,Clinical Reasoning in the
Health Professions
,For Elsevier:
Publisher: Heidi Harrison
Associate Editor: Siobhan Campbell
Development Editor: Veronika Watkins
Project Manager: Gail Wright
Senior Designer: George Ajayi
Illustration Manager: Merlyn Harvey
Illustrator: Richard Morris
,Clinical Reasoning in
the Health Professions
THIRD EDITION
Joy Higgs BSc GradDipPhty MHPEd PhD AM
Strategic Research Professor in Professional Practice, and Director, Education for Practice
Institute, Charles Sturt University, Australia
Mark A. Jones BSc(Psych) PT MAppSc
Program Director, Postgraduate Coursework Masters Programs, School of Health Sciences,
University of South Australia, Australia
Stephen Loftus BDS MSc PhD
Pain Management Research Institute, Royal North Shore Hospital, Sydney, Australia;
Senior Lecturer, Education for Practice Institute, Charles Sturt University, Australia
Nicole Christensen MAppSc PT
Assistant Professor, Doctor of Physical Therapy Program, Samuel Merritt College, USA,
PhD candidate, University of South Australia, Australia
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,# 2008, Elsevier Limited. All rights reserved.
# 2000 Elsevier Limited. All rights reserved.
# J. Higgs 2000 for Chapters 1, 3, 14, 24 and 35
# M. A. Jones 2000 for Chapters 12 and 36
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First edition 1995
Second edition 2000
Third edition 2008
ISBN: 978-0-7506-8885-7
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A catalog record for this book is available from the Library of Congress
Notice
Neither the Publisher nor the Editors assume any responsibility for any loss or injury and/or damage
to persons or property arising out of or related to any use of the material contained in this book. It is
the responsibility of the treating practitioner, relying on independent expertise and knowledge of the
patient, to determine the best treatment and method of application for the patient.
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, v
Contents
Contributors ix
Preface xiii
SECTION 1 Clinical reasoning and 9. Dimensions of clinical reasoning capability 101
clinical decision making – nature Nicole Christensen, Mark A. Jones, Joy Higgs and
and context 1 Ian Edwards
1. Clinical decision making and multiple problem
spaces 3 SECTION 2 Reasoning, expertise and
Joy Higgs and Mark A. Jones knowledge 111
2. The context for clinical decision making in the 10. The development of clinical reasoning
21st century 19 expertise 113
Della Fish and Joy Higgs Henny P.A. Boshuizen and Henk G. Schmidt
3. Clinical reasoning and models of practice 31 11. Expertise and clinical reasoning 123
Franziska Trede and Joy Higgs Gail Jensen, Linda Resnik and Amy Haddad
4. Collaborative decision making 43 12. Clinical reasoning and biomedical knowledge:
Franziska Trede and Joy Higgs implications for teaching 137
David R. Kaufman, Nicole A. Yoskowitz and
5. Action and narrative: two dynamics of clinical Vimla L. Patel
reasoning 55
Maureen Hayes Fleming and Cheryl Mattingly 13. Knowledge, reasoning and evidence for
practice 151
6. Clinical reasoning and generic thinking Joy Higgs, Mark A. Jones and Angie Titchen
skills 65
Stephen Brookfield 14. Knowledge generation and clinical reasoning in
practice 163
7. Clinical reasoning and patient-centred care 77 Joy Higgs, Della Fish and Rodd Rothwell
Sue Atkins and Steven J. Ersser
15. Understanding knowledge as a sociocultural
8. Factors influencing clinical decision making 89 historical phenomenon 173
Megan Smith, Joy Higgs and Elizabeth Ellis Dale Larsen, Stephen Loftus and Joy Higgs
,vi Contents
16. Professional practice judgement artistry 181
Margo Paterson and Joy Higgs
SECTION 5 Communicating about clinical
reasoning 329
30. Learning to communicate clinical
SECTION 3 Clinical reasoning research
reasoning 331
trends 191
Rola Ajjawi and Joy Higgs
17. Methods in the study of clinical reasoning 193 31. Learning the language of clinical reasoning 339
José F. Arocha and Vimla L. Patel Stephen Loftus and Joy Higgs
18. A history of clinical reasoning research 205 32. Beyond the restitution narrative: lived bodies and
Stephen Loftus and Megan Smith expert patients 349
Suzanne Alder and Debbie Horsfall
19. A place for new research directions 213
Joy Higgs and Stephen Loftus 33. Facilitating clinical decision making in students
in intercultural fieldwork placements 357
Lindy McAllister and Gail Whiteford
SECTION 4 Clinical reasoning and clinical 34. Using decision aids to involve clients in clinical
