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