Qualitative Health Research 1–11 © The Author(s) 2016 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1049732316650418 qhr.sagepub.com Article Medical education researchers describe two distinct sys- tems involved in reasoning: one of which tends to be rapid, contextual, unconscious, and intuitive, referred to as System 1, and another which tends to be slow, analyti- cal, conscious, and conceptual, referred to as System 2 (Kahneman, 2011). Debate continues as to the nature of the relationship between these components of cognition (Monteiro & Norman, 2013). One tradition assumes that System 1 leads to errors in decision making as a result of heuristic bias, which can only be corrected through System 2 (Kahneman, 2011). Following this theory, clini- cians learn analytic strategies that encourage bias avoid- ance by engaging in System 2 reasoning with the help of algorithms and checklists (Coderre, Wright, & McLaughlin, 2010; Croskerry, 2009; Mamede, Schmidt, & Rikers, 2007; Schön, 1983). More recently, researchers have begun moving away from bias avoidance models and are interested in the role of experience, context and memory, that is, features of System 1, in learning and decision making (Norman, 2005). Recent research sug- gests that clinical assessments based on System 1 can be just as or more accurate when compared with assessments based on System 2 (Ilgen et al., 2013; Norman et al., 2014); however, because it is unconscious, investigating System 1 continues to present challenges for researchers. This work does, however, suggest a need for further investigations of nonanalytic forms of knowledge acqui- sition and their use in clinical practice. A less explored aspect of clinical reasoning is the influence of the social environment and clinical culture on how and in what form information is received and put to use. In contrast to individualistic models, clinical cog- nition has been described as distributed, such that reason- ing and practice are dynamically produced and culturally constituted among groups of individuals working toward a shared goal (Hutchins, 1990; Hutchins & Klausen, 1996). This perspective assumes that clinical contexts are suffused with social meanings (Haas & Shaffir, 1987) born out through the acquisition and use of language to describe and explain cooperative action (Frank, 2010; Lingard et al., 2012). The social process of reasoning and decision making exists in communicative acts: the vari- ous utterances, writings, directives (Lingard et al., 2004), 650418QHR XX X 10.1177/1049732316650418Qualitative Health ResearchPeters et al. research-article 2016 1 McMaster University, Hamilton, Ontario, Canada Corresponding Author: Amanda Peters, Department of Sociology, 627 Kenneth Taylor Hall, McMaster University, 1280 Main St. W., Hamilton, Ontario, Canada L8S 4L8. Email: petera8@mcmaster.ca Examining the Influence of Context and Professional Culture on Clinical Reasoning Through Rhetorical-Narrative Analysis Amanda Peters 1 , Meredith Vanstone 1 , Sandra Monteiro 1 , Geoff Norman 1 , Jonathan Sherbino 1 , and Matthew Sibbald 1 Abstract According to the dual process model of reasoning, physicians make diagnostic decisions using two mental systems: System 1, which is rapid, unconscious, and intuitive, and System 2, which is slow, rational, and analytical. Currently, little is known about physicians’ use of System 1 or intuitive reasoning in practice. In a qualitative study of clinical reasoning, physicians were asked to tell stories about times when they used intuitive reasoning while working up an acutely unwell patient, and we combine socio-narratology and rhetorical theory to analyze physicians’ stories. Our analysis reveals that in describing their work, physicians draw on two competing narrative structures: one that is aligned with an evidence-based medicine approach valuing System 2 and one that is aligned with cooperative decision making involving others in the clinical environment valuing System 1. Our findings support an understanding of clinical reasoning as distributed, contextual, and influenced by professional culture. Keywords clinical reasoning; evidence-based medicine; rhetorical theory; socio-narratology; professional culture; medical education; Ontario, Canada; qualitative research