critical thinking definition in medical

Medical Student Guide For Critical Thinking

Critical thinking is an essential cognitive skill for every individual but is a crucial component for healthcare professionals such as doctors, nurses and dentists. It is a skill that should be developed and trained, not just during your career as a doctor, but before that when you are still a medical student.

To be more effective in their studies, students must think their way through abstract problems, work in teams and separate high quality from low quality information. These are the same qualities that today's medical students are supposed to possess regardless of whether they graduate in the UK or study medicine in Europe .

In both well-defined and ill-defined medical emergencies, doctors are expected to make competent decisions. Critical thinking can help medical students and doctors achieve improved productivity, better clinical decision making, higher grades and much more.

This article will explain why critical thinking is a must for people in the medical field.

Definition of Critical Thinking

You can find a variety of definitions of Critical Thinking (CT). It is a term that goes back to the Ancient Greek philosopher Socrates and his teaching practice and vision. Critical thinking and its meaning have changed over the years, but at its core always will be the pursuit of proper judgment.

We can agree on one thing. Critical thinkers question every idea, assumption, and possibility rather than accepting them at once.

The most basic definition of CT is provided by Beyer (1995):

"Critical thinking means making reasoned judgements."

In other words, it is the ability to think logically about what to do and/or believe. It also includes the ability to think critically and independently. CT is the process of identifying, analysing, and then making decisions about a particular topic, advice, opinion or challenge that we are facing.

Steps to critical thinking

There is no universal standard for becoming a critical thinker. It is more like a unique journey for each individual. But as a medical student, you have already so much going on in your academic and personal life. This is why we created a list with 6 steps that will help you develop the necessary skills for critical thinking.

1. Determine the issue or question

The first step is to answer the following questions:

• What is the problem?
• Why is it important?
• Why do we need to find a solution?
• Who is involved?

By answering them, you will define the situation and acquire a deeper understanding of the problem and of any factors that may impact it.

Only after you have a clear picture of the issue and people involved can you start to dive deeper into the problem and search for a solution.

2. Research

Nowadays, we are flooded with information. We have an unlimited source of knowledge – the Internet.

Before choosing which medical schools to apply to, most applicants researched their desired schools online. Some of the areas you might have researched include:

• If the degree is recognised worldwide
• Tuition fees
• Living costs
• Entry requirements
• Competition for entry
• Number of exams
• Programme style

Having done the research, you were able to make an informed decision about your medical future based on the gathered information. Our list may be a little different to yours but that's okay. You know what factors are most important and relevant to you as a person.

The process you followed when choosing which medical school to apply to also applies to step 2 of critical thinking. As a medical student and doctor, you will face situations when you have to compare different arguments and opinions about an issue. Independent research is the key to the right clinical decisions. Medical and dentistry students have to be especially careful when learning from online sources. You shouldn't believe everything you read and take it as the absolute truth. So, here is what you need to do when facing a medical/study argument:

• Gather relevant information from all available reputable sources
• Pay attention to the salient points
• Evaluate the quality of the information and the level of evidence (is it just an opinion, or is it based upon a clinical trial?)

Once you have all the information needed, you can start the process of analysing it. It’s helpful to write down the strong and weak points of the various recommendations  and identify the most evidence-based approach.

Here is an example of a comparison between two online course platforms , which shows their respective strengths and weaknesses.

When recommendations or conclusions are contradictory, you will need to make a judgement call on which point of view has the strongest level of evidence to back it up. You should leave aside your feelings and analyse the problem from every angle possible. In the end, you should aim to make your decision based on the available evidence, not assumptions or bias.

4. Be careful about confirmation bias

It is in our nature to want to confirm our existing ideas rather than challenge them. You should try your best to strive for objectivity while evaluating information.

Often, you may find yourself reading articles that support your ideas, but why not broaden your horizons by learning about the other viewpoint?

By doing so, you will have the opportunity to get closer to the truth and may even find unexpected support and evidence for your conclusion.

Curiosity will keep you on the right path. However, if you find yourself searching for information or confirmation that aligns only with your opinion, then it’s important to take a step back. Take a short break, acknowledge your bias, clear your mind and start researching all over.

5. Synthesis

As we have already mentioned a couple of times, medical students are preoccupied with their studies. Therefore, you have to learn how to synthesise information. This is where you take information from multiple sources and bring the information together. Learning how to do this effectively will save you time and help you make better decisions faster.

You will have already located and evaluated your sources in the previous steps. You now have to organise the data into a logical argument that backs up your position on the problem under consideration.

6. Make a decision

Once you have gathered and evaluated all the available evidence, your last step  is to make a logical and well-reasoned conclusion.

By following this process you will ensure that whatever decision you make can be backed up if challenged

Why is critical thinking so important for medical students?

The first and most important reason for mastering critical thinking is that it will help you to avoid medical and clinical errors during your studies and future medical career.

Another good reason is that you will be able to identify better alternative options for diagnoses and treatments. You will be able to find the best solution for the patient as a whole which may be different to generic advice specific to the disease.

Furthermore, thinking critically as a medical student will boost your confidence and improve your knowledge and understanding of subjects.

In conclusion, critical thinking is a skill that can be learned and improved.  It will encourage you to be the best version of yourself and teach you to take responsibility for your actions.

Critical thinking has become an essential for future health care professionals and you will find it an invaluable skill throughout your career.

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Critical Thinking in medical education: When and How?

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Critical thinking in healthcare and education

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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

Critical thinking in clinical medicine: what is it?

Affiliation.

• 1 Department of Psychiatry, University of Montreal, Montreal, PQ, Canada. [email protected]
• PMID: 22994988
• DOI: 10.1111/j.1365-2753.2012.01897.x

In this paper, we explore the recent emphasis, in various medical contexts, of the term 'critical' or the notion of 'being critical'. We identify various definitions of being critical and note that they differ strikingly. What are these different uses of the term trying to capture that is important in clinical medicine and medical education? We have analysed these qualities as responsibilist, epistemic virtues. We believe that a virtues approach is best able to make sense of the non-cognitive elements of 'being critical', such as the honesty and courage to question claims in the face of persuasion, authority or social pressure. Medical educators and professional bodies seem to agree that being critical is important and desirable. Yet, it is unclear how this quality can be optimally fostered and balanced with the constraints that act upon individual practitioners in the context of institutional medicine including professional standards and the demands of the doctor-patient relationship. Other constraints such as authoritarianism, intimidation and financial pressures may act against the expression of being critical or even the cultivation of critical thinking. The issue of the constraints on critical thinking and the potential hazards it entails will require further consideration by those who encourage being critical in medicine.

© 2012 Blackwell Publishing Ltd.

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Cultivating Critical Thinking in Healthcare

Published: 06 January 2019

Critical thinking skills have been linked to improved patient outcomes, better quality patient care and improved safety outcomes in healthcare (Jacob et al. 2017).

Given this, it's necessary for educators in healthcare to stimulate and lead further dialogue about how these skills are taught , assessed and integrated into the design and development of staff and nurse education and training programs (Papp et al. 2014).

So, what exactly is critical thinking and how can healthcare educators cultivate it amongst their staff?

What is Critical Thinking?

In general terms, ‘ critical thinking ’ is often used, and perhaps confused, with problem-solving and clinical decision-making skills .

In practice, however, problem-solving tends to focus on the identification and resolution of a problem, whilst critical thinking goes beyond this to incorporate asking skilled questions and critiquing solutions .

Several formal definitions of critical thinking can be found in literature, but in the view of Kahlke and Eva (2018), most of these definitions have limitations. That said, Papp et al. (2014) offer a useful starting point, suggesting that critical thinking is:

‘The ability to apply higher order cognitive skills and the disposition to be deliberate about thinking that leads to action that is logical and appropriate.’

The Foundation for Critical Thinking (2017) expands on this and suggests that:

‘Critical thinking is that mode of thinking, about any subject, content, or problem, in which the thinker improves the quality of his or her thinking by skillfully analysing, assessing, and reconstructing it.’

They go on to suggest that critical thinking is:

• Self-directed
• Self-disciplined
• Self-monitored
• Self-corrective.

Key Qualities and Characteristics of a Critical Thinker

Given that critical thinking is a process that encompasses conceptualisation , application , analysis , synthesis , evaluation and reflection , what qualities should be expected from a critical thinker?

In answering this question, Fortepiani (2018) suggests that critical thinkers should be able to:

• Formulate clear and precise questions
• Gather, assess and interpret relevant information
• Reach relevant well-reasoned conclusions and solutions
• Think open-mindedly, recognising their own assumptions
• Communicate effectively with others on solutions to complex problems.

All of these qualities are important, however, good communication skills are generally considered to be the bedrock of critical thinking. Why? Because they help to create a dialogue that invites questions, reflections and an open-minded approach, as well as generating a positive learning environment needed to support all forms of communication.

Lippincott Solutions (2018) outlines a broad spectrum of characteristics attributed to strong critical thinkers. They include:

• Inquisitiveness with regard to a wide range of issues
• A concern to become and remain well-informed
• Alertness to opportunities to use critical thinking
• Self-confidence in one’s own abilities to reason
• Open mindedness regarding divergent world views
• Flexibility in considering alternatives and opinions
• Understanding the opinions of other people
• Fair-mindedness in appraising reasoning
• Honesty in facing one’s own biases, prejudices, stereotypes or egocentric tendencies
• A willingness to reconsider and revise views where honest reflection suggests that change is warranted.

Papp et al. (2014) also helpfully suggest that the following five milestones can be used as a guide to help develop competency in critical thinking:

Stage 1: Unreflective Thinker

At this stage, the unreflective thinker can’t examine their own actions and cognitive processes and is unaware of different approaches to thinking.

Stage 2: Beginning Critical Thinker

Here, the learner begins to think critically and starts to recognise cognitive differences in other people. However, external motivation  is needed to sustain reflection on the learners’ own thought processes.

Stage 3: Practicing Critical Thinker

By now, the learner is familiar with their own thinking processes and makes a conscious effort to practice critical thinking.

