Situativity: a family of social cognitive theories for understanding clinical reasoning and diagnostic error

Abstract

The diagnostic error crisis suggests a shift in how we view clinical reasoning and may be vital for transforming how we view clinical encounters. Building upon the literature, we propose clinical reasoning and error are context-specific and proceed to advance a family of theories that represent a model outlining the complex interplay of physician, patient, and environmental factors driving clinical reasoning and error. These contemporary social cognitive theories (i.e. embedded cognition, ecological psychology, situated cognition, and distributed cognition) can emphasize the dynamic interactions occurring amongst participants in particular settings. The situational determinants that contribute to diagnostic error are also explored.

Keywords: clinical reasoning; complexity; diagnostic error; distributed cognition; ecological psychology; embodied cognition; situated cognition; situativity; social cognitive theory.