Epistemology and uncertainty: a follow-up study with third-year medical students.

BACKGROUND AND OBJECTIVES Prior research results indicate a relationship between medical epistemology (ie, how a physician organizes and prioritizes the biological and psychosocial data of a patient presentation) and stress reactions to uncertainty among primary care physicians. However, little is known about when this relationship forms. The purpose of this study was to begin answering this question by exploring the relationship between medical epistemology and stress reactions to uncertainty among a group of 89 third-year medical students from the class of 2010 of a three-campus state medical school located in the southwestern US. METHODS Data from Likert-type measures of medical epistemology and stress reactions to uncertainty were extracted from course evaluation information that was collected at the start (T1) and end (T2) of a continuity clinic experience that spanned most of the students' third year. Using these data, the authors conducted a simple bivariate regression analysis to identify the relationship between medical epistemology and stress reactions to uncertainty (Model 1), and a multivariate regression analysis to test for the independent effect of medical epistemology on stress reactions to uncertainty while controlling for gender and specialty interest (Model 2). These two regression models were calculated for both the T1 and T2 data sets. RESULTS The two regression models at T1 indicated no significant relationships between medical epistemology and stress reactions to uncertainty; however, the two regression models at T2 indicated that a biopsychosocial epistemology is associated with less stress reactions to uncertainty, and a biomedical epistemology is associated with more stress reactions to uncertainty. CONCLUSIONS The third year is an opportune time for medical educators to help shape and develop students' medical epistemology and stress reactions to uncertainty.