@article{13971,
  author = {Abigail Konopasky and Anthony R. Artino and Alexis Battista and Megan Ohmer and Paul A Hemmer and Dario Torre and Divya Ramani and Jeroen J G van Merrienboer and Pim W. Teunissen and Elexis McBee and Temple Ratcliffe and Steven J. Durning},
  title = {Understanding context specificity: the effect of contextual factors on clinical reasoning},
  abstract = {<jats:title>Abstract</jats:title><jats:sec id="j_dx-2020-0016_s_999_w2aab3b7c84b1b6b1aab1c17b1Aa"><jats:title>Background</jats:title><jats:p>Situated cognition theory argues that thinking is inextricably situated in a context. In clinical reasoning, this can lead to <jats:italic>context specificity</jats:italic>: a physician arriving at two different diagnoses for two patients with the same symptoms, findings, and diagnosis but different <jats:italic>contextual factors</jats:italic> (something beyond case content potentially influencing reasoning). This paper experimentally investigates the presence of and mechanisms behind context specificity by measuring differences in clinical reasoning performance in cases with and without contextual factors.</jats:p></jats:sec><jats:sec id="j_dx-2020-0016_s_998_w2aab3b7c84b1b6b1aab1c17b2Aa"><jats:title>Methods</jats:title><jats:p>An experimental study was conducted in 2018–2019 with 39 resident and attending physicians in internal medicine. Participants viewed two outpatient clinic video cases (unstable angina and diabetes mellitus), one with distracting contextual factors and one without. After viewing each case, participants responded to six open-ended diagnostic items (e.g. problem list, leading diagnosis) and rated their cognitive load.</jats:p></jats:sec><jats:sec id="j_dx-2020-0016_s_997_w2aab3b7c84b1b6b1aab1c17b3Aa"><jats:title>Results</jats:title><jats:p>Multivariate analysis of covariance (MANCOVA) results revealed significant differences in angina case performance with and without contextual factors [Pillai’s trace = 0.72, F = 12.4, df =(6, 29), p<jats:italic> &lt; </jats:italic>0.001, <jats:inline-formula id="j_dx-2020-0016_ineq_001_w2aab3b7c84b1b6b1aab1c17b3b1b3Aa"><jats:alternatives><jats:inline-graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="graphic/j_dx-2020-0016_eq_001.png" /><jats:tex-math>$\eta _{\rm p}^2 = 0.72$</jats:tex-math></jats:alternatives></jats:inline-formula>], with follow-up univariate analyses indicating that participants performed statistically significantly worse in cases with contextual factors on five of six items. There were no significant differences in diabetes cases between conditions. There was no statistically significant difference in cognitive load between conditions.</jats:p></jats:sec><jats:sec id="j_dx-2020-0016_s_996_w2aab3b7c84b1b6b1aab1c17b4Aa"><jats:title>Conclusions</jats:title><jats:p>Using typical presentations of common diagnoses, and contextual factors typical for clinical practice, we provide ecologically valid evidence for the theoretically predicted negative effects of context specificity (i.e. for the angina case), with large effect sizes, offering insight into the persistence of diagnostic error.</jats:p></jats:sec>},
  year = {2020},
  journal = {Diagnosis (Berl)},
  volume = {79},
  chapter = {257-264},
  pages = {257-264},
  month = {05/2020},
  issn = {2194-802X},
  doi = {10.1515/dx-2020-0016},
}