Towards Embracing Clinical Uncertainty: Lessons from Social Work, Optometry and Medicine

Summary: The oral transmission and transformation of client information in an apprenticeship setting provides a rich environment in which to observe students and their expert supervisors managing uncertainty. In this Canadian-based study, we examined the communicative features of 12 social work supervisions involving social work students and their supervisors and enriched our observations with subsequent interviews of the participants. Findings: Social work students viewed the acknowledgement and examination of uncertainty as a touchstone of competent social work. This observation contrasted with our past study of medical and optometry students who focused on personal deficit and a distrust of acknowledging uncertainty. Our observations and interviews revealed a unique professional signature to the novice rhetoric of uncertainty (seeking guidance, deflecting criticism, owning limits, showing competence) that suggests differing professional identities and contextual settings. Applications: An attitudinal shift toward accepting and trusting uncertainty in medicine and optometry may facilitate an enriched educational environment for students and a more open dialogue with patients about uncertainty. The unique professional signatures of this rhetoric offer insights into how professional identity shapes attitudes and behaviors toward uncertainty and suggest a source of tension within interdisciplinary healthcare teams

Immunosuppressive therapy for kidney transplantation in adults: a systematic review and economic model.

End-stage renal disease is a long-term irreversible decline in kidney function requiring renal replacement therapy: kidney transplantation, haemodialysis or peritoneal dialysis. The preferred option is kidney transplantation, followed by immunosuppressive therapy (induction and maintenance therapy) to reduce the risk of kidney rejection and prolong graft survival.This article is freely available. Click on the 'Additional Link' above to access the full-text