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Self, Others and Context: Reframing Clinical Reasoning as a Socio-Cognitive Practice.

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Τίτλος: Self, Others and Context: Reframing Clinical Reasoning as a Socio-Cognitive Practice.
Συγγραφείς: Pelaccia T; Prehospital Emergency Care Service (SAMU 67), Strasbourg University Hospital, Strasbourg, France.; Centre for Training and Research in Health Sciences Education (CFRPS), Faculty of Medicine, University of Strasbourg, Strasbourg, France., Wyer P; Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York, USA., Sherbino J; McMaster Health Education Research, Innovation and Theory (MERIT) Research Centre, McMaster University, Hamilton, Ontario, Canada.; Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada., Norman G; McMaster Health Education Research, Innovation and Theory (MERIT) Research Centre, McMaster University, Hamilton, Ontario, Canada.
Πηγή: Journal of evaluation in clinical practice [J Eval Clin Pract] 2026 Sep; Vol. 32 (6), pp. e70619.
Τύπος έκδοσης: Journal Article; Review
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 9609066 Publication Model: Print Cited Medium: Internet ISSN: 1365-2753 (Electronic) Linking ISSN: 13561294 NLM ISO Abbreviation: J Eval Clin Pract Subsets: MEDLINE
Imprint Name(s): Original Publication: Oxford, England : Wiley-Blackwell, c1995-
Ιατρικοί όροι (MeSH): Clinical Reasoning* , Cognition*, Humans ; Clinical Competence ; Artificial Intelligence
Περίληψη: Rationale, Aims and Objectives: Clinical reasoning is often studied as if it occurred inside the clinician's head. Yet, in practice, clinicians think, decide and act through constant interaction with patients, colleagues, technologies, routines and local constraints. This article challenges predominantly individual and decontextualised accounts of clinical reasoning and reframes reasoning as a situated socio-cognitive practice. We aim to show how explicit and tacit knowledge interact with the social, material and organizational environments in which clinical practice unfolds.
Methods: We develop a conceptual synthesis drawing on research in clinical reasoning, situated and distributed cognition, ecological psychology, workplace learning and knowledge translation. Tacit knowledge, particularly know-how and know-who, is used as a bridge between individual cognitive processes and the healthcare ecosystem. Distributed cognition, affordances, communities of practice and mindlines are mobilised as complementary analytical lenses.
Results: This synthesis conceptualises clinical reasoning as an emergent capability arising from interactions among Self, Others and Context. Expertise depends not only on what clinicians know, but also on their ability to perceive what matters, mobilise the right resources, judge whom to trust, and adapt action to the situation at hand. This perspective helps explain why expert performance may deteriorate across unfamiliar settings and why artificial intelligence should be understood not as a substitute for reasoning, but as a cognitive artefact whose value depends on clinicians' capacity to critically interpret and contextualise its outputs. It also highlights the importance of authentic participation, cognitive apprenticeship and socially supported reflection in developing clinical expertise.
Conclusions: Clinical reasoning is neither an isolated mental process nor a simple response to context. It is an accomplishment distributed across clinicians, other people, artefacts and environments. Reframing it in this way shifts attention from how clinicians think in isolation to how reasoning actually works in practice, with important implications for clinical work, education, artificial intelligence and research.
(© 2026 The Author(s). Journal of Evaluation in Clinical Practice published by John Wiley & Sons Ltd.)
