Self, Others and Context: Reframing Clinical Reasoning as a Socio-Cognitive Practice

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.

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.

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.

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.