UNASSIGNED: The present study conducts a retrospective bibliometric analysis to examine the quantifiable and qualitative evolution of the concept of tolerance to ambiguity (TA) over time. Additionally, a scientometric analysis using quantitative methods on scientific measurements and trends aims to profile and identify the concept, as well as its development in research themes. The relevance of this study is underscored by the growing interest and development of research on TA, particularly in fields like entrepreneurship where psychological factors are significant.
UNASSIGNED: The research includes highly relevant literature, such as Budner and Frenkel-Brunswick, which define TA as a predisposition to perceive ambiguous situations as desirable and as a personality variable centered on the emotional and perceptual domain, respectively. Data was obtained from the eight indices comprising the main Web of Science collection, covering research from 1975 to December 2022. A total of 378 articles were identified.
UNASSIGNED: The analysis reveals that scientific production peaked in 2022 with 45 articles. In terms of citations, 7,773 were found, with the highest concentration in 2022, totaling 1,203 citations. This indicates a significant increase in research interest and output related to TA.
UNASSIGNED: The study highlights the growing exploration of the concept of TA, emphasizing its importance across multiple disciplines in dealing with uncertainty. The research demonstrates that TA significantly influences decision-making and adaptability, highlighting its value in business and educational settings. By analyzing leading publications, authors, and research centers, the study shows the diversity of approaches to understanding TA, indicating a promising direction for future research.

OBJECTIVE: Ambiguity tolerance specific to the clinical context - in contrast to ambiguity tolerance as a personality trait - may vary with experience and has received considerable attention. Although this tolerance appears to be related to burnout and work engagement, few studies have examined this association among physicians. Thus, we aimed to examine the relationships between clinical context-specific ambiguity tolerance, burnout, and work engagement among physicians in Japan.
METHODS: We conducted a nationwide cross-sectional study in Japan. We invited family physicians from 14 family medicine residency programs and physicians with specialties other than family medicine from monitors of an Internet survey company to participate in the study. We measured ambiguity tolerance in the clinical context using the Japanese version of the Tolerance of Ambiguity in Medical Students and Doctors (J-TAMSAD) scale, burnout using the Japanese version of the Burnout Assessment Scale (BAT-J), and work engagement using the Utrecht Work Engagement Scale (UWES). We performed a multivariable linear regression analysis to determine whether the J-TAMSAD scale score was associated with the BAT-J and UWES scores.
RESULTS: 383 respondents were included in the analysis. After adjustment for possible confounders, clinical context-specific ambiguity tolerance showed a dose-dependent negative association with burnout (adjusted mean difference  -0.39, 95% confidence interval (CI) -0.56 to -0.22 for the highest J-TAMSAD score quartile compared with the lowest). Ambiguity tolerance in the clinical context also showed a dose-dependent positive association with work engagement (adjusted mean difference 0.83, 95% CI 0.49 to 1.16 for the highest J-TAMSAD score quartile compared with the lowest).
CONCLUSIONS: Our study showed that tolerance for ambiguity in the clinical context was negatively associated with burnout, and positively associated with work engagement. These findings will be useful in developing interventions aimed at preventing burnout and promoting work engagement among physicians.

Uncertainty is pervasive throughout healthcare practice. Uncertainty tolerance (i.e. adaptively responding to perceived uncertainty) is considered to benefit practitioner wellbeing, encourage person-centred care, and support judicious healthcare resource utilisation. Accordingly, uncertainty tolerance development is increasingly referenced within training frameworks. Practical approaches to support healthcare learners\' uncertainty tolerance development, however, are lacking.
Drawing on findings across the literature, and the authors\' educational experiences, twelve tips for promoting healthcare learners\' uncertainty tolerance were developed.
Tips are divided into 1. Tips for Learners, 2. Tips for Educators and Supervisors, and 3. Tips for Healthcare Education Institutions and Systems. Each tip summarises relevant research findings, alongside applications to educational practice.
Approaches to developing uncertainty tolerance balance factors supporting learners through uncertain experiences, with introducing challenges for learners to further develop uncertainty tolerance. These tips can reassure healthcare education stakeholders that developing learner uncertainty tolerance, alongside core knowledge, is achievable.

