How Medical Uncertainty Incentivizes Medical Specialists to Engage in Excessive Testing:
The Mediating Role of Competence Threat and the Moderating Role of Tenure
Daniël D. Wijnja (s2465086) University of Groningen
Department of Human Resource Management and Organizational Behaviour Nettelbosje 2, 9747 AE Groningen, The Netherlands
E-mail: d.d.wijnja@student.rug.nl
Author Note
The present paper is my master’s thesis and is written under the supervision of L. Maxim Laurijssen. Correspondence concerning this thesis should be addressed to D.D.Wijnja,
d.d.wijnja@student.rug.nl.
Abstract
Medical expenditures are going through the rough and in order to keep costs under control it is important to discern what contributes to this rapid growth of costs. The present research focuses on medical specialists, who form a large majority of these costs. Medical specialists oftentimes face medical uncertainty, and the present research argues that this is associated with feelings of a lack of control, which are then associated with increased excessive testing, which unnecessarily inflates healthcare costs. Excessive testing may help boost feelings of control as medical specialists may not be able to control the outcomes of testing but rather they can keep ordering tests, which may provide feelings of control. Data was gathered among 234 medical specialist, who completed a questionnaire. Results revealed that medical uncertainty is positively associated to competence threat, however competence threat does not automatically lead to excessive testing. Moreover, the influence of tenure does not show significant effects on the relation between competence threat and excessive testing.
Excessive Testing
How Medical Uncertainty Incentivizes Medical Specialists to Engage in Excessive Testing:
The Mediation Role of Competence Threat and the Moderating Role of Tenure Dutch healthcare costs are continuously increasin, and impose a strong responsibility on governments for an adequate allocation of resources among healthcare provisions and patients (Polder, Meerding, Bonneux, & Maas, 2002). The total healthcare expenditures in the Netherlands increased from €6.5 billion in 1972 to €89.7 billion in 2011(Krabbe-
Alkemade, Groot, & Lindeboom, 2017). Governments have tried over the years to control the increasing expenditures by implementing different budgeting systems. Unfortunately, policy makers’ attempts have proven largely unsuccessful so far in reducing these expenditures (Krabbe-Alkemade, Groot, & Lindeboom, 2017). Indeed, medical specialist pay forms one of the major sources of these costs and comprises up to 80% of all healthcare expenditures (Bohmer & Harshbarger, 1999).
The present research argues that one major reason why medical specialist pay keeps increasing is because the excessive testing of patients by medical specialists. This frequent testing is due to the competence threat – the inability to reach desired or valued outcomes.
This competence threat in turn is the result of the uncertainty experienced by medical
specialists. As healthcare becomes more complex it also becomes more uncertain to medical specialists what patients suffer and how to treat patients (Fox, 2000). Indeed, recent research seems to suggest that medical specialists experience a lot of stress in their work due to this uncertainty, and that uncertainty only increases as patients become more ill, suffer from more illnesses at the same time (i.e., comorbidity), and illnesses themselves become more complex as research uncovers more details and subtleties regards those illnesses (cf. Fox, 2000;
Visser, Smets, Oort, & De Haes, 2003). The present research draws from compensatory
control theory (Landau, Kay, & Whitson, 2015), which argues and shows that people
generally have a strong desire for control and try to restore control when it is undermined.
One way that people may restore control when they cannot control the outcome – as with medical uncertainty – is to try to control the process (Thompson, Nanni, Levine, & 1994).
Excessive testing – keep ordering a test even though the results do not change significantly – may be one way in which people may experience more control. Recent research by Sah, Elias, and Ariely (2013) showed that medical specialists tend to test more when test results remain vague or inconclusive. The present research argues that excessive testing is a way for medical specialists to experience control when it is undermined via the uncertainty they experience in their work
Furthermore, I argue that the link between competence threat and excessive testing is stronger for those medical specialists with a relatively short tenure. It is not so much that higher tenure medical specialists experience less uncertainty, however they have built up a track record through the years which makes that their career less depending on a particular medical decision according to research on uncertainty in work (Cheng & Chang , 2008).
