Navigating Uncertainty in Clinical Practice: A Structured Approach.

The practice of clinical medicine is imbued with uncertainty. The ways in which clinicians and patients think about, communicate about, and act within situations of heightened uncertainty can have significant implications for the therapeutic alliance and for the trajectory and outcomes of clinical care. Despite this, there is limited guidance about the best methods for physicians to recognize, acknowledge, communicate about, and manage uncertainty in clinical settings. In this paper, we propose a structured approach for discussing and managing uncertainty within the context of a clinician-patient relationship. The approach involves four steps: Recognize, Acknowledge, Partner, and Seek Support (i.e., the RAPS framework). The approach is guided by existing literature on uncertainty as well as our own experience as clinicians working at different stages of career. We define each component of the approach and present sample language and actions for how to implement it in practice. Our aim is to empower clinicians to regard situations of high uncertainty as an opportunity to deepen the therapeutic alliance with the patient, and simultaneously to grow and learn as practitioners.

Facilitating the transition to residency: A resident-as-coach pilot program.

BACKGROUND: The transition from medical school to residency is a critical developmental phase; coaching may help students prepare for this role transition. AIMS: We explored whether near-peer coaching could improve a specific workplace skill prior to residency. METHODS: A resident-as-coach program was piloted for the medicine sub-internship, an advanced acting internship rotation. Between March and June 2021, 26 students were assigned a resident coach (n = 16). Resident coaches completed one training session, and student-coach dyads met for one coaching session on 'pre-rounding'- gathering patient data before rounds. The program was evaluated through surveys and focus groups. RESULTS: 20/26 students and 14/16 residents completed the survey. 19/20 students identified a pre-rounding challenge and reported increased pre-rounding efficiency; all committed to one actionable step for improvement. All 16 residents felt their coaching skills improved. In focus groups, students valued the program's focus on honing a relevant skill in a safe, near-peer setting. Residents expressed their intent to incorporate coaching into their future work. CONCLUSIONS: A resident-as-coach model can be effective in preparing students for residency, while concurrently building residents' coaching skills.

Customised knowledge-sharing platform to foster resident quality improvement activities, tracking and scholarship.

INTRODUCTION: Meeting accreditation requirements to train resident physicians in quality improvement (QI) may require more than education. Barriers to resident QI engagement underscore the need to demonstrate the impact and value of resident QI work. It is not known whether a platform to track and publicise resident QI projects and scholarship is feasible or acceptable to implement within a residency programme. We aimed to create a searchable online platform and associated programming to promote resident QI work. METHODS: This intervention targeted resident physicians in an internal medicine residency training programme at a tertiary, academic medical centre. We designed an intervention to track resident QI and related scholarship in a searchable online platform, including practical details of implementing each project. Newsletters and events were used to publicise these project profiles. RESULTS: During the 2020-2021 academic year, 104 projects were profiled from 238 sourced projects. Average readership was 31.5% across 11 newsletters sent to residents and key faculty. DISCUSSION: A platform to track and share resident QI work and scholarship can be feasibly and acceptably implemented within a residency programme, serving as a novel way to engage residents around QI.