References: Am J Nurs. 1982 Mar;82(3):402-7. (PMID: 6917683)
Acad Med. 2017 Jan;92(1):23-30. (PMID: 27782919)
Perspect Med Educ. 2019 Jun;8(3):177-186. (PMID: 31161478)
J Eval Clin Pract. 2024 Aug;30(5):788-796. (PMID: 38825755)
Hum Factors. 2008 Jun;50(3):456-60. (PMID: 18689053)
Front Psychol. 2021 Apr 08;12:571298. (PMID: 33897512)
NPJ Digit Med. 2025 Jun 10;8(1):345. (PMID: 40494886)
Med Teach. 2011;33(3):188-99. (PMID: 21345059)
J Eval Clin Pract. 2024 Jun;30(4):533-538. (PMID: 38300231)
Med Teach. 2023 Dec;45(12):1323-1333. (PMID: 37043405)
Acad Med. 2004 Oct;79(10 Suppl):S70-81. (PMID: 15383395)
Acad Emerg Med. 2025 Mar;32(3):320-326. (PMID: 39428907)
Vocat Learn. 2022;15(3):427-448. (PMID: 35818439)
Soc Hist Med. 1995 Dec;8(3):361-81. (PMID: 11609050)
Fam Med. 2026 Feb;58(2):138-144. (PMID: 42102843)
Med Educ. 2016 Jan;50(1):124-31. (PMID: 26695472)
Diagnosis (Berl). 2020 Aug 27;7(3):181-190. (PMID: 32142479)
J Eval Clin Pract. 2008 Oct;14(5):767-70. (PMID: 19018908)
Adv Health Sci Educ Theory Pract. 2017 Aug;22(3):723-739. (PMID: 27544386)
Clin Teach. 2025 Jun;22(3):e70096. (PMID: 40300863)
JMIR Med Inform. 2025 Aug 1;13:e80898. (PMID: 40749188)
Implement Sci. 2015 Apr 09;10:45. (PMID: 25890280)
JAMA Netw Open. 2024 Oct 1;7(10):e2440969. (PMID: 39466245)
Soc Sci Med. 2010 Jun;70(11):1728-36. (PMID: 20356662)
Med Educ. 2005 Apr;39(4):418-27. (PMID: 15813765)
Med Educ. 2012 May;46(5):464-72. (PMID: 22515754)
Acad Emerg Med. 2017 Jul;24(7):785-795. (PMID: 28449293)
Med Educ. 2023 May;57(5):382-384. (PMID: 36760219)
Clin Simul Nurs. 2022 Aug;69:26-39. (PMID: 35754937)
J Health Soc Behav. 2010;51 Suppl:S67-79. (PMID: 20943584)
Acad Emerg Med. 2025 Nov;32(11):1189-1196. (PMID: 40900438)
Med Educ. 2020 Jan;54(1):66-73. (PMID: 31468581)
Diagnosis (Berl). 2020 Aug 27;7(3):227-240. (PMID: 32352400)
Am Psychol. 2009 Sep;64(6):515-26. (PMID: 19739881)
Clin Public Health Guidel. 2024 Apr 05;1(2):e12013. (PMID: 42740804)
Implement Sci. 2013 Jun 21;8:72. (PMID: 23799906)
J Gen Intern Med. 2024 Apr;39(5):851-857. (PMID: 38243110)
Adv Health Sci Educ Theory Pract. 2009 Oct;14(4):535-46. (PMID: 18798005)
Acad Emerg Med. 2025 Mar;32(3):348-350. (PMID: 39573893)
Ann Emerg Med. 2016 Jun;67(6):747-751. (PMID: 26298449)
Diagnosis (Berl). 2020 Aug 27;7(3):241-249. (PMID: 32031971)
JAMA. 2025 Jan 28;333(4):319-328. (PMID: 39405325)
Med Educ. 2023 Jan;57(1):76-85. (PMID: 35771936)
Med Teach. 2009 Aug;31(8):685-95. (PMID: 19811204)
Acad Med. 2021 Nov 1;96(11S):S81-S86. (PMID: 34348381)
Adv Health Sci Educ Theory Pract. 2009 Oct;14(4):595-621. (PMID: 18034364)
Can Med Educ J. 2015 Dec 11;6(2):e61-70. (PMID: 27004079)
BMJ. 2004 Oct 30;329(7473):1013. (PMID: 15514347)
Contributed Indexing: Keywords: artificial intelligence; clinical reasoning; cognition; medical education
Entry Date(s): Date Created: 20260925 Date Completed: 20260925 Latest Revision: 20260928
Update Code: 20260928
PubMed Central ID: PMC13614000
DOI: 10.1111/jep.70619
PMID: 42788646
Βάση Δεδομένων: MEDLINE
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  Data: Rationale, Aims and Objectives: Clinical reasoning is often studied as if it occurred inside the clinician's head. Yet, in practice, clinicians think, decide and act through constant interaction with patients, colleagues, technologies, routines and local constraints. This article challenges predominantly individual and decontextualised accounts of clinical reasoning and reframes reasoning as a situated socio-cognitive practice. We aim to show how explicit and tacit knowledge interact with the social, material and organizational environments in which clinical practice unfolds.<br />Methods: We develop a conceptual synthesis drawing on research in clinical reasoning, situated and distributed cognition, ecological psychology, workplace learning and knowledge translation. Tacit knowledge, particularly know-how and know-who, is used as a bridge between individual cognitive processes and the healthcare ecosystem. Distributed cognition, affordances, communities of practice and mindlines are mobilised as complementary analytical lenses.<br />Results: This synthesis conceptualises clinical reasoning as an emergent capability arising from interactions among Self, Others and Context. Expertise depends not only on what clinicians know, but also on their ability to perceive what matters, mobilise the right resources, judge whom to trust, and adapt action to the situation at hand. This perspective helps explain why expert performance may deteriorate across unfamiliar settings and why artificial intelligence should be understood not as a substitute for reasoning, but as a cognitive artefact whose value depends on clinicians' capacity to critically interpret and contextualise its outputs. It also highlights the importance of authentic participation, cognitive apprenticeship and socially supported reflection in developing clinical expertise.<br />Conclusions: Clinical reasoning is neither an isolated mental process nor a simple response to context. It is an accomplishment distributed across clinicians, other people, artefacts and environments. Reframing it in this way shifts attention from how clinicians think in isolation to how reasoning actually works in practice, with important implications for clinical work, education, artificial intelligence and research.<br /> (© 2026 The Author(s). Journal of Evaluation in Clinical Practice published by John Wiley & Sons Ltd.)
