Appendix 1: Video 1.1 Transcript

If you were to ask me, ‘What is a spider bite kit?’ eight years ago, I wouldn’t have had a clue. You can hear from my accent that I actually wasn’t raised here.

I arrived in Australia in May 2016, or the year of winters, as I like to call it, with just my partner and a few suitcases. Everything was unfamiliar. People tried to reassure me that the move would be easy because I speak English. Soon after arriving, I realised just how uncertain the world could be: I didn’t know what a spider bite kit was; I kept turning on the windshield, I mean windscreen, wipers instead of the turn signal. People kept talking about ‘long blacks’ in the ‘arvo’ and a bushfire season. I was lost, to say the least.

While some days felt daunting, I loved the opportunities to be able to be curious. I was open and vulnerable when feeling confused in conversation, and I asked lots of questions. In fact, I actually said to a close friend recently how much I missed those days of realising nearly every day that I was learning something new. While at times the uncertainties did bring anxiety, fear, and concern – especially around topics related to where I live or survival kind of topics – there were many times that there was almost a joy in the uncertainty.

Uncertainty doesn’t just cling to us expats, though; it turns out uncertainty is a feature of all workplaces and of life. As the saying goes, ‘The only certainty is uncertainty’. We can’t predict the future, and the complexities of human nature mean that we will literally not ever know it all.

My name is Michelle Lazarus, and my team researches something that we all experience: uncertainty. We look at how we perceive and respond to unknowns, complexities, and ambiguities. If you name a career, I can tell you where uncertainty creeps in.

Let’s think about healthcare. While the media portrayals suggest that we know everything in healthcare, and all diagnoses come in 30 minutes, everyone involved with healthcare experiences and manages uncertainty. There are biomedical uncertainties: Is the chest pain reflux? Or is it heart attack? And there are psychosocial ones: How much does the patient need to know? How much do I want to know as a patient? Who am I within the healthcare team? What’s my role in the healthcare system?

Another field filled with uncertainty is business and economics. Those terms conjure up images of hard facts and numbers, statistics, and certainty. But how and when the numbers are used, which ones are relevant, and what they even mean when they’re ‘crunched’ is filled with uncertainty. Economic models, for instance: they are all about future planning, but they rely on data from the past. How much of these historic numbers apply to the context today?

When I mention the word science, what do you picture? The field of research is literally predicated on unknowns. After all, we wouldn’t be studying it if it was known. What questions to ask, though? What information is relevant to your current study? What methods to use, how to interpret the data, and then even how to communicate the result and how it’s heard by the world is all filled with uncertainty. The example often used is that of a hurricane or cyclone. We understand the principles of how these weather patterns work. But if you were to ask me or a weather person to give you an exact path on an exact day of the cyclone, they probably can’t.

If you are, or have ever been, a student, formally or informally, like I was when I moved to Australia, you would know that learning and teaching is also filled with uncertainty. Teachers can’t be sure about what their students knew before they come into the classroom and what they’re taking away from what they’re teaching today. And these unknowns are just ‘scratching the surface’, as they say. What I realised is that uncertainty for students, or myself as a learner, they’re never ending. Not only are we unsure of the knowledge (that’s why we’re here: to learn), but we’re also unfamiliar with where to park, how to learn, who to go to for help. We have a general lack of awareness about the entire context in which the learning is taking place. The questions we have when we’re learning are endless.

There’s a key theme underpinning every single one of these scenarios that I’ve explained, and that’s humans. Our unpredictable thoughts, behaviours, and actions, our autonomy and agency: all contribute to the spark igniting the flames of uncertainty. When we think about it in these terms, we wouldn’t want to eliminate our autonomy and freedom by eliminating the uncertainty. We want to, instead, see the uncertainty, acknowledge the uncertainty, and then adaptively and effectively manage it. This is known as our uncertainty tolerance. And we can see that it becomes a critical skill in the workplace and in life.

Think of the start of the global pandemic. How did you respond? Curious, competent, appropriate grocery shopping? Acknowledgement, ambivalence, continuing with normal activities? Or anxious, vulnerable, and panic-buying toilet paper? This question illustrates the current conceptual model of uncertainty tolerance. Importantly, your answer isn’t a value judgement. There’s no right or wrong here. And your answer likely changed depending on your unique circumstances. Uncertainty tolerance is a psychological construct with a stimulus – in this case, an entirely novel virus, which we perceive and respond to across the way we think, the way we feel, and the way we act. There are factors that are termed moderators, which can influence how we perceive or respond to this uncertainty. In my case, when it came to COVID, I had family overseas who were vulnerable in a country where the pandemic was raging. This caused me to feel a little less tolerant of the uncertainty.

There’s some research that suggests that our natural response to uncertainty is to perceive it as a threat, something negative to avoid. However, the same research suggests that uncertainty actually can provide an advantage. We tend to experience joy and hope for longer periods when faced with uncertainty. And the unknown can actually help us learn and retain knowledge better. It is the uncertainty which is the seed for opportunity, creativity, and hope.

Our research, and others’ research, had a very important finding. We aren’t born with a static amount of uncertainty tolerance. It’s something that we can change and adapt through the way we think, feel, and act. In fact, I thought this work was so important that I put together a book with Monash Publishing titled The Uncertainty Effect: How to Survive and Thrive through the Unexpected, which describes some of the different ways we can perceive and respond to this uncertainty. Additionally, we have a wide variety of publicly available research that you can read through, and I encourage you to explore.

In the face of uncertainties, the antidote isn’t certainty. In fact, certainty in its truest form is rarely possible. When we pretend that the uncertainty doesn’t exist, or we create endless checklists to try and control the uncertainty, or we engage in doom-scrolling to try to gather and outcompete the uncertainty with knowledge, we aren’t removing the uncertainty; we’re only ineffectively responding to it. This means that the uncertainty is still there, but we aren’t well prepared to face it, which can result in burnout, difficulty problem solving, disengagement, and a need for increased oversight, because we’ve become basically paralysed in the uncertainty.

There are actions we can take to help adaptively respond to uncertainty, including transparency about when and how uncertainty is present in a given situation. We can communicate what we know and what we don’t know but how we’re going to find out. We can engage in critical reflection, where we consider our thoughts, feelings, and current responses to the uncertainty as well as plan for our responses to future similar uncertainty. There are many more options we have in responding to uncertainty that show adaptive responses. Even sharing our experiences of uncertainty with those that we trust can be invaluable. We can learn we aren’t alone, and we can learn from others.

When we adaptively respond to uncertainty, there’s evidence that we are more satisfied in our jobs, more creative in our solutions. We’re able to be more judicious and thoughtful in our actions, and we can make more decisions independently.

Margaret Drabble, the writer, once said, ‘When nothing is sure, everything is possible’. By drawing on our uncertainty tolerance, by adaptively responding to and seeing the uncertainty instead of fearing and hiding from it, we’re able to see all of these possibilities.

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Preparing Learners for Uncertainty in Health Professions Copyright © 2024 by Michelle D. Lazarus and Georgina C. Stephens is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.

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