Abstract
OBJECTIVES: To examine how experienced healthcare educators conceptualize and teach uncertainty tolerance and identify strategies to inform medical education curricula for complex, unpredictable clinical environments. METHODS: We conducted a qualitative phenomenological study with 15 healthcare educators during a multiday, high-fidelity prehospital simulation at a United States military-affiliated medical training facility. Participants completed semistructured interviews, a demographic questionnaire, and the Intolerance of Uncertainty Scale-Short Form. Interviews were transcribed and analyzed using iterative coding and constant comparison to identify themes grounded in participants' lived experiences. This study was reported in accordance with the Standards for Reporting Qualitative Research guidelines. RESULTS: Four themes emerged: (1) confidence through exposure-early, repeated, realistic practice fosters automatic responses under pressure; (2) safety fosters engagement-psychological safety, supportive leadership, and diversity of thought encourage active engagement with uncertainty; (3) growth through insight-structured reflection, constructive feedback, and learning from mistakes promote development; and (4) navigating ambiguity with flexible thinking-cognitive flexibility, probabilistic reasoning, and philosophical reframing support decision-making without paralysis. CONCLUSION: Uncertainty tolerance is a teachable, multifaceted competency. Curricular strategies should include early and repeated exposure, psychologically safe learning environments, structured reflection, and training in flexible thinking. Integrating these elements, particularly in high-stakes specialties like emergency medicine, may improve clinical reasoning, patient care, and clinician resilience. These findings serve as a foundation for further research to empirically examine how such approaches influence clinical reasoning, patient care, and clinician well-being.