Date of Award

7-9-2025

Document Type

Dissertation

Degree Name

Doctor of Philosophy (Ph.D.)

School Name

College of Health Professions

Department

Health Professions

Major Advisor

Dr. Christy Kane

Second Advisor

Dr. Lyndsey Blair

Third Advisor

Dr. Michelle Brown

Abstract

Background: Uncertainty tolerance is crucial for healthcare providers facing complex clinical situations. However, there is a gap in the literature regarding effective interventions for developing this skill in the physician associate population.

Purpose: This study aimed to address this gap by investigating the impact of multiple immersive simulations, each involving an ambiguous diagnosis, on pre-clinical physician associate students' uncertainty tolerance.

Methods: Fifty-five pre-clinical physician associate students were invited to participate in the study. Using a quasi-experimental pre- and post-design, uncertainty tolerance was measured using both the Tolerance of Ambiguity in Medical Students and Doctors scale and the Tolerance for Ambiguity scale.

Results: Pre- and post-intervention surveys revealed a statistically significant reduction in uncertainty tolerance. While survey scores improved during simulation cases three and four, these gains were not sustained. Repeated scale assessments showed no significant difference between active participation and observation simulation roles, and prior healthcare experience was not correlated with uncertainty tolerance. Psychometric analyses revealed limitations in the reliability and validity of the scales in this population.

Conclusions: This study is the first to contribute to the literature on uncertainty tolerance among physician associate students, offering evidence on the use of immersive simulation with diagnostic ambiguity to influence this critical non-technical skill. It highlights the impact of the mode of engagement (role) during simulation and the effect of prior healthcare experience. The results emphasize the need for the inclusion of clinical uncertainty in health professions curricula and support the use of simulation-based strategies to shape learners' ability to navigate uncertainty.

Available for download on Saturday, July 18, 2026

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