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Re-Imagining Clinical Reasoning: An Updated Cognitive Framework for Real-World Medical Practice
Isaac K S Ng1, Valencia Long2, Ainsley R Y B Lee1
1Division of Rheumatology and Allergy, Department of Medicine, National University Hospital, Singapore, Singapore.
Journal of Evaluation in Clinical Practice
|August 13, 2026
Summary
This study proposes a new three-tiered expert intuitionist model for clinical reasoning, moving beyond the traditional dual-process framework. This enhanced model offers a more ecologically valid understanding of how clinicians think and make decisions in practice.
Area of Science:
- Medical Education
- Cognitive Science
- Clinical Psychology
Background:
- Clinical reasoning is central to medical education but lacks consensus on conceptual foundations and pedagogy.
- Current dual-process models of clinical reasoning (intuitive vs. analytical) face critiques regarding construct validity and real-world applicability.
Purpose of the Study:
- To review core domains of clinical reasoning.
- To formulate a novel three-tiered expert intuitionist model for clinical reasoning.
- To enhance the understanding of clinical thinking in real-world medical practice.
Main Methods:
- Synthesizing theories of skilled intuition.
- Integrating the 4E theorem of mind-body-environment interactions.
- Incorporating higher-order metacognition.
Main Results:
- Development of a three-tiered expert intuitionist model for clinical reasoning.
- Articulating a more ecologically valid framework for understanding clinician cognition.
- Identifying practical applications for medical education and training pedagogy.
Conclusions:
- The proposed three-tiered model offers a more applicable framework for clinical reasoning in practice.
- This model enhances the understanding of how clinicians think by integrating intuition, embodiment, and metacognition.
- The model provides a foundation for improved medical educational and training strategies.
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