Stage 4: Advanced Critical Thinker

As an advanced critical thinker, the learner is able to identify different cognitive processes and consciously uses critical thinking skills.

Stage 5: Accomplished Critical Thinker

At this stage, the skilled critical thinker can take charge of their thinking and habitually monitors, revises and rethinks approaches for continual improvement of their cognitive strategies.

Facilitating Critical Thinking in Healthcare

A common challenge for many educators and facilitators in healthcare is encouraging students to move away from passive learning towards active learning situations that require critical thinking skills.

Just as there are similarities among the definitions of critical thinking across subject areas and levels, there are also several generally recognised hallmarks of teaching for critical thinking . These include:

• Promoting interaction among students as they learn
• Asking open ended questions that do not assume one right answer
• Allowing sufficient time to reflect on the questions asked or problems posed
• Teaching for transfer - helping learners to see how a newly acquired skill can apply to other situations and experiences.

(Lippincott Solutions 2018)

Snyder and Snyder (2008) also make the point that it’s helpful for educators and facilitators to be aware of any initial resistance that learners may have and try to guide them through the process. They should aim to create a learning environment where learners can feel comfortable thinking through an answer rather than simply having an answer given to them.

Examples include using peer coaching techniques , mentoring or preceptorship to engage students in active learning and critical thinking skills, or integrating project-based learning activities that require students to apply their knowledge in a realistic healthcare environment.

Carvalhoa et al. (2017) also advocate problem-based learning as a widely used and successful way of stimulating critical thinking skills in the learner. This view is echoed by Tsui-Mei (2015), who notes that critical thinking, systematic analysis and curiosity significantly improve after practice-based learning .

Integrating Critical Thinking Skills Into Curriculum Design

Most educators agree that critical thinking can’t easily be developed if the program curriculum is not designed to support it. This means that a deep understanding of the nature and value of critical thinking skills needs to be present from the outset of the curriculum design process , and not just bolted on as an afterthought.

In the view of Fortepiani (2018), critical thinking skills can be summarised by the statement that 'thinking is driven by questions', which means that teaching materials need to be designed in such a way as to encourage students to expand their learning by asking questions that generate further questions and stimulate the thinking process. Ideal questions are those that:

• Embrace complexity
• Challenge assumptions and points of view
• Question the source of information
• Explore variable interpretations and potential implications of information.

To put it another way, asking questions with limiting, thought-stopping answers inhibits the development of critical thinking. This means that educators must ideally be critical thinkers themselves .

Drawing these threads together, The Foundation for Critical Thinking (2017) offers us a simple reminder that even though it’s human nature to be ‘thinking’ most of the time, most thoughts, if not guided and structured, tend to be biased, distorted, partial, uninformed or even prejudiced.

They also note that the quality of work depends precisely on the quality of the practitioners’ thought processes. Given that practitioners are being asked to meet the challenge of ever more complex care, the importance of cultivating critical thinking skills, alongside advanced problem-solving skills , seems to be taking on new importance.

Additional Resources

• The Emotionally Intelligent Nurse | Ausmed Article
• Refining Competency-Based Assessment | Ausmed Article
• Socratic Questioning in Healthcare | Ausmed Article
• Carvalhoa, D P S R P et al. 2017, 'Strategies Used for the Promotion of Critical Thinking in Nursing Undergraduate Education: A Systematic Review', Nurse Education Today , vol. 57, pp. 103-10, viewed 7 December 2018, https://www.sciencedirect.com/science/article/abs/pii/S0260691717301715
• Fortepiani, L A 2017, 'Critical Thinking or Traditional Teaching For Health Professionals', PECOP Blog , 16 January, viewed 7 December 2018, https://blog.lifescitrc.org/pecop/2017/01/16/critical-thinking-or-traditional-teaching-for-health-professions/
• Jacob, E, Duffield, C & Jacob, D 2017, 'A Protocol For the Development of a Critical Thinking Assessment Tool for Nurses Using a Delphi Technique', Journal of Advanced Nursing, vol. 73, no. 8, pp. 1982-1988, viewed 7 December 2018, https://onlinelibrary.wiley.com/doi/10.1111/jan.13306
• Kahlke, R & Eva, K 2018, 'Constructing Critical Thinking in Health Professional Education', Perspectives on Medical Education , vol. 7, no. 3, pp. 156-165, viewed 7 December 2018, https://link.springer.com/article/10.1007/s40037-018-0415-z
• Lippincott Solutions 2018, 'Turning New Nurses Into Critical Thinkers', Lippincott Solutions , viewed 10 December 2018, https://www.wolterskluwer.com/en/expert-insights/turning-new-nurses-into-critical-thinkers
• Papp, K K 2014, 'Milestones of Critical Thinking: A Developmental Model for Medicine and Nursing', Academic Medicine , vol. 89, no. 5, pp. 715-720, https://journals.lww.com/academicmedicine/Fulltext/2014/05000/Milestones_of_Critical_Thinking___A_Developmental.14.aspx
• Snyder, L G & Snyder, M J 2008, 'Teaching Critical Thinking and Problem Solving Skills', The Delta Pi Epsilon Journal , vol. L, no. 2, pp. 90-99, viewed 7 December 2018, https://dme.childrenshospital.org/wp-content/uploads/2019/02/Optional-_Teaching-Critical-Thinking-and-Problem-Solving-Skills.pdf
• The Foundation for Critical Thinking 2017, Defining Critical Thinking , The Foundation for Critical Thinking, viewed 7 December 2018, https://www.criticalthinking.org/pages/our-conception-of-critical-thinking/411
• Tsui-Mei, H, Lee-Chun, H & Chen-Ju MSN, K 2015, 'How Mental Health Nurses Improve Their Critical Thinking Through Problem-Based Learning', Journal for Nurses in Professional Development , vol. 31, no. 3, pp. 170-175, viewed 7 December 2018, https://journals.lww.com/jnsdonline/Abstract/2015/05000/How_Mental_Health_Nurses_Improve_Their_Critical.8.aspx

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The Value of Critical Thinking in Nursing

• How Nurses Use Critical Thinking
• How to Improve Critical Thinking
• Common Mistakes

Some experts describe a person’s ability to question belief systems, test previously held assumptions, and recognize ambiguity as evidence of critical thinking. Others identify specific skills that demonstrate critical thinking, such as the ability to identify problems and biases, infer and draw conclusions, and determine the relevance of information to a situation.

Nicholas McGowan, BSN, RN, CCRN, has been a critical care nurse for 10 years in neurological trauma nursing and cardiovascular and surgical intensive care. He defines critical thinking as “necessary for problem-solving and decision-making by healthcare providers. It is a process where people use a logical process to gather information and take purposeful action based on their evaluation.”

“This cognitive process is vital for excellent patient outcomes because it requires that nurses make clinical decisions utilizing a variety of different lenses, such as fairness, ethics, and evidence-based practice,” he says.

How Do Nurses Use Critical Thinking?

Successful nurses think beyond their assigned tasks to deliver excellent care for their patients. For example, a nurse might be tasked with changing a wound dressing, delivering medications, and monitoring vital signs during a shift. However, it requires critical thinking skills to understand how a difference in the wound may affect blood pressure and temperature and when those changes may require immediate medical intervention.

Nurses care for many patients during their shifts. Strong critical thinking skills are crucial when juggling various tasks so patient safety and care are not compromised.

Jenna Liphart Rhoads, Ph.D., RN, is a nurse educator with a clinical background in surgical-trauma adult critical care, where critical thinking and action were essential to the safety of her patients. She talks about examples of critical thinking in a healthcare environment, saying:

“Nurses must also critically think to determine which patient to see first, which medications to pass first, and the order in which to organize their day caring for patients. Patient conditions and environments are continually in flux, therefore nurses must constantly be evaluating and re-evaluating information they gather (assess) to keep their patients safe.”

The COVID-19 pandemic created hospital care situations where critical thinking was essential. It was expected of the nurses on the general floor and in intensive care units. Crystal Slaughter is an advanced practice nurse in the intensive care unit (ICU) and a nurse educator. She observed critical thinking throughout the pandemic as she watched intensive care nurses test the boundaries of previously held beliefs and master providing excellent care while preserving resources.

“Nurses are at the patient’s bedside and are often the first ones to detect issues. Then, the nurse needs to gather the appropriate subjective and objective data from the patient in order to frame a concise problem statement or question for the physician or advanced practice provider,” she explains.

Top 5 Ways Nurses Can Improve Critical Thinking Skills

We asked our experts for the top five strategies nurses can use to purposefully improve their critical thinking skills.

Case-Based Approach

Slaughter is a fan of the case-based approach to learning critical thinking skills.

In much the same way a detective would approach a mystery, she mentors her students to ask questions about the situation that help determine the information they have and the information they need. “What is going on? What information am I missing? Can I get that information? What does that information mean for the patient? How quickly do I need to act?”

Consider forming a group and working with a mentor who can guide you through case studies. This provides you with a learner-centered environment in which you can analyze data to reach conclusions and develop communication, analytical, and collaborative skills with your colleagues.

Practice Self-Reflection

Rhoads is an advocate for self-reflection. “Nurses should reflect upon what went well or did not go well in their workday and identify areas of improvement or situations in which they should have reached out for help.” Self-reflection is a form of personal analysis to observe and evaluate situations and how you responded.

This gives you the opportunity to discover mistakes you may have made and to establish new behavior patterns that may help you make better decisions. You likely already do this. For example, after a disagreement or contentious meeting, you may go over the conversation in your head and think about ways you could have responded.

It’s important to go through the decisions you made during your day and determine if you should have gotten more information before acting or if you could have asked better questions.

During self-reflection, you may try thinking about the problem in reverse. This may not give you an immediate answer, but can help you see the situation with fresh eyes and a new perspective. How would the outcome of the day be different if you planned the dressing change in reverse with the assumption you would find a wound infection? How does this information change your plan for the next dressing change?

