What aspects of clinical uncertainty are addressed by published competencies in evidence-based medicine? A scoping review.

Abstract

Uncertainty is inherent within medicine. Evidence-based medicine (EBM) teaching within medical curricula seeks to prepare doctors to make clinical decisions within conditions of uncertainty. The goals and scope of training for medical students and doctors are defined by published EBM competencies. We conducted a scoping review to identify the aspects of clinical uncertainty that are addressed by EBM competencies. A scoping review was conducted to identify and synthesise existing literature and models of clinical uncertainty, with help from an advisory group. Reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Five databases (MEDLINE, EMBASE, PsycINFO, ERIC and Web of Science Core Collection) and supplementary searches. The searches were performed on 7 March, 2023, repeated and updated on 19 February 2025. We included empirical research studies that described uncertainty related to clinical decision-making in medical students and doctors. Screening against the inclusion/exclusion criteria, first using titles/abstracts and then full text, was conducted independently by EJ and one other author. Disagreements were discussed and resolved by the full team. Data from included studies were used to create an overarching framework and typology of clinical uncertainty relevant to EBM, which was then mapped to published EBM competencies. 44 of 3048 papers met the inclusion criteria. The overarching framework and typology described types of uncertainty, properties and modifiers of the uncertainty, which led to responses and strategies that clinicians adopted within conditions of uncertainty. The mapping process revealed that EBM competencies focus on the theoretical, technical and cognitive aspects of clinical uncertainty, and tend to neglect real-world clinical decision-making, doctor-patient interaction and behavioural/emotional responses to uncertainty. The new framework and typology facilitate better conversations about uncertainty within everyday clinical practice. Findings from the mapping exercise can help medical educators to better align EBM teaching with clinical practice, helping them to better prepare doctors for clinical uncertainty. The findings enable different parts of medical curricula to forge stronger connections, for example, linking EBM teaching, communication skills teaching and clinical placements.