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REVIEW

Five decades of research and theorization on

clinical reasoning: a critical review
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Advances in Medical Education and Practice
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Shahram Yazdani Abstract: Clinical reasoning is a complex cognitive process that is essential to evaluate and
Maryam Hoseini Abardeh manage a patient’s medical problem. The aim of this paper was to provide a critical review of
the research literature on clinical reasoning theories and models. To conduct our study, we
Department of Medical Education, School
of Medical Education, Shahid Beheshti applied the process of conducting a literature review in four stages in accordance with the
University of Medical Sciences, Tehran, approach of Carnwell and Daly. First, we defined the scope of the review as being limited to
Iran
clinical reasoning theories and models in medical education. In the second stage, we
For personal use only.

conducted a search based on related words in PubMed, Google Scholar, PsycINFO, ERIC,
ScienceDirect and Web of Science databases. In the third stage, we classified the results of
the review into three categories, and in the fourth stage, we concluded and informed further
Video abstract studies. Based on the inclusion and exclusion criteria, 31 articles were eligible to be
reviewed. Three theories and two models were recognized and classified into three cate-
gories. Several theories and models have been proposed in relation to clinical reasoning, but
it seems that these theories and models could only explain part of this complex process and
not the whole process. Therefore, to fulfill this gap, it may be helpful to build a Meta-model
or Meta-theory, which unified all the models, and theories of clinical reasoning.
Keywords: clinical reasoning, medical education, review

Introduction
Point your SmartPhone at the code above. If you have a Clinical reasoning is a complex cognitive process that is essential to evaluate and
QR code reader the video abstract will appear. Or use:
https://youtu.be/R0phQSYGWUQ manage a patient’s medical problem.1 It includes the diagnosis of the patient
problem, making a therapeutic decision and estimating the prognosis for the
patient.2 In describing the importance of clinical reasoning, it has been acknowl-
edged that clinical reasoning is the central part of physician competence,3 and
stands at the heart of the clinical practice,4 it has an important role in physicians’
abilities to make diagnoses and decisions.1 Clinical reasoning has been the subject
of academic and scientific research for decades;5 and its theoretical underpinning
has been studied from different perspectives.6 Clinical reasoning is a challenging,
promising, complex, multidimensional, mostly invisible,7 and poorly understood
process.8 Researchers have explored its nature since 1980,9 but due to the lack of
Correspondence: Maryam Hoseini theoretical models, it remains vague. Most used theoretical models have limited
Abardeh
School of Medical Education, Shahid explanatory power, and are based on certain assumptions about what constitutes
Beheshti University of Medical Sciences, clinical reasoning.10 In the literature of clinical reasoning, several competing
Shahid Chamran Highway, Tehran Velenjak
Street, Tehran, Iran theories and models have been raised.1,11–13 Although most of the theoretical
Tel +98 212 243 9982 contributions on clinical reasoning belong to the 20th century, proposing new
Fax +98 212 243 9784
Email [email protected] models are well continued into the 21st century, for example, Haring and her

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 Yazdani and Hoseini Abardeh Dovepress