Develop a Questioning Mind

McGowan has learned that “critical thinking is a self-driven process. It isn’t something that can simply be taught. Rather, it is something that you practice and cultivate with experience. To develop critical thinking skills, you have to be curious and inquisitive.”

To gain critical thinking skills, you must undergo a purposeful process of learning strategies and using them consistently so they become a habit. One of those strategies is developing a questioning mind. Meaningful questions lead to useful answers and are at the core of critical thinking .

However, learning to ask insightful questions is a skill you must develop. Faced with staff and nursing shortages , declining patient conditions, and a rising number of tasks to be completed, it may be difficult to do more than finish the task in front of you. Yet, questions drive active learning and train your brain to see the world differently and take nothing for granted.

It is easier to practice questioning in a non-stressful, quiet environment until it becomes a habit. Then, in the moment when your patient’s care depends on your ability to ask the right questions, you can be ready to rise to the occasion.

Practice Self-Awareness in the Moment

Critical thinking in nursing requires self-awareness and being present in the moment. During a hectic shift, it is easy to lose focus as you struggle to finish every task needed for your patients. Passing medication, changing dressings, and hanging intravenous lines all while trying to assess your patient’s mental and emotional status can affect your focus and how you manage stress as a nurse .

Staying present helps you to be proactive in your thinking and anticipate what might happen, such as bringing extra lubricant for a catheterization or extra gloves for a dressing change.

By staying present, you are also better able to practice active listening. This raises your assessment skills and gives you more information as a basis for your interventions and decisions.

Use a Process

As you are developing critical thinking skills, it can be helpful to use a process. For example:

• Ask questions.
• Gather information.
• Implement a strategy.
• Evaluate the results.
• Consider another point of view.

These are the fundamental steps of the nursing process (assess, diagnose, plan, implement, evaluate). The last step will help you overcome one of the common problems of critical thinking in nursing — personal bias.

Common Critical Thinking Pitfalls in Nursing

Your brain uses a set of processes to make inferences about what’s happening around you. In some cases, your unreliable biases can lead you down the wrong path. McGowan places personal biases at the top of his list of common pitfalls to critical thinking in nursing.

“We all form biases based on our own experiences. However, nurses have to learn to separate their own biases from each patient encounter to avoid making false assumptions that may interfere with their care,” he says. Successful critical thinkers accept they have personal biases and learn to look out for them. Awareness of your biases is the first step to understanding if your personal bias is contributing to the wrong decision.

New nurses may be overwhelmed by the transition from academics to clinical practice, leading to a task-oriented mindset and a common new nurse mistake ; this conflicts with critical thinking skills.

“Consider a patient whose blood pressure is low but who also needs to take a blood pressure medication at a scheduled time. A task-oriented nurse may provide the medication without regard for the patient’s blood pressure because medication administration is a task that must be completed,” Slaughter says. “A nurse employing critical thinking skills would address the low blood pressure, review the patient’s blood pressure history and trends, and potentially call the physician to discuss whether medication should be withheld.”

Fear and pride may also stand in the way of developing critical thinking skills. Your belief system and worldview provide comfort and guidance, but this can impede your judgment when you are faced with an individual whose belief system or cultural practices are not the same as yours. Fear or pride may prevent you from pursuing a line of questioning that would benefit the patient. Nurses with strong critical thinking skills exhibit:

• Learn from their mistakes and the mistakes of other nurses
• Look forward to integrating changes that improve patient care
• Treat each patient interaction as a part of a whole
• Evaluate new events based on past knowledge and adjust decision-making as needed
• Solve problems with their colleagues
• Are self-confident
• Acknowledge biases and seek to ensure these do not impact patient care

An Essential Skill for All Nurses

Critical thinking in nursing protects patient health and contributes to professional development and career advancement. Administrative and clinical nursing leaders are required to have strong critical thinking skills to be successful in their positions.

By using the strategies in this guide during your daily life and in your nursing role, you can intentionally improve your critical thinking abilities and be rewarded with better patient outcomes and potential career advancement.

Frequently Asked Questions About Critical Thinking in Nursing

How are critical thinking skills utilized in nursing practice.

Nursing practice utilizes critical thinking skills to provide the best care for patients. Often, the patient’s cause of pain or health issue is not immediately clear. Nursing professionals need to use their knowledge to determine what might be causing distress, collect vital information, and make quick decisions on how best to handle the situation.

How does nursing school develop critical thinking skills?

Nursing school gives students the knowledge professional nurses use to make important healthcare decisions for their patients. Students learn about diseases, anatomy, and physiology, and how to improve the patient’s overall well-being. Learners also participate in supervised clinical experiences, where they practice using their critical thinking skills to make decisions in professional settings.

Do only nurse managers use critical thinking?

Nurse managers certainly use critical thinking skills in their daily duties. But when working in a health setting, anyone giving care to patients uses their critical thinking skills. Everyone — including licensed practical nurses, registered nurses, and advanced nurse practitioners —needs to flex their critical thinking skills to make potentially life-saving decisions.

Meet Our Contributors

Crystal Slaughter, DNP, APRN, ACNS-BC, CNE

Crystal Slaughter is a core faculty member in Walden University’s RN-to-BSN program. She has worked as an advanced practice registered nurse with an intensivist/pulmonary service to provide care to hospitalized ICU patients and in inpatient palliative care. Slaughter’s clinical interests lie in nursing education and evidence-based practice initiatives to promote improving patient care.

Jenna Liphart Rhoads, Ph.D., RN

Jenna Liphart Rhoads is a nurse educator and freelance author and editor. She earned a BSN from Saint Francis Medical Center College of Nursing and an MS in nursing education from Northern Illinois University. Rhoads earned a Ph.D. in education with a concentration in nursing education from Capella University where she researched the moderation effects of emotional intelligence on the relationship of stress and GPA in military veteran nursing students. Her clinical background includes surgical-trauma adult critical care, interventional radiology procedures, and conscious sedation in adult and pediatric populations.

Nicholas McGowan, BSN, RN, CCRN

Nicholas McGowan is a critical care nurse with 10 years of experience in cardiovascular, surgical intensive care, and neurological trauma nursing. McGowan also has a background in education, leadership, and public speaking. He is an online learner who builds on his foundation of critical care nursing, which he uses directly at the bedside where he still practices. In addition, McGowan hosts an online course at Critical Care Academy where he helps nurses achieve critical care (CCRN) certification.

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Defining Critical Thinking

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The trend of critical thinking disposition in medical students and its relationship with their academic performance

Abdolhussein shakurnia.

Department of Immunology, Medical Faculty, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

Tayebe Fazelinia

1 Department of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

Nasrin Khajeali

2 Department of Medical Education, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran

BACKGROUND:

Critical thinking is one of the important skills required for medical students. It is considered as a main component in medical education and training competent physicians. The current study aimed to investigate the trend of critical thinking disposition of medical students and its association with their academic performance.

MATERIALS AND METHODS:

This descriptive cross sectional study was conducted in 2019 on 315 medical students of Ahvaz Jundishapur University of Medical sciences. A two-section questionnaire was used for data collection. The first section dealt with demographic characteristics and the second section included Ricketts critical thinking disposition inventory using t -test, analysis of variance, and Pearson correlation coefficient.

Mean and standard deviation of critical thinking disposition of medical students was 121.85 ± 11.32. No significant difference was observed between the mean score of critical thinking disposition and years of study ( P = 0.74, F = 0.590). Pearson correlation test also showed no significant association between critical thinking disposition and the students’ grade point average ( P = 0.89, r = 0.007).

CONCLUSIONS:

The results of the current study showed that medical students’ level of critical thinking disposition is above average, and there is no significant correlation between critical thinking disposition and years of study and academic performance of the students. It seems that the educational process in medical school has not been effective in improving the level of students’ critical thinking disposition.

Introduction

Medical faculties involved in training of health-care manpower are always worried about improvement of quality of graduates in providing health care. Physicians in health-care system are faced with unprecedented problems in workplace to which there is no unique and absolutely correct answer. Therefore, they should often make clinical decisions regarding complicated matters with little guidance and limited time and resources. The problem-solving ability in patient bedside is invaluable. Critical thinking can provide a wider view, creative solutions, and multiple paths when dealing with problems.[ 1 , 2 , 3 ]

According to the evidences, critical thinking skills have been linked to improved patient outcomes, better quality patient care, and improved health outcomes in health-care system. Critical thinking is one the important skills in clinical decision-making. Reinforcement of critical thinking skill lets the physician provide the best health-care services by making informed decision.[ 4 , 5 ] In this regard, world federation for medical education (WFME) introduces critical thinking as the main skill for medical students to be achieved during their educational courses.[ 6 ]

Critical thinking is a reasonable, systematic, effective, logical, and outcome-based thinking which analyzes and investigates the information scientifically. Critical thinking consists of two aspects of skill and disposition. Aspect of skill of critical thinking emphasizes cognitive strategies. Without positive disposition regarding critical thinking, this type of thinking does not manifest itself, it is an attribute or habit of mind that is integrated into one's beliefs or actions to effectively solve problems and make decisions as a product of thinking.[ 7 , 8 ] Skills are not enough to enable a person to think critically; if that person does not have the disposition or motivation to do them, there will be no critical thinking.[ 9 ] Therefore, critical thinking disposition is a vital part of critical thinking process.

