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Re-visioning clinical reasoning, or stepping out from the skull
1Peninsula School of Medicine, University of Plymouth, Plymouth, UK.
Medical Teacher
|December 16, 2020
Summary
Clinical reasoning models must expand beyond internal cognitive processes to include environmental and social interactions. Embracing extended cognition and ecological perception offers a more complete understanding of adaptive expertise in healthcare.
Area of Science:
- Cognitive Science
- Medical Education
- Philosophy of Mind
Background:
- Current models of clinical reasoning are limited, focusing on internal cognitive processes within the individual.
- These models, often rooted in experimental psychology and neuroscience, neglect the influence of external factors like social interactions and environmental context.
- This 'inside-the-skull' approach is insufficient for fully explaining complex clinical decision-making.
Purpose of the Study:
- To propose a more comprehensive model for clinical reasoning.
- To integrate the concepts of extended cognition and ecological perception into clinical reasoning frameworks.
- To advocate for a shift from 'ego-logical' to 'ecological' models of cognition in medicine.
Main Methods:
- Conceptual analysis of existing cognitive models in clinical reasoning.
- Integration of theories of extended cognition, which posits that cognition is not confined to the brain.
- Application of ecological psychology principles, emphasizing perception and action within an environment.
Main Results:
- Clinical reasoning is enhanced by social dialogues (doctor-patient, colleagues) and cultural contexts.
- Artefacts like computers and narrative structures play a crucial role in augmenting cognitive processes.
- Extended cognition, framed as 'sensemaking' or 'adaptive expertise', offers a more holistic view.
Conclusions:
- Clinical reasoning should be viewed as an open, dynamic, nonlinear, and complex system.
- Future models must incorporate external factors, including social interactions and environmental influences.
- Adopting an 'externalistic' or 'ecological perception' model counters the limitations of purely internal cognitive accounts.
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