The Uncertainties of Evidence-based Medicine: A Cultural Analysis of (Bio)medical Socialization

This dissertation examined how biomedical culture in the United States – particularly the ideology of certainty embedded in evidence-based medicine (EBM) – shaped clinicians’ responses to uncertainty. Uncertainty is a pervasive feature of medical practice, with significant implications for clinical decision-making, provider well-being, and health equity. Drawing on cultural sociology, cognitive theory, and the sociology of medical education, I explored how uncertainty was taught, experienced, and managed across educational and clinical settings.Using a multi-method design, this study combined participant observation in grand rounds and an outpatient clinic, interviews and surveys with medical students, and patient simulations. I found that uncertainty was often reframed in formal education, but both formal and informal settings provided tools to manage uncertainty. Medical students prioritized management strategies such as consulting databases and colleagues. Diagnostic closure frequently occurred prematurely, especially in cases involving contested or unexplained syndromes. Organizational constraints further shaped how uncertainty was managed, aligning clinical action with institutional priorities over patient-centered care. This project contributed to sociological understandings of professional socialization, the hidden curriculum, and the cultural construction of medical knowledge. I emphasized the need for uncertainty-conscious approaches to medical education and policy that better prepare clinicians to navigate the complexities of real-world practice.