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Medical Education 2011: 45: 927–938

OBJECTIVES  Prior work has found that a doctor’s clinical reasoning performance varies on a case‐by‐case (situation) basis; this is often referred to as ‘context specificity’. To explore the influence of context on diagnostic and therapeutic clinical reasoning, we constructed a series of videotapes to which doctors were asked to respond, modifying different contextual factors (patient, doctor, setting). We explored how these contextual factors, as displayed by videotape encounters, may have influenced the clinical reasoning of board‐certified internists (experts). Our purpose was to clarify the influence of context on reasoning, to build upon education theory and to generate implications for education practice.

METHODS  Qualitative data about experts were gathered from two sources: think‐aloud protocols reflecting concurrent thought processes that occurred while board‐certified …