Short tenure employees are more hesitant to make mistakes because they cannot rely on a rich clinical experience and may therefore tests more excessively to prevent decisions unfavorable for their career. This reasoning is in line with Fox (2002), who states that more experienced medical specialists may better cope with medical uncertainty as they have more clinical experience. That is, medical experts still experience a lack of control due to the uncertainty, but they can cope with it better and, hence, they test less excessively compared to medical novices. Even though medical experts and novices may be similar in that they are unable to reach desired outcomes, medical experts may have developed other strategies and behaviors to regain control, which may prevent them from testing excessively.
All in all, the present research aims to uncover how medical uncertainty may be
associated with excessive testing via the effect that medical uncertainty has on medical
specialists’ lack of control. I add to the literature on medical uncertainty by demonstrating
how it may affect medical specialists’ decision-making. More practically, if it can be shown that long tenure medical specialists indeed requests tests less excessively, the way their decisions are made should be considered and taught to medical students. By teaching this potentially more effective way of decision-making, we could prevent unnecessary testing in the future which may possibly inhibit rising medical costs
Medical Uncertainty and Competence Threat
Uncertainty is central to medicine and is inherent in many medical encounters.
(Ogden et al., 2002). Medical uncertainty in this research is defined as the fact that medical specialists often have to deal with vague symptoms, unclear cases in their work, which makes selecting the right diagnoses and treatments more difficult (Fox, 2000). Uncertainty
complicates and curtails the ability of physicians to prevent, diagnose, and treat disease, illness, and injury and to predict the progression and outcome of patients’ medical conditions and the results of the medical decisions and actions taken on their behalf (Fox, 2000; Ogden et al., 2002). Research offers conflicting recommendations as to how medical specialists should cope with their uncertainty. One the one hand, research argues that concealing
uncertainty is best as sharing it with patients may be detrimental to patients’ evaluation of the consultation (Ogden et al., 2002). On the other hand, research also showed that medical specialist should communicate the uncertainty as some patients value the honesty – which may strengthen the trust relationship – and complete information (Gordon et al., 2000; Ogden et al., 2002).
Medical uncertainty is associated with negative outcomes, such as increased stress for the medical specialist (Visser et al., 2003). Arguably due to more vocal patients who are better informed, patients tolerate inaction less and more quickly perceive the medical specialist as unknowledgeable and may even start a lawsuit (De Jaegher, 2010). More
importantly, research seems to suggest that the uncertainty that medical specialists experience
may also induce competence threat – a perceived lack of control over reaching desired outcomes or end-states.
Research on compensatory control theory argues and showed that people have a strong desire for order and causality in their lives according to Whitson and Galinsky (2008).
A preponderance of research has converged on the notion that perceptions of personal control—an individual’s belief that he or she can personally predict, affect, and steer events in the present and future—are key contributors to physical and mental wellbeing (Langer &
Rodin, 1976; Luck, Pearson, Maddern, & Hewett., 1999). This perception of personal control can effectively relieve the anxious uncertainty of a random and chaotic world (Kay, Gaucher, McGregor, & Nash, 2010). Recent research by Ma and Kay (2017) showed that uncertainty induces feelings of a lack of personal control, that is, competence threat.
In healthcare, the uncertainty that medical specialists experience may make them aware of the limited control they have over valued patient outcomes, such as longevity, quality of life, and treatment effectiveness (Fox, 2000). This awareness may lead to competence threat – the inability to reach desired and valued outcomes.
Hypothesis 1: medical uncertainty is positively related to competence threat.
