Adapting the Tolerance of Ambiguity in Medical Students and Doctors (TAMSAD) Scale for Physician Assistant/Associate Education.

Abstract

Introduction: Tolerance of ambiguity influences learner wellbeing, decision making, and clinical performance. Existing measures, including the Tolerance of Ambiguity in Medical Students and Doctors (TAMSAD) scale developed by Hancock et al, do not reflect the unique training context of physician assistant/associate (PA) students. This pilot study adapted the TAMSAD scale for PA education and evaluated feasibility and preliminary reliability.

Methods: Physician assistant/associate educators, practicing PAs, and an assessment expert reviewed original TAMSAD scale items to revise or remove items referencing medical student or physician-specific contexts. Physician assistant/associate students from both didactic and clinical phases assessed item clarity and relevance. The final 30-item PA-adapted instrument was distributed electronically to students at 1 PA program. Descriptive statistics were calculated and internal consistency was assessed using Cronbach's alpha. Independent t-tests and one-way ANVOA explored subgroup differences.

Results: Thirty students participated; 23 provided complete item responses. Internal consistency for the total scale was α = 0.62. No significant differences were observed between didactic and clinical students (P = .44) or across levels of prior health care experience (P = .39). No students completed the planned retest.

Discussion: This pilot demonstrates feasibility of adapting and administering a PA-specific ambiguity tolerance instrument and provides initial reliability evidence. Findings will guide refinement of item wording and support next-phase, multi-institution validation. A validated PA-specific scale may help programs identify learners who would benefit from targeted support and inform curricular strategies to strengthen students' ability to manage clinical ambiguity.