Reframing context specificity in team diagnosis using the theory of distributed cognition

James G. Boyle*, Matthew R. Walters, Susan Jamieson, Steven J. Durning

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Context specificity refers to the vexing phenomenon whereby a physician can see two patients with the same presenting complaint, identical history and physical examination findings, but due to specific situational (contextual) factors arrives at two different diagnostic labels. Context specificity remains incompletely understood and undoubtedly leads to unwanted variance in diagnostic outcomes. Previous empirical work has demonstrated that a variety of contextual factors impacts clinical reasoning. These findings, however, have largely focused on the individual clinician; here we broaden this work to reframe context specificity in relation to clinical reasoning by an internal medicine rounding team through the lens of Distributed Cognition (DCog). In this model, we see how meaning is distributed amongst the different members of a rounding team in a dynamic fashion that evolves over time. We describe four different ways in which context specificity plays out differently in team-based clinical care than for a single clinician. While we use examples from internal medicine, we believe that the concepts we present apply equally to other specialties and fields in health care.

Original languageEnglish
Pages (from-to)235-241
Number of pages7
Issue number3
StatePublished - 1 Aug 2023
Externally publishedYes


  • clinical reasoning
  • context specificity
  • distributed cognition
  • error
  • situated cognition
  • situativity theor
  • teams


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