Teaching Critical Thinking in Medical Education

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Teaching Critical Thinking in Medical Education

• John Epling, MD, MSEd
• SUNY-Upstate Medical University
• Tiffany A. Koszalka, PhD
• Syracuse University

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Before we start...

• Let's think about our teaching...
• What types of teaching strategies do you use?
• How well do these strategies actively engage your
  students?
• What type of thinking and learning responses do
  these strategies evoke in your students?
• Please take a few minutes to record your
  responses to these questions on page 1 of the
  session handout

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Today

• Critical thinking definitions and dimensions
• Critical thinking in medical education
• Technology and teaching critical thinking
• Examples of critical thinking activities
• Discussion on integrating critical thinking
  activities
• Summary

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What is critical thinking?

• How do you define critical thinking?
• Please take a few minutes to record your response
  on the bottom of page 1 of the session handout

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What is critical thinking?

• 70's/80's reaction to reproductive learning
• Ennis ('89) reflective thinking focused on
  deciding what to believe or do
• Paul ('92) question, goal, point of view,
  assumptions, central concepts, principles/theories
  , data, reasoning, consequences

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What is critical thinking?

• Dimensions of critical thinking
• Ennis
• logical judges relationships between terms
• critical knows criteria for judging statements
• pragmatic statement good enough for goal
• But there's more...

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What is critical thinking?

• Walters above creativity, imagination,
  insight, intuition
• Litecky ('92) - the active mental effort to make
  meaning of our world by carefully examining
  thought in order to better understand content

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What is critical thinking?

• Resnick and Klopfer ('87)
• non-algorithmic
• complex
• yields multiple solutions
• nuanced judgement and interpretation
• multiple criteria

• self-regulation of thinking process
• imposing meaning
• effortful

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What is critical thinking?

• William Graham Sumner (1906)
• ...the examination and test of propositions of
  any kind which are offered for acceptance, in
  order to find out whether they correspond to
  reality or not...It is a mental habit and
  power...It is our only guarantee against
  delusion, deception, superstition, and
  misapprehension of ourselves and our earthly
  circumstances.

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What is a critical thinker?

• A well-cultivated critical thinker
• Raises vital questions and problems, formulating
  them clearly and precisely
• Gathers and assesses relevant information, using
  abstract ideas to interpret it effectively
• Comes to well-reasoned conclusions and solutions,
  testing them against relevant criteria and
  standards
• Thinks openmindedly within alternative systems of
  thought, recognizing and assessing, as need be,
  their assumptions, implications, and practical
  consequences and
• Communicates effectively with others in figuring
  out solutions to complex problems.
• (from CriticalThinking.org)

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Complex Thinking Process
Content/Basic Thinking accepted
knowledge metacognition
Creative Thinking generated knowledge
Critical Thinking reorganized knowledge
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Is critical thinking different than other
thinking?

• Critical thinking can be seen as having two
  components
• a set of skills to process and generate
  information and beliefs, and
• the habit, based on intellectual commitment, of
  using those skills to guide behavior.
• It is thus to be contrasted with
• the mere acquisition and retention of information
  alone, (because it involves a particular way in
  which information is sought and treated,)
• the mere possession of a set of skills, (because
  it involves the continual use of them,) and
• the mere use of those skills ("as an exercise")
  without acceptance of their results.
• From http//www.criticalthinking.
  org/University/univclass/Defining.html

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What is the purpose of critical thinking?

• "The purpose of critical thinking is, therefore,
  to achieve understanding, evaluate view points,
  and solve problems. Since all three areas involve
  the asking of questions, we can say that critical
  thinking is the questioning or inquiry we engage
  in when we seek to understand, evaluate, or
  resolve."
• Maiorana, Victor P. Critical Thinking
  Across the Curriculum Building the Analytical
  Classroom. 1992.

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What are the dimensions of critical thinking?35
dimensions of critical thought

• Affect
• Independence, feelings, perspective, intellect,
  confidence, etc.
• Cognitive Macro abilities
• Generalizing, clarifying, questioning, connecting
• Cognitive Micro skills
• Compare and contrast, infer, predict, distinguish
• See page 2 of session handout .. Review the list
  and Circle the dimensions you believe that you
  prompt in your students during your teaching

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Activities that prompt critical thinking

• What types of instructional activities do you
  think prompt critical thinking?