Competence Threat and Excessive Testing
A lack of personal control can have far reaching consequences. People depend strongly on a sense of control and if this control is lost they will create an illusion of control accordingly (Kay et al., 2009). People will engage in compensatory behaviors to boost
feelings of personal control (Kay et al., 2009). For instance, research showed that people will start to see patterns in noise or adhering to superstitions, defend the legitimacy of the socio- political institutions that offer control, or believe in an interventionist God (Kay et al., 2009).
According to Kay and colleagues, (2009) humans have developed an arsenal of compensatory
psychological and perceptual systems designed to preserve a sense of order and non-
randomness even when personal control vanishes. In situations of competence threat, people may engage in compensatory behaviors to maintain an illusion of control regardless of whether they objectively have control.
For medical specialists, one intuitively appealing solution seems to perform more diagnostic tests to reduce this uncertainty. At face value, diagnostic tests are designed to provide concluding evidence regards a patients’ illnesses and typically aids in selecting the right diagnosis and eventual treatments (Fox, 2002; Groopman, 2008). However, not all tests are reliable or yield conclusive results and the clinical practice is more ambivalent and ambiguous than one might think (cf. Fox, 2002; Groopman, 2008). The structure, order, and control that medical specialists seek seems not to be improved by engaging in testing, but recent research shows that medical specialists engage in excessive testing regardless of the outcomes. This seems to suggest that testing may boost medical specialists’ feelings of control even though objectively it does not.
In my research, I argue that excessive testing may provide medical specialists with an
illusion of control. Research on outcome versus process control showed that when people
generally cannot predict or obtain valued outcomes directly, they may shift to attempts to
trying to control the process. For instance, research on HIV-positive men revealed that when
patients receive the news that they cannot be cured was associated with experiences of a lack
of outcome control (Thompson et al., 1994). The researchers then observed that people adapt
and engage in what the authors refer to as “consequence-related” control, in which patients
come up with reasons why they accept their faith. Similar to compensatory control research,
patients believe that there is a “reason” why they are ill, and patients report feeling better and
less depressed. Similarly, medical specialists who cannot objectively regain control via
diagnostic tests may engage in excessive testing as a form of process control. The fact that
they have control over requesting a test, the execution of the test and receiving the results
may reduce their personal experience of a lack of control, that is, competence threat.
Although the real control over the situation is still minimal, the procedural control provides a perceived feeling of control. Objectively, the outcomes of tests are still inconclusive and unreliable. Yet the process of ordering tests instills a subjective – illusory – feeling of control.
Hypothesis 2a: Competence Threat is positively related to Excessive Testing.
Hypothesis 2b: Competence Threat mediates the link between Medical Uncertainty and Excessive testing.
The Moderating Role of Tenure
Interestingly, research seems to suggest that medical specialists’ clinical experience may help them cope better with the uncertainty in their work even though they still
experience competence threat due a lack of control (Fox, 2002). That is, as medical
specialists become more tenured they seem to have found strategies or availability via more skills and clinical expertise, and it may be that this prevents them from engaging in excessive (cf. Fox, 2002). In this research I also take into consideration an assumed effect of tenure on the excessiveness of testing by medical specialists.
As medical specialists’ tenure may shield them from engaging in excessive testing due to the availability of other strategies to cope with their competence threat, I argue that the reverse is also true. That is, medical specialists’ with a relatively short tenure engage in extra excessive testing. Research on job insecurity seems to suggest that newcomers are insecure about whether their job will exist and whether they will meet or reach expectations in their work (Israel & House, 1994). Job insecurity refers to an individual`s perception of the potential threat to continuity in his or her current job (Cheng & Chang, 2008). I argue that medical specialists in any phase of their career (training till retirement) will be faced with uncertainty, however the way they deal with this uncertainty makes a difference.
Consequently, short tenure may be a stress factor for newcomer medical specialists who are
still in because they do not yet rely on an established career according (cf. Kuhnert &
Vance,1992). This makes them more hesitant about wrong decisions and, subsequently, may be the reason why medical specialists with shorter tenure engage in more excessive testing compared to those with longer tenure
Hypothesis 3a: The link between competence threat and excessive testing is positive for lower levels of tenure.
