{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T07:18:20Z","timestamp":1787815100900,"version":"build-2784847793"},"reference-count":36,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Evaluation Clinical Practice"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Clinical reasoning in contemporary practice often involves ill\u2010structured, poorly defined problems that span the biopsychosocial domain and require reasoning under high relational complexity. Despite sustained scholarly attention to clinical reasoning, few models are both theoretically grounded and usable for clinicians who face this complexity. At the same time, the World Health Organization Family of International Classifications (WHO\u2010FIC) offers a rich but complex ontology that was not designed primarily to support clinical reasoning in practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To develop a two\u2010stage WHO\u2010FIC\u2010based ontological model of clinical reasoning that is conceptually coherent yet remains cognitively tractable in the face of complexity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A conceptual analysis was undertaken. It integrated three strands: (1) WHO\u2010FIC classification theory, including recent work on harmonisation; (2) empirical and theoretical literature on clinical reasoning; and (3) cognitive theories of bounded rationality, fast\u2010and\u2010frugal heuristics, relational complexity, and framing. These strands were used to derive design constraints for a clinically usable ontology. They were then synthesised into a two\u2010stage, graph\u2010based model designed to manage the complexity\u2010coherence trade\u2010off in clinical reasoning.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Stage 1 introduces a parsimonious triad\u2014Body, Activity, and Environment\u2014represented as a complete three\u2010node graph with bidirectional relations. This triad provides an etiologically neutral and cognitively economical starting point for framing complex clinical problems. Stage 2 introduces three emergent constructs\u2014Health Condition, Participation, and Intervention\u2014derived compositionally from Stage 1 relations and aligned with ICD\u201011, ICF, and ICHI, respectively. The model supports iterative movement between stages through composition and decomposition. It incrementally increases complexity while keeping relational load within cognitively feasible bounds and preserves the value of diagnosis while reducing its tendency to dominate problem framing. A worked case illustrates how the ontology supports reasoning about complex, time\u2010dependent problems through repeated movement between stages.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The proposed ontology addresses key ambiguities within WHO\u2010FIC, including the relationship between Activity and Participation and the perceived hierarchical privileging of diagnosis. It offers a more coherent and cognitively usable framework while respecting limits on human reasoning and managing the complexity\u2010coherence trade\u2010off. The model provides a theoretically grounded heuristic scaffold for clinicians and educators who work with complexity. It also contributes to clinical reasoning literature by emphasising reasoning about concepts, not only cases, with implications for interprofessional education and practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jep.70526","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T19:51:34Z","timestamp":1783540294000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Managing the Complexity\u2010Coherence Trade\u2010Off in Clinical Reasoning: A Two\u2010Stage Graph Ontology Based on WHO International Classifications"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-4971-9351","authenticated-orcid":false,"given":"David","family":"Kellett","sequence":"first","affiliation":[{"name":"Rankin Park Centre, John Hunter Hospital Hunter New England Health Newcastle New South Wales Australia"},{"name":"School of Medicine and Public Health The University of Newcastle Newcastle New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"key":"e_1_2_11_2_1","first-page":"140","article-title":"Teaching Clinical Reasoning: Principles From the Literature to Help Clinicians Improve Their Teaching","volume":"24","author":"Cook D. 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