colleagues proposed a conceptual model for expert judg- articles from 1974 up to 2018 have been reviewed by
ment of clinical reasoning of medical students.14 However, researchers (n=170) (Table 1).
there is no general agreement as to which of these is the Then, the articles that presented theories or models of
best.15 The purpose of this paper is to provide a critical clinical reasoning in medicine or provided evidence in
review of the research literature on clinical reasoning relation to them were selected to full-text study. Studies
theories and models and present a comprehensive view were eligible for this critical review if they presented a
of main models and theories of clinical reasoning in med- model or a theory of clinical reasoning, or related critiqued
ical education. A clearer understanding of clinical reason- models and theories or the studies that add some features
ing models and theories help medical teachers for to the theories and models of clinical reasoning (n=47).
teaching, planning, and assessment of clinical reasoning. The inclusion criteria of selecting studies were: 1) pub-
This paper tries to clarify the current knowledge regarding lished articles in English and Persian and 2) published
the clinical reasoning models and theories and present a articles in the field of medicine. Studies were excluded if
classification of the main theories and models. they provided clinical reasoning models or theories in
other fields (like nursing and optometry), examined the
clinical reasoning in the field of artificial intelligence
Materials and methods (like clinical decision support systems), and/or examined
Grant noted, “A critical review aims to demonstrate that the
brain biology and brain functions (like fMRI studies).
writer has extensively researched the literature and critically
evaluated its quality.”16 It included a degree of analysis and
conceptual innovation.16 In this study, we applied the process
Step 3: organizing the results of the
of conducting a literature review according to Carnwell and review into categories
Daly.17 They proposed a “four-stage” method that included: 1) After excluding irrelevant studies, a total of 31 documents
“Defining the scope of the review,” 2) “Identifying and select- were initially selected for review which is shown in
ing the sources of relevant information,” 3) “Organizing the PRISMA flowchart below (Figure 1).
results of the review into categories,” and 4) “Concluding and Models and theories which were extracted from stu-
informing further studies.”17 dies, classified to three categories and each category, based
on Carnwel and Daly approach, reviewed in three steps:
first, we present a summary of the models and theories,
Step 1: defining the scope of the review and then reflect other author’s views and finally, we pre-
The scope of this review was limited to the main clinical sent our view (Table 2).17 If a model or theory explains
reasoning theories and models proposed in medical educa- about the process of clinical reasoning our first category
tion literature. We concentrated our review on published owns it while models and theories which clarified the
works in scholarly journals between the years 1970 and formation of knowledge structures and their application
2018. during the clinical reasoning process belongs to the second
category, and our third category consisted models and
Step 2: identifying and selecting the theories which consider more than one processing modes
of clinical reasoning.
sources of relevant information
At this stage, each of the two reviewers conducted a
separate search based on keywords – “clinical reasoning,” Results
“diagnostic reasoning,” “clinical reasoning theory,” “clin- First category: theories and models based
ical reasoning model,” “script theory,” “hypothetico– on the process of clinical reasoning
deductive model,” “cognitive continuum theory,” and This category includes the models and theories that
“dual processing theory” – in PubMed, Google Scholar, explain the clinical reasoning process, between models
PsycINFO, ERIC, ScienceDirect and Web of Science data- and theories that we reviewed, only hypothetico-deductive
bases. The results were pooled and extensive literature model was eligible to get placed in the first category as the
were found (n=305) which was from 1970 to 2018, but most reputed model that explains the clinical reasoning
due to lack of access to the full text of some articles, and process. This model was proposed by Elstein (1978), and,
after removing duplicated studies, the title and abstract of according to this model, the physicians primarily generate

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Table 1 Scientific studies about clinical reasoning that has been title and abstract reviewed
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First decade Second decade Third decade Fourth decade Fifth decade

Feinstein (1974)41 Kraytman et al (1981)45 Elstein et al (1990)18 Charlin et al (2000)12 Aleluia et al (2010)113
42 46 51 79
Rubin (1975) Feltovich et.al (1984) Joseph & Patel (1990) Carter & Robinson (2001) Corcoran (2010)114
Elstein et al (1978)43 Kuipers & Kassirer (1984)47 Patel et al (1990)52 Harries & Harries (2001)80 Mariasin (2010)115
Elstein & Bordage (1979)44 Schmidt & de Volder (1984)23 Norman et al (1990)53 Round (2001)6 Lee et al (2010)116
48 25 81
McGuire (1985) Schmidt et al (1990) Elstein & Schwarz (2002) Omana et al (2010)117
Patel et al (1986)19 Ericsson (1991)54 Nendaz (2002)82 Wilhelmsson (2010)118
Barrows et al (1987)31 Kaufman (1991)55 Patel et al (2002)83 Thomson et al(2010)8
32 56 84
Case et al (1988) Mattingly (1991) Bleakley et al (2003) Amini et al (2011)119
Hamm (1988)39 Custers et al (1992)57 Coderre et al (2003)85 Durning (2011)120

