‘I was a bit hasty … I was a young resident!’ Medical residents' responses to clinical uncertainty

INTRODUCTION: Uncertainty is intrinsic to medical practice. Improving trainees' uncertainty tolerance requires exploring their responses to clinical uncertainty in clinical contexts. Although previous research works have highlighted the role of self-assessment, contextual cues and responsibility, existing models-developed for experienced physicians-often fail to capture residents' intuitive, situated responses. This study explores residents' behavioural responses to clinical uncertainty, focusing on how contextual features shape their actions and decision making. Following Hillen et al., we define behavioural responses as the actions individuals take to cope with uncertain situations. METHODS: Using an interpretative paradigm, we conducted a thematic analysis of semi-structured interviews with residents from several medical specialties. Considering that age, gender and clinical experience shape responses to uncertainty, we used a maximum variation sampling strategy to ensure diversity in year of residency and gender among participants. Audio-recorded interviews were conducted following a pretested interview guide focusing on residents' lived experiences of uncertainty and transcribed into verbatims. Analysis combined deductive coding, informed by Hillen's framework and Han's taxonomy, with inductive theme generation to capture novel insights. RESULTS: Fourteen participants described three main behavioural responses to clinical uncertainty, aligned with Han's taxonomy: reducing uncertainty, protection and adaptation. Their responses were determined by situational determinants, including the patient, the problem at hand, the environment and their individual characteristics. Over time, participants progressed from avoiding uncertainty or relying on supervisors to taking a more systemic and situated approach, integrating a combination of complementary strategies to balance the objectives of patients and physicians. This approach fostered the development of competence in navigating complex clinical situations. DISCUSSION: Our study shows that uncertainty is a situated experience shaped by dynamic interactions between practitioners and context. Recognising this helps move beyond a purely cognitive view, framing uncertainty as a core competency developed through experiential learning and supported by adaptive strategies.