Since medical training system is now faced with many challenges in satisfying the expectations of society in promoting health. The necessity of training creative, thoughtful, and efficient graduates with high potential of decision-making is indispensable. Naturally, critical thinking provides this opportunity for physicians to provide more valuable services in caring process through making accurate decisions.[ 9 , 10 ]

Experts of medical education consider the development of critical thinking skills necessary for medical students to improve quality of medical education and introduce this skill as one of the medical education standards accreditation of schools of medicine.[ 4 , 11 ]

Training medical students to provide appropriate care for patients in today's developed world needs education which reinforces critical thinking. Therefore, to be aware of the quality of education provided in universities, it is necessary to evaluate the growth and development of critical thinking in students. Despite the importance of critical thinking in the educational process, the results of various studies indicate that in general, students’ ability to use critical thinking skills is low. The trend toward critical thinking in university students has yielded different results. Some studies have reported an increasing trend in the level of students “critical thinking and some other studies have reported a lack of difference in the level of students” critical thinking in different years and a descending trend.[ 12 , 13 , 14 , 15 ]

Training medical students to provide appropriate care for patients needs education which reinforces critical thinking. Therefore, to be aware of the quality of education provided in universities, it is necessary to evaluate the growth and development of critical thinking in students. The finding of Taheri et al. study showed a difference among critical thinking disposition of first and last semester and critical thinking disposition in students of last semester was greater than that of the first semester students.[ 12 ] Barkhordary, Shakurnia and Baniasad, and Kaya et al. in their studies on students of nursing and medicine found no significant statistical difference among critical thinking disposition based on the year of study.[ 13 , 14 , 15 ] Results of the study by Fathiazar et al. and Lei et al. indicate that the trend of mean critical thinking disposition in students is descending.[ 16 , 17 ] Numerous factors for the difference or lack of difference in critical thinking among students during study years in university are reported which necessitates performing further studies in this regard to clarify its reasons.[ 16 , 18 , 19 ]

Findings of the studies conducted on the relationship between critical thinking and educational performance have also showed different results. While some studies point to the positive association between critical thinking disposition and educational performance, results of other studies report lack of such association between these two variables.[ 20 , 21 , 22 ] Therefore, due to heterogeneity of results, further studies in this regard can be helpful. Given the importance and role of critical thinking in the future profession of medical students and in the diagnosis and treatment of diseases, and the necessity of having the ability to analyze and critically think in the complicated and vital environment of health system in which they will be employed after graduation, critical thinking is important for diagnosis and treatment of diseases due to , without critical thinking, physicians are prone to cognitive errors, Cognitive errors can lead to diagnostic errors, which result in increased patient morbidity and mortality.

A diagnostic errors leads to error treatment and since there is no comprehensive research regarding critical thinking disposition of medical students in this university, this study aimed to investigate the status of critical thinking disposition in students of medical fields, its trend during education in university, and its association with educational performance.

Materials and Methods

Study design and setting.

This research is a descriptive cross-sectional study which investigates the trend of critical thinking disposition and its association with educational performance of medical students.

Study participants and sampling

Study population was all medical students studying at Ahvaz Jundishapur University of Medical Sciences in academic year of 2019–2020, and their number was 1759 individuals based on the reports by educational office of the faculty of medicine.

Sample size in this study was estimated to be 317 using Morgan and Krejcie table. Due to probability of incomplete questionnaires and considering 5% of attrition rate, 332 students were considered as study sample.

Data collection tool and technique

Willingness to participate in the study and informed completion of the questionnaire were considered as inclusion criteria and lack of willingness to participate in the study and not completing the questionnaire were considered as exclusion criteria.

Data gathering tool in the study was a two-section questionnaire. The first section consists of demographic characteristics of students. The second section is the Ricketts critical thinking disposition inventory. This questionnaire is a self-assessment tool which examines critical thinking disposition in students. The questionnaire consists of 33 questions in three subscales of innovation (11 phrases); maturation (9 phrases) and involvement (13 phrases), and is graded as 5-scale Likert from[ 1 ] absolutely disagree to[ 5 ] absolutely agree.[ 23 ]

Validity and reliability of the questionnaire have been assessed and confirmed in previous studies.[ 24 ] In Iran, Pakmehr et al. confirmed the validity and reliability of the Persian version of the questionnaire using factorial analysis and calculating Cronbach's alpha coefficient.[ 25 ] In the current study, validity and reliability of the questionnaire were assessed using the opinion of experts (face validity) and calculating Cronbach's alpha coefficient, and Cronbach's alpha achieved for whole questionnaire was 0.828 and for items of innovation, maturation, and involvement, it was 0.730, 0.542, and 0.819, respectively.

Range of scores is among 33–165 with a mean of 99, and the score of 99 is considered an average level in assessment of the level of critical thinking disposition. These values are between 1 and 55 with an average of 33 for the subscale of innovation, between 9 and 45 with an average of 27 for the subscale of maturation, and between 13 and 65 with an average of 39 for the subscale of involvement.

In this study, the grade point average (GPA) value of the students was considered as index and criterion for assessment of educational achievement. Classification of students into two groups with high and low educational achievement based on cut-off point of GPA of students in this study which obtained at 15.93 was done.

The researcher uploaded the questionnaire to a website and sent its link for 332 medical students after obtaining ethical approval and permission from the school of medicine. After being briefed on the objectives of the study, the students were asked to respond the questions one by one and to send the filled questionnaire for the researcher.

The questionnaires were anonymous and the students were assured that their information would remain confidential.

To assess normality of the variables, Kolmogorov–Smirnov test was used. Result of this test showed that data distribution was normal ( P = 0.43). Data were analyzed after coding using SPSS version 18 (IBM Corporation, Armonk, NY, USA). To analyze data, descriptive, and inferential methods were used. Mean, standard deviation, and frequency were used to analyze data descriptively, and to compare groups, analysis of variance (ANOVA) and t -test were used. Pearson correlation coefficient was used to determine probable association between the students’ score of critical thinking disposition and their GPA. P < 0.05 was considered as statistically significant in all tests.

Ethical consideration

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all participants for being included in the study.

Most students were female (61%) and the rest were male (39%). The mean grade point average of the students was 15.91; 179 students had GPA higher than the mean value (57%). The mean total score of critical thinking disposition of the students was 121.85 ± 11.32.

Table 1 shows the mean and standard deviation of critical thinking disposition score and its subscales of innovation, maturation, and involvement. According to the findings, the mean score of critical thinking disposition was greater than the average in the students.

Mean and standard deviation of critical thinking disposition of medical students

SD=Standard deviation

ANOVA test showed no significant difference between the educational years and mean score of critical thinking disposition ( P = ‒0.74, F = 0.590).

Comparison of mean scores of students in subscales also showed no significant difference in the subscales except for maturation subscale which showed significant difference in various years of education ( F = 2.333, P = 0.032) [ Table 2 ].

Comparison of mean of critical thinking disposition of medical students by educational year

Out of the 332 questionnaires distributed among students, 315 questionnaires were completely filled and returned (response rate of 94.6%). Mean age of students was 23.43 years with standard deviation of 2.46 (19 to 29 years).

Mean of critical thinking disposition in males and females was 122.83 ± 11.44 and 121.23 ± 11.23, respectively. Comparing the mean scores of critical thinking disposition and its subscales using independent t -test showed no significant difference between critical thinking disposition by gender ( P = 0.22) [ Figure 1 ].

Mean scores of critical thinking disposition and its sub-scales during years of education

Mean scores of critical thinking disposition in students with low and high GPA were 122.13 ± 11.60 and 121.64 ± 11.60, respectively; and the result of independent t -test indicates that there is no significant difference between in two groups of students ( P = 0.70). Pearson correlation test also showed that there is no significant correlation between the students’ critical thinking disposition and GPA ( P = 0.89, r = 0.007).

In the current study that the trend of critical thinking disposition of medical students was evaluated, the results showed that mean score of critical thinking disposition of the medical students was 121.85 ± 11.32 which is greater than the average level, given the score range of 33–165. Results of the studies conducted in Tehran and Isfahan Universities of Medical Sciences also showed the level of critical thinking disposition of the medical students to be at an average level[ 12 , 26 ] which is in line with the current study. In explaining this result, it can be argued that medical students need to strengthen the level of their critical thinking disposition compared to other students. This is because the level of critical thinking disposition of medical students is far from the desired level and because in medical sciences, students’ future careers require the ability to solve problems and make decisions about patient problems to provide appropriate services. Therefore, appropriate measures need to be taken in educational programs so that this skill is maximized in these students.

Other results of the current study indicate that as medical students go to proceed in their educational programs, their score of critical thinking disposition does not increase. Although it is expected that the critical thinking disposition will increase in higher years of study at university when the students become more experienced, the findings indicate that there is no significant relationship between the critical thinking disposition and academic years. It seems that the educational process in medical school has not been effective in improving the level of students’ critical thinking disposition. Probably, since in the educational programs of medical students, the category of critical thinking disposition has not received special attention, and new educational facilities and methods of medical education are not employed to strengthen this principle. Not surprisingly, no significant difference in critical thinking disposition of students during the study period can be expected. In fact, neglecting the reinforcement of critical thinking disposition in medical education at university has led to unchanged in critical thinking disposition of students, which should be taken as a serious warning. Numerous factors can play a role in justifying the lack of growth in critical thinking disposition in universities, especially Iranian universities during the years of study. For example, in most universities, the lecture method is used predominantly in teaching and less emphasis on active teaching methods. Lecture as a dominant method, in many universities, promotes a passive method of teaching in which critical thinking is either only implicitly taught or barely taught. Researchers suggest that to improve the critical thinking disposition, teachers should pay more attention to active methods such as problem-based learning, simulation, concept map, and appropriate assessment methods.[ 4 , 26 ]

In field of medical sciences, researchers have compared the level of critical thinking disposition during years of education in medical students and have reported different results. The results of the current study were in line with the findings of the studies by Barkhordary, Shakurnia and Baniasad, Athari, and Kaya et al. which did not report any significant difference among critical thinking disposition and years of education.[ 10 , 13 , 14 , 15 ] However, our results are not in line with those of Taheri et al. [ 12 ] and Mslm[ 27 ] which reported an ascending trend between critical thinking disposition and years of education and those of Fathiazar et al. [ 16 ] and Huang et al. [ 28 ] which reported a descending trend. These discrepancies can be the result of factors such as training environment, training method, methods of assessment, and various cultural factors.

According to the results, there was no significant association between critical thinking disposition and educational performance. This issue can be a result of dominance of traditional training method of assessment of students in Iranian universities where in the assessment of students, the skill of critical thinking and analysis is not considered, and memorization is more emphasized. Ranjbar and Esmaili[ 29 ] investigated critical thinking disposition in nursing and midwifery students and its association with the educational status, and their results did not show any significant association, which was in line with the current study.