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Groen & Patel et al (1988)49 Evans & Patel (1992)58 Norman & Eva (2003)86 Franklin et.al.(2011)121
50 59 87
Girotto & Legrenzi (1989) Florance (1992) Eshach & Bitterman (2003) Pelaccia et al (2011)1
Henny Boshuizen et al (1992)60 Groves et al (2003)88 Thomson et al (2011)8
Higgs (1992)20 Hardin (2003)89 Adams (2012)122
61 90
Arocha et al (1993) Charlin &Van der Vleuten (2004) Ashoorion et al (2012)123
Hassebrock et al (1993)62 Eva (2004)91 Van Bruggen (2012)124
Patel et al (1993)63 Rikers et al (2004)92 Charlin et al (2012)125
64 93
Schmidt et al (1993) Verkoeijen et.al (2004) Demirören & Palaoğlu (2012)126
Higgs (1993)65 Holyoak & Morrison (2005)21 Braude (2012)127
Joseph Arocha et al (1993)66 Norman (2005)3 Braude (2012)128
67 94
Bordage (1994) Tamayo-Sarver (2005) Khatami et al (2012)129
Elstein (1994)22 Anderson (2006)95 Lucchiari & Pravettoni (2012)10
Patel et al (1994)68 Bowen (2006)96 Loftus (2012)4
69 97
Jones (1995) Eva & Cunnington (2006) Marcum (2012)34
Joseph Arocha & Patel (1995)70 Loftus (2006)5 Nouh et al (2012)130
Custers (1995)71 Montgomery (2006)98 Shaban (2012)131
26,28 99
Custers et al (1996) Novak et al (2006) Adams (2013)9
Hammond (1996)38 Thornton (2006)100 Custers (2013)40
Mandin et al (1997)30 Auclair (2007)101 Audétat et al (2013)132
72 102
Van de Wiel (1997) Schmidt & Rikers (2007) Da Silva (2013)133
Allen et al (1998)73 Norman et al (2007)11 Evans & Stanovich (2013)36
Chang & Bordage (1998)74 Banning(2008)103 Gigante (2013)134
75 13
Charlin et al (1998) Evans (2008) Kriewaldt (2013)135
Custers et al (1998)24 Harasym et al (2008)29 Lubarsky et al (2013)136

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Cuthbert (1999)76 Heiberg (2008)104 Munshi et al (2013)137
77 7
Kaufman et al (1999) Higgs (2008) Smith (2013)138
Round (1999)78 Humbert (2008)105 Weiss et al (2013)139

705
Yazdani and Hoseini Abardeh

Ilgen et al (2013)140

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Table 1 (Continued).

706
First decade Second decade Third decade Fourth decade Fifth decade

Noreen et al (2008)106 Bowen & Ilgen (2014)141

107

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Vertue & Haig (2008) Delany & Golding (2014)142
Braude(2009)108 Bissessur et al (2009)109 Freiwald et al (2014)143
Carrière et al (2009)110 Geisler et al (2014)144
Yazdani and Hoseini Abardeh

35,37
Croskerry (2009) Gordon (2014)145
Elstein (2009)33 Holmboe & Durning (2014)146
Stempsey (2009)15 Hrynchak et al (2014)147
111

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Rehder & Woo Kim (2009) Hochberg et al (2014)148,149
Vosniadou (2009)112 Monajemi (2014)150
Roots (2014)151
Salkeld (2014)152
Smith et al (2014)153
Capaldi (2015)154
Custers (2015)27
Gaba (2015)155
Islam et al (2015)156
Lafleur & Leppink (2015)157
Lubarsky et al (2015)158
Park et al (2015)159
Lisk (2016)160
McBee et al (2016)161
Gruppen (2017)162
Haring et al (2017)14
Jarodzka et al (2017)163
Norman et.al (2017)164
Ten Cate et.al (2017)165
Zamani et al (2017)166
Bowen & ten Cate (2018)167
Custers (2018)168
Daly (2018)2
King et al (2018)169
Keemink et al (2018)170
Lopes et al (2018)171
Yazdani & Hoseini (2017)172
Yazdani et al (2018)173
Higgs et al (2018)174
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Identification
Records identified through database searching Additional records identified through other sources
(n=305) (n=7)

Records after duplicates removed

(n=142)
Screening

Records screened by title and

Record excluded
abstract
(n= 123)
(n= 170)
Eligibility

Full-text articles assessed for

eligibility Full-text articles excluded with reasons
(n= 47) (n= 16)

Studied included in critical review

(n= 31)
Included

Figure 1 PRISMA flowchart.

