Basic Science Reasoning and Clinical Reasoning Intertwined: Epistemological Analysis and Consequences for Medical Education.

The aim of this paper is to emphasize the distinction between basic medical science (and reasoning) and clinical science (and reasoning) in order to illuminate some basic philosophical and cognitive issues in medical education. The Kunhian concept of exemplar refers to the field of growth of scientific knowledge and in this sense is related to the "anti-theoretical" emphasis on problem solving performance. In cognitive science this (and similar) types of postpositivistic objections to the formalistic excess of the neopositivistic tradition are exploited to stress the relevance of the distinction between theories and their domains of application. This objection is exploited to stress the difference between established bodies of scientific knowledge and their processes of discovery and/or application and, in medical knowledge, between clinical reasoning (situated, concerned with attributes of people) and basic science reasoning (unsituated, concerned with attributes of entities such as organs, bacteria, viruses). Exploiting the theoretical consequences of the previous analysis I will try to answer some questions: What is the role of problem solving in teaching and learning, as different from conventional basic science-centred education? Is it relevant, in medical education, an epistemological and logical awareness of the main methodological topics? Finally, the analysis of the significance of abduction in a unified epistemological model of medical reasoning is exploited to individuate the proper ontological level dealing with the entities and relationships belonging to the dynamism of the underlying domain knowledge (for instance biomedical physics) and the consequences for medical education.