decision-making approaches 221 decision making 367
Lyndal Trevena, Alex Barratt and
20. Clinical reasoning in medicine 223 Kirsten McCaffery
Alan Schwartz and Arthur S. Elstein
21. Clinical reasoning in nursing 235 SECTION 6 Teaching and learning clinical
Marsha E. Fonteyn and Barbara J. Ritter reasoning 377
22. Clinical reasoning in physiotherapy 245
Mark A. Jones, Gail Jensen and Ian Edwards 35. Teaching and learning clinical reasoning 379
Susan Ryan and Joy Higgs
23. Clinical reasoning in dentistry 257
Shiva Khatami, Michael I. MacEntee and 36. Helping physiotherapy students develop clinical
Stephen Loftus reasoning capability 389
Nicole Christensen, Mark A. Jones, Ian Edwards
24. Clinical reasoning in occupational therapy 265 and Joy Higgs
Chris Chapparo and Judy Ranka
37. Speech–language pathology students: learning
25. Ethical reasoning 279 clinical reasoning 397
Ian Edwards and Clare Delany Lindy McAllister and Miranda Rose
26. Multidisciplinary clinical decision making 291 38. Teaching clinical reasoning in nursing
Anne Croker, Stephen Loftus and Joy Higgs education 405
Suzanne Narayan and Sheila Corcoran-Perry
27. Treatment decision making in the medical
encounter: the case of shared decision 39. Assessing clinical reasoning 413
making 299 C.P.M. van der Vleuten, G.R. Norman and
Cathy Charles, Amiram Gafni and Tim Whelan L.W.T. Schuwirth
28. Algorithms, clinical pathways and clinical 40. Using simulated patients to teach clinical
guidelines 309 reasoning 423
Karen Grimmer and Stephen Loftus Helen Edwards and Miranda Rose
29. Clinical reasoning to facilitate cognitive– 41. Peer coaching to generate clinical reasoning
experiential change 319 skills 433
Mark A. Jones and Ian Edwards Richard Ladyshewsky and Mark A. Jones
, Contents vii
42. Using open and distance learning to develop 46. Using case reports to teach clinical
clinical reasoning skills 441 reasoning 477
Janet Grant Darren A. Rivett and Mark A. Jones
43. Cultivating a thinking surgeon: using a clinical 47. Using mind mapping to improve students’
thinking pathway as a learning and assessment metacognition 485
process 451 Mary Cahill and Marsha Fonteyn
Della Fish and Linda de Cossart
Index 493
44. Teaching clinical reasoning and culture 461
Elizabeth Henley and Robyn Twible
45. Teaching clinical reasoning to medical
students 469
Ann Sefton, Jill Gordon and Michael Field
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, ix
Contributors
Rola Ajjawi BAppSci(Physiotherapy)Hons PhD Mary E. Cahill BNS RN
Associate Lecturer in Medical Education, Centre for Staff Nurse, Department of Oncology, Rhode Island
Innovation in Professional Health Education and Hospital, Providence, Rhode Island, USA
Research (CIPHER), Faculty of Medicine, University of
Christine Chapparo DipOT MA PhD FAOTA
Sydney, Australia
Senior Lecturer, Faculty of Health Sciences, University
Suzanne Alder MAPS of Sydney, Australia
Senior Psychologist, Mental Health Project Officer,
NSW Central West Division of General Practice, Cathy Charles PhD
Bathurst, Australia Professor, Department of Clinical Epidemiology and
Biostatistics, McMaster University, Hamilton, Canada
José F. Arocha
Associate Professor and Associate Chair of Graduate Nicole Christensen MAppSc PT
Studies, Department of Health Studies and Assistant Professor, Doctor of Physical Therapy
Gerontology, University of Waterloo, Canada Program, Samuel Merritt College, USA; PhD
candidate, University of South Australia, Australia
Sue Atkins MSc DipNEd RN
Principal Lecturer, School of Health and Social Care, Sheila A. Corcoran-Perry PhD FAAN
Oxford Brookes University, UK Professor Emeritus, formerly University of Minnesota,
USA
Alexandra Barratt MBBS MPH PhD
Associate Professor, Epidemiology, School of Public Linda de Cossart PhD
Health, University of Sydney, Australia Consultant Vascular and General Surgeon, Countess of
Chester NHS Foundation Trust and Council Member,
Henny P.A. Boshuizen PhD
Royal College of Surgeons of England, UK
Professor of Education and Educational
Technology; Dean of the Master Programme on Anne Croker BAppSc(Physio) GradDipPublicHealth
Educational Design for Active Learning, The PhD Candidate, Charles Sturt University, Australia
Netherlands
Clare Delany BApplSciPhysio MPhysio(manip) MHlth
Stephen D. Brookfield PhD MedLaw PhD
Distinguished University Professor, University of St School of Physiotherapy, University of Melbourne,
Thomas, Minneapolis-St Paul, USA Australia
