Cognition in the Clinic: The Case for Cognitive Ethnography in Family Medicine

In family medicine, clinical reasoning often requires family physicians to provide patient care across a heterogeneity of clinical problems and a wide range of clinical contexts. The relationship between clinical reasoning and context has long been implicated in the medical education literature; however, traditional conceptualizations of clinical reasoning have focused on individual cognition and have positioned context as external to the process itself. More recently, clinical reasoning has been defined through the integration of knowledge and context. This emerging conceptualization requires research methodologies that place a greater emphasis on how this integration takes place in real-world practice settings. Despite this need, such methodologies remain underutilized and underexplained in the medical education literature. This article provides an overview of cognitive ethnography, a methodology that can explore the integration of knowledge and context in real-world settings. Using a case study of cognitive ethnography exploring adaptive expertise in family medicine, this article further shares an example of how to design and implement cognitive ethnography in family medicine research. A greater understanding of the realities of clinical reasoning in the family medicine context is crucial to support the ongoing research, training, and academic conversations in family medicine.