Epistemological Issues in Clinical Reasoning: A Scoping Review

Area of Science:

• Medical Education
• Cognitive Science
• Philosophy of Medicine

Background:

• Clinical reasoning (CR) is crucial for accurate diagnoses and treatments.
• Significant uncertainty exists regarding the definition, scope, and methods of CR.
• Conceptual imprecision in CR contributes to medical errors and erodes patient trust.

Purpose of the Study:

• To map the definitions and conceptual frameworks of CR in medical and health sciences literature.
• To address the core issues of explainability and accountability in clinical reasoning.
• To synthesize diverse perspectives on CR to foster clarity and consensus.

Main Methods:

• A scoping review adhering to PRISMA-ScR guidelines was conducted.
• Systematic literature searches were performed across major databases (PubMed, Scopus, Web of Science, PhilPapers).
• Data were extracted and descriptively synthesized from 26 eligible studies by two independent reviewers.

Main Results:

• Five major conceptual perspectives on CR were identified: Integrative/Contextual, Dual-Process, Expertise/Tacit, Hypothetico-Deductive, and Outcome-Oriented.
• A significant number of studies (6/26) failed to provide explicit definitions of CR, highlighting its conceptual opacity.
• The literature reveals a lack of consensus, with diverse and sometimes conflicting views on CR.

Conclusions:

• The literature demonstrates substantial diversity and a critical lack of consensus on the definition of CR.
• CR requires conceptual clarity, explainability, and public justification, belonging to the "logical space of reasons".
• Making CR processes explicit is an epistemological and ethical imperative to reduce medical errors and improve medical education.