Balancing knowledge with uncertainty

Creating cases which helps foster uncertainty tolerance

One way to support learners’ uncertainty tolerance development is through “grey cases” which mimic real-world workplace uncertainty. Instead of typical, case-based learning approaches where learners work through a case towards a definitive singular “answer”, grey cases have variable endpoints, can include unknowns, and often use real-world data to stimulate uncertainty. The goal here is to focus more on the process of learning, than the destination.

To help learners manage uncertainty in grey cases, these grey cases are designed to be done in teams, so that learners work together – sharing knowledge and experiences – to manage the educational uncertainty.

What is included in the cases?

For our healthcare teaching, a grey case presentation describes the patient’s symptoms (e.g. pain in the upper right quadrant of the abdomen) for which relevant questions are posed (i.e. which structure may be at risk, and why? What is your differential diagnosis and why?).

Each clinical anatomy question includes multiple-choice answers (sometimes A-Z!) to provide discussion boundaries and prevent learners from drowning in an abyss of uncertainty while focusing them on the intended learning outcomes.

Learners debate, and defend, their selections by engaging both their anatomical knowledge (i.e. ‘certainty’) and relevant aspects of the clinical case presentation (i.e. ‘uncertainty’) – balancing knowns with unknowns. Many of the cases have no clear-cut resolutions, and more than one answer which is probable.

Discussing the results

This approach allows learners the opportunity to discuss and consolidate large amounts of anatomical knowledge in the context of authentic (and uncertain) clinical experiences. In doing so, learners practice managing the types of uncertainty they will face in their future careers.

Be prepared for students who don’t ‘like it’. 

This approach can be very challenging. Don’t give up. Transformative learning takes time, and is often uncomfortable. Most students will appreciate this approach, even come to value it, over time.

Be kind and supportive.

Feeling uncertain, especially in high-stakes scenarios where grades matter, can be unsettling. Students may need extra support or encouragement to make it through.

Be transparent about your own experiences managing uncertainty.  

This can help students realise they are not alone, and can help them identify tools (from your experiences) for managing uncertainty.

Be mindful and deliberate in where, when, and how you integrate uncertainty into your classroom.

Uncertainty is naturally everywhere, that doesn’t mean that students will learn to manage it well. A curriculum which is purpose-built for, and longitudinally infused with, uncertainty tolerance teaching practices will have a greater effect on learner’s development of this critical skill.

Don’t reinvent wheels to stimulate uncertainty in the classroom.

The real-world is messy and ambiguous, use real data or cases as the starting point for your uncertainty tolerance teaching.

Be prepared to have your own uncertainty tolerance challenged.

This may be a novel approach to your teaching, and this can be challenging!

Train your staff about this approach. 

It only takes one person giving THE answer to undermine this approach. Invest time into supporting staff in how to effectively deliver this type of teaching.