a limited number of diagnostic hypotheses or problem adequate description of the process of clinical reasoning
formulations in the process of solving a diagnostic pro- has challenged by the case specificity findings.7
blem and then testing them. These hypotheses guide Nevertheless, some researchers defend hypothetico-
further patient information.18,19 Unlike the findings of deductive model, Elstein argued that the small set of
hypothetico-deductive model that claim: “primarily gener- solutions that generated in this model transformed an
ated and tested hypotheses by expert and novice are the unstructured problem to structured one and it is an
same,” Patel believed that it is not consistent in other effective way to solve diagnostic problems.18 This
domains, like physics.19 model is recommended by medical experts as a useful
Higgs argued that this model posits the idea that the reasoning strategy for medical students.22 Hypothetico-
process of clinical reasoning is largely a sequential deductive model is applicable when data are vague or
process.20 Charlin pointed out that the psychological reveal over time,22 and is a representation of clinical
mechanisms involved in the generation and testing of reasoning.20 This model represents a description of the
relevant hypotheses are unfamiliar,12 and Holyoak argued mental processes used by physicians and has repeatedly
that this model does not distinguish between novice and been validated by empirical studies and is the basis for
expert clinical reasoning strategies.21 Loftus believed that modern clinical education.12
the collected information and the way they interpreted, Hypothetico-deductive model assumes the physician
distorted by the used hypothesis.5 This model as an starts hypothesizing after collecting patient information

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Table 2 The list of 31 related literatures that included in the review

708
Category no. Theory/model Author Year Aspects related to supporting/criticizing the model

First category: theories and models based on the process Hypothetico- Elstein 199018 The description of the hypothetico-deductive model
of clinical reasoning deductive model The advantages of hypothetico-deductive model

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Patel 198619 Lack of consistency of hypothetico-deductive model with other domains
Yazdani and Hoseini Abardeh

Higgs 199220 Clinical reasoning process is not sequential

Charlin 200012 Unfamiliarity of psychological mechanisms involved in this model

Holyoak 200521 No differentiation between novice and expert clinical reasoning

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Loftus 20065 Clarification of the role of hypothesis in clinical reasoning process

Higgs 20087 Adequate description of the process of clinical reasoning

Elstein 199422 Application of hypotheses for framing of clinical problems

Second category: theories and models based on the Illness script theory Schmidt 198423 The description of the illness script theory
knowledge structure Formation and development of the illness script
Custers 199824 The description of the illness script theory

Schmidt 199025 The structure of illness script

Formation and development of the illness script

Custers 199626 The structure of illness script

27
Custers 2015 Script concordance test
Formation and development of the illness script

Custers 199628 The structure of illness script

Harasym 200829 Formation and development of the illness script

30
Mandin 1997 Distinction between the concept of the script and the schema

Pattern recognition Barrows 198731 The description of the model

model
Case S 198732 It used by experienced practitioners

Norman 200711 The most usual form of nonanalytic processes

Elstein 200933 Unanswered questions about pattern recognition model

34
Marcum 2012 The complexity of cognitive processes involved in clinical reasoning to be ignored.

Higgs 20087 Pattern recognition model examined in limited field of expertise.

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 Dovepress Yazdani and Hoseini Abardeh

and then tests hypotheses, while we believe the physician

Clarification of the place of pattern recognition and hypothetico-deductive models

starts hypothesizing initially from his/her clinical encoun-
ter. The initial hypotheses can be strong or weak, depend-
ing on whether the physician is an expert or novice, the
difference between the novice and the expert lies in
the quality of the hypotheses they made. Therefore, since
Aspects related to supporting/criticizing the model

the initial hypothesis of an expert has good quality,

hypothesis testing will be fast and efficient. The simplicity
Proposing a model based on dual processing theory
of this model in describing the process of clinical reason-
ing is both strength and the weakness of it, as a strength,

Criticized this theory in five major themes

Models based on dual processing theory

because it simply portrays the start point of the process of
clinical reasoning so it can be used to design the teaching
plan and evaluate clinical reasoning. As a weakness,
The description of the theory

The description of the theory

The description of the theory

because it considers the process of diagnostic reasoning
Advantages of this theory

Advantages of this theory

in dual processing theory.

very simple, while even for a novice, this process does not
occur so easily, and other factors (such as the individual’s
knowledge structure, the context, the health system, etc.)
affect the process of clinical reasoning, but this model
does not consider these factors.

