Practice Uncertainties

When I spoke with health professionals about supervision in my PhD research, I noticed how often they talked about their uncertainties in day-to-day practice. I noticed three main sources of uncertainty

  • Practice Demands – Being busy, having too much to do, how to prioritise, feeling burdened.
  • Platform for Practice – Feeling uncertain about knowledge, skills, experiences and/or things outside of work and/or things linked to personal qualities, attributes and preferences.
  • Socio-professional – Wondering if you look like the professional you are meant to be/trained to be, wondering whether you are doing what others expect.

Practitioners’ uncertainties can arise in relation to what they anticipate practice encounters are going to be like and the lived experiences of those anticipated practice encounters. So, for example, practice uncertainties may arise when:

  • we anticipated a practice encounter will be pretty straight forward but, in the end, we feel it didn’t go as smoothly as anticipated,
  • we anticipate a practice encounter is going to be tricky and it turns out we were right to predict this, perhaps confirming our suspicions that we need to brush up our knowledge and skills or gain more experience,
  • we perceive or get feedback about a practice encounter which is at odds with our own interpretation of the event,
  • we feel we are not meeting our own or others’ expectations,
  • we encounter novel practice situations which we have not had prior experience of,
  • we feel we have too much to do and not enough time to do it.

Inevitable uncertainty as a prompt for learning

Recent experiences in the Covid-19 pandemic remind us of the inevitability of uncertainty in healthcare practice, an idea that René Fox wrote about back in the 1950s when thinking about medical education and practice. However, prior to the enormous wave of uncertainty which accompanied the pandemic, I suggest we had lost touch with this idea and had come to confuse ‘being evidence-informed’ with ‘feeling certain’. We had come to view uncertainty predominately as a marker for risk. This suggests we had also lost sight of other long held ideas about uncertainty as a prompt for learning and the links between uncertainty, learning and in turn, reducing risk. Anyone who is interested in this idea of uncertainty as a prompt for learning might like to explore the work of Pragmatist John Dewey, writing in the early 1900s and more recently Webster-Wright’s ideas about Authentic Professional Learning.

Unpicking our uncertainties in practice

In reality, our practice uncertainties don’t fit into neat categories but are interwoven and often feel messy and ill-defined. In work with some people I supervise I am finding that thinking about possible sources of uncertainty in terms of practice demands, a platform for practice and socio-professional factors can help to identify a starting point when we are trying to work out how we might resolve the uncertainties and feel more readied for practice.

Further reading and resources

To find the possible further reading mentioned in this blog and activities for exploring the idea of practice uncertainties go to Ideas and Resources