Structured Skepticism as a Meta-Regulatory Architecture in Clinical Reasoning: Toward an Epistemology of Diagnostic...

Clinical reasoning scholarship has extensively examined dual-process cognition, cognitive bias, Bayesian updating and diagnostic error. However, comparatively little theoretical attention has been directed toward supervisory mechanisms that regulate transitions between intuitive and analytic reasoning and prevent premature diagnostic closure.

To conceptualize structured skepticism as a meta-regulatory epistemic function within clinical reasoning and to clarify its role in stabilizing diagnostic judgment under uncertainty.

Conceptual analysis integrating clinical reasoning theory, diagnostic error research, Bayesian models of inference, metacognition literature and fallibilist epistemology. The study synthesizes interdisciplinary frameworks to construct a theoretical account of skepticism as regulatory cognitive architecture rather than attitudinal doubt.

Structured skepticism is defined as a deliberate meta-cognitive interruption that reopens hypothesis space, compels probabilistic recalibration and mitigates overconfidence bias. It operates at the level of epistemic supervision rather than primary hypothesis generation. The proposed model positions skepticism as a regulatory loop between intuitive and analytic cognition, serving as a safeguard against premature closure.

Recognizing skepticism as meta-regulatory architecture clarifies mechanisms underlying diagnostic reliability and reframes epistemic humility as structural necessity. The framework offers implications for medical education, diagnostic safety and AI-integrated clinical environments and invites future empirical validation.