Critical thinking by Students Undertaking a PBL-based Medical Curriculum: What is the Evidence? Dr. Susan Jamieson, Faculty of Medicine

Critical thinking by Students Undertaking a PBL-based Medical Curriculum: What is the Evidence?

Dr. Susan Jamieson, Faculty of Medicine.

Research-Teaching Linkages: MEDEV approach

• Theme outcomes include:– To develop critical and deductive skills in

graduates

• Individual projects to ask questions such as: – How is critical thinking developed in your

programme?

• MEDEV RTL Project Leaders– Planned to ask MEDEV schools where and how

graduate research attributes such as research/critical thinking/deductive reasoning skills are developed in their curricula

http://www.enhancementthemes.ac.uk/themes/ResearchTeaching/RT_MED.asp [accessed 25.1.08]

Research-Teaching Linkages: MEDEV approach

• Theme outcomes include:– To develop critical and deductive skills in

graduates

• Individual projects to ask questions such as: – How is critical thinking developed in your

programme?

• MEDEV RTL Project Leaders– Planned to ask MEDEV schools where and how

graduate research attributes such as research/critical thinking/deductive reasoning skills are developed in their curricula

http://www.enhancementthemes.ac.uk/themes/ResearchTeaching/RT_MED.asp [accessed 25.1.08]

What is critical thinking?

• “a reflective scepticism”, “ a healthy scepticism” (McPeck, 1990, p.42)

• a questioning mind

• an ability to detect strengths and flaws in arguments

• an ability to make judgments against specific criteria

• a willingness to question one’s own views and beliefs, as well as others’

Critical thinking as a graduate skill

• Barnett (1997): “defining concept of a Western University”

• Glasgow University website:– 449 hits on 22.05.06– 385 hits on 18.09.06– 420 hits on 20.03.07– 456 hits on 25.01.08

Critical thinking as a graduate skill in medicine

• The Scottish Doctor (2000): ‘critical thinking’ is a ‘level 3’ learning outcome

• GMC Medical Education Conference (2005): “…we want … [students] … to be critical thinkers” (McCrorie, p.15)

• Report on GMC visit to Leeds Medical School in 2004-5: students comment on CT content (item 18, p.3)

• QABME Report on GMC visit to University of Wales’ School of Medicine in 2005-6: intercalated degree course “was designed to enhance research skills and critical thinking” (item 48, p.10)

• Post-‘Tomorrow’s Doctors’ curricular reforms have led to: “a student-centred approach, which encourages students to learn by intellectual discovery and critical thinking” (Davison et al, 1999)

critical thinking is

considered to underlie clinical

reasoning and

judgement

Problem-based

learning

Claims made for PBL-based medical curricula

• better retention of knowledge• fosters self-directed learning • communication skills• team-working• integrated/contextual learning of basic

science• critical thinking

Claims made for PBL-based medical curricula

• better retention of knowledge• fosters self-directed learning • communication skills• team-working• integrated/contextual learning of basic

science• critical thinking

What does the literature say?

• substantial literature in nurse education

• studies in traditional (non-PBL) medical schools

• only 2 studies in a single PBL-based, medical school, by a North American research group (Kamin et al, 2001, 2003)

Glasgow’s medical undergraduates: critical thinkers?

A case study to look for evidence of critical

thinking by students in a Scottish medical

school with a PBL-based curriculum.

PBL: The Glasgow Steps

• Grasp the meaning …• List the main issues• Activate your mind• Specify the questions• Got what you need?• Offer your answers• What’s our role in this?

– definitions – learning issues– brainstorming– learning objectives – resources– debrief– reflection on group

process

Acronym courtesy of: Professor N. Price, IBLS, University of Glasgow




process





process





process


We don’t just do PBL!

• Fixed resource sessions• Plenaries• Clinical skills• Vocational studies

Davison et al , 1999

– community diagnosis

The research questions

• Is there evidence for critical thinking by students in a Scottish medical school with a PBL-based curriculum? Specifically:

(i) Is there evidence for critical thinking by individual students in this curriculum?

(ii) Is there evidence for critical thinking by students in a group situation, in particular the PBL tutorial?

(iii) Is there evidence for critical thinking by students during an assessment task?
















Study design

• Individual students

• In a group situation

• In an assessment task

Content analysis of concurrent verbalisation (the ‘think aloud’ technique), with stimulated recall

Discourse analysis of critical thinking within PBL tutorials

Documentary analysis of exam scripts

So where are we?

• Ethics application • Identify cases for think-aloud task• Invitation to Y2 to participate in assessment arm• Pilot of think aloud technique • Trial coding scheme with videos of PBL tutorials• Recruitment of PBL groups for discourse analysis• Filming of PBL tutorials (x 4)• Invitation to Y1 students to participate in ‘think

aloud’ sessions• Invitation to Y1 to participate in assessment arm• ‘Think aloud’ sessions (x 12)

watch this space … !!

References

• Barnett, R. (1997) Higher education: A critical business. Bucks: Open University Press.

• Davison, H. et al (1999). Community-oriented medical education in Glasgow: developing a community diagnosis exercise. Medical Education 33 91): 55-62.

• Kamin, C.S. et al (2001) Measuring critical thinking in problem-based learning discourse. Teaching and Learning in Medicine. 13 (1): 27-35.

• Kamin, C.S. et al (2003) A comparison of critical thinking in groups of third-year medical students in text, video and virtual PBL case modalities. Academic Medicine. 78 (2): 204-211.

• McCrorie, P. (2005) In From here to where: GMC Medical Education Conference. http://www.gmc-uk.org/education/med_ed/9_may_2005_education_conference.pdf [accessed 18.09.06]

• McPeck, J. (1990) Teaching critical thinking. Philosophy of Education Research Library. London: Routledge.

• QABME: the School of Medicine, University of Wales Report for 2005/06. General Medical Council. http://www.gmc-uk.org/education/undergraduate/undergraduate_qa/reports/Cardiff_2006.pdf [accessed 25.01.08]

• Report of the Visiting Team to the University of Leeds Medical School for 2004/05. General Medical Council. http://www.gmc-uk.org/education/undergraduate/undergraduate_qa/reports/Leeds_2005.pdf [accessed 25.01.08]

• The Scottish Deans’ Medical Curriculum Group. (2000) The Scottish doctor: Learning outcomes. http://www.scottishdoctor.org/node.asp?id=outcomes [accessed 18.09.06 ]

Thank you!

Coding scheme

• Categories of critical thinking (indicators)– Imparting new information (4)– Clarifying/agreeing on terms/concepts (4)– Bringing outside knowledge/experience to bear (2)– Linking ideas, interpretation (7)– Justification (4)– Practical utility (application) (2)– Teaching each other (2)– Critical assessment (3)

• Group process issues – Rapport, explaining process, division of labour, (4)

votingKamin CS, O’Sullivan PS, Younger M, Deterding R. Measuring critical

thinking in problem-based learning discourse. Teach Learn Med. 2001;13:27

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Critical thinking by Students Undertaking a PBL-based Medical Curriculum: What is the Evidence? Dr. Susan Jamieson, Faculty of Medicine