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Activities that prompt critical thinking

• embedded questions
• simulations
• case studies, problem-based learning
• metacognitive strategies (guided note-taking)
  e.g. creating own study guide placing new
  knowledge into a 3D model of the 'world'
• putting collected data into a personal
  'scrapbook'
• developing a student portfolio

• selecting and evaluating resources
• creating checklists or evaluation schema
• creating a model
• conducting an interview
• creating an 'expert' lecture
• taking sides, becoming the expert, defending
  position
• taking a journey through a new environment and
  exploring all aspects
• working collaboratively to socially negotiate
  tasks

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Critical Thinking and Med Ed

• Not much on critical thinking
• more in nursing/health professions lit.
• West, JAMA 20002841105-1110
• concept mapping exercise peds residents
• found expected change in maps pre and post
  educational intervention

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Critical Thinking and Med Ed

• Jane Scott
• Watson-Glaser Critical Thinking Assessment
• pre-MS1, end-MS3
• CT increased over 2 years.
• could not predict clerkship performance

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Critical Thinking and Med Ed

• Critical Appraisal and Critical Thinking
• Kee, QJM 2004 97609
• argument analysis, logical fallacy
• Simulation-based Med Ed
• Ziv, Medical Teacher 200527(3)193
• learning from mistakes

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Technology and Critical Thinking

• using computers as mindtools
• What types of computer software stimulate
  critical thinking?

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Learning with computers (mindtools)

• Learning with computers (mindtools) requires
• Thinking harder about a subject matter domain
• Thinking deeply about the domain
• Engaging in meaningful learning
• Active - manipulative
• Constructive articulative / reflective
• Intentional - purposive
• Authentic complex / contextual
• Collaborative socially negotiated

Mindtools (Computer tools
Active Passive
Teacher/System
Student
Presentation Creation
(From Jonassen, p. 11)
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Common Mindtools and how may they help students
engage in critical thinking

• Databases (Semantic Organizing Tool)
• Concept maps (Semantic Organizing Tool)
• Intentional search tools (Interpretation Tool)
• Visualization tools (Interpretation Tool)
• Spreadsheets (Dynamic Modeling Tool)
• Microworlds / Simulations (Dynamic Modeling Tool)
• Expert Systems (Dynamic Modeling Tool)
• Systems Modeling tools (Dynamic Modeling Tool)
• Presentation/Hypermedia tools (Knowledge
  Construction Tool)
• Live conversation environments (Social
  Collaboration Tool)

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Example 1

• Epidemiology Simulation engages learners in
• Analyzing and recognizing patterns
• Hypothesizing, planning, and predicting
• Identifying causal relationships
• Generating alternatives and evaluating choices
• Elaborating explanations
• Designing and problem solving

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Example 2

• Concept mapping engages learners in
• Connecting, comparing and contrasting information
  
• Recognizing patterns
• Classifying and sequencing information
• Identifying causal relationships
• Summarizing and visualizing information
• West, Pomeroy, Park, Gerstenberger, Sandoval
  (2000, JAMA) Critical thinking in graduate
  medical education The role of concept mapping in
  assessment

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Example 2First year med students pre-instruction
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Example 2second/third year med students
post-instruction
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Example 3

• EBM WebQuests
• not DOING one...
• CREATING one... engages learners in
• Prioritizing, classifying, verifying, and
  assessing information
• Identifying main ideas and finding / defining
  content sequences
• Identifying patterns, organizing information,
  describing content
• Comparing and contrasting information

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CT and Med Ed - Ideas

• What do we ALREADY do that promotes critical
  thinking?
• Use page 3 of the session handout to describe
  critical thinking activities that you already use
  in 2 or 3 of your teaching areas
• And .. think about how can we make teaching and
  learning better for medical students through
  integration of critical thinking activities

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Commonly used activities that prompt critical
thinking at Upstate

Which do you use and How?

• embedded questions
• simulations
• case studies, problem-based learning
• metacognitive strategies (guided note-taking)
  e.g. creating own study guide placing new
  knowledge into a 3D model of the 'world'
• putting collected data into a personal
  'scrapbook'
• developing a student portfolio

• selecting and evaluating resources
• creating checklists or evaluation schema
• creating a model
• conducting an interview
• creating an 'expert' lecture
• taking sides, becoming the expert, defending
  position
• taking a journey through a new environment and
  exploring all aspects
• working collaboratively to socially negotiate
  tasks

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Discussion

• Break into two teams based on your interests
• Pre-clinical teaching
• Clinical teaching
• In your team identify a topic
• Discuss how critical thinking activities can be
  integrated into teaching this topic and consider
  
• How practical is it to integrate these types of
  activities
• What barriers (personal / system) may prevent
  this integration
• How can this activity be evaluated
• Record your responses on page 4 of the session
  handout and prepare to share your ideas

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Summary

• Was critical thinking prompted during this
  session?
• If yes, in what ways?
• If no, how could it have been?

Reflection questions, embedded questions,
classifying teaching activities, summarizing,
self-evaluation, collaborating on a problem,
engaging with content from multiple perspectives
. . .