Second category: theories and models based on the

knowledge structure
200836

200935
37

201336
10

199638

198839

201340
20111
Year

2009

2012

For this category, we considered theories and models that

explain the formation of knowledge structures in the clin-
ical reasoning process, by this description and the inclu-
Hammond
Croskerry

Croskerry

sion criteria just one theory and one model of clinical

Lucchiari
Author

Custers
Pelaccia

Hamm
Evans

Evans

reasoning gain eligibility to include, the “illness script

theory” and the “pattern recognition model.”
The illness script theory proposed by Barrows and
Cognitive continuum

Feltovich consists of three components: 1) enabling condi-

Theory/model

Dual processing

tions, 2) fault, and 3) consequences.23 The first component is

the factors such as age, sex, current medication, previous
theory

medical history, occupation, risk behavior, hereditary, and

environment affect the probability of someone gets a disease,
are the patient’s contextual and background factors that refer
to “Enabling conditions.” These “Enabling conditions” can
cause the latter pathophysiological malfunctioning that
Third category: compilation theories and mode

called “fault” which is the second component of illness

script. Consequences of this fault are complaints, signs, and
symptoms that consist of the third component.24 Illness
scripts are the list-like structures,25 which conceptualized as
a specific representation of clinical knowledge.26 Script con-
Table 2 (Continued).

cordance test designed according to this theory.27

While we were studying about Illness script theory, we
Category no.

realized that we could categorize studies into two broad

groups. The first group is the studies that deal with the
concept of the script, the schema, and the illness script, and
their features, distinctions, and components (Table 3).24,26–28

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Table 3 The studies that deal with the concept of “script,” Schema as a knowledge structure has an “if/then” format-
“schema,” and “illness script,” and their features, distinctions, ting and occurs sequentially, in the sense that this sequence
and components
divided into two branches: “if” and “then,” so we can claim
Author year out that its format is algorithmic. This algorithm starts with a
Custers et al. (1996)26 hypothesis in a person’s mind or something that a person
Custers et al. (1996)28 thinks about and then continues with inquiries and searches
Custers et al. (1998)24 that a physician has performed and then with the findings that
Custers et al. (2015)27 a physician has reached, and finish with the decisions that he/
Loftus (2006)5
she has finally taken (Figure 2).
Charlin (2000)12
In terms of the structure of the script, we also agree with
Schmidt’s view that the scripts are list-like structures, but
The second group deals with the formation and devel- unlike Charlin, who believed that “the script describes the
opment of the illness script during the acquisition of structure of clinical knowledge,” we believe that the script
expertise and changes in the physician’s knowledge struc- is not necessarily the structure of clinical knowledge, but a
ture (Table 4).23,25,26,29 knowledge structure that has clinical applications. The
The first group of studies also looked at the distinction script is schemas for common situations, which include a
between the concept of the script and the schema, but this packet or a list of expectations of what people see or do at a
distinction was not clear in the literature. The schemas and given location. The schemas and scripts are stored in long-
scripts are stored in long-term memory.30 term memory, and if physicians encounter a clinical case
that matches with them, they will retrieve it from long-term
Table 4 The studies that deal with the formation and develop-
memory and move it to short-term memory (Figure 3).
ment of “illness script” during the acquisition of expertise and
changes in the physician’s knowledge structure
Author year
Pattern recognition model
In the pattern recognition model, a physician directly
Schmidt et al. (1990)25 compares the pattern of the patient’s problem with disease
Schmidt et al. (1984)23
patterns and if found them similar to each other, then
Harasym et al. (2008)29
select the pattern that matches it.31 Experienced

F1 D1

I1 F2 D2

F6 D5
H2 I3
H1 F3
F7 D6

F4 D3

I2
F5 D4

“Finding” box
“Think about” / hypotheses box

“Look for” / inquiry box “Decision” box

Figure 2 Generic flow of events in a typical schema. D1: Decision No 1; D5: Decision No 6; F1: Finding No 1; F5: Finding No 5; H1: Hypothesis No 1; H2: Hypothesis No 2; I1:
Inquiry No 1; I3: Inquiry No 3.

