Academy Insights

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Academy Insights

HMS Academy Insights, the Academy's monthly published web-based e-newsletter, promotes and enhances faculty development of a large medical educator community across HMS and its affiliated hospitals. Through publication of the Academy Insights, we link medical educators across institutions, foster collaboration and build community, recognize our members' achievements and highlight academic scholarship in the field of medical education. Academy Insights provides direct links to useful educational resources including journal articles, books, apps, websites, presentations, and other teaching tools

Academy Insights: Vol. 7, No. 6

Critical Thinking: The What, How, and Why   
Grace Huang, MD

Dental students Ingrid Carvo and Daniel Brein work on a patient at the Teaching Practices of the Harvard Dental Center.  They are observed by Drs. Inyang Isong and Armando Pardo

Why we studied it: Critical thinking is fundamental to everything we do as clinicians.  It crucially underlies the data synthesis, diagnosis, and treatment of patients.  Without critical thinking, diagnostic errors, cognitive biases, and mismanagement would prevail in our approach to patients.

What we are talking about: Many different terms have been used in the literature, such as clinical reasoning, analytic processing, diagnostic reasoning.  We consider critical thinking to encompass all these constructs and to extend beyond medicine to all spheres of life.  One definition relevant to clinical medicine is "the ability to apply higher cognitive skills (e.g. analysis, synthesis, self-reflection, perspective-taking) and/or the disposition to be deliberate about thinking (being open-minded or intellectually honest) (1) that leads to action that is logical and appropriate."  Of note, this definition reflects not just cognitive skills but also our belief that attitudes are of equal importance in critical thinking.

What we did: Debbie Lindell, RN, PhD (Case Western), Lynn Jaffe, OT (Florida Gulf Coast), Amy Sullivan, EdD (HMS), and I collaborated on a multi-institutional research project (2) that is in its 6th year.  We conducted semi-structured interviews of 44 faculty at 8 nursing and medical schools who were nominated by their peers as expert teachers of critical thinking. We performed a qualitative analysis on these transcripts.

What we found: Faculty are explicit about teaching particular cognitive habits that promote critical thinking.  Two principles predominate: making the material and the thinking process clinically relevant, and shifting one's perspective to broaden the mind about a problem.  They also employed the group process as conducive to critical thinking (since engaging with other people gets you to think more deeply) and framing questions that probe understanding.  What was also evident was that faculty were very cognizant about fostering CT as a means to bettering patient's care, rather than focusing on critical thinking as an intellectual exercise.

The following quotes express the findings better than we could:

"It's more asking the 'why' question, so, 'Why do you think that?' If there's something you disagree with, focusing less on the disagreement and looking at the reasons for the disagreement, so trying to get underneath sort of the root of a person's claim or belief."

"So, for example, when a student is articulating an argument, I'll say, 'Well, why do you think?' - I'll ask probing questions and ask clarifying questions and clarify key facts, all these sort of like basic components that we think are likely to lead to critical thinking.

"They can't just be data gatherers. They need to have begun at least to make an attempt to process the information and work things out for themselves. It forces them to always be assessing and really trying to analyze information, not simply collect it."

What is next: Having codified critical thinking into teaching strategies that faculty can put into play immediately, we have submitted a second manuscript on how to craft a learning environment that nurtures critical thinking.  Lastly, we will propose guidelines for health professions schools considering critical thinking initiatives at the institutional level.

What I learned along the way: Multi-institutional research has been tremendously rewarding with a collegial, hardworking group of like-minded educators.

  1. Huang GC, Newman LR, Schwartzstein RM. Critical thinking in health professions education: summary and consensus statements of the Millennium Conference 2011. Teach Learn Med 2014;26 (1):95- 102.
  2. Huang GC, Lindell D, Jaffe LE, Sullivan AM. A multi-site study of strategies to teach critical thinking: 'why do you think that?'. Med Educ. 2016 Feb;50

To read more from the July Insights click here