According to the findings of a research by Mirzaie and Mirzaie, there was a significant association between elements of curriculum and critical thinking disposition, such that reinforcing each of the elements of curriculum (content, objective, method, and assessment) was accompanied with reinforcement of critical thinking disposition in students.[ 30 ] Pakmehr et al. also showed that there is a significant association between quality of training and critical thinking disposition of the students.[ 31 ]

Therefore, any targeted attempt to promote quality of teaching methods should be performed considering other elements of medical curriculum. Importance of developing critical thinking skills is so important that some experts consider critical thinking as the major objective of university education and experiences and believe training is teaching critical thinking to the student.

Unfortunately, the methods of teaching and learning in the Iranian Universities pay more attention to increasing and strengthening memorization, and less to training and developing the skills of critical thinking. Therefore, to fulfill its mission, the higher education system needs to review the goals, content and educational materials, teaching-learning methods and assessment system, and everything related to the curriculum.

Limitation and recommendation

The most important limitation of this research is that the study sample was limited to medical students of Ahvaz Jundishapur University of Medical Sciences, so the generalizing of the results should be done cautiously. It is recommended to select a larger study sample from universities of medical sciences of the country in further studies. In addition, design of the current study was cross-sectional, and there is no possibility of assessment of changes in critical thinking disposition level in students from the entry to university until graduation.

Conclusions

The findings showed that critical thinking disposition in medical students is higher than average, and there is no significant association between critical thinking disposition and years of education and educational performance of the students. Given the positive relationship between curriculum elements and students’ critical thinking disposition, it is necessary to review the curriculum and its elements, especially in the field of teaching-learning strategies.

The curriculum should be organized in a way that strengthens the critical thinking disposition and skills of in medical students. It is suggested that more comprehensive research be conducted in other universities of medical sciences by considering other variables related to the critical thinking disposition to identify the factors and variables predicting the critical thinking disposition levels in students.

Financial support and sponsorship

Conflicts of interest.

There are no conflicts of interest.

Acknowledgements

This article was extracted from the thesis of the general physician degree with the code of IR.AJUMS.REC.1398.871 which was approved by Ethics Committee of Ahvaz Jundishapur University of Medical Sciences. Researchers appreciate the cooperation of all medical students of Ahvaz Jundishapur University of Medical Sciences who participated in this research.

Constructing critical thinking in health professional education

• Original Article
• Open access
• Published: 04 April 2018
• Volume 7 , pages 156–165, ( 2018 )

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• Renate Kahlke   ORCID: orcid.org/0000-0002-4473-5039 1 &
• Kevin Eva 1  

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Introduction

Calls for enabling ‘critical thinking’ are ubiquitous in health professional education. However, there is little agreement in the literature or in practice as to what this term means and efforts to generate a universal definition have found limited traction. Moreover, the variability observed might suggest that multiplicity has value that the quest for universal definitions has failed to capture. In this study, we sought to map the multiple conceptions of critical thinking in circulation in health professional education to understand the relationships and tensions between them.

We used an inductive, qualitative approach to explore conceptions of critical thinking with educators from four health professions: medicine, nursing, pharmacy, and social work. Four participants from each profession participated in two individual in-depth semi-structured interviews, the latter of which induced reflection on a visual depiction of results generated from the first set of interviews.

Three main conceptions of critical thinking were identified: biomedical, humanist, and social justice-oriented critical thinking. ‘Biomedical critical thinking’ was the dominant conception. While each conception had distinct features, the particular conceptions of critical thinking espoused by individual participants were not stable within or between interviews.

Multiple conceptions of critical thinking likely offer educators the ability to express diverse beliefs about what ‘good thinking’ means in variable contexts. The findings suggest that any single definition of critical thinking in the health professions will be inherently contentious and, we argue, should be. Such debates, when made visible to educators and trainees, can be highly productive.

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What this paper adds

‘Critical thinking’ is a term commonly used across health professional education, though there is little agreement on what this means in the literature or in practice. We depart from previous work, which most often attempts to create a common definition. Instead, we offer a description of the different conceptions of critical thinking held in health professional education, illustrate their dynamic use, and discuss the tensions and affordances that this diversity brings to the field. We argue that diversity in conceptions of critical thinking can allow educators to express unique and often divergent beliefs about what ‘good thinking’ means in their contexts.

Even though the term critical thinking is ubiquitous in educational settings, there is significant disagreement about what it means to ‘think critically’ [ 1 ]. Predominantly, authors have attempted to develop consensus definitions of critical thinking that would finally put these disagreements to rest (e. g. [ 2 , 3 , 4 , 5 ]). They define critical thinking variously, but tend to focus on a rational process involving (for example) ‘interpretation, analysis, evaluation, inference, explanation, and self-regulation’ [ 2 ]. Other authors have challenged this perspective by arguing that critical thinking is a more subjective process, emphasizing the role of emotion and relationships [ 6 , 7 , 8 , 9 ]. In the tradition of critical pedagogy, critical thinking has meant critiquing ideology [ 10 , 11 , 12 ]. Last, still others have argued that critical thinking is discipline or subject-specific, meaning that critical thinking is not universal, but does have a relatively stable meaning within different disciplines [ 13 , 14 , 15 , 16 , 17 , 18 ]. However, none of these attempts to clarify the ambiguity that surrounds critical thinking have led to agreement, suggesting that each of these perspectives offers, at best, a partial explanation for the persistence of disagreements.

This is problematic in health professional education (HPE) because professional programs are mandated to educate practitioners who have a defined knowledge base and skill set. When curriculum designers, educators, researchers, or policy-makers all agree that we should teach future professionals to ‘think critically’, resting on the assumption that they also agree on what that means, they may find themselves working at cross-purposes. Moreover, the focus on a stable meaning for critical thinking, whether within a discipline or across disciplines, cannot account for the potential value of the multiplicity of definitions that exist. That is, the availability of diverse conceptions of critical thinking likely enables educators to express diverse elements of and beliefs about their work, thereby suggesting a need to explore the conceptions of critical thinking held in HPE, and the contexts that inform those conceptions.

With the historical focus on developing broad definitions of critical thinking and delineating its component skills and dispositions, little has been done either to document the diverse conceptions of this term in circulation amongst active HPE practitioners or, perhaps more importantly, to illuminate the beliefs about what constitutes ‘good thinking’ that lie behind them and the relationships between them. Perhaps clarity in our understanding of critical thinking lies in the flexibility with which it is conceptualized. This study moves away from attempting to create universal definitions of critical thinking in order to explore the tensions that surround different, converging, and competing beliefs about what critical thinking means.

In doing so, we map out conceptions of critical thinking across four health professions along with the beliefs about professional practice that underpin those conceptions. Some of these beliefs may be tied to a profession’s socialization processes and many will be tied to beliefs about ‘good thinking’ that are shared across professions, since health professionals work within shared systems [ 19 ] toward the same ultimate task of providing patient care. It is the variety of ways in which critical thinking is considered by practitioners on the whole that we wanted to understand, not the formal pronouncements of what might be listed as competencies or components of critical thinking within any one profession.

Hence, with this study, we sought to ask:

How do educators in the health professions understand critical thinking?

What values or beliefs inform that understanding?

To explore these questions, we adopted a qualitative research approach that focuses on how people interpret and make meaning out of their experiences and actively construct their social worlds [ 20 ].

This study uses an emergent, inductive design in an effort to be responsive to the co-construction of new and unexpected meaning between participants and researchers. While techniques derived from constructivist grounded theory [ 21 ] were employed, methods like extensive theoretical sampling (that are common to that methodology) were not maintained because this study was intended to be broadly exploratory. This ‘borrowing’ of techniques offers the ability to capitalize on the open and broad approach offered by interpretive qualitative methodology [ 20 ] while engaging selectively with the more specific tools and techniques available from constructivist grounded theory [ 22 , 23 ].

The first author has a background in sociocultural and critical theory. Data collection and early analyses were carried out as part of her dissertation in Educational Policy Studies. As a result of her background in critical theory, there was a need for reflexivity focused on limiting predisposition toward participant interpretations of critical thinking that aligned with critical theory. The senior author was trained in cognitive psychology, and contributed to the questioning of results and discussion required to ensure this reflexivity. The first author’s dissertation supervisor also provided support in this way by questioning assumptions made during the initial stages of this work.

Participants were recruited through faculty or departmental listservs for educators. Senior administrators were consulted to ensure that they were aware of and comfortable with this research taking place in their unit. In some cases, administrators identified a few key individuals who were particularly interested in education. These educators were contacted directly by the first author to request participation.

The purposive sample includes four educators from each of four diverse health professional programs ( n  = 16 in total): medicine, nursing, pharmacy, and social work. All participants self-identified as being actively involved in teaching in their professional program and all were formally affiliated with either the University of Alberta (Medicine, Nursing, and Pharmacy) or the University of Calgary (Social Work). These four professions were selected to maximize diversity in approaches to critical thinking given that these professions have diverse perspectives and roles with respect to patient care. However, participants all worked in Alberta, Canada, within the same broad postsecondary education and healthcare contexts.

In addition, sampling priority was given to recruiting participants practising in a diverse range of specialties: primary care, geriatrics, paediatrics, mental health, critical care, and various consulting specialties. Specific specialties within each profession are not provided here in an effort to preserve participant anonymity. The goal was not to make conclusions about the perspective of any one group; rather, diversity in profession, practice context, gender, and years in practice was sought to increase the likelihood of illuminating diverse conceptions of critical thinking.

Data generation

Participants were invited to participate in two in-person semi-structured interviews conducted by the first author. All but one participant completed both interviews. Interviews were audio-recorded and interview guides are included in the online Electronic Supplementary Material. The first was about 1 hour in length and discussed how participants think about critical thinking in their teaching, professional practice, and other contexts. Participants were invited to bring a teaching artefact that represented how they teach critical thinking to the interview. Artefacts were used as a visual elicitation strategy to prompt discussion from a new angle [ 24 ]. Questions focused on what the participant thought about teaching critical thinking using the artefact and how they identified critical thinking (or lack thereof) in their students. Artefacts were not analyzed independently of the discussion they produced [ 25 ].