BACKGROUND: Ambiguity is inherent to the medical field; hence, assessing and educating medical trainees regarding ambiguity tolerance is essential. The Tolerance of Ambiguity in Medical Students and Doctors (TAMSAD) scale-a novel instrument that assesses ambiguity tolerance in clinical settings-has been widely used for medical education research in Western countries. However, a version of this scale applicable to the intricate clinical contexts of Japan has not yet been developed. In this study, we developed the Japanese version of the TAMSAD (J-TAMSAD) scale and tested its psychometric properties.
METHODS: In this multicenter study, we collected data through a cross-sectional survey in two universities (medical students) and ten hospitals (residents) across Japan, and evaluated the structural validity, criterion-related validity, and internal consistency reliability of the J-TAMSAD scale.
RESULTS: We analyzed the data of 247 participants. The sample was randomly divided in half, with exploratory factor analysis (EFA) performed on one half and confirmatory factor analysis (CFA) on the other. EFA led to an 18-item J-TAMSAD scale comprising five factors. CFA showed acceptable fit for this five-factor model (comparative fit index = 0.900, root mean square error of approximation = 0.050, standardized root mean square residual = 0.069, goodness of fit index = 0.987). There was a positive correlation between the J-TAMSAD scale scores and total reverse scores on the Japanese version of the Short Intolerance of Uncertainty Scale (Pearson correlation coefficient 0.41). The internal consistency was found to be satisfactory (Cronbach\'s alpha 0.70).
CONCLUSIONS: The J-TAMSAD scale was developed, and its psychometric properties were confirmed. The instrument can be useful for assessing tolerance of ambiguity among medical trainees in Japan. With further validation, it could be used to verify the educational effectiveness of curricula that foster ambiguity tolerance in medical trainees, or even in research assessing the relationship with other variables.

BACKGROUND: Medicine is a field that is simultaneously factual and ambiguous. Medical students have their first exposure to full time clinical practice during clerkship. While studies have examined medical trainees\' tolerance of ambiguity (TOA), the extent to which TOA is affected by clinical experiences and its association with perfectionism is unknown. The aim of this study was to evaluate the effect of clerkship experience on TOA and perfectionism in medical students.
METHODS: This was a multiple sampling, single cohort study of students in their first year of clinical clerkship which is comprised of 6 core rotations. Consenting students completed an online anonymous survey assessing their tolerance of ambiguity (TOA) and perfectionism in their first (pre) and last (post) 12 weeks of their clinical clerkship year. Tolerance of Ambiguity in Medical Students and Doctors (TAMSAD) and The Big Three perfectionism scale-short form (BTPS-SF) were used to assess TOA and perfectionism respectively. Pre-Post mean comparisons of TOA and perfectionism were assessed via t-tests.
RESULTS: From a cohort of 174 clinical clerkship students, 51 students responded to pre-survey, 62 responded to post-survey. Clerkship was associated with a significant decrease in TOA (p < 0.00) with mean pre-TOA scores of 59.57 and post TOA of 43.8. Perfectionism scores were not significantly different over time (p > 0.05). There was a moderate inverse correlation between TOA and perfectionism before clerkship (r = 0.32) that increased slightly after clerkship (r = 0.39). Those preferring primary care specialties had significantly lower rigid and total perfectionism scores in pre-clerkship than those choosing other specialties, but this difference was not found post-clerkship.
CONCLUSIONS: Exposure to clerkship decreased TOA while perfectionism remained stable in medical students. These results were not expected as exposure has been previously shown to increase TOA. The frequency of rotation changes maintaining a cycle of anxiety may be an underlying factor accounting for these results. Overall these results require further investigation to better characterize the role of clinical exposure on TOA.

BACKGROUND: Certain personal attributes, such as perfectionism and tolerance of ambiguity, have been identified as influential in high achieving students. Medical students have been identified as high achievers and perfectionistic, and as such may be challenged by ambiguity. Medical students undertake a long and challenging degree. Personality has been shown to influence the well-being and coping and may equip some students to better cope with challenges. This paper examines the association between temperament and character personality profiles with measures of tolerance of ambiguity and with both adaptive and maladaptive constructs of perfectionism.
METHODS: A self-report questionnaire collected data on a sample of 808 Australian medical students in 2014 and 2015. Personality was measured using the Temperament and Character Inventory (TCIR-140) and classified traits as profiles using a latent class analysis. Two profiles were found. Profile 1 was characterized by low-average levels of Harm Avoidance, and high to very high levels of Persistence, Self-Directedness and Cooperativeness. Moderately-high levels of Harm Avoidance and high levels of Persistence, Self-Directedness and Cooperativeness characterized Profile 2. Moderation regression analyses were conducted to examine the association between the personality profiles with levels of Tolerance of Ambiguity (MSAT-II), Perfectionism-Concern over Mistakes and Perfectionism-High Standards (FMPS), considering demographic characteristics.
RESULTS: Students with Profile 1 were higher in levels of Tolerance of Ambiguity, and Perfectionism-High Standards, and lower levels of Perfectionism-Concern over Mistakes compared to Profile 2. These findings remained statistically significant after adjusting for age and gender. A significant personality by age interaction on Tolerance of Ambiguity was found. While higher levels of Tolerance of Ambiguity were associated with older age overall, it remained low across age for students with a personality Profile 2.
CONCLUSIONS: A particular combination of personality traits was identified to be associated with low Tolerance of Ambiguity and high levels of maladaptive Perfectionism. An intolerance of ambiguity and over concern about mistakes may be maladaptive and underlie vulnerability to stress and poor coping. The psychobiological model of personality provides insight into traits that are stable and those that can be self-regulated through education and training. The interaction between biological mechanisms and socio-cultural learning is relevant to a sample of medical students because it accounts for interaction of the biological or innate aspects of their personal development within an intense and competitive learning environment of medical school.

