title: A typology of uncertainty derived from an analysis of critical incidents in medical residents: A mixed methods study.
abstract: BACKGROUND
  Medical uncertainty is inherently related to the practice of the physician and generally affects his or her patient care, job satisfaction, continuing education, as well as the overall goals of the health care system. In this paper, some new types of uncertainty, which extend existing typologies, are identified and the contexts and strategies to deal with them are studied.
  
  
  METHODS
  We carried out a mixed-methods study, consisting of a qualitative and a quantitative phase. For the qualitative study, 128 residents reported critical incidents in their clinical practice and described how they coped with the uncertainty in the situation. Each critical incident was analyzed and the most salient situations, 45 in total, were retained. In the quantitative phase, a distinct group of 120 medical residents indicated for each of these situations whether they have been involved in the described situations and, if so, which coping strategy they applied. The analysis examines the relation between characteristics of the situation and the coping strategies.
  
  
  RESULTS
  From the qualitative study, a new typology of uncertainty was derived which distinguishes between technical, conceptual, communicational, systemic, and ethical uncertainty. The quantitative analysis showed that, independently of the type of uncertainty, critical incidents are most frequently resolved by consulting senior physicians (49 % overall), which underscores the importance of the hierarchical relationships in the hospital. The insights gained by this study are combined into an integrative model of uncertainty in medical residencies, which combines the type and perceived level of uncertainty, the strategies employed to deal with it, and context elements such as the actors present in the situation. The model considers the final resolution at each of three levels: the patient, the health system, and the physician's personal level.
  
  
  CONCLUSIONS
  This study gives insight into how medical residents make decisions under different types of uncertainty, giving account of the context in which the interactions take place and of the strategies used to resolve the incidents. These insights may guide the development of organizational policies that reduce uncertainty and stress in residents during their clinical training.
authors.affiliation: Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico. lizhamui@gmail.com.|Unidad de Posgrado, División de Estudios de Posgrado, Ciudad Universitaria Mexico, Edificio G, 2 piso, oficina G226, C.P. 04510, Coyoacán, D.F., Mexico City, Mexico. lizhamui@gmail.com.
authors.forename: Alicia
authors.initials: A
authors.lastname: Hamui-Sutton
authors.affiliation: Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico. vivesvarela@gmail.com.
authors.forename: Tania
authors.initials: T
authors.lastname: Vives-Varela
authors.affiliation: Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico. samm2_j@hotmail.com.
authors.forename: Samuel
authors.initials: S
authors.lastname: Gutiérrez-Barreto
authors.affiliation: Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico. iwin.leenen@gmail.com.|Instituto Nacional para la Evaluación de la Educación, Mexico City, Mexico. iwin.leenen@gmail.com.
authors.forename: Iwin
authors.initials: I
authors.lastname: Leenen
authors.affiliation: Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico. melchorsm@gmail.com.
authors.forename: Melchor
authors.initials: M
authors.lastname: Sánchez-Mendiola
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data; D008297:Male; D011795:Surveys and Questionnaires; D013647:Task Performance and Analysis; D035501:Uncertainty