Interview 1 data were analyzed to produce a visual depiction of the aggregate terms, ideas, and relationships described by participants. The visual depiction took the form of a ‘mind map’ (see Appendix C of the Electronic Supplementary Material) that was generated using MindMup free online software [ 26 ]. In developing the mind map, we sought descriptions of participants’ views that remained as close to the data as possible, limiting interpretations and inferences. The ‘clusters’ that appear in the mind map (e. g., the cluster around ‘characteristics of the critical thinker’) represent relationships or categories commonly described when participants discussed those terms. Terms were not weighted or emphasized based on frequency of use (through font size or bolding) in an effort to allow individual participants to emphasize or deemphasize terms as they thought appropriate during the second interview.

Where there was no clear category or relationship, terms were left at the first level of the mind map, connected directly to ‘critical thinking’ at the centre. Including more connections and inferences would likely have improved the readability of the map for participants; however, we chose to include connections and exact language used by participants (even in cases where terms seemed similar) as often as possible, in an effort to limit researcher interpretation. That said, any attempt to aggregate data or to represent relationships is an act of interpretation and some inferences were made in the process, such as the distinction between descriptions about ‘characteristics’ of the critical thinker (the top left hand corner of the map) and ‘processes’ such as ‘reasoning’ or ‘examining assumptions’ (on the right side of the map). The second interview lasted approximately 45 minutes during which a visual elicitation approach invited participants to respond to the mind map.

Visual elicitation involves employing visual stimuli to generate verbal interview data. Participant-generated mind maps are often used in qualitative data collection [ 27 ], but the literature on using researcher-generated diagrams for visual elicitation is relatively thin [ 25 , 28 ]. In this study, using a researcher-generated mind map for visual elicitation offered several advantages. First, as with other forms of visual elicitation, diagrams of this kind can help participants develop candid responses and avoid rehearsed narratives [ 24 , 29 ]. For example, we used mind maps as one mechanism to reduce the tendency for participants who were familiar with the literature on critical thinking to get stuck on narrating seemingly rehearsed definitions of critical thinking. Second, we chose to use a mind map because it provided a social setting through which participants could react to language generated by others. Doing so does not allow the same degree of social negotiation inherent in focus groups, but it avoids the difficulty involved in attempts to disentangle individual from group views [ 30 ]. Third, the visual elicitation method was chosen because it offered a form of member check [ 31 ] that allowed researchers to understand the evolving nature of participants’ conceptions of critical thinking, rather than assuming that participants offer a single true conception during each and every discussion [ 32 ]. In other words, the mind map was used to prompt participants to elaborate their conception of critical thinking and locate it relative to other participants.

In interview 2, participants were asked to begin by discussing areas or terms on the mind map that resonated most with their own conception of critical thinking; they were then asked to discuss terms or concepts on the map that resonated less or with which they disagreed. They were also asked to comment on how relationships between ideas were represented through the map so that researchers could get a sense of the extent to which the relationships between the concepts depicted reflected the participants’ understanding of those relationships [ 28 ]. Participants were encouraged to disagree with portions of the map and most did actively disagree with some of the terms and relationships depicted, suggesting that the map did not come to dictate more than elicit individual interpretations [ 28 ]. Although participants were encouraged to ‘mark up’ the mind map, and the ‘marked up’ mind maps were treated as data, the primary data sources for this study were the audio-recorded interviews [ 25 ].

Participants were aware that the mind map represented aggregate data from the four health professions in the study, but were not initially told whether any of the responses came predominantly from any one profession; they did not generally seem to be attempting to associate terms with other professions. Nonetheless, interview 2 data are a mix of participants’ reactions to the ideas of others and their elaborations of their own understandings. Naturally, these data build on data generated in interview 1, and represent reactions to both the researcher interpretation of the data and to the conceptions of critical thinking offered by others. Interview 1 data tended to offer an initial, open impression of how participants think about critical thinking in their contexts. Because of these different approaches to data generation, quotes from interview 1 and 2 are labelled as ‘INT1’ or ‘INT2’, respectively.

Data analysis

Data were coded through an iterative cycle of initial and focused coding [ 33 ] with NVivo software. Initial line-by-line coding was used to develop codes that were close to the data, involving minimal abstraction. Initial codes were reviewed by the first author and dissertation supervisor to abstract categories (conceptions of critical thinking), sub-categories (features of those conceptions), and themes related to the relationships between those categories. Focused coding involved taking these categories and testing them against the data using constant comparison techniques derived from constructivist grounded theory [ 21 ]. Category development continued during the framing of this paper, and authors engaged in ongoing conversations to modify categories to better fit the data. In this process, we returned to the data to look for exceptions that did not fit any category, as well as contradictions and overlap between categories.

Interpretive sufficiency [ 34 ], in this study, occurred when no new features illustrating participants’ conceptions of critical thinking were identified. Memos were kept to track the development or elimination of initial insights or impressions. Institutional ethics approval was obtained from the University of Alberta.

Participant identities have been masked to preserve anonymity. The abbreviation ‘MD’ refers to educators in medical education, ‘NURS’ to nursing, ‘PHARM’ to pharmacy, and ‘SW’ to social work. Participants within each group were then assigned a number. For example, the code NURS3 is a unique identifier for a single participant.

Three main conceptions of critical thinking were identified, each of which will be elaborated in greater detail below: biomedical critical thinking, humanist critical thinking, and social justice-oriented critical thinking. It is important to note that these categories focus on the process and purpose of critical thinking, as defined by participants. Participant comments also spoke to the ‘characteristics’ or ‘dispositions’ of critical thinkers, such as ‘open-mindedness’ or ‘creativity’. The focus of this study, however, was on uncovering what critical thinking looks like as opposed to what a ‘critical thinker’ looks like.

The results below interweave responses from different professional groups in order to emphasize the way in which each of the three core conceptions that we have identified crosses professional boundaries. We then provide a brief discussion of the relationships between these three conceptions, emphasizing the limited extent to which these conceptions were profession-specific, and the tensions that we observed between these conceptions. In general, we also interweave results from both interviews because the discussion in interview 2 tended to reinforce the themes arising from interview 1, especially with respect to indications that different conceptions were used fluidly by individuals over time and dependent on the context being discussed. The interview from which data arose is marked after each quote and we have mentioned explicitly whenever a comment was made in specific response to the mind map presented during interview 2.

In this way, our data extend the literature on critical thinking by offering an appreciation of how each of these conceptions provide educators a different way of thinking, talking, and teaching about their work in HPE. We found that even individual participants’ conceptions of critical thinking shifted from time to time. That is, they often articulated more than one understanding of critical thinking over the course of an interview or between interviews 1 and 2. Some of these conceptions were shared by multiple participants but individual constellations of beliefs about what critical thinking means were unique and somewhat idiosyncratic. Thus, while participants’ conceptions of critical thinking were both idiosyncratic and common, they were also flexible and contextual; the meaning of critical thinking was continuously reconstructed and contested. In this way, critical thinking offered a window through which to explore how beliefs about what constitutes ‘good thinking’ in a profession are challenged in educational settings.

Biomedical critical thinking

Participants articulating a biomedical approach saw critical thinking and clinical reasoning as nearly synonymous. They emphasized a process that was rational, logical, and systematic. One participant articulated that critical thinking is ‘ to be able to reason logically’ (NURS4 INT1). Another related:

You have to kind of pull together data that’s relevant to the subject you’re dealing with. You have to interpret it, you have to analyse it, and you have to come up with some type of conclusions at the end as to how you deal with it. (PHARM3 INT1)

Participants discussing this approach agreed that critical thinking involved a systematic process of gathering and analyzing data: ‘I think [critical thinking and clinical reasoning] are the same. I think clinical reasoning is basically taking the data you have on a patient and interpreting it, and offering a treatment plan’ (MD1 INT1).

In keeping with an emphasis on the rational and logical, participants espousing this view often reacted negatively when they saw references to emotion on the mind map in interview 2: ‘as soon as you bring your emotions into the room, you’re no longer applying what I think is critical thinking’ (MD4 INT2). Participants also noted that decision-making was an important component of critical thinking: ‘ you have to make a decision. I think it’s a really important part of it’ (MD2 INT2).

For participants from pharmacy, in particular, critical thinking often meant departing from ‘rules’ that guide clinical practice in order to engage in reasoning and make situationally nuanced decisions. One pharmacist, describing a student not engaging in critical thinking, related that the student asked:

‘Have you ever seen Victoza given at 2.4   milligrams daily?’ … It’s very, you know, it’s very much yes or no. But at a deeper level, it’s actually missing things. … [There are] all these other factors that change the decision, right? … On paper there might be a regular set of values for the dose, … [but] without the rest of the background, that’s a very secondary thing. (PHARM4 INT1)

This perspective was identified as the dominant conception of critical thinking because the terms and concepts falling under this broad approach were most frequently discussed by participants; moreover, when participants discussed other conceptions of critical thinking, they were often explicitly drawing contrast to the biomedical view. While the biomedical perspective was dominant in all four groups (although primarily as a contrasting case for social workers), participants tended to occupy more than one perspective over the course of an interview. They might talk primarily about biomedical critical thinking, but also explicitly modify that perspective by drawing on the other two approaches identified: humanist critical and social justice-oriented critical thinking.

Humanist critical thinking

Participants, when adopting this view, described critical thinking as directed toward social good and oriented around positive human relationships. Humanist conceptions of critical thinking were often positioned as an alternative to the dominant biomedical perspective: ‘having to think of somebody else, at their most vulnerable, makes you know that knowledge alone, science alone, won’t get that patient to the place you want the patient to be. It won’t provide the best care’ (NURS1 INT1). In being so positioned, the humanist conception of critical thinking explicitly departed from the biomedical, which emphasized ‘setting aside’ emotion and de-emphasized the role of relationships in healthcare. In the humanist perspective, participants often discussed the purpose of critical thinking as:

Thinking about something for the betterment of yourself and the betterment of others. We’re social beings as human beings. … I think [critical thinking] has a higher purpose. … But I think that [if] critical thinking … [is] a human trait that we have or hope to have, then it has to have those components of what we are as humans. (NURS1 INT1)

Another participant emphasized that: ‘a great part of critical thinking is that human element and the consideration of ultimately what’s a good thing, a common good’ (NURS2 INT1).

