Learning to navigate uncertainty in primary care: a scoping literature review

Background: Clinical practice occurs in the context of uncertainty. Primary care is a clinical environment that accepts and works with uncertainty differently from secondary care. Recent literature reviews have contributed to understanding how clinical uncertainty is taught in educational settings and navigated in secondary care, and, to a lesser extent, by experienced GPs. We don’t know how medical students and doctors in training learn to navigate uncertainty in primary care. Aim: In this scoping review, we asked the question: What is known about primary care as an opportunity for learning to navigate uncertainty? Design & setting: Scoping review of articles written in English. Method: Using a scoping review methodology, Embase, Medline and Web of Science databases were searched, with additional articles obtained through citation searching. Studies were included in this review if they (a) were based within populations of medical students and/or doctors in training, and (b) considered clinical uncertainty or ambiguity in primary care, or a simulated primary care, setting. Study findings were analysed thematically. Results: Thirty-six studies were included from which three major themes were developed: uncertainty contributes to professional identity formation (PIF), adaptive responses, and maladaptive behaviours. Relational and social factors that influence PIF were identified. Adaptive responses included adjusting epistemic expectations, and shared decision-making. Conclusion: Educators can play a key role in helping learners navigate uncertainty through socialisation, discussing primary care epistemology, recognising maladaptive behaviours and fostering a culture of constructive responses to uncertainty.