Council on Medical Student Education in Pediatrics


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COMSEP Meeting in Ottawa, ON

Poster Presentation:

Tolerance for Ambiguity and Pediatrics Selection and Performance

LeeAnne P. Flygt,University of Michigan,Ann Arbor,Michigan,Joel . Purkiss,University of Michigan,Ann Arbor,MI,Sally . Santen,University of Michigan,Ann Arbor,MI,David . Belmonte,University of Michigan,Ann Arbor,MI,Rishindra M. Reddy,University of Michigan,Ann Arbor,MI,R. Brent Stansfield,University of Michigan,Ann Arbor,MI,Jocelyn Schiller,University of Michigan,Ann Arbor,MI


The practice of medicine is characterized by uncertainty. Prior studies have suggested that physicians in medical fields such as pediatrics have higher tolerance for ambiguity (TFA) than physicians in procedural fields. The literature is lacking, however, in how TFA affects performance on pediatric clerkships. Furthermore, while the influence of TFA on career specialty has been described for some fields, it is not well understood for pediatrics.

Research Questions:

Do students with higher TFA do better in the Pediatrics clerkship?  Do students who go on to match in Pediatrics residencies have higher TFA relative to those in other residencies?


Students from the graduating classes of 2014 and 2015 completed Budner’s 16-item TFA Scale (scores range from 1-7, with higher scores indicating more TFA). Association between TFA and Pediatrics clerkship performance was examined two ways: first using the numeric clinical performance alone, then using the final overall clerkship grade (Honors, High-Pass, Pass, Fail).  Pearson's R was used to examine association between TFA and numeric clinical performance; ANOVA was used for TFA and letter grade.  Field of practice was determined using subsequent residency match lists; association between TFA and residency choice was examined using independent-sample t-tests.


There is no evidence of association between TFA and Pediatrics clerkship clinical performance score (R=0.056, p=0.497, n=152), nor with overall grade (ANOVA F(2,149)=0.458, p=0.617). Students who received Honors in the clerkship had a mean TFA score=4.80, those with High Pass=4.85, and those with Pass=4.76.  No difference was found in mean TFA score for those matching in Pediatrics (mean TFA score 4.80) vs. non-Pediatrics residencies (mean TFA score 4.86) (t(144)=0.51,p=0.61).  Furthermore, no difference was seen between hospital-based, medical or surgical specialties, nor between surgical vs non-surgical residencies (p>0.05 in all comparisons).


Contrary to prior findings, our study suggests that students can excel in their pediatrics clerkship regardless of their tolerance for uncertain situations. Our study also suggests that students chose whatever specialty they desire, regardless of their TFA.