In addressing the relational aspects of humanist critical thinking, participants argued that the focus on ‘hard’ sources of data, such as lab tests or imaging, in biomedical critical thinking was limiting. They were concerned that ‘hard data’ tend to be perceived as more objective and thus more important in biomedical critical thinking, compared with subjective patient narratives. They argued that the patient’s story is essential to critical thinking:

I think it doesn’t matter what kind of expert you are, you have to be able to think about patients in the context that they’re in and consider what the patient has to say, and really hear them. So I think that’s an important—that was a total lack of critical thinking in a totally, ‘I’m just going to get through this next patient to the next one’ . (MD1 INT1)

Taken together, these perspectives suggest that biomedical approaches to critical thinking fail to address the complex relational and psychosocial aspects of professional practice.

Social justice-oriented critical thinking

In social justice-oriented approaches to critical thinking participants articulated a process of examining the assumptions and biases embedded in their world. They often explicitly rejected biomedical conceptions of critical thinking as ‘ reductionistic ’ (SW3 INT1) because, in their view, these approaches fail to address the thinker’s own biases. Educators taking a social justice approach felt that: ‘critical thinking … is around things like … recognizing your own bias and recognizing the bias in the world’ (SW1 INT1). In this perspective, participants saw critical thinking as a process of analyzing and addressing the ways in which individual and societal assumptions limit possible actions and access to resources for individuals and social groups.

Unlike biomedical critical thinking and similar to the humanist view, participants articulating this conception tended to make the values and goals of critical thinking, as they conceived of it, explicit. They often contrasted their articulation of values in critical thinking with the ‘assumed’ and unarticulated values present in the biomedical perspective:

If you are not orientated in a social justice position, [critical thinking is] more about the mechanics, which is valuable as well, but … if we don’t understand the values associated with what we think, it seems to not be meaningless but there’s a piece missing or it’s assumed. The values are assumed. (SW3 INT1)

When taking this perspective, participants argued that it is necessary to understand social systems in order to think critically about individual patient cases. One educator questioned:

Why are there a disproportionate number of aboriginal inpatients than any other group? … When you start critically thinking about seeing the whole patient … there are issues related with all of society and that’s why people have more diabetes. (PHARM1 INT1)

Other participants had measured responses to this approach. One participant added to their primarily biomedical approach in order to accommodate perspectives encountered in the mind map, relating that behind their diagnostic work all physicians:

Certainly see a wide spectrum of social and economic status and cultures and things and recognizing that our system is kind of biased against certain groups as it is and knowing that but really not having a good sense of knowing even where to start deconstructing it. (MD2 INT2)

Relationships between conceptions of critical thinking

Results of this study suggest that critical thinking means a variety of things in different contexts and to different people. It might be tempting to see the three approaches outlined above as playing out along professional boundaries. Certainly, the social justice-oriented conception was more common among social work educators; the humanist approach was most common among participants from nursing; perspectives held by physician educators frequently aligned with dominant biomedical conceptions. In pharmacy, educators seemed to straddle all three perspectives, though they commonly emphasized a biomedical approach. Several participants suggested that their faculty or profession has a common understanding of critical thinking: ‘ critical thinking, for me and maybe for our faculty, is around things like … ’ (SW1 INT1).

However, while the disciplinary tendencies discussed above do appear in the data, these tendencies were not stable; participants often held more than one view on what critical thinking meant simultaneously, or shifted between perspectives. Participants also articulated approaches that were not common in their profession at certain moments, positioning themselves as ‘an outlier’, or positioning their specialty as having a different perspective than the profession as a whole, such that critical thinking might mean ‘thinking like a nurse’, or ‘thinking in geriatrics’. Further, participants’ perspectives shifted depending on the context in which they imagined critical thinking occurring.

This type of positioning and re-positioning occurred in both interviews, although they were particularly pronounced in interview 2, where participants were explicitly asked to react to different viewpoints by responding to the mind map. Examples of shifting perspectives in interview 1 occurred especially when participants from medicine shifted between biomedical and humanist conceptions. These shifts suggested a persistent tension and negotiation between characterizations of critical thinking as a rational process of data collection and analysis, and a more humanist approach that accounts for emotion and the relationship between professional and patient or family. Where participants sought to extend their notion of data beyond ‘hard data’ there is a sense of blending humanism with biomedical approaches to critical thinking. In the quote below, the participant brings together a call for a humanist relationship building with a need to gather and analyze all of the data, including important data about the patient’s experience:

I have colleagues who’ll say [to their patients]: ‘just say yes or no.’ … And it’s not very good and they’re missing stuff. So, critical thinking is—I guess it’s sort of dynamic in that you have to have time and you also have to have an interaction. (MD1 INT1)

While the participants described above negotiated between biomedical and humanist perspectives, participants primarily espousing a social justice-oriented conception of critical thinking responded to the ‘assumed’ values of the biomedical model. In talking about a problem solving-oriented biomedical approach, one participant argued that ‘ it’s important as well to have that, those foundational elements of how we think about what we think, but if we don’t understand the values associated … there’s a piece missing’ (SW3 INT1). Another stated that ‘critical thinking seems to be a neutral kind of process or—no, that can’t be true, can it?’ (SW1 INT2) with the mid-sentence shift indicating that two ways of conceptualizing critical thinking had come into conflict. This participant primarily discussed a social justice-oriented conception of critical thinking, which is not neutral, but at this moment also articulated a neutral, clinical reasoning-oriented or biomedical conception.

These relatively organic moments of negotiation certainly demonstrate a sense of conflicting values, of toggling between one perspective and another. However, they also suggest that there are ways in which these contradictions can be productively sustained. In negotiating between humanist and biomedical perspectives, educators effectively modify the dominant perspective.

In interview 2, when discussing the mind map, participants often encountered views that differed from their own. They responded either by making sense of and accommodating the new perspective, or by rejecting it. As an example of the former approach, one physician reacted to the ‘social justice-oriented’ corner of the mind map (specifically ‘examining assumptions’) by explaining how there are:

Assumptions in the background that come up for me all the time in terms of the different ways people live and want to live and how we run into it all the time … it’s always in the background and actually influencing you and until someone challenges the way you approached something, you don’t know what your assumptions are. (MD1 INT2)

As an example of a participant disagreeing with a perspective encountered in the mind map, one participant rejected social justice as an important component of critical thinking in medicine. They related that critical thinking has ‘got everything to do with reasoning, which makes sense. … Social justice has nothing to do with critical thinking’ (MD4 INT2). Interestingly, this participant also spoke at length about the link between social justice and critical thinking in the first interview, suggesting that a conception might seem ‘wrong’ when an individual is thinking and talking about it in one context, and entirely ‘right’ in another context.

Such results demonstrate that individual conceptions of critical thinking are multiple and flexible, not predetermined or stable. Educators bring certain values or perspectives into the foreground as they relate to the context under discussion, while others recede into the background. Though many participants seemed to have a primary perspective, multiple perspectives on critical thinking can co-exist and are actively negotiated by the individual.

In overview, the three broad conceptions of critical thinking offered here (biomedical, humanist, and social justice-oriented) echo approaches to critical thinking found in the critical thinking literature [ 11 , 35 , 36 , 37 ]. However, this study extends the literature in two key ways. First, our data point to ways in which different conceptions of critical thinking conflict and coalesce, within the field, within each profession, and even within individuals. Second, this tension offers an early empirical account of critical thinking in the health professions that suggests there may be benefits to maintaining flexibility in how one conceives of the concept.

The diverse conceptions of critical thinking identified all appear to have some value in HPE. It might be tempting to view each conception as a unique but stable perspective, reflecting thinking skills that are used within a particular context or value orientation. However, the multiplicity and flexibility of participants’ conceptions in this study offers some explanation as to why previous attempts to develop either generic (e. g. [ 2 , 3 , 5 ]) or discipline-specific [ 13 , 15 , 16 , 17 ] definitions and delineations of critical thinking have failed to stick.

Conceptions of critical thinking are not stable within a context or for a single educator. Educators’ conceptions of critical thinking shift within and between contexts as they navigate overlapping sets of values and beliefs. When educators take up different conceptions of critical thinking, the shifts they make are not just pragmatic; they actively negotiate the values and practices of the different communities in which they participate. Although we certainly saw hints of differences between professions, the strength of this study is that it captured the ways in which conceptions of critical thinking are not stably tied to any given profession. Critical thinking is connected to a broader idea of what ‘good thinking’—and, by extension, the ‘good professional’—looks like for each educator [ 38 ] within a given context or community.

These observations lead one to speculate about what purpose fluidity in conceptions of critical thinking might serve. Educators often have different values and goals for their profession, and, thus, it is not surprising that the meaning of critical thinking would be contested both within and across professions. Through their conceptions of critical thinking, participants contest ideas about what thinking is for in their profession—whether it should be focused on individual patient ‘problems’ or broader social issues, and the extent to which humanism is an important component of healthcare.

It is understandable that so much of the literature on critical thinking has sought to clarify a single ‘right’ definition; there is an argument for making a collective decision about what ‘good thinking’ means. Such a decision might offer clarity to interprofessional teaching and practice, or provide a foundation on which educational policy can be based. However, the critical thinking literature has long sought such a universal agreement and disagreements persist. Results of this study suggest a new approach, one that can account for multiple conceptions of critical thinking within and across health professions and practice contexts. The visual elicitation approach employed, asking participants to respond to the mind map, offered a unique perspective on the data that illuminated contradictions between conceptions held by individual participants, between participants, and between the conceptions themselves.

