The inseparability of context and clinical reasoning

Andrew Olson, Juliane E. Kämmer, Ahmed Taher, Robert Johnston, Qian Yang, Shawn Mondoux, Sandra Monteiro

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations


Early descriptions of clinical reasoning have described a dual process model that relies on analytical or nonanalytical approaches to develop a working diagnosis. In this classic research, clinical reasoning is portrayed as an individual-driven cognitive process based on gathering information from the patient encounter, forming mental representations that rely on previous experience and engaging developed patterns to drive working diagnoses and management plans. Indeed, approaches to patient safety, as well as teaching and assessing clinical reasoning focus on the individual clinician, often ignoring the complexity of the system surrounding the diagnostic process. More recent theories and evidence portray clinical reasoning as a dynamic collection of processes that takes place among and between persons across clinical settings. Yet, clinical reasoning, taken as both an individual and a system process, is insufficiently supported by theories of cognition based on individual clinicals and lacks the specificity needed to describe the phenomenology of clinical reasoning. In this review, we reinforce that the modern healthcare ecosystem – with its people, processes and technology – is the context in which health care encounters and clinical reasoning take place.

Original languageEnglish (US)
Pages (from-to)533-538
Number of pages6
JournalJournal of Evaluation in Clinical Practice
Issue number4
StatePublished - Jun 2024

Bibliographical note

Publisher Copyright:
© 2024 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons Ltd.


  • clinical guidelines
  • diagnostic reasoning
  • system dynamics


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