A situated cognition model for clinical reasoning performance assessment: a narrative review

Abstract

BackgroundClinical reasoning performance assessment is challenging because it is a complex, multi-dimensional construct. In addition, clinical reasoning performance can be impacted by contextual factors, leading to significant variation in performance. This phenomenon called context specificity has been described by social cognitive theories. Situated cognition theory, one of the social cognitive theories, posits that cognition emerges from the complex interplay of human beings with each other and the environment. It has been used as a valuable conceptual framework to explore context specificity in clinical reasoning and its assessment. We developed a conceptual model of clinical reasoning performance assessment based on situated cognition theory. In this paper, we use situated cognition theory and the conceptual model to explore how this lens alters the interpretation of articles or provides additional insights into the interactions between the assessee, patient, rater, environment, assessment method, and task.MethodsWe culled 17 articles from a systematic literature search of clinical reasoning performance assessment that explicitly or implicitly demonstrated a situated cognition perspective to provide an “enriched” sample with which to explore how contextual factors impact clinical reasoning performance assessment.ResultsWe found evidence for dyadic, triadic, and quadratic interactions between different contextual factors, some of which led to dramatic changes in the assessment of clinical reasoning performance, even when knowledge requirements were not significantly different.ConclusionsThe analysis of the selected articles highlighted the value of a situated cognition perspective in understanding variations in clinical reasoning performance assessment. Prospective studies that evaluate the impact of modifying various contextual factors, while holding others constant, can provide deeper insights into the mechanisms by which context impacts clinical reasoning performance assessment.

Sociocultural learning in emergency medicine: a holistic examination of competence

“…Examining clinical reasoning performance through situativity and systems theories is a perspective that is fundamentally different from cognitive and behavioral approaches because it examines how sociocultural systems can shape the individual mind [1][2][3]. A significant gap exists in the research on how best to research and analyze this process.…”

“…This level of competence is challenging to achieve because of the numerous contextual factors that need to be filtered in and out and don't always travel through a complex system in a timely manner, a tendency to avoid mistakes, and a desire to reach autonomous practice as quickly as possible [7][8][9]12]. In an activity system, situativity [1][2][3], systems [7][8][9], and activity theories [13] may be most appropriate for supporting the development and assessment of Situated Competence.…”

“…For example, the theories catalogued under situativity theory illustrate the complex ways situated cognition, distributed cognition, embodied cognition, and ecological psychology diverge yet also overlap [2]. Emerging evidence suggests that situativity theory could be useful in understanding how contextual factors impact clinical reasoning performance and a research agenda combining these broad theories alongside more precise theories is recommended [3]. In this paper, a trans-theoretical model of situativity and systems theories is combined to examine a novel way of understanding clinical reasoning performance in the complex context of medical practice.…”

Understanding the social in diagnosis and error: a family of theories known as situativity to better inform diagnosis and error

“…Clinical reasoning is embedded within systems; if the social and technical aspects of the system are poorly designed and integrated, poor system performance is likely to follow. By extension, one can reasonably hypothesize a negative, and at times unpredictable, impact on diagnosis [12,13]. The second STS principle argues that optimization of technical or social, to the exclusion of the other, increases the probability of unpredictable and harmful effects on system performance.…”

“…Rounding out this special edition are a compilation of provocative essays and useful review articles pertaining to situativity that will help deepen the reader's understanding of the more focused papers highlighted earlier. Rencic and colleagues conducted a literature review through the lens of situativity and discuss clinical reasoning performance through this synthesis [12,22]. Schuwirth and colleagues review the assessment of decision making through different perspectives to include situativity [23].…”