Integration of Cognition and Emotion: A Postformal Operations Model of Physician-Patient Interaction

We modeled Labouvie-Vief's description of the integration of emotion and cognition in postformal thought in young adults by assessing tolerance for ambiguity (TFA) and empathy development in medical students to examine their effects on clinical behaviors. In this 4-year longitudinal study, 133 freshmen medical students were assessed on tolerance for ambiguity at Time 1, and 90 of these were assessed on empathy as juniors at Time 2. At Time 3, 66 seniors were again assessed on empathy, and 61 of these were assessed on physician-patient interactions. Results showed that our postformal operations model was a good fit for the data. TFA (indirect) and empathy (direct) predicted standardized patients' ratings of medical students across eight clinical encounters. The examination of transitions within specific postformal stages offers a promising approach to theory refinement.