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  Data: Am J Nurs. 1982 Mar;82(3):402-7. (PMID: <searchLink fieldCode="PM" term="%226917683%22">6917683)</searchLink><br />Acad Med. 2017 Jan;92(1):23-30. (PMID: <searchLink fieldCode="PM" term="%2227782919%22">27782919)</searchLink><br />Perspect Med Educ. 2019 Jun;8(3):177-186. (PMID: <searchLink fieldCode="PM" term="%2231161478%22">31161478)</searchLink><br />J Eval Clin Pract. 2024 Aug;30(5):788-796. (PMID: <searchLink fieldCode="PM" term="%2238825755%22">38825755)</searchLink><br />Hum Factors. 2008 Jun;50(3):456-60. (PMID: <searchLink fieldCode="PM" term="%2218689053%22">18689053)</searchLink><br />Front Psychol. 2021 Apr 08;12:571298. (PMID: <searchLink fieldCode="PM" term="%2233897512%22">33897512)</searchLink><br />NPJ Digit Med. 2025 Jun 10;8(1):345. (PMID: <searchLink fieldCode="PM" term="%2240494886%22">40494886)</searchLink><br />Med Teach. 2011;33(3):188-99. (PMID: <searchLink fieldCode="PM" term="%2221345059%22">21345059)</searchLink><br />J Eval Clin Pract. 2024 Jun;30(4):533-538. (PMID: <searchLink fieldCode="PM" term="%2238300231%22">38300231)</searchLink><br />Med Teach. 2023 Dec;45(12):1323-1333. (PMID: <searchLink fieldCode="PM" term="%2237043405%22">37043405)</searchLink><br />Acad Med. 2004 Oct;79(10 Suppl):S70-81. (PMID: <searchLink fieldCode="PM" term="%2215383395%22">15383395)</searchLink><br />Acad Emerg Med. 2025 Mar;32(3):320-326. (PMID: <searchLink fieldCode="PM" term="%2239428907%22">39428907)</searchLink><br />Vocat Learn. 2022;15(3):427-448. (PMID: <searchLink fieldCode="PM" term="%2235818439%22">35818439)</searchLink><br />Soc Hist Med. 1995 Dec;8(3):361-81. (PMID: <searchLink fieldCode="PM" term="%2211609050%22">11609050)</searchLink><br />Fam Med. 2026 Feb;58(2):138-144. (PMID: <searchLink fieldCode="PM" term="%2242102843%22">42102843)</searchLink><br />Med Educ. 2016 Jan;50(1):124-31. (PMID: <searchLink fieldCode="PM" term="%2226695472%22">26695472)</searchLink><br />Diagnosis (Berl). 2020 Aug 27;7(3):181-190. (PMID: <searchLink fieldCode="PM" term="%2232142479%22">32142479)</searchLink><br />J Eval Clin Pract. 2008 Oct;14(5):767-70. (PMID: <searchLink fieldCode="PM" term="%2219018908%22">19018908)</searchLink><br />Adv Health Sci Educ Theory Pract. 2017 Aug;22(3):723-739. (PMID: <searchLink fieldCode="PM" term="%2227544386%22">27544386)</searchLink><br />Clin Teach. 2025 Jun;22(3):e70096. (PMID: <searchLink fieldCode="PM" term="%2240300863%22">40300863)</searchLink><br />JMIR Med Inform. 2025 Aug 1;13:e80898. (PMID: <searchLink fieldCode="PM" term="%2240749188%22">40749188)</searchLink><br />Implement Sci. 2015 Apr 09;10:45. (PMID: <searchLink fieldCode="PM" term="%2225890280%22">25890280)</searchLink><br />JAMA Netw Open. 2024 Oct 1;7(10):e2440969. (PMID: <searchLink fieldCode="PM" term="%2239466245%22">39466245)</searchLink><br />Soc Sci Med. 2010 Jun;70(11):1728-36. (PMID: <searchLink fieldCode="PM" term="%2220356662%22">20356662)</searchLink><br />Med Educ. 