Matically described and consequently, the precise teaching actions for trainees are unclear. It is crucial to recognize that various forms of evidence exist. Qualitative research is a viable form of evidence and also illustrates how our traditional assumptions fail to consider the implications of context, meanings, and clinical practice. The tools for addressing this uncertainty in the actual practice of general medicine have their own characteristics: 1) the doctor-patient care relationship; 2) continuity of care; and 3) context (family, community). In this scenario, the main teaching aid is the reflection-action cycle, a method for professionals to reflect on their implicit knowledge and actions while in the midst of practice. Within this framework, qualitative and story-based teaching methods to prepare trainees for clinical uncertainty would include: 1. Narrative Medicine and Story Analysis (Reflective Writing, Shared Reading, Real Patient Histories); 2. Structured Discussion Groups (Balint groups, Schwartz rounds, Practice Inquiry); and 3. Role Modeling and Mentoring. This strategy promotes a more holistic and adaptive approach to addressing the challenges of real-world uncertainty in general practice.

Medical schools have traditionally been influenced by the "Technical Rationality" model, which defines professional practice as the application of scientific theories and techniques to instrumental problems. However, this model has significant limitations, as it does not adequately address complex, uncertain, unique, or value-conflicting situations, which are common in general practice (1). Furthermore, the strategies general practitioners use to manage uncertainty have not been systematically described, and consequently, the precise educational strategies for teaching them to trainees are unclear. There is often a perception that competent general practitioners usually know more than they can say. They exhibit a kind of know-in-practice, most of which is tactic (1). Exploring these uncertainty management strategies employed by general practitioners working in community primary care settings, making them visible, and organizing them within a conceptual taxonomy is an important task that can guide efforts to understand and teach them. It is important to develop an epistemology of the practice of general medicine that recognizes and legitimizes the uncertainty management strategies specific to this level of care, as a rigorous form of professional knowledge (2).

This article is a personal viewpoint; it aims to reflect on, synthesize, and conceptualize, based on a selected narrative review and the author's experience, some educational strategies to prepare residents for clinical uncertainty in primary care.

When a patient presents with a new problem, general practitioners must confront a certain amount of uncertainty regarding its assessment and optimal treatment. Reducing uncertainty in decision-making involves finding and using evidence (data, information, research) to make more informed, confident, and less risky decisions, transforming the unknown into analyzable and manageable scenarios, although uncertainty is not always completely eliminated. We can distinguish between many approaches to reducing uncertainty, as well as between different kinds of evidence. Uncertainty is frequently represented in terms of probability or normative reasoning, and evidence-based medicine (EBM) is the most successful effort to apply statistical theory to clinical decision-making. Conventional quantitative-objective medical research only has methods for measuring separate parts of the whole; however, the study of the body is the study of individual wholeness in relation to its context (3-5). It is necessary to develop some technical and pragmatic aspects of the biopsychosocial model to facilitate the introduction of comprehensive data into the medical framework in primary health care. This requires considering qualitative research and observational techniques as tools for obtaining evidence (6)It is essential to recognize that there are diverse forms of evidence and that preliminary work prior to research is required to identify the most appropriate methods for generating it, including assessing safety, acceptability, relevance, quality, and effectiveness. Both qualitative and quantitative research are useful sources of evidence. But, in general clinical practice, qualitative research is especially useful for providing relevant and contextualized evidence that allows for understanding information in complex situations with patients who are not eligible for randomized clinical trials, or where there is no prior systematic knowledge, and it is necessary to understand the phenomenon in context and with the implications of that context (something that quantitative research does not consider). Qualitative research is a viable form of evidence and also illustrates how our traditional assumptions about evidence do not consider the implications of context, meanings, and clinical practice (6).

So, what evidence do general practitioners apply to their practice? EBM is just one option that should be chosen after evaluating the context and contextualized after its application (7). Numerous characteristic and unique aspects of general practitioner work in practice provide evidence and facilitate decision-making in real-life situations (8, 9): 1) Internal congruence with the physician (emotion, intuition, ethics, knowledge, reasoning, experience, empathy, empowerment, compassion, creativity, the five senses...); 2) Congruence with other stakeholders (for contextualization, strategic planning, patient and community involvement, effectiveness, multiple relationships within an ecological system...); 3) Internal congruence with clinical semiology (EBM, clinical epidemiology, congruence of information from diverse sources...); 4) Temporal congruence (continuity of personalized medical care, temporal evidence, narrative medicine...) (10).

Thus, the tools or the practical way for addressing this uncertainty in the actual practice of each patient consultation have their own characteristics in general practice. These are basically:

1. Doctor-patient care relationship (a technical instrument at the service of diagnosis and treatment). Communication and the doctor-patient relationship connect the biomedical and psychosocial aspects of clinical care. This doctor-patient relationship indicates to the primary care physician (as if they were showing us the way to a place) the clinical environment for achieving diagnosis and treatment. Thus, the doctor-patient care relationship is a technical instrument at the service of the diagnosis and treatment of the patient (4, 11).
2. Continuity of care (repeated patterns of events and trends). Recognizing the repetition of a certain pattern of symptom expression in a patient, or the variation of that predictable pattern, leads to diagnosis. Continuity of care in general medicine—the long-term relationship established between the GP and the patients in their office—allows the doctor to observe repeated patterns of events and trends or regularities across generations, family functioning and its relationship to events, family structure, coalitions between members, family rules, myths, rituals, etc. The epidemiological and clinical efficiency of continuity of care (an application of Bayes' theorem): It allows the evaluation of probabilities, given the pre-test probability, at a very low cost. (12).
3. Context (family, community, etc.). Unfold the information during the interview instead of gathering it. Instead of starting with "What's wrong?" It is preferable to ask, "What are you like?" and "What is your context?" in order to situate your clinical complaints within it (the same symptoms can be assessed -take on meaning- differently depending on the context). Begin with the context and only then analyze the symptoms and signs. For the GP, it is fundamental to be attentive to the relational context in which the person lives. Diagnosis in general medicine requires us to have a panoramic vision: to see the patient as emerging from the group (family, community, etc.) (13-15).