In a similar vein, medical specialists with a long tenure are less affected by the medical uncertainty and, consequently, their competence threat, as they have more clinical experience to build on and already have established jobs (De Witte, 1999; Kuhnert & Vance, 1992), and may engage in less excessive testing compared to medical specialists with less tenure.
Hypothesis 3b: The link between competence threat and excessive testing is negative
for higher levels of tenure.
Method Respondents and Procedure
A questionnaire study was conducted amongst 426 medical specialists (for specialties, see Appendix B). 192 respondents were excluded due to missing data and uncompleted questionnaires, resulting in a final sample of 234 medical specialists (56.8% male, 43.2%
female).
The questionnaire was completed by a total of 234 healthcare professionals (56,8%
male, 43.2% female) ranging in age from 20 to 67 (Mage = 42.97; SDage = 11.99).
Participants had Dutch as their mother tongue, and worked in a healthcare environment directly with patients. The healthcare professionals’ work experience ranged from 0 to 54 years (M = 17.91; SD = 11.45). Their education level varied from university education (56.8%), higher professional education (34.2%), senior secondary vocational education (4.3%), pre-university education (3%), senior general secondary education (1.3%) to primary school (0.4%).
Participants of this research were approached via LinkedIn, in person and by other participants as a snowball effect. All participants were instructed that the questionnaire contains questions about their work perceptions. Respondents were informed that it would take, on average, 15 minutes to complete the questionnaire and respondents could complete the questionnaire in a paper-and-pencil form as well as online via Qualtrics. All participants were informed that responses would be treated confidentially and anonymously. The
questionnaire included measures for medical uncertainty, competence threat, excessive
testing, and tenure. The questionnaire concluded with demographic questions and participants
were thanked for their participation.
Measures
Medical uncertainty. Medical uncertainty was measured by a self-report scale based on the conceptualization of medical uncertainty by Fox (2000). This self-report scale consists of 6 items (see Appendix A). Sample of items include: “In my current job my goals are unclear or vague” and “In my current job it is unclear or vague what I have to do and what is expected of me“. The participants responded on a Likert-type rating scale (1 = completely disagree to 7 = completely agree) and their scores were averaged into a single job satisfaction score (M = 2.41; SD = 1.07; α = 0.87).
Competence threat. Competence threat was assessed using four items from the competence frustration scale (Chen et al., 2008), which are all measured on a Likert-type rating scale ranging from (1 = completely disagree to 7 = completely agree) (M = 2.15; SD = 1.14 ; α = 0.87). Sample items include: “in my current job, I have serious doubts about whether I can do things right“ and “In my current job I am disappointed with my work performance“ (see Appendix A for all items).
Excessive testing. In order to assess people’s tendency to test excessively, we used the critical incident technique (Flanagan, 1954). Particularly, we asked participants to remember a situation in which it was unclear what the patient suffered from. We then connected our excessive testing follow-up questions to the story that people self-reported.
Two items were used to measure excessive testing behavior on a Likert-type rating scale (1 = very unlikely to 7 = very likely): “how likely is it that you perform additional tests or diagnostics for the purposes of diagnostics and possibly a treatment “and “if test results are unreliable or unclear, how likely is it that you would perform another test or diagnostic tool“.
These items are computed into one excessive testing score, with higher score indicated a
higher propensity to engage in excessive testing. (M = 7. 51; SD = 2.50 ; α = 0.81).
Tenure. We measured medical specialists’ tenure using one item (“how long are you doing this job?”) with higher numbers indicated more tenure. The amount of tenure is the number of years a healthcare worker has worked in this profession (Finkelstein & Hambrick, 1990). Tenure in position can change highly experienced workers into inexperienced ones only because the just changed position due to promotion for example. Tenure in position covers the entire career of the healthcare workers and is therefore a better variable in for this research topic. Tenure in position was asked in the demographical part of the questionnaire (M = 13.70; SD = 10.52).
