Uncertainty is inherent within the practice of medicine and being able to manage clinical scenarios where there is uncertainty is an important part of a doctor’s role. How a doctor responds to uncertainty will impact how they think, feel and behave. Doctors who have less positive responses to uncertainty, sometimes referred to as having lower Uncertainty Tolerance, are more likely to develop stress and anxiety and make clinical decisions that are less positive for patients. This includes being more likely to order excessive investigations or admit patients to hospital.
Our research has focussed on how we measure Uncertainty Tolerance in medical students and early career doctors (using the TAMSAD scale), if Uncertainty Tolerance is linked with psychological wellbeing in this population, what strategies can support the development of improved Uncertainty Tolerance, and how uncertainty can be better communicated with patients.
This research has supported us to reach the following conclusions. Doctors at transition points in their career have been found to struggle most with Uncertainty Tolerance. This can make the start of postgraduate training, or periods of transition to new environments and roles, potentially difficult periods for doctors to navigate. Despite these challenges it has been demonstrated that how a doctor responds to uncertainty can be modified and improved by education and training. The role of a supervisor and the impact of the training environment are therefore crucial at supporting early career doctors to develop more positive responses to uncertainty.
We are continuing to research and develop resources to help clinical supervisors better support their Resident Doctors develop improved Uncertainty Tolerance, and to support improved communication of uncertainty with patients. Details of our outputs include traditional academic papers, podcasts, links to the TAMSAD scale and evidence of its use, and guidelines for supervisors.
For further information please do get in contact.
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Hancock, J., Roberts, M., Monrouxe, L. and Mattick, K. (2015) Medical student and junior doctors’ tolerance of ambiguity: development of a new scale, Advances in Health Sciences Education, 20(1): 113‐130.
Hancock, J. Hammond, JA. Roberts, M. and Mattick, K. (2017) Comparing tolerance of ambiguity in veterinary and medical students, Journal of Veterinary Medical Education, 44(3): 523‐ 530.
Hancock, J, Mattick K. (2020). Ambiguity tolerance and psychological wellbeing in medical training: a systematic review. Medical Education 54(2):125-137.
Patel P, Hancock J, Rogers M, Pollard SR. Improving uncertainty tolerance in medical students: A scoping review. Med Educ. 2022;1‐11. doi:10.1111/medu.14873
Patel P, Hancock J. Uncertainty tolerance scales: Weighing up the research. Medical Education. 2023;57(9).
Hancock J, Ukoumunne OC, Mattick K et al. Re-evaluating the factor structure of the Tolerance of Ambiguity of Medical Students And Doctors (TAMSAD) scale in newly qualified doctors [version 1; peer review: awaiting peer review] MedEdPublish 2024, 14:16 https://doi.org/10.12688/mep.20132.1
Hancock J, Ukoumunne OC, Burford B, Vance G, Gale T, Mattick K. (2025) Tolerance of ambiguity and psychological wellbeing in newly qualified doctors: An analysis over multiple time points. Med Educ.;1‐11.
Jack E, Hancock J, Rogers M, et alWhat aspects of clinical uncertainty are addressed by published competencies in evidence-based medicine? A scoping reviewBMJ Open 2026;16:e109013. doi: 10.1136/bmjopen-2025-109013
Blog by Amy Chinner (PhD student) “Understanding Uncertainty – Involving People with Lived Experience in Research into Medical Communication and Decision Making” https://sites.exeter.ac.uk/apex/2026/02/04/understanding-uncertainty-involving-people-with-lived-experience-in-research-into-medical-communication-and-decision-making-by-abi-chinner-evans/
Mastering Clinical Uncertainty: Why Curiosity is an Integral Skill for Every Doctor: https://doctorstraining.com/insights-hub/mastering-clinical-uncertainty-why-curiosity-is-an-integral-skill-for-every-doctor/
Choppy waters: how educators can support their learners to navigate healthcare uncertainty
The PAPERs podcast, #2 Uncertainty – That’s what one fears most: https://paperspodcast.ki.se/2023/03/07/uncertainty-tolerance-medical-education/