Critical Thinking in Medical Education
Critical thinking is crucial to any education effort, but it is arguably the most important skill to learn in the medical environment where issues can be unstructured, complex, and difficult to analyze. There are many ways to define critical thinking, and a number of different methods for applying critical thinking to specific issues and problems. There is no one single, “correct” way to think critically. However, several core principles are common to almost all models. In Critical Thinking: What it is and Why it Counts, Peter Facione identifies and explains these core principles and skills, and also defines several heuristics that we typically use when reasoning about topics. Recognition of these heuristics help identify weaknesses and biases in our thinking, and help us understand the importance and relevance of critical thinking to our everyday environments.
Critical Thinking: What it is and Why it Counts
A feature of western education throughout history has been the tendency of teachers to tell students what to think. From the earliest universities, students learned passages from classic texts by rote and were assessed on how well they could regurgitate that content. This form of education is valuable, but it is also rigid, and may hinder development of new knowledge because it so heavily weights established knowledge patterns and modes of thinking. At the start of his book Stirring Up Thinking, Ben Johnson describes his assessment of thinking and thinking critically, and challenges his readers to develop independent thinking. His introduction is presented below:
Thinking vs Thinking Critically
One of the central points of critically evaluating assumptions includes examining an issue from multiple viewpoints. In your work environment you will typically interact with individuals who will have a different cultural background, assumption set, and biases than your own. Frequently, you will have to overcome these hurdles to establish a working relationship for a given project.
Collison et al provide some insight into the function of critical thinking from the perspective of an instructor facilitating critical thinking among students. This reading identifies strategies to help sharpen the focus of a dialogue and to help participants deepen discussion of any given topic. While the focus of the paper is online threaded discussion, the principles can be applied to any mode of interaction – face-to-face, telephone, written/electronic; and to any type of interaction – instructor-student, professional-client, peer-to-peer, etc.
The ability to focus a discussion and to unpack key topic areas, perspectives, assumptions, and biases held by participants is critical to reach a consensus decision and drive any project forward. Click on the icon below to access:
From Critical Thinking Strategies from Facilitating Online Learning: Effective Strategies for Moderators by George Collison, Bonnie Elbaum, Sarah Haavind, and Robert Tinker (Atwood Publishing: Madison, WI, 2000).
Approaches to Fostering Critical Thinking
Bransford on expertise and its transferability
don't assume it, constant revisiting - "lifelong" in lifelong learning
Beyond specific interactions with a patient, administrator, or other coworker, any project will require adequate research on the project background and analysis of the requirements.
Once a particular project area is known, it is important to establish a cogent information set on its scope and the factors that will affect implementation. Richard Paul and Linda Elder present a structured process for critiquing one’s own reasoning and examining research in The Miniature Guide to Critical Thinking: Concepts and Tools. These processes are presented below. While rigorous application of these steps will at first seem time-consuming and perhaps a little awkward, just as with learning any new skill, over time they will become easier to apply and you will eventually apply these steps almost instinctively to the problems you are asked to address:
A Checklist for Reasoning (Paul and Elder)
- All reasoning has a purpose
- State your purpose clearly
- Distinguish your purpose from related purposes
- Check periodically to be sure you are still on target
- Choose significant and realistic purposes
- All reasoning is an attempt to figure something out, to settle some question, solve some problem
- State the question at issue clearly and precisely
- Express the question in several ways
- Break the question into sub-questions
- Distinguish questions that have definitive answers from those that are a matter of opinion and from those that require consideration of multiple viewpoints
- All reasoning is based on assumptions
- Clearly identify your assumptions and determine whether they are justifiable
- Consider how your assumptions are shaping your point of view
- All reasoning is done from some point of view
- Identify your point of view
- Seek other points of view and identify their strengths as well as weaknesses
- Strive to be fair-minded in evaluating all points of view
- All reasoning is based on data, information, and evidence
- Restrict your claims to those supported by the data you have
- Search for information that opposes your position as well as information that supports it
- Make sure that all information used is clear, accurate, and relevant to the question at issue
- Make sure you have gathered sufficient information
- All reasoning is expressed through, and shaped by, concepts and ideas
- Identify key concepts and explain them clearly
- Consider alternative concepts or alternative definitions of concepts
- Make sure you are using concepts with care and precision
- All reasoning contains inferences and interpretations by which we draw conclusions and give meaning to data
- Infer only what the evidence implies
- Check inferences for their consistency with each other
- Identify assumptions that lead to your inferences
- All reasoning leads somewhere or has implications and consequences
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- Trace the implications and consequences that follow from your reasoning
- Search for negative as well as positive implications
- Consider all possible consequences
Paul R, Elder L, Foundation for Critical Thinking. The Miniature Guide to Critical Thinking : Concepts & Tools. 3rd ed. Dillon Beach, Calif.: Foundation for Critical Thinking; 2003.
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