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Context matters: toward a multilevel perspective on context in clinical reasoning and error

  • Justin J. Choi EMAIL logo and Steven J. Durning
Published/Copyright: December 9, 2022
Diagnosis
From the journal Diagnosis Volume 10 Issue 2

Abstract

Context in diagnosis and management of patients is a vexing phenomenon in medicine and health professions education that can lead to unwanted variation in clinical reasoning performance and even errors that cause patient harm. Studies have examined individual-, team-, and system-level contextual factors, but the ways in which multiple contextual factors can interact, how both distracting and enabling factors can impact performance and error, and the boundaries between context and content information are not well understood. In this paper, we use a theory-based approach to enhance our understanding of context. We introduce a multilevel perspective on context that extends prior models of clinical reasoning and propose a micro-meso-macro framework to provide a more integrated understanding of how clinical reasoning is both influenced by and emerges from multiple contextual factors. The multilevel approach can also be used to study other social phenomena in medicine such as professionalism, learning, burnout, and implicit bias. We call for a new paradigm in clinical reasoning research and education that uses multilevel theory and analysis to enhance clinical reasoning performance expertise and improve the quality of patient care.

Keywords: clinical reasoning; context; emergence; multilevel; teamwork
Corresponding author: Justin J. Choi, MD, Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, LH-355, New York, NY 10021, USA, Phone: 646-962-5897, Fax: 212-746-4734, E-mail:

  1. Research funding: None declared.

  2. Author contributions: All authors have accepted respon-sibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest. The views expressed herein are those of the authors and not necessarily those of the Department of Defense or other federal agencies.

  4. Informed consent: Not applicable.

  5. Ethical approval: Not applicable.

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Received: 2022-10-24
Accepted: 2022-11-28
Published Online: 2022-12-09

© 2022 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Editorials
  3. An equation for excellence in clinical reasoning
  4. Quantifying diagnostic excellence
  5. Review
  6. A scoping review of distributed cognition in acute care clinical decision-making
  7. Opinion Papers
  8. Context matters: toward a multilevel perspective on context in clinical reasoning and error
  9. Occam’s razor and Hickam’s dictum: a dermatologic perspective
  10. Original Articles
  11. Differences in clinical reasoning between female and male medical students
  12. Introducing second-year medical students to diagnostic reasoning concepts and skills via a virtual curriculum
  13. Bad things can happen: are medical students aware of patient centered care and safety?
  14. Impact of diagnostic checklists on the interpretation of normal and abnormal electrocardiograms
  15. Cerebrospinal fluid lactate as a predictive biomarker for tuberculous meningitis diagnosis
  16. Empowering quality data – the Gordian knot of bringing real innovation into healthcare system
  17. Collective intelligence improves probabilistic diagnostic assessments
  18. Why people fail to participate in annual skin cancer screening: creation of the perceptions of annual skin cancer screening scale (PASCSS)
  19. Instructions on appropriate fasting prior to phlebotomy; effects on patient awareness, preparation, and biochemical parameters
  20. Clinician factors associated with delayed diagnosis of appendicitis
  21. Real-world assessment of the clinical performance of COVID-VIRO ALL IN rapid SARS-CoV-2 antigen test
  22. Lack of a prompt normalization of immunological parameters is associated with long-term care and poor prognosis in COVID-19 affected patients receiving convalescent plasma: a single center experience
  23. Letters to the Editor
  24. Uncontrolled confounding in COVID-19 epidemiology
  25. VAPES: a new mnemonic for considering paroxysmal disorders
  26. Congress Abstracts
  27. SIDM2022 15th Annual International Conference
https://doi.org/10.1515/dx-2022-0117
Keywords for this article
clinical reasoning; context; emergence; multilevel; teamwork

Articles in the same Issue

  1. Frontmatter
  2. Editorials
  3. An equation for excellence in clinical reasoning
  4. Quantifying diagnostic excellence
  5. Review
  6. A scoping review of distributed cognition in acute care clinical decision-making
  7. Opinion Papers
  8. Context matters: toward a multilevel perspective on context in clinical reasoning and error
  9. Occam’s razor and Hickam’s dictum: a dermatologic perspective
  10. Original Articles
  11. Differences in clinical reasoning between female and male medical students
  12. Introducing second-year medical students to diagnostic reasoning concepts and skills via a virtual curriculum
  13. Bad things can happen: are medical students aware of patient centered care and safety?
  14. Impact of diagnostic checklists on the interpretation of normal and abnormal electrocardiograms
  15. Cerebrospinal fluid lactate as a predictive biomarker for tuberculous meningitis diagnosis
  16. Empowering quality data – the Gordian knot of bringing real innovation into healthcare system
  17. Collective intelligence improves probabilistic diagnostic assessments
  18. Why people fail to participate in annual skin cancer screening: creation of the perceptions of annual skin cancer screening scale (PASCSS)
  19. Instructions on appropriate fasting prior to phlebotomy; effects on patient awareness, preparation, and biochemical parameters
  20. Clinician factors associated with delayed diagnosis of appendicitis
  21. Real-world assessment of the clinical performance of COVID-VIRO ALL IN rapid SARS-CoV-2 antigen test
  22. Lack of a prompt normalization of immunological parameters is associated with long-term care and poor prognosis in COVID-19 affected patients receiving convalescent plasma: a single center experience
  23. Letters to the Editor
  24. Uncontrolled confounding in COVID-19 epidemiology
  25. VAPES: a new mnemonic for considering paroxysmal disorders
  26. Congress Abstracts
  27. SIDM2022 15th Annual International Conference
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