Tolerance for Ambiguity Among Medical Students: Patterns of Change During Medical School and Their Implications for Professional Development.

PURPOSE: Tolerance for ambiguity (TFA) is important for physicians, with implications for ethical behavior and patient care. This study explores how medical students' TFA changes from matriculation to graduation and how change in empathy and openness to diversity are associated with this change. METHOD: Data for students who took the Matriculating Student Questionnaire (MSQ) in 2013 or 2014 and the Medical School Graduation Questionnaire (GQ) in 2017 or 2018 were drawn from the Association of American Medical Colleges (n = 17,221). Both the MSQ and GQ included a validated TFA scale and a shortened version of the Interpersonal Reactivity Index; the MSQ also included an openness to diversity scale. Tercile groups were used to assess how TFA changed from the MSQ to GQ, and regression analyses were used to assess associations between change in TFA and openness to diversity and between change in TFA and change in empathy. RESULTS: Mean TFA scores decreased (d = -.67) among students with the highest TFA at matriculation but increased (d = .60) among students with the lowest TFA at matriculation. Regression results showed that change in TFA was significantly and positively associated with change in empathy (beta = .05, P < .001) and that openness to diversity (as reported at matriculation) was significantly and positively associated with TFA at graduation (beta = .05, P < .001). CONCLUSIONS: This is the first nationally representative study to suggest that medical students' TFA changes over time, but in different directions depending on TFA at matriculation. TFA over time was also associated with change in empathy and openness to diversity. Medical schools should consider strategies to assess TFA in their admissions processes and for cultivating TFA throughout the learning process.

Ambiguity tolerance of students matriculating to U.S. medical schools.

PURPOSE: To examine the psychometric adequacy of a tolerance for ambiguity (TFA) scale for use with medical students. Also, to examine the relationship of TFA to a variety of demographic and personal variables in a national sample of entering U.S. medical students. METHOD: The authors used data from the 2013 Association of American Medical Colleges Matriculating Student Questionnaire in which questions on TFA were included for the first time that year. Data from 13,867 entering medical students were analyzed to examine the psychometric properties of the TFA scale. In addition, the relationships of TFA to sex, age, perceived stress, and desire to work in an underserved area were analyzed. Finally, the relationship of TFA to specialty preference was examined. RESULTS: The TFA scale was found to be psychometrically adequate for use in a medical student population. TFA was found to be higher in men and in older students. Lower TFA was associated with higher perceived stress levels. Students with higher TFA were more likely to express desire to work in an underserved area. Different levels of TFA may be associated with certain specialty preferences. CONCLUSIONS: These findings support the assessment of TFA to understand how this personal characteristic may interact with the medical school experience and with specialty choice. Longitudinal work in this area will be critical to increase this understanding.

Gender and trauma as predictors of military attrition: a study of Marine Corps recruits.

Recent studies have shown high rates of premilitary trauma exposure among U.S. military enlistees. Given the association of trauma with later stressor vulnerability, it is important to examine the role of premilitary stress and trauma in adaptation to the stress of recruit training. U.S. Marine Corps recruits (N = 1,530) were surveyed for premilitary histories of interpersonal trauma to examine the relationship between premilitary trauma and attrition from recruit training. The majority of the recruits (47.5% of men and 68.1% of women) reported experiencing at least one interpersonal trauma before entering the Marine Corps. Individuals with a history of interpersonal trauma were at significantly greater risk for attrition; they were 1.5 times more likely to drop out of recruit training than were individuals without a trauma history. These findings suggest that developing interventions to bolster recruits' coping skills may improve adaptation to the recruit training environment and thus decrease attrition.