Uncertainty management as multiple goal regulation

Short abstract

Trainees juggle multiple goals in clinical spaces ‐ e.g. keeping their patients safe and impressing their supervisors. How do these multiple goals shape their responses to uncertainty? #MedEd

1. INTRODUCTION

Navigating the demands of modern medical practice inevitably exposes trainees to uncertainty, especially as they assume greater responsibility for patient care. Diagnoses, prognoses, and treatment recommendations must often rely on incomplete information, potentially reflecting the limits of current medical knowledge. Feelings of uncertainty can signal valuable opportunities for further learning and the development of self‐regulated learning skills, ¹ but they can also contribute to anxiety, stress, and burnout. ² Additionally, efforts to reduce or avoid these feelings may risk unnecessary healthcare use and potentially even patient safety. ² , ³ To support trainees' professional development while also prioritising their well‐being and the safety of patients, it is therefore critical to understand why they respond to uncertainty in particular ways and how these responses shape their emotions, self‐regulated learning and patient care.

In this issue, Belhomme et al. explored residents' responses to clinical uncertainty. These included attempts to reduce uncertainty on their own or by asking their supervisor for help, protect themselves from uncertainty by distributing responsibility across the team and adapt to uncertainty by disclosing it to patients and incorporating it into shared decision‐making. Residents' responses depended on situational factors such as clinical urgency and were often accompanied by negative emotions, particularly among more junior residents.

Belhomme et al.'s findings illustrate that trainees' responses to uncertainty are shaped, at least in part, by their need to navigate multiple priorities, or goals, in clinical spaces. These goals may include keeping patients safe, developing as independent clinicians, protecting professional legitimacy, impressing supervisors, fostering peer relationships and performing well on assessments. These priorities may come into conflict as trainees consider how to manage uncertainty, shaping their responses. For example, Belhomme et al. reported that, when residents felt that uncertainty needed to be urgently resolved because the situation posed an immediate risk to patient safety, they forwent independent problem‐solving and sought help from their supervisor. By contrast, they prioritised independent problem‐solving when situations were less acute.

Trainees' responses to uncertainty are shaped, at least in part, by their need to navigate multiple priorities, or goals, in clinical spaces.

That responses to uncertainty involve navigating multiple goals suggests that theories of multiple goal regulation may offer additional insight into how trainees manage uncertainty and how educators can better support them in doing so productively. These theories focus on how individuals pursue and prioritise multiple goals and navigate conflicts between them. Although they have received increasing attention in the psychology, education and management literatures, ⁴ , ⁵ they remain relatively underutilised in health professions education.

Theories of multiple goal regulation may offer additional insight into how trainees manage uncertainty.

Theories of multiple goal regulation conceptualise behaviour as continuous stream of goal‐directed action. ⁴ Goals are cognitive representations of states that individuals want to achieve (approach goals) or avoid (avoidance goals) and may involve discrete aims (e.g., cure my patient's illness) or enduring concerns (e.g., avoid my legitimacy being questioned). Because actions often implicate multiple goals, individuals' decisions for how to act involve navigating goal conflict. These decisions are influenced by the value they assign to particular goals and their expectations that actions will move them closer to, or further from, these goals. From this perspective, individuals tend to select actions they expect to maximise progress towards their most valued goals. For example, the tendency for residents to deprioritise independent problem‐solving when patient safety is under threat aligns with research showing that individuals place more value on, and thus tend to prioritise, goals that are urgently threatened. ⁶ Actions that advance some goals while undermining others, referred to as inherent goal conflicts, are often associated with mixed or negative emotions and may undermine individuals' basic psychological needs. ⁷ , ⁸ The anxiety and stress associated with uncertainty may therefore stem, at least in part, from recognising that a response (e.g., asking a supervisor for help) may resolve one goal (e.g., ensuring patient safety) but hinder another (e.g., learning to be an independent clinician). ³

To better understand residents' responses to uncertainty, educators may find it useful to ‘map’ the factors that shape trainees' goals and, in turn, their responses to uncertainty. ⁹ Such mapping begins by identifying the network of goals implicated in residents' responses to uncertainty. ¹⁰ For example, residents could be presented with a series of clinical vignettes featuring commonly reported responses to uncertainty—such as those described by Belhomme et al. (e.g., asking a supervisor for help, disclosing uncertainty to a patient)—and asked to identify the potential positive or negative consequences (i.e., goals) of each response (e.g., receiving a poor assessment and losing patient trust). Drawing on theories of multiple goal regulation, residents could also be asked to rate the importance of each consequence and the perceived likelihood that the response would lead to it. Following this activity, educators could reflect on the structures, policies, people, tools, and beliefs that shape which goals are valued and considered likely outcomes of particular responses to uncertainty. For example, a lack of psychological safety may increase trainees' expectation that disclosing uncertainty to their supervisor may negatively affect their performance on assessments. ³

Educators may find it useful to ‘map’ the factors that shape trainees' goals and, in turn, their responses to uncertainty.

Equipped with a goal map, educators may be better positioned to identify situations in which residents are especially likely to respond to uncertainty in ways that undermine self‐regulated learning, elicit negative emotion, or threaten patient safety. For example, junior residents who lack self‐regulated learning skills may expect that asking their supervisor for help is far likelier to ensure patient safety than engaging in independent problem‐solving, biassing them towards the former and hindering opportunities to further develop such skills. As another example, residents who lack patient communication skills may expect that disclosing uncertainty to patients will undermine patient trust. As a final example, residents in a particularly competitive training environment may expect that disclosing uncertainty and seeking advice from other trainees may undermine their standing among their peers.

Educators can then consider how structures, policies, people, tools and beliefs might be recalibrated to encourage adaptive responses which promote self‐regulated learning, positive emotion and patient safety. The aim of such efforts is to modify a goal's subjective value and/or the perceived likelihood that it will be impacted by a particular response. For example, supervisors can model a mindset and strategies that decouple trainees' expectations that disclosing uncertainty will threaten their performance on assessments, compromise their professional legitimacy, or undermine patient trust.

Educators can then consider how structures, policies, people, tools and beliefs might be recalibrated to encourage adaptive responses.

Belhomme et al.'s study offers a compelling account of residents' responses to uncertainty and provides a strong foundation for applying theories of multiple goal regulation to shape education in this domain. Mapping the goal landscape trainees traverse in clinical practice may help educators better support adaptive responses to uncertainty as trainees develop into independent clinicians.

DECLARATION OF GENERATIVE AI AND AI‐ASSISTED TECHNOLOGIES IN THE WRITING PROCESS

Microsoft Copilot was used to edit for wordsmithing and grammar at the very end of the drafting process. The author uploaded a draft of the manuscript to Copilot and asked for suggested edits to improve clarity and readability. Some edits were adopted while others were not. Copilot did not have an impact on the substantive content of the paper. The author takes full responsibility for the content of the published article.

AUTHOR CONTRIBUTIONS

Adam G. Gavarkovs: Conceptualization; writing—original draft; writing—review and editing.

Gavarkovs AG. Uncertainty management as multiple goal regulation. Med Educ. 2026;60(8):837‐839. doi: 10.1111/medu.70231

DATA AVAILABILITY STATEMENT

Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.