Critical thinking in healthcare and education
BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j2234 (Published 16 May 2017) Cite this as: BMJ 2017;357:j2234
All rapid responses
The authors use a lot of words. Unnecessarily.
Critical thinking is required in every human activity.
Exception: a soldier in uniform.
"Theirs not to reason why,
Theirs but to do and die . . . "
No child can learn unless he (she) questions: Why? Why? Why?
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Walker (2003) highlighted that many individuals believe that the tendency to think critically must be nurtured. We have seen educated healthcare professionals in healthcare facilities but does that mean that they have critical thinking skills? I agree with Jonathan Sharples et al in the article, “Critical thinking in healthcare and education”arguing about the importance for clinicians and patients to learn to think critically and that the teaching and learning of these skills to be explicitly considered.
Critical thinking includes “analysis, inference, interpretation, explanation, synthesis and self –regulation” (Facione, 2011). The healthcare team should be able to utilize their critical thinking skills as they come in contact with their patients daily. Critical thinking has been well documented in nursing but the evidence in medicine is limited (Batool, 2010; Iranfar, Sepahi, Khoshay, Rezaei, Matin, Keshavarzi, & Bashiri, 2012; Mahmoodabad, Nadrian, & Nahangi, 2012; Maudsley & Strivens, 2000). Are nurses the only group of health professionals taking care of patients? Certainly not, other members of the healthcare team work collaboratively with each other to ensure optimal patient care. Thus critical thinking is essential among healthcare professionals.
Critical thinking is integral in caring for patients and before one can teach patients to think critically, he or she needs to model the behavior but how can one model what they do not know? Riddel (2007) emphasized that critical thinking is a complex process and not a single way of thinking. Cottrell (2011) concurred with Riddel and added that critical thinking includes identification of the views of individuals, evaluation of evidence to explore alternate views, being unbiased in weighing the evidence and opposing arguments.
However, Romeo (2010) defines critical thinking as an attribute that strengthens the decision making and problem solving skills of an individual. In order for students to develop critical thinking skills and depositions, the faculty needs to reconsider their philosophy of teaching and implement critical thinking in the curricula (Billings & Halstead, 2012). Educators can design their teaching plans to facilitate critical thinking disposition and critical learning. If students in healthcare professions are taught critical thinking early in their programs, they will be able to develop the skill and will be able to utilize same effectively in their practice.
The healthcare system is evolving and emphasis should be placed on healthcare professionals to develop creative and critical thinking skills so that they can administer optimal patient care and be able to teach their patients how to think critically.
References
Batool, T. (2010). Hyposkillia and critical thinking: Lost skills of doctors.APS Journal of case reports, 1(1), 9.
Billings, D. M., & Halstead, J. A. (2012). Teaching in nursing: A guide for faculty (4th ed.). St. Louis: Elsevier Health Sciences.
Cottrell, S. (2011). Critical thinking skills: Developing effective analysis and argument. Palgrave Macmillan.
Facione, P. A. (2011). Critical thinking: What it is and why it counts. Insight Assessment, 2007(1), 1-23.
Iranfar, S., Sepahi, V., Khoshay, A., Rezaei, M., Matin, B. K., Keshavarzi, F., & Bashiri, H. (2012). Critical thinking disposition among medical students of Kermanshah University of Medical Sciences. ducational Research in Medical Sciences Journal, 1(2), 63-68.
Mahmoodabad, S. S. M., Nadrian, H., & Nahangi, H. (2012). Critical thinking ability and its associated factors among preclinical students in Yazd Shaheed Sadoughi University of Medical Sciences (Iran). Medical Journal of the Islamic Republic of Iran, 26(2), 50.
Maudsley, G., & Strivens, J. (2000). ‘Science’,‘critical thinking’and ‘competence’ for tomorrow’s doctors. A review of terms and concepts.Medical Education, 34(1), 53-60.
Riddell, T. (2007). Critical assumptions: Thinking critically about critical thinking. Journal of Nursing Education, 46(3).
Romeo, E. M. (2010). Quantitative research on critical thinking and predicting nursing students’ NCLEX-RN performance. Journal of Nursing Education, 49(7), 378-386.
Walker, S. E. (2003). Active learning strategies to promote critical thinking. Journal of athletic training, 38(3), 263.