Construct: Induction into the Gold Humanism Honor Society (GHHS) during medical school is recognized as an indicator of humanistic orientation and behavior. Various attitudes and interpersonal orientations including empathy and patient-centeredness have been posited to translate into behaviors constituting humanistic care.
BACKGROUND: To our knowledge there has never been a longitudinal, multi-institutional empirical study of the attitudinal and interpersonal orientations correlated with GHHS membership status.
METHODS: We used the American Medical Association Learning Environment Study (LES) data set to explore attitudinal correlates associated with students whose behaviors are recognized by their peers as being exceptionally humanistic. Specifically, we examined whether empathy, patient-centeredness, tolerance of ambiguity, coping style, and perceptions of the learning environment are associated with GHHS membership status. We further considered to what extent GHHS members arrive in medical school with these attitudinal correlates and to what extent they change and evolve differentially among GHHS members compared to their non-GHHS peers. Between 2011 and 2015, 585 students from 13 North American medical schools with GHHS chapters participated in the LES, a longitudinal cohort study using a battery of validated psychometric measures including the Jefferson Scale of Empathy, Patient-Practitioner Orientation Scale and Tolerance of Ambiguity Questionnaire. In the final survey administration, students self-identified as GHHS inductees or not (non-GHHS). T tests, effect sizes, and longitudinal generalized mixed-effects models examined the differences between GHHS and non-GHHS students.
RESULTS: Students inducted into GHHS scored significantly higher on average over 4 years than non-GHHS inductees on clinical empathy, patient-centered beliefs, and tolerance of ambiguity. GHHS students reported higher levels of empathy and patient-centeredness at medical school matriculation. This difference persists in the 4th year of medical school and when controlling for time, race, gender, and school.
CONCLUSIONS: GHHS inductees enter medical school with different attitudes and beliefs than their non-GHHS classmates. Although humanistic attitudes and beliefs vary over time during students\' 4 years, the gap between the two groups remains constant. Medical schools may want to consider selecting for specific humanistic traits during admissions as well as fostering the development of humanism through curricular interventions.

BACKGROUND: Obstetrician cognitive and affective traits have been identified to have relationships with their patients\' perinatal outcomes. The objective was to identify relationships between obstetrician demographic and practice characteristics and physician coping, self-efficacy, anxiety and ambiguity tolerance.
METHODS: Obstetricians at a single institution were surveyed using 5 validated scales measuring coping skills, tolerance for ambiguity, cognitive engagement and trait anxiety. Demographics and practice characteristics were assessed. Chi-square tests, t-tests, ANOVA and linear regression were used to assess relationships between physician characteristics and cognitive traits.
RESULTS: Ninety-four physicians participated. Women expressed greater proactive coping than men (p = 0.03) on the Proactive Coping scale. Providers with greater delivery volume expressed lower engagement in cognitive efforts (p = 0.03) on the Need for Cognition scale. Maternal-fetal medicine physicians demonstrated greater ambiguity tolerance (p < 0.01) and cognitive engagement (p = 0.012) than general obstetricians. Differences by specialty persisted after adjustment for potentially confounding factors.
CONCLUSIONS: Practice type and specialty appeared to be related to several cognitive characteristics. It remains uncertain whether these differences are a cause or a consequence of specialty training and whether they result in differences in obstetric outcomes.

The concept of tolerance of ambiguity (AT) is defined as the way in which an individual tends to perceive and deal with confusing, vague, and unclear situations. AT is generally considered as an important personality trait, but the neural mechanisms underlying individual differences in AT have never been investigated. Using voxel-based morphometry and MSTAT-II scale, we investigated the correlations between AT and regional white matter volume (rWMV) and regional gray matter volume (rGMV) in 351 young healthy subjects. We found AT to be positively correlated with rGMV in the dorsolateral prefrontal cortex (DLPFC), and negatively correlated with rGMV in the precuneus. These results indicate that increased rGMV in the left DLPFC may lead to characteristics of ambiguous stimuli consideration from multiple contexts and risk taking. Decreased rGMV in the left precuneus may be associated with a high tolerance for ambiguity, which attributes uncertainty to self-related factors.