Results Preliminary Analyses
All hypotheses were tested using the PROCESS-macro (model 14). Medical uncertainty was entered as the independent variable, competence threat as the mediator, tenure as the moderator, and excessive testing as the dependent variable. All variables were mean-centered prior to analysis. Preliminary inspection of potential control variables did not warrant using them in the final analysis. Consequently, all analyses are reported without control variables.
Hypothesis Testing
Hypothesis 1 states that medical uncertainty is positively related to competence threat.
In line with the first hypothesis the regression analysis revealed that medical uncertainty was positively related to competence threat, b = 0.60, SEb = 0.06, t(230) = 10.49, p < .001, indicating that a higher level of medical uncertainty is indeed related to a higher level of competence threat.
The second hypothesis (2a) states that competence threat is positively related to
excessive testing. The regression analysis showed no support for this hypothesis, b = -0.30,
SEb = 0.17, t(227) = -1.75, P = .08. Interestingly, there was, however, a trend in the opposite
direction. That is, these results showed that competence threat was negatively related to excessive testing rather than positively. Next, a PROCESS mediation analysis (Model 4) was run to test the prediction that competence threat mediates the link between medical
uncertainty, and competence threat. These analyses reveal (no) mediation effect of competence threat, estimate: -.16; Bca CI: [-.39, .04]. In short there was (no) support for hypothesis 2b.
Finally, hypothesis 3 predicts an interaction effect between competence threat and tenure. Analyses revealed no significant interaction between competence threat and tenure, b
= -.002, SEb = .01, t(227) = -0.20, P = .84. Consequently, there was no support for hypothesis 3.
Discussion
In the present research, it was hypothesized that medical uncertainty is positively related to excessive testing (Hypothesis 1). Indeed, results revealed support for this hypothesis. Further it was stated that competence threat is positively related to excessive testing (Hypothesis 2a) however no evidence has been found. Another hypothesis in this research was the one that competence threat mediates the link between medical uncertainty and excessive testing (Hypothesis 2b). Despite opposing suspicion, no significant additional evidence was found for this hypothesis. The second last hypothesis stated that the link between competence threat and excessive testing is positive for lower levels of tenure (Hypothesis 3a). However no conclusive evidence has been found for this hypothesis either.
Last hypothesis stated that the link between competence threat and excessive testing is
negative for higher levels of tenure (Hypothesis 3b), but no proof has been found for this
hypothesis either. It was predicted that competence threat would mediate this relationship. On
top of that, this study takes into consideration the effect of tenure on the relation between
medical uncertainty and excessive testing. The results of this study indicated that medical
uncertainty and competence threat are positively associated, however competence threat and excessive testing are not associated at all, so there is no mediation effect of competence threat. Lastly, for the effect of tenure on the relationship of medical uncertainty and excessive testing was no support, nor for high tenure or low tenure.
Theoretical Implications
The present research contributes to the literature in several ways. First, to my
knowledge, the present study is the first to empirically test the notion that medical uncertainty is linked to experiences of competence threat (cf. Fox, 2000). Previous research by Visser, Smets, Oort, and De Haes (2003) seems to suggest that medical specialists may feel
powerless when they are confronted with ambiguous patient encounters. The present research extends this by addressing personal control perceptions. Interestingly, medical specialists self-report a relatively high general experience of competence threat (M = 4.32).
Second, the present study does not corroborate the findings by Sah and colleagues (2000) that medical specialists typically engage in excessive testing. Although initially it was argued that competence threat and the need for control should be significantly associated to an increased number of medical tests in order to boost feelings of control, the present
research found an effect in the opposite direct (Thompson et al.,1994). Research by Kay and
colleagues (2009) stated that in situations of uncertainty, people used to create a kind of
certainty for themselves due to their dependence of control. Initially, it was reasoned that this
could be a search for procedural control as well, however an increase in competence threat
lowers the excessiveness of testing according to the present study’s findings. One alternative
account of the present findings may be that medical specialists do not perceive tests to be a
legitimate way to boost feelings of control. Arguably, the tests that showed inconclusive
results may be expected to yield even more inconclusive results, thereby even further
undermining medical specialists’ experience of competence threat.
