Clinical Reasoning in the Health Professions. 3rd Edition

The concept of evidence-based practice has dual implications for educators of chiropractors. Its mandatory inclusion within the curriculum ensures graduates are equipped with the most appropriate skills-set to participate successfully in the contemporary practise of chiropractic. Also, educators must critically adopt the evidence-based way of thinking to their own practices in learning and teaching within chiropractic programs. This book by Higgs is exceptional in three areas; it understands and appreciates a reasonable role for evidence-based practice in a range of health disciplines, it sets its invaluable exploration of clinical reasoning within a contemporary context that appreciates the need to move beyond competencies, and it is itself evidence-based with a number of chapters reporting the research work in this field undertaken by doctoral students of Higgs and others. The first edition in 1995 provided a unique Australian-style clarity for the often obfuscated concepts of clinical decision-making, such as hypothetico-deductive reasoning. This writer adopted those concepts in his teaching and now welcomes this third edition as an international work with almost 70 contributors from reputable institutions in many countries. There is a Distinguished University Professor from Minnesota, a Professor of Education in Medicine from the UK and a Professor for Innovate Assessment from the Netherlands, just to single out three contributors to demonstrate the depth of global thinking captured in this book. But the thing that makes this book suited for consideration by the readers of this journal is the intellectual content that is applicable to our educational practice. The work is presented in six sections, the first two exploring the nature and context of clinical reasoning and then reasoning, expertise and knowledge. Nowhere is Higgs more persuasive than when she discusses the need in health care for education rather than training. The argument is that competencies are skills and as such they are visible and measurable however they are not a sufficient basis for professional conduct. Higg's argument is that good professional practice is context-specific (p. 29). In turn this presents a need for the preparation and development of health care professionals to include changing their understanding, the capacity to reflect on and apply reasoning to new situations. The development of understanding lies well beyond competencies and represents capability, a matter addressed in detail elsewhere in the book by Nicole Christensen, a doctoral student of Higgs. The third chapter is a discussion on clinical reasoning research trends and then the final three explore the different approaches to clinical decision-making and the better ways these can be communicated, ending with teaching and learning clinical reasoning. These sections include a number of case-based chapters and cover the gamut from teaching to assessing applied clinical reasoning in a range of health professions. The depth and scale of this work is exemplary as it relates to an evidence-based approach to clinical reasoning. Whilst not inclusive of chiropractic as a discipline there is no doubting the importance of the need for this work and its principles to be embraced and implemented world-wide by educators of chiropractors.