Such an approach offers a vehicle for thinking and talking about what kind of thinking is valued, both within and between professions. When conceptions of critical thinking are understood as flexible instead of stable, these acts of modification and contestation can be viewed as potential moments for critical self-reflection for individuals and for professional groups on the whole. Moreover, through their discussions of critical thinking, educators actively intervened to consider and assert what they value in their work.

These different conceptions might be complementary as often as they are incompatible. In fact, we would argue that ‘good thinking’ is inherently contentious (and should be) because it is such struggles over what ‘the good’ means in HPE that allow for challenges to the status quo. Advances at the heart of HPE and practice have been hard-won through deliberate reflection, discussion, action, and (often) conflict. For example, the ongoing movement toward relationship-oriented care has arguably occurred as a result of unexpected pushback regarding the limits of considering good healthcare as being entirely patient-centred. Thus, there is a need to bring unarticulated assumptions about important topics into the light so that the goals and values of educators and policy-makers can be openly discussed, even though they are unlikely to ever be fully resolved.

Strengths and limitations

This study offered a broad sample of educators from four different professions, who practised in a range of disciplinary contexts. Given that the sampling approach taken sought breadth rather than depth, the results explore a range of conceptions of critical thinking across HPE, rather than allowing strong claims about any one profession or context. The sample also focussed on conceptions of critical thinking within health professions education at specific institutions in Edmonton, Alberta. A multi-institutional study might build on these results to elaborate the extent to which each health profession has a core shared conception of critical thinking that translates across institutional settings. We expect that there may be significant differences between settings, given that what is meant by critical thinking seems to be highly contextual, even from moment to moment. Mapping aspects of context that impact how individuals and groups think about critical thinking would tell us much more about the values on which these conceptions are based.

Subsequent studies might also explore the extent to which conceptions of critical thinking among those identifying as ‘educators’ are comparable to those identifying as primarily ‘clinicians’. Although the boundary is definitely blurry, these groups engage in different kinds of work and participate in different communities, which we suspect may result in differences in how they conceive of critical thinking.

Conclusions

Rather than attempting to ‘solve’ the debate about what critical thinking should mean, this study maps the various conceptions of this term articulated by health professional educators. Educators took up biomedical, humanist, and social justice-oriented conceptions of critical thinking, and their conceptions often shifted from moment to moment or from context to context. The ‘mapping’ approach adopted to study this issue allowed for an appreciation of the ways in which educators actively modify and contest educational and professional values, even within their own thinking. Because critical thinking appears to be both value and context driven, arriving at a single right definition or taxonomy of critical thinking is unlikely to resolve deep tensions around what ‘good thinking’ in HPE means. Moreover, such an approach is unlikely to be productive. Such tensions produce challenges for shared understanding at the same time that they produce a productive space for discussion about core issues in HPE.

Abrami PC, Bernard RM, Borokhovski E, et al. Instructional interventions affecting critical thinking skills and dispositions: a stage 1 meta-analysis. Rev Educ Res. 2008;78:1102–34.

Article   Google Scholar  

Facione PA. Critical thinking: a statement of expert consensus for purposes of educational assessment and instruction. Millbrae: California Academic Press; 1990.

Google Scholar  

Black B. Critical thinking—a definition and taxonomy for Cambridge Assessment: supporting validity arguments about critical thinking assessments administered by Cambridge Assessment. 34 th IAEA Annual Conference; 09.9.2008; Cambridge; 2008.

Fischer SC, Spiker VA, Riedel SL. Critical thinking training for army officers volume two: a model of critical thinking. Arlington: US Army Research Institute; 2009.

Ennis RH. Critical thinking: a streamlined conception. In: Davies M, Barnett R, editors. The Palgrave handbook of critical thinking in higher education. New York: Palgrave MacMillan; 2015. pp. 31–47.

Chapter   Google Scholar  

Thayer-Bacon B. Transforming critical thinking: thinking constructively. New York: Teachers College Press; 2000.

Thayer-Bacon B. Caring and its relationship to critical thinking. Educ Theory. 1993;43:323–40.

Walters KS. Critical thinking, rationality, and the vulcanization of students. In: Walters KS, editor. Re-thinking reason: new perspectives on critical thinking. Albany: State University of New York Press; 1994. pp. 61–80.

Warren KJ. Critical thinking and feminism. In: Walters KS, editor. Re-thinking reason: new perspectives on critical thinking. Albany: State University of New York Press; 1994. pp. 199–204.

Brookfield SD. Speaking truth to power: teaching critical thinking in the critical theory tradition. In: Davies M, Barnett R, editors. The Palgrave handbook of critical thinking in higher education. New York: Palgrave MacMillan; 2015. pp. 529–43.

McLaren PL. Forward: critical thinking as a political project. In: Walters KS, editor. Re-thinking reason: new perspectives on critical thinking. Albany: State University of New York Press; 1994. pp. ix–xv.

Giroux H. Toward a pedagogy of critical thinking. In: Walters KS, editor. Re-thinking reason: new perspectives on critical thinking. Albany: State University of New York Press; 1994. pp. 199–204.

McPeck JE. Critical thinking and the ‘Trivial Pursuit’ theory of knowledge. In: Walters KS, editor. Re-thinking reason: new perspectives on critical thinking. Albany: State University of New York Press; 1994. pp. 101–18.

Chan ZC. A systematic review of critical thinking in nursing education. Nurse Educ Today. 2013;33:236–40.

Scheffer BK, Rubenfeld MG. A consensus statement on critical thinking in nursing. J Nurs Educ. 2000;39:352–9.

Krupat E, Sprague JM, Wolpaw D, Haidet P, Hatem D, O’Brien B. Thinking critically about critical thinking: ability, disposition or both? Med Educ. 2011;45:625–35.

Jones A. A disciplined approach to critical thinking. In: Davies M, Barnett R, editors. The Palgrave handbook of critical thinking in higher education. New York: Palgrave MacMillan; 2015. pp. 169–82.

Papp KK, Huang GC, Lauzon Clabo LM, et al. Milestones of critical thinking: a developmental model for medicine and nursing. Acad Med. 2014;89:715–20.

Grace S, Innes E, Joffe B, East L, Coutts R, Nancarrow S. Identifying common values among seven health professions: an interprofessional analysis. J Interprof Care. 2017;31(3):1–10. https://doi.org/10.1080/13561820.2017.1288091 .

Merriam SB. Qualitative research: a guide to design and implementation. San Francisco: Jossey-Bass; 2009.

Charmaz K. Constructing grounded theory. 2nd ed. Thousand Oaks: SAGE; 2014.

Kahlke RM. Generic qualitative approaches: pitfalls and benefits of methodological mixology. Int J Qual Methods. 2014;13:37–52.

Varpio L, Martimianakis MA, Mylopoulos M. Qualitative research methodologies: embracing methodological borrowing, shifting and importing. In: Cleland J, Durning SJ, editors. Researching medical education. Chichester: John Wiley & Sons; 2015. pp. 245–55. https://doi.org/10.1002/9781118838983.ch21 .

Wheeldon J. Is a picture worth a thousand words? Using mind maps to facilitate participant recall in qualitative research. Qual Rep. 2011;16:509–22.

Umoquit MJ, Tso P, Tünde V‑A, O’brien M, Wheeldon J. Diagrammatic elicitation: defining the use of diagrams in data collection. Qual Rep. 2013;18(60):1–12.

MindMup 2. Available from: https://www.mindmup.com/ . Accessed: 1 March 2018

Wheeldon J, Framing Experience FJ. Concept maps, mind maps, and data collection in qualitative research. Int J Qual Methods. 2009;8:68–83.

Crilly N, Blackwell A, Clarkson PJ. Graphic elicitation: using research diagrams as interview stimuli. Qual Res. 2006;6:341–66.

Hathaway AD, Atkinson M. Active interview techniques in research on public deviants: exploring the two-cop personas. Field methods. 2003;15:161–85.

Onwuegbuzie AJ, Dickinson WB, Leech NL, Zoran AG. A qualitative framework for collecting and analyzing data in focus group research. Int J Qual Methods. 2009;8:1–21.

Kinchin IM, Streatfield D, Hay DB. Using concept mapping to enhance the research interview. Int J Qual Methods. 2010;9:52–68.

Varpio L, Ajjawi R, Monrouxe L, O’Brien B, Rees C. Shedding the cobra effect: problematizing thematic emergence, triangulation, saturation and member checking. Med Educ. 2017;51:40–50.

Saldaña J. The coding manual for qualitative researchers. 2nd ed. Thousand Oaks: SAGE; 2013.

Christians CG. Ethics and politics in qualitative research. In: Denzin NK, Lincoln YS, editors. Handbook of qualitative research. 2nd ed. Thousand Oaks: SAGE; 2000. pp. 133–55.

Kahlke RM, White J. Critical thinking in health sciences education: considering ‘three waves’. Creat Educ. 2014;4:21–9.

Introduction WKS. beyond logicism in critical thinking. In: Walters KS, editor. Re-thinking reason: new perspectives on critical thinking. Albany: State University of New York Press; 1994. pp. 1–22.

Barnett R. A curriculum of critical being. In: Davies M, Barnett R, editors. The Palgrave handbook of critical thinking in higher education. New York: Palgrave MacMillan; 2015. pp. 63–76.

Pithers RT, Soden R. Critical thinking in education: a review. Educ Res. 2000;42:237–49.

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Acknowledgements

We thank Dr. Paul Newton for his contributions to the analysis of these data, in his role as supervisor of the dissertation work on which this manuscript is based. Thanks also to Dr. Dan Pratt for his help and support in developing this manuscript.

Support for this work was provided by the Government of Alberta (Queen Elizabeth II Graduate Scholarship), by the Social Sciences and Humanities Research Council (Doctoral Fellowship), and by the University of British Columbia (Postdoctoral Fellowship).

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Kahlke, R., Eva, K. Constructing critical thinking in health professional education. Perspect Med Educ 7 , 156–165 (2018). https://doi.org/10.1007/s40037-018-0415-z

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