Strategies embedding critical thinking into curriculum: Intentional Teaching and Thinking

By:  Taryn Bainum, Pharm.D., BCPS, BCCCP

The temptation to “Google” answers is strong among younger generations who have always had such technology at their fingertips. With artificial intelligence emerging, there is even more risk of outsourcing thinking rather than enhancing our own. Critical thinking (CT) was once inadvertently taught by learners having to go through the process of determining which source or sources to use, researching the topic, and synthesizing answers. Now more than ever, there is a need to explicitly teach CT skills which then translate to clinical reasoning (CR) skills.

Research evidence suggests that making CT objectives explicit while teaching this skill set is associated with greater improvement in CT skills than when the concepts are simply embedded.¹ Data also shows that the most effective means of developing CT skills is to teach CT separately before applying it to course content. It is likely that most pharmacy school curricula have CT embedded in courses that involve group work and problem-based learning scenarios. However, students may benefit more from being explicitly taught the definition and process of CT before encountering it as embedded content. In order to understand the process and apply it, students need to know what CT is as well as barriers and biases that could hinder the skill. This could be done by adding a course dedicated to explaining critical thinking or simply adding this concept into an existing course where students would be taught the “why,” “what,” and “how” of CT. Because guarding against cognitive biases starts with being aware they exist,² it is important to educate students on the common pitfalls that derail CT. For example, the availability bias can result in something being thought of as “more likely” because it quickly and easily comes to mind. If a student knows they have the propensity to make this error, they can begin to avoid it.

If we formally introduce CT into curricula, we must also have a method by which to assess it. There is data indicating that CT assessments, such as the Health Science Reasoning Test (HSRT) can help assess changes in CT skills and predict success in endeavors such as professional licensure examinations.³ At a time when admission criteria such as the PCAT exam are being eliminated, assessments such as the HSRT could serve as valuable pieces of information for admissions processes. In addition, utilizing CT assessments could help evaluate curricular changes and serve as documentation for the Accreditation Council for Pharmacy Education (ACPE) and Center for Advancement of Pharmacy Education (CAPE) outcomes that emphasize development of critical thinking skills in student-pharmacists.^4,5 

Outside of formal CT training, faculty and preceptors should strive to incorporate these concepts into their daily teaching routines. CT skills can be utilized in both didactic and experiential settings to enhance student comprehension and ability to apply knowledge. While there are many ways to incorporate CT, I have focused on a couple of methods that I think are especially useful and perhaps different from techniques frequently discussed in CT literature. 

“Baby Step” Questioning

Socratic questioning is a well-established method of teaching that focuses on probing learners’ thought processes. A variation of this is asking questions to “baby step” learners in the correct direction. This method requires the questioner to be flexible and ask questions in response to the learner’s answers and thoughts. This would ideally take the place of providing answers or terminating discussion when a learner expresses a lack of knowledge. For example, if a learner states they do not know why their patient is on full-dose anticoagulation, a potential question would be to ask the learner to list all possible reasons a patient would be on full-dose anticoagulation and assess if any apply. 

Problem-Based Learning (PBL) Case Reports

Another valuable activity is a “morning report” style patient case that prompts students to generate a differential of possible problems, seek out specific pieces of information in order to generate a complete problem list, then develop an appropriate treatment plan. This activity promotes CT skills, allows for application of deductive reasoning skills, and fosters thoughtful discussion. This method focuses on both diagnosis and treatment and can be tailored more towards treatment when engaging pharmacy students.

PBL Case Report Process

There are many different activities, games, and methods by which CT or CR can be taught. While I believe these are extremely beneficial for learners, they would be even more so if they were formally taught CT earlier in the pharmacy curriculum. I encourage faculty and preceptors to insert this into curricula wherever possible and into daily teaching. We should also make significant efforts to develop CT skills within ourselves as faculty and preceptors in order to pass this along to learners. What are other faculties and schools implementing in their curricula to assist students developing their CT skills?

References

1. Abrami PC, Bernard RM, Borokhovski E, et al. Instructional interventions affecting critical thinking skills and dispositions: A stage 1 meta-analysis. Review of Educational Research. 2008;78(4):1102-34.
2. Croskerry P. From mindless to mindful practice—Cognitive bias and clinical decision making. N Engl J Med. 2013;368(26):2445-8.
3. Health Science Educators Focus on Critical Thinking. Insight Assessment.  Accessed February 28, 2023. 
4. Accreditation Council for Pharmacy Education. Accreditation standards and key elements for the professional program in pharmacy leading to the doctor of pharmacy degree. Approved January 25, 2015. Released February 2, 2015. Accessed February 28, 2023.
5. Medina MS, Farland MZ, Malcom DR, et al. AACP curriculum outcomes and entrustable professional activities (COEPA) 2022. Accessed February 28, 2023. 

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Author Bio:

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Pulses is a scholarly blog supported by Currents in Pharmacy Teaching and Learning