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Most commonly observed path in schema

Script
F1 D1

H1
I1 F2 D2 I1
F6 D5
F3
H2 I3
H1 F3 H2
F7 D6
I3
F4 D3
F7
I2
D6
F5 D4

“Think about” / hypotheses box “Finding” box

“Look for” / inquiry box “Decision” box

Figure 3 Script as a routinized pathway of previously used schema. D1: Decision No 1; D5: Decision No 6; F1: Finding No 1; F5: Finding No 5; H1: Hypothesis No 1; H2:
Hypothesis No 2; I1: Inquiry No 1; I3: Inquiry No 3.

practitioners often use pattern recognition to achieve a modes of reasoning – “analytical” and “non-analytical,”
medical diagnosis.32 Norman and his colleagues argue these modes are the characteristics of both first and second
that pattern recognition is the most usual form of nonana- category, so we cannot involve them in one of them,
lytic processes.11 However, Elstein proposed some ques- therefore they form our third category.
tions about this model, as followed: The dual-processing theories commonly have two dif-
ferent processing modes in which they refer to: System 1
● When dose a person use a pattern recognition model? and System 2.13 System 1 described as a fast, automatic
● When is this method preferable to the hypothetico- and intuitive mode, which shares similarities through per-
deductive method? ception, while System 2 is slow and analytic mode that
● What guarantees that the choice of a pattern or an applies rules without inferring emotions.7
illness script is correct? Croskerry believed that dual-processing theory is an
● What happens if the pattern or script stored in the applicable model in multiple domains of health care like
knowledge base is wrong?33 decision-making and it can be useful in teaching decision
theory or in making a platform to future research.35 Pelaccia
This model considers the complexity of cognitive pro- et al noted that in the framework of this theory, the pattern
cesses involved in clinical reasoning to be insignificant.34
recognition and hypothetico-deductive models are the basis
Based on the definition of the pattern recognition model, it
of the intuitive system and the analytic system, respectively.1
only mentions the existence of patterns in mind, but does not
Evans and Stanovich criticized this theory in five major
explain how the construction of these patterns occurred. The
themes: 1) various theorists have proposed multiple and
studies which designed to prove that the pattern recognition
vague definitions for this theory, 2) there is no consistency
model happens in reality are in a limited field of expertise, like
in associated attribute clusters with dual systems, 3) distinc-
radiology, dermatology, and pathology. 7 So the pattern recog-
tions are referred to the continuum of processing and not to
nition model is not extendable to all medical specialties.
discrete processing; 4) the apparent dual-process phenom-
Third category: compilation theories and model enon can present by single-process accounts; and 5) the
Some of the included documents were about “dual proces- evidence base for the dual-processing theory is ambiguous
sing” and “cognitive continuum” theories that explain two or unconvincing.36

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In the reviewing of the literature, we found out that the first category in our study just address the process of
some of the researchers established their models based on clinical reasoning and do not pay attention to knowledge
dual-processing theory like Marcum,34 Croskerry,35,37 and structures and cognition; in the second category, they just
Lucchiari and Pravettoni.10 focused on knowledge structures and their formations dur-
Dual-processing theory employs many of the see- ing clinical reasoning process and do not clarify the pro-
mingly contradictory features that have been proposed cess of clinical reasoning. In addition, the dual processing
for clinical reasoning in the literature (such as fast, slow, and cognitive continuum theories that form the third cate-
reflective, etc.). It seems that, in reality, a physician does gory just covered the cognition part of the clinical reason-
not use just intuitive or analytic systems and the mind of ing. Therefore, to fulfill this gap, it may be helpful to build
physician operates in the space between them, while the a Meta-model or Meta-theory, which unified all the mod-
dual-processing theory ignores this. els, and theories of clinical reasoning. Although our focus
The theories and models that have been proposed fol- was on the main models and theories of clinical reasoning
lowing this theory have led to the introduction of cognitive in the field of medical education, but we acknowledge that
concepts such as metacognition and perception and their there are other models and theories of clinical reasoning in
role in the process of clinical reasoning. This theory has the literature and their absence can be the bias of this
relatively clarified the role of emotions and their place of study.
influence in the process of clinical reasoning, and has also
contributed to clarifying the concept of intuition in clinical
reasoning.
Acknowledgment
This work was part of a PhD dissertation, funded and
The second theory that has placed in third categories is
financially supported by the Shahid Beheshti University
cognitive continuum, as Hammond claimed, this theory
of Medical Sciences, Tehran, Iran.
considered two poles, an intuitive cognition and an analy-
tical cognition, in which various modes or forms of cogni-
tion have relational order on a continuum, and this Disclosure
assumption rejected the dual-processing approach.38 The authors report no conflicts of interest in this work.
Hamm believed, this theory does not explain the informa-
tion processing that is the basis of analysis and intuition,
but based on analytical and intuitive cognitive attributes it
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