year (23.13 ± 6.38). Compared to baseline scores, preclinical, clinical, and fourth-year scores were significantly lower, with p-values of 0.0004, 0.007, and 0.042, respectively.

Conclusions
This study reveals a concerning trend: TFA declines sharply early in medical school and shows only slight improvement over four years. This decline may stem from the demands, stressors, and regimented nature of medical education, which often foster rigid approaches to problem-solving and discomfort with uncertainty. These findings suggest that medical schools could possibly mitigate this decline through early curricular interventions and support systems designed to cultivate adaptability and resilience in navigating ambiguity.