Competing interests: No competing interests
Critical thinking is an essential cognitive skill for the individuals involved in various healthcare domains such as doctors, nurses, lab assistants, patients and so on, as is emphasized by the Authors. Recent evidence suggests that critical thinking is being perceived/evaluated as a domain-general construct and it is less distinguishable from that of general cognitive abilities [1].
People cannot think critically about topics for which they have little knowledge. Critical thinking should be viewed as a domain-specific construct that evolves as an individual acquires domain-specific knowledge [1]. For instance, most common people have no basis for prioritizing patients in the emergency department to be shifted to the only bed available in the intensive care unit. Medical professionals who could thinking critically in their own discipline would have difficulty thinking critically about problems in other fields. Therefore, ‘domain-general’ critical thinking training and evaluation could be non-specific and might not benefit the targeted domain i.e. medical profession.
Moreover, the literature does not demonstrate that it is possible to train universally effective critical thinking skills [1]. As medical teachers, we can start building up student’s critical thinking skill by contingent teaching-learning environment wherein one should encourage reasoning and analytics, problem solving abilities and welcome new ideas and opinions [2]. But at the same time, one should continue rather tapering the critical skills as one ascends towards a specialty, thereby targeting ‘domain-specific’ critical thinking.
For the benefit of healthcare, tools for training and evaluating ‘domain-specific’ critical thinking should be developed for each of the professional knowledge domains such as doctors, nurses, lab technicians and so on. As the Authors rightly pointed out, this humongous task can be accomplished only with cross border collaboration among cognitive neuroscientists, psychologists, medical education experts and medical professionals.
References
1. National Research Council. (2011). Assessing 21st Century Skills: Summary of a Workshop. J.A. Koenig, Rapporteur. Committee on the Assessment of 21st Century Skills. Board on Testing and Assessment, Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press.
2. Mafakheri Laleh M, Mohammadimehr M, Zargar Balaye Jame S. Designing a model for critical thinking development in AJA University of Medical Sciences. J Adv Med Educ Prof. 2016 Oct;4(4):179–87.
Competing interests: No competing interests
Michael J. Hope Cawdery points out that critical thinking is not explicitly taught or assessed in most education programmes for health professionals. I would go further and suggest that it is actively discouraged in today’s doctors - who often seem to have very little idea about why a particular treatment or, indeed, the human body works.
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Critical thinking, the ability to think clearly and rationally about what to do or what to believe, is essential for the practice of medicine. Few doctors are likely to argue with this. Yet, until recently, the UK regulator the General Medical Council and similar bodies in North America did not mention “critical thinking” anywhere in their standards for licensing and accreditation,1 and critical thinking is not explicitly taught or assessed in most education programmes for health professionals.
Oh dear! I am not surprised to see this statement because the current system of medical Directives (aka guidelines and possible suit for negligence) effectively limits the possibility of “Critical thinking” and leads to the so-called “defensive medicine” which at best, leads to second best treatment.
On top of this is the problem of the 10 minute appointment. To be able to think critically in such a limited time to sort out all the potential and relevant signs and syptoms of an “atypical” case is just not feasible even for the most brilliant GP. It is in this area that the “experts” on time management/clinical diagnosis will have to develop a system of, say, nurse lead triage to ensure the GP gets the time to do what he/she has been trained to do. Such a procedure would also re-invigorate the professionalism and interest in the job.
That the UK regulator and GMC were apparently unaware/uninterested in “critical thinking” comes as no surprised. These bodies are unfortunately steeped in the past and relying on research such as the Ancel Keys flawed Seven Countries Study
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Thinking critically about critical thinking Re: Critical thinking in healthcare and education
I don't want to be seen as 'having a go at' the response by Kadene Leslie, but it does seem to be typical of nurses, and their 'love of 'models''.
Thinking critically, if HCPs are using the term 'critical thinking' (two 'everyday words') to convey something different from what a layman would take from the term 'critical thinking', HCPs are doing something wrong!
And I'm reasonably sure a lay person would interpret 'critical thinking' as 'thinking about things, to decide if they make sense or not - as opposed to just believing what you are presented with'. Doing that involves thinking analytically - which really comes down to 'what do I know, and am I sure I know it - and what else do I need to know, and is it possible for me to find that out ?' - and I suspect that such thinking comes naturally to some people, and can probably also be taught at least to some extent.
But I'm not convinced that 'reading about models of critical thinking' is as useful as figuring it out for yourself.
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