Thirdly, the results of this study give a non-significant identification that a lower level of tenure lowers the amount of excessive testing. This may indicate that specialists of
younger age are not always testing more excessively which was not directly expected because they cannot rely on a significant amount of skills and clinical expertise as mentioned by Fox (2002). It might be that older specialists engage in more excessive testing compared to their younger counterparts. It could be that young specialists are a bit uninhibited. The younger specialists perhaps apply the theory learned at school more directly instead of leaving room for uncertainty.
Lastly, the results of this study might explain the negative correlation between
competence threat and excessive testing. Research by Kay and colleagues (2009) showed that in situations of insecurity, people tend to see patterns in a random scatter plot and in random noise. Their explanation for this phenomenon is that people crave for security and if this security lacks, the start seeing non-existent relations or patterns. This might also be the case for the medical specialists with a high degree of competence threat. Because of the
ambiguous and uncertain situation, they might start seeing patterns or they imagine that they can draw a conclusion just to perceive some certainty. This means that they will no longer investigate further, which can be an explanation for the negative correlation between competence threat and excessive testing.
Practical Implications
More practically, medical uncertainty may be a real issue among medical specialists
that should not be taken lightly. Previous research already uncovered how – generally –
competence threat and lack of control may be stressful (Kay et al., 2015). Similarly, medical
specialists may find it stressful to cope with medical uncertainty in helping their patients. For
instance, Visser (2003) argued that medical uncertainty is not only stressful for the medical
specialists, but also for the patient, one potential solution to at least mitigate these potential
negative effects is to communicate openly and honestly with patients. In line with Gordon and colleagues (2002), open and honest communicated can improve the relation between the medical specialist and their patient, which may contribute to a better understanding of the medical case and reduce stress that is the result from the uncertain and oftentimes ambiguous clinical situation.
Finally, working together with other medical specialists may be paramount to
overcome competence threat. Fundamental research by Kay and colleagues (2009) showed that people are inclined to see patterns in random scatter plots and random noise. This poses the threat that medical specialists will interpret inconclusive tests as yielding a definitive conclusion. Working together with other medical specialists may help overcome this, by having a less personally involved medical specialist also overlooking test results on order to aid a more neutral and less biased conclusion. This can be the reason for a limited extent of testing or a decreased amount of testing, because people start drawing conclusions from the data they have, however without sound evidence just to perceive a sense of control. Because it is then looked at by two specialists at the same time. The chances of a more rational look at it are greater because it is unlikely that both specialists will conclude exactly the same based on imagination.
Strength and Limitations
As befits every study, this study is not without its limitations. The design of the study
only measures whether medical specialists test more excessive at the same time as medical
uncertainty occurs. However, this research design does not contain a high degree of internal
validity because excessive testing can be influenced by many other factors besides medical
uncertainty. Thus, although we see a significant positive relation between medical uncertainty
and competence threat and a negative trend between competence threat and excessive testing,
by using this research design, we cannot draw any conclusion concerning reasons of the
fluctuation in the extent of testing. More formal, correlation does not always mean that there is a causal relationship
A strong part of this study is the large sample size and diversity of real-life
professional healthcare workers. Moreover, the extensive simple correlation between age and excessive testing, beside the regression between tenure and excessive testing, adds some extra information. This shows namely that the older the specialist, the more the greater the chance that excessive testing will take place. However if tenure is added, the chance of excessive testing will decrease which is more in accordance with the fourth hypothesis.
