Critical Thinking in Medical Practice

Dr. Z. ZayapragassarazanAssociate Professor

Department of Medical EducationJIPMER

Puducherry

Why this topic?

I think, therefore I am.

- Rene Descartes

Objectives

‐to define ‘Critical Thinking’‐to describe the importance of critical thinking‐to explain the attributes of critical thinkers‐to administer a critical thinking skills test

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Thinking

The action of using one's mind to produce thoughts

Bloom’s Thinking Triangle

Use two squares to put all the cows in separate pens

Critical Thinking

• Critical thinking is reasonable, reflective thinkingthat is focused on deciding what to believe ordo.

• Critical thinking is skillful, responsible thinkingthat is conducive to good judgment because it issensitive to context, relies on criteria, and is self‐correcting.

• Critical thinking is thinking about your thinking,while you’re thinking, in order to make yourthinking better.

A purposeful, organized, mental process that we use to understand the world and make informed decisions. 

Four Men in Hats• Four men buried up to their necks in the ground. They cannot 

move, so they can only look forward. Between A and B is a brick wall which cannot be seen through. 

• They all know that between them they are wearing four hats‐‐two black and two white‐‐but they do not know what color they are wearing. Each of them know where the other three men are buried. 

• In order to avoid being shot, one of them must call out to the executioner the color of their hat. If they get it wrong, everyone will be shot. They are not allowed to talk to each other and have 10 minutes to work it out. 

• After one minute, one of them calls out. • Question: Which one of them calls out? Why is he 100% certain of 

the color of his hat? • This is not a trick question. There are no outside influences nor 

other ways of communicating. They cannot move and are buried in a straight line; A & B can only see their respective sides of the wall, C can see B, and D can see B & C. 

Four Men in Hats

Answer• C calls out that he is wearing a black hat. • Why is he 100% certain of the color of his hat? After a 

while, C comes to the realization that he must answer. • This is because D can't answer, and neither can A or B. • D can see C and B, but can't determine his own hat color. 

B can't see anyone and also can't determine his own hat color. A is in the same situation as B, where he can't see anyone and can't determine his own hat color. 

• Since A, B, and D are silent, that leaves C. C knows he is wearing a black hat because if D saw that both B and C were wearing white hats, then he would have answered. But since D is silent, C knows that he must be wearing a black hat as he can see that B is wearing a white hat. 

Aspects of Critical Thinking

• Abstract Thinking:thinking past what your senses tell you

• Creative Thinking: thinking “out of the box,” innovating

• Systematic Thinking: organizing your thoughts into logical steps

• Communicative Thinking:being precise in giving your ideas to others.

• Divergent Thinking:One question leads to many answers

• Convergent Thinking:Many Questions leads to one answer

What is involved in Critical ThinkingQuestion: what is being asked?Purpose: why do I want the answer?Point of View:  where do I stand to look at the 

question?Information: what data do I have?Concepts: what ideas are involved?Assumptions:  what am I taking for granted?Inferences: what conclusions am I drawing?Consequences:  what are the implications of my 

question?

Why should we think critically?• Avoid  medical/clinical errors• Identify better alternate options• Increases productivity• Better clinical decision making• Avoid poor or delayed decisions• Save time and energy• Work in resource limited settings• Quality thinking and quality work output• Brings in innovation  (Creativity)• Avoid litigations• Reduces fatigue• Develops confidence• Helps to climb the leadership ladder

What Critical Thinkers do?

Do more data gatheringAvoid premature conclusionsSee inconsistencies in informationUtilize knowledge more extensively and explicitly to make decisionsAre aware of limitations and doubtsMonitor and evaluate their own decisions Involve patients more fullyProvide patients with options

Fostering Critical Thinking

• Self awareness about our own thinking style• Learning to critique• Learning to ask questions • Trying to find more alternate solutions• Reflect on what happened• Use concept maps and mind mapping• Read literature

Exercise

Section 1: InferenceInference 1: There is inadequate data Inference 2: This is probably true Inference 3: This is TrueInference 4: This is False

Section 2: Recognition of assumptionAssumption 1: NoAssumption 2: NoAssumption 3: YesAssumption 4: No

Section 3: DeductionDeduction 1: YesDeduction 2: NoDeduction 3: Yes

Section 4: InterpretationInterpretation 1: YesInterpretation 2: NoInterpretation 3: Yes

Section 5: Evaluation of ArgumentsArgument 1: StrongArgument 2: StrongArgument 3: Weak

ScoringOverall Score Performance Assessment Description

0-3 Not manifested

This result is consistent with possible insufficient test-taker effort, cognitive fatigue, or possible reading or language comprehension issues.

4-6 Weak

This result is predictive of difficulties with educational and employment related demands for reflective problem solving and reflective decision making.

7-9 Moderate

This result indicates the potential for skills-related challenges when engaged in reflective problem-solving and reflective decision-making associated with learning or employee development.

10-12 Strong

This result is consistent with the potential for academic success and career development.

13& above Superior

This result indicates critical thinking skill that is superior to the vast majority of test-takers. Skills at the superior level are consistent with the potential for more advanced learning and leadership.

You are rating your disposition toward critical thinking over the past two days:• Give yourself 1 point for every “Yes” on odd numbered items and for every “No” on even numbered items. 

• 15 & Above ‐ generally positive.• 10‐14 ‐mixed overall disposition toward critical thinking. 

• Below 10 ‐ averse or hostile toward critical thinking. 

• Interpret results on this tool cautiously. At best this tool offers only a rough approximation with regard to a brief moment in time ie two days. 

Thanks