And in this scenario, what are the teaching methods or educational strategies to prepare trainees for clinical uncertainty in general medicine? Certainly, “maps” are needed, but “being educated is not about arriving at a destination, but about traveling with a different vision.” The ability to act with a sensitive understanding of risks and benefits is what separates the wise person from the bureaucrat. It is not about spending a lot of time considering distant possibilities; the key is to find the meaningful ones. So, in general medicine teaching instead of this conventional language of science, the language of stories should be used. Stories have a psychological impact that equations and graphs lack. Stories refer to meanings; they help explain why things happen in a certain way. They give order and meaning to events—a crucial aspect of understanding future possibilities. The dominant belief in a quantifiable and deterministic truth has begun to disappear. Now there are many forms of knowledge (2, 16-18). Thus, qualitative and story-based teaching methods to prepare trainees for clinical uncertainty would include:

1. Narrative Medicine and Story Analysis. Narrative medicine is based on the ability to recognize, absorb, interpret, and act upon patients' stories. This can include: Reflective Writing: Trainees are asked to write narratives (anonymous if necessary) about clinical encounters that caused them discomfort, doubt, or frustration. These texts (sometimes called "thought stories") become material for group discussion, where their emotional experiences are validated and the sources of uncertainty are analyzed; Shared Reading: Analyzing literature, poetry, or short stories that explore illness and the human experience. This helps trainees develop empathy and understand the experience of suffering from a perspective deeper than simple biology; Real patient stories: Using real medical histories to go beyond the data and focus on the patient's life context, values ​​and expectations, which are often the factors that complicate clinical decision-making (19).
2. Structured Discussion Groups. These methods provide a safe and facilitated space for trainees to share experiences and learn collectively. They include: Balint Groups (20): Small groups of clinicians or trainees who meet regularly with a trained leader to present and discuss difficult cases, focusing on the clinician-patient relationship and the clinician's emotions, not on clinical or diagnostic facts. The aim is to understand how their own emotional response influences uncertainty and care; Schwartz Rounds (21): Multidisciplinary forums where healthcare professionals meet to discuss the social and emotional aspects of patient care. They are based on narratives presented by the practitioners themselves and encourage empathy and mutual support; Practice Inquiry (22): Small groups that meet to present "dilemma cases" from their daily practice. They share experiences, review the available evidence, and draw implications for improving practice, accepting uncertainty as part of the process
3. Role Modeling and Mentoring (23-25). How mentors handle uncertainty is crucial for trainees. This includes: Mentor transparency: General practice mentors should model the acceptance of uncertainty. Openly discussing their own doubts, mistakes made, and how they navigate a lack of information teaches trainees to tolerate incompleteness and to accept themselves as "good enough doctors"; Longitudinal follow-up of patients: Allowing trainees to follow the same patients over time enables them to see the natural progression of illnesses and how initial (often uncertain) decisions develop, providing a more realistic perspective than the acute, resolved cases seen in hospitals versus the chronic ones, with multimorbidity and polypharmacology, with multiple psycho-social interrelationships and never "cured" in the sense of EBM.

These qualitative and narrative methods to face the education about uncertainty for of trainees in general medicine, help normalize uncertainty, reducing anxiety and burnout, and fostering a more humane, reflective, and collaborative medical practice (26, 27).

The main teaching resource, transversal to all educational strategies in general medicine, is the reflection-action cycle. A simple alternative to prevent the development of maladaptive behaviors is to facilitate a reflection-action process, either individually by the tutor or through the formation of personal and professional development groups with a facilitator who helps them reflect. The concept of "reflection-in-action" is described as a method for professionals to reflect on their implicit knowledge and actions while in the midst of practice. This process allows them to adjust their approaches, create new theories, and solve unique problems creatively and effectively. Reflection-in-action is not based solely on established theories but involves active, experimental research within the context of practice (1). Moving through this cycle (from concrete experience to reflection and analysis of that experience, to the identification of theoretical frameworks that explain the experience, and finally to their application through active experimentation), new learning is integrated, and consequently, knowledge, skills, and attitudes are consolidated, developed, and refined over time. The tutor facilitates the entire process through a combination of support and the presentation of challenges. The tutor is not a teacher but a facilitator who fosters the development of the learner's strategies for finding their own solutions. Failing to complete the learning of certain training content (not reaching a destination) can be resolved, but not completing the reflection-in-action cycle is "not having traveled; it is not having lived the adventure" (5). In summary, the traditional model of "technical rationality," which defines medical knowledge for addressing the uncertainty of decision-making as the application of quantitative and objective scientific theories and techniques and has dominated education and professional practice, presents limitations when faced with complex, uncertain, or unique situations at the level of general practice. Consequently, general medical training must evolve to include the development of reflective and experimental skills in practical contexts. This approach allows professionals to manage situations that do not fit into traditional categories of technical knowledge, integrating thought and action to generate new solutions. Within this framework, qualitative teaching methods allow us to overcome the dichotomy between rigor and relevance, promoting a more comprehensive and adaptive approach to addressing the challenges of real-world uncertainty in general medicine.