Training for Uncertainty in Veterinary Education

This thesis addresses the question of how veterinary students learn to cope with uncertainty in professional practice. There is currently a lack of clarity in discussion of what constitutes effective coping with uncertainty in veterinary practice and indeed how this might be taught or assessed as part of the veterinary education process. This is despite wide recognition that managing uncertainty is central to practice in the health professions, reflected in the fact that the ability to cope with uncertainty is considered a “day one competency” for veterinary surgeons. This research adopted both extensive and intensive perspectives to address the central research question. Orienting concepts were developed form the literature on workplace learning, approaches to clinical uncertainty and individual differences in tolerance of uncertainty and ambiguity. The extensive perspective used a survey study to describe tolerance of ambiguity among veterinary students at a UK veterinary school. On average, ambiguity tolerance did not change during the classroom based part of veterinary training.Individual trajectories were often more erratic and some students moved between the highest and lowest categories during the course of training. Previous education and status as a mature student were both associated with greater tolerance of ambiguity, suggesting that educational and life experiences can produce changes in this disposition. The intensive perspective comprised a qualitative case study, using clinical case discussion recordings and semi-structured interviews to develop an understanding of the mechanisms which influence learning to cope with uncertainty in the context of an international elective placement. Using the language of situated learning theory, learning to cope with uncertainty was described as legitimate peripheral participation in the uncertainty work of a community of practice. Uncertainty work is a novel concept used to describe navigating ambiguity, complexity and risk in professional practice . Using this theoretical framework to draw together findings from both intensive and extensive perspectives suggested the central role of gaining access to uncertainty work in professional learning. Generative mechanisms have been proposed to explain the empirical findings. Access to uncertainty work was negotiated between students and staff in the context of clinical and educational practice. Trust was central to gaining access to uncertainty work, and this was reflected in increasing clinical responsibility. Ambiguity tolerance was described in this context as a disposition of individuals which can influence their engagement with and access to uncertainty work. Through an exploration of the significance of these mechanisms in the context of Veterinary education, implications for curriculum and policy have been highlighted. Although the use of measures of ambiguity tolerance in selection are considered problematic, there can be clear scope to support students in accessing uncertainty work and to highlight encounters with uncertainty work as integral to the professional role, providing opportunities to promote personal and professional development through reflective practice.