2005 Apr;39(4):418-27. (PMID: <searchLink fieldCode="PM" term="%2215813765%22">15813765)</searchLink><br />Med Educ. 2012 May;46(5):464-72. (PMID: <searchLink fieldCode="PM" term="%2222515754%22">22515754)</searchLink><br />Acad Emerg Med. 2017 Jul;24(7):785-795. (PMID: <searchLink fieldCode="PM" term="%2228449293%22">28449293)</searchLink><br />Med Educ. 2023 May;57(5):382-384. (PMID: <searchLink fieldCode="PM" term="%2236760219%22">36760219)</searchLink><br />Clin Simul Nurs. 2022 Aug;69:26-39. (PMID: <searchLink fieldCode="PM" term="%2235754937%22">35754937)</searchLink><br />J Health Soc Behav. 2010;51 Suppl:S67-79. (PMID: <searchLink fieldCode="PM" term="%2220943584%22">20943584)</searchLink><br />Acad Emerg Med. 2025 Nov;32(11):1189-1196. (PMID: <searchLink fieldCode="PM" term="%2240900438%22">40900438)</searchLink><br />Med Educ. 2020 Jan;54(1):66-73. (PMID: <searchLink fieldCode="PM" term="%2231468581%22">31468581)</searchLink><br />Diagnosis (Berl). 2020 Aug 27;7(3):227-240. (PMID: <searchLink fieldCode="PM" term="%2232352400%22">32352400)</searchLink><br />Am Psychol. 2009 Sep;64(6):515-26. (PMID: <searchLink fieldCode="PM" term="%2219739881%22">19739881)</searchLink><br />Clin Public Health Guidel. 2024 Apr 05;1(2):e12013. (PMID: <searchLink fieldCode="PM" term="%2242740804%22">42740804)</searchLink><br />Implement Sci. 2013 Jun 21;8:72. (PMID: <searchLink fieldCode="PM" term="%2223799906%22">23799906)</searchLink><br />J Gen Intern Med. 2024 Apr;39(5):851-857. (PMID: <searchLink fieldCode="PM" term="%2238243110%22">38243110)</searchLink><br />Adv Health Sci Educ Theory Pract. 2009 Oct;14(4):535-46. (PMID: <searchLink fieldCode="PM" term="%2218798005%22">18798005)</searchLink><br />Acad Emerg Med. 2025 Mar;32(3):348-350. (PMID: <searchLink fieldCode="PM" term="%2239573893%22">39573893)</searchLink><br />Ann Emerg Med. 2016 Jun;67(6):747-751. (PMID: <searchLink fieldCode="PM" term="%2226298449%22">26298449)</searchLink><br />Diagnosis (Berl). 2020 Aug 27;7(3):241-249. (PMID: <searchLink fieldCode="PM" term="%2232031971%22">32031971)</searchLink><br />JAMA. 2025 Jan 28;333(4):319-328. (PMID: <searchLink fieldCode="PM" term="%2239405325%22">39405325)</searchLink><br />Med Educ. 2023 Jan;57(1):76-85. (PMID: <searchLink fieldCode="PM" term="%2235771936%22">35771936)</searchLink><br />Med Teach. 2009 Aug;31(8):685-95. (PMID: <searchLink fieldCode="PM" term="%2219811204%22">19811204)</searchLink><br />Acad Med. 2021 Nov 1;96(11S):S81-S86. (PMID: <searchLink fieldCode="PM" term="%2234348381%22">34348381)</searchLink><br />Adv Health Sci Educ Theory Pract. 2009 Oct;14(4):595-621. (PMID: <searchLink fieldCode="PM" term="%2218034364%22">18034364)</searchLink><br />Can Med Educ J. 2015 Dec 11;6(2):e61-70. (PMID: <searchLink fieldCode="PM" term="%2227004079%22">27004079)</searchLink><br />BMJ. 2004 Oct 30;329(7473):1013. (PMID: <searchLink fieldCode="PM" term="%2215514347%22">15514347)</searchLink>
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