by Judith Curry
The quest for certainty blocks the search for meaning. Uncertainty is the very condition to impel man to unfold his powers. Erich Fromm
This post continues the themes raised in the previous post on Ignorance.
An article entitled Education and the Art of Uncertainty has been published in the journal Radiology (h/t Matthew Hincman). Its a short article, I encourage you to read it. Some excerpts:
Medical textbooks typically present information couched in terms of knowledge rather than opinion. Lecturers in medical school, residency, and continuing medical education programs often present material as though it were a simple fact, thereby implicitly squelching any skepticism.
Yet applying medical research, textbooks, journal articles, and lecture materials to patient care inevitably represents an uncertain art. Radiologists find themselves reporting imaging findings by offering differential diagnoses and stating that the examination is “consistent with” or “highly suggestive of” a particular diagnosis. [U]ncertainty is an intrinsic and ineradicable feature of the practice of medicine.
The best radiologist is not the one who is always the most certain but the one who most accurately conveys the degree of uncertainty inherent to each case and, where appropriate, acts to reduce this uncertainty.
Despite the ubiquity of uncertainty in radiologic practice, the training of medical students, residents, and fellows in diagnostic imaging frequently fails to take uncertainty adequately into account. When learners attempt to discuss cases of unknowns, faculty members are likely to focus on telling the learners whether they got the case “right” or “wrong.” This creates a false expectation on the part of the learner that every case has a correct answer, in light of which all other answers are more or less wrong.
[G]ood radiologists must be adept at managing uncertainty. In order to foster a greater aptitude for coping with and managing uncertainty, educators should consider lowering their shield of infallibility. If our goal is to maintain a facade of incontrovertibility, then admitting uncertainty is a mistake. If our goal is to educate excellent radiologists, then helping learners develop the ability to make the most of uncertainty is crucial.
It is only by asking questions and expressing doubts that any of us can fully develop our abilities to recognize and explore the limits of our knowledge.
One way of helping learners manage uncertainty more effectively is to foster a genuine dialogue at the viewing station. Dialogue is not the same as debate, and it is important to distinguish between the two. Debate is characterized by a compe- tition between individuals for some extrinsic good, such as wealth, power, and prestige. Those engaged in a debate want to prove themselves right and zealously seek out weaknesses in their opponent’s position in an effort to win the contest.
Once an individual has staked out a territory, he or she is bound to protect it, even when it becomes apparent that there is a better point of view. In extreme cases, individuals may completely lose sight of the pursuit of truth and focus all of their energies on merely defeating the other side. A frequent outcome of debate is alienation because at least one individual generally emerges as the loser and is therefore less inclined to engage in such discussions in the future.
Educators that are accustomed to the debater’s frame of mind may be threatened when their dicta are questioned by a learner. Educators may find themselves immediately adopting a defensive posture or launching an attack on the questioner because they do not want to be shown to be wrong. Not coincidentally, some of the most aggressive interrogators are also the most insecure practitioners. The aggressive questioning serves as a means to deflect potential scrutiny of the interrogator’s knowledge. Yet in addition to discouraging trainees from asking questions, such interrogation ultimately proves counterproductive because it undermines the development of effective learning habits.
Dialogue, on the other hand, creates an entirely different atmosphere. Dialogue is driven not by a desire to win a contest but by a desire to get closer to the truth. When a resident poses a question, it is usually sparked not by a suspicion that the educator is wrong but by a desire to discern and better understand an important idea or principle.
If learners are not easily convinced, educators can encourage them to explore the underlying assumptions and implications of their positions. In the best cases, learners will identify some of the weaknesses or contradictions on their own. The goal is not to tell the learners what they should know but to help them to become more self-reflective practitioners. Becoming more self-reflective includes recognizing and acknowledging uncertainty and learning to express opinions with a degree of confidence that is faithful to the uncertainty inherent in the case itself.
In this situation, educators do more than merely avoid perpetuating incorrect ideas by suggesting to learners that they are wrong; educators are placing the responsibility of identifying and exploring error squarely on learners’ shoulders. This is a wise education strategy because learners will bear that responsibility for the rest of their lives. The goal is not merely to avoid mistakes but to learn how to be a more reflective and capable learner.
Uncertainty is a necessary ingredient in the recipe for discovery. Certainty gets in the way of discovery because we are not inclined to investigate further the things we think we know for certain. By contrast, it is in the first moments of uncertainty that the opportunity for discovery is greatest. By training learners to be intolerant of uncertainty, we are rendering them unfit to learn and discover. By encouraging them to tolerate and manage uncertainty more adeptly, we develop better physicians.
JC comment: I was very much struck by the discussion of debate versus dialogue, which resonates with some of the issues raised in The Righteous Mind. The educational issues raised by this article are profound, and I remain very concerned with how the topic of climate change is being taught in our universities.