Facing uncertainty in primary care: perceptions, strategies and educational needs - a qualitative explorative study with German general practice trainees.

BACKGROUND

Uncertainty is an inherent aspect of everyday practice in primary care with a context of low-prevalence conditions. Dealing with diagnostic ambiguity and therapeutic uncertainty constitutes a central challenge within postgraduate medical training in general practice (GP). This study aimed to explore how GP trainees perceive and manage uncertainty and their educational needs to tailor specific measures.

MATERIALS AND

METHODS

In 2025, GP trainees of the Competence Centre Baden-Württemberg (KWBW) were recruited by purposive sampling to participate in an interview-study. A semi-structured interview guide was specifically developed. All interviews were transcribed verbatim and subsequently analysed using a content-analytical approach by three researchers.

RESULTS

22 interviews with mean duration of 46 min (min. 36 min, max. 70 min) were performed. GP trainees experienced uncertainty regarding themselves (intrapersonal), their patients (interpersonal) and the primary care context (systemic). Common strategies to manage included watchful waiting, seeking collegial advice, consulting external sources and relying on experience and intuition. Uncertainty was more perceived in outpatient than in inpatient settings and was linked to various emotions. The interviewees recommend early and longitudinal integration of uncertainty management into training, as it represents a relevant competency in daily primary care.

CONCLUSION

Navigating uncertainty appears a crucial skill, especially in primary care but current GP trainees have not experienced specific training. As a result, trainees often feel unprepared to manage it, which does not only affect outcomes of care such as quaternary prevention but also poses mental burden. Specific measures with longitudinal integration into postgraduate curricula may enhance trainees' competency in navigating uncertainty and thereby could also reduce mental burden and support .