Directions for Future Research
In this study shows that medical uncertainty can lead to an increased level of
competence threat among medical specialists, however is also shows that competence threat did not increase medical specialists’ testing behavior. Moreover, it was shown that tenure does not influence the effect of medical uncertainty on competence threat. Although the hypothesis assumed a positive relation between medical uncertainty and excessive testing, no relation was found. There was even a negative a trend between competence threat and
excessive testing. As already mentioned, due to the crave for control which is inherent in people, people might see illusionary patterns or tend to take hasty conclusions just to perceive a feeling of control. This might explain the negative direction of the relationship between competence threat and excessive testing, although not significant. This might be an item for further research, because the relation between medical uncertainty and competence created has been shown, however the elaboration of this phenomenon is unknown yet.
Another topic for future research might be the influence of tenure on professional coping with competence threat. Although this study does not show a relation between
competence threat and excessive testing for either high or low tenure, the negative correlation
between age of the specialists and excessive testing was stronger than the correlation between
tenure and excessive testing in this study. It might be that this study did not use the right research model or operationalization, however further research may find a better way to measure the influence of tenure on excessive testing.
Conclusion
Overall, the present research shows that medical uncertainty is positively associated
to competence threat, however competence threat does not automatically lead to excessive
testing. Moreover, the influence of tenure does not show significant effects on the relation
between competence threat and excessive testing. This research certainly confirms the
suspicion of a relationship between medical uncertainty on competence threat and judging
from the interviews quite a few specialists seem to suffer from medical uncertainty in their
work. However, the way in which this uncertainty is expressed remains the question. This
research has not found an increase in taking medical test as a reaction on the increased level
of uncertainty. Perhaps competence threat shows itself in a different way, for example by
creating the illusion of control. However, what clearly emerges from the interviews and from
this present study is that the medical specialists are often exposed to difficult ambiguous
cases, which lead to a desire for certainty to compensate for this medical uncertainty.
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Table 1
Means, Standard Deviations, Scale Reliabilities, and Correlations
M SD (1) (2) (3) (4) (5) (6) (1) Medical uncertainty 2,41 1,07 (0,87)
(2) Competence threat 2,15 1,14 0,57** (0,87)
(3) Excessive testing 7,51 2,50 -0,02 -0,10 (0,81)
(4) Tenure
(5) Age
(6) Sex
13,70
42,97
1,43
10,52
11,99
0,50
-0,44
-0,12
0,004
-0,08
0,19
0,11
-0,14*
0,18 0,62 1 -0,16
- 0,08 - 0,06 -0,16 1
Note. N = 234. Cronbach’s alphas are displayed on the diagonal. * p < .05; ** p < .01.
Appendix A Medical uncertainty.
Item 1 - In my current job my goals are unclear or vague.
Completely disagree 1 2 3 4 5 6 7 completely agree
Item 2 - In my current job it is unclear or vague what I have to do and what is expected of me.
Completely disagree 1 2 3 4 5 6 7 completely agree
Item 3 - In my current job, my duties are unclear or vague.
Completely disagree 1 2 3 4 5 6 7 completely agree
Item 4 - In my current job it is uncertain whether I will successfully complete my duties.
Completely disagree 1 2 3 4 5 6 7 completely agree
Item 5 - In my current job it is difficult to predict whether I will achieve my goals.
Completely disagree 1 2 3 4 5 6 7 completely agree
Item 6 - In my current job it is difficult to predict whether I will achieve desired outcomes.
Completely disagree 1 2 3 4 5 6 7 completely agree
Competence threat
Item 1 - In my current job, I have serious doubts about whether I can do things right
Completely disagree 1 2 3 4 5 6 7 completely agree
Item 2 - In my current job I am disappointed with my work performance.
Completely disagree 1 2 3 4 5 6 7 completely agree
Item 3 - In my current job I feel insecure about my skills.
Completely disagree 1 2 3 4 5 6 7 completely agree
Item 4 - In my current job I feel incompetent because of mistakes I make.
Completely disagree 1 2 3 4 5 6 7 completely agree
