Steering through the murky waters of a scientific conflict: situated and symbolic models of clinical cognition

The situated action perspective, which embraces a diversity of views, challenges several of the fundamental assumptions of the symbolic information-processing framework underlying cognitive science and artificial intelligence. In this paper, we consider the following issues: symbolic representations, plans and actions, distributed cognition, and the transfer of learning. We evaluate each of these issues in terms of research and theories in clinical cognition and examine the implications for education and training, and for the integration of intelligent systems in medical practice. We argue for a reconceptualization of the symbolic framework in terms of the way the role of internal representations and cognitive activities are perceived. However, symbolic representations are integral to medical cognition and should continue to be central in any theoretical framework. A re-examination of cognitive science in medicine in terms of the relationship among physicians, technology, and the workplace could prove to be constructive in bridging the gap between theory and practice.