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 [accessed ]

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 [accessed ]

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 –385 hits on –420 hits on –456 hits on

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 : students comment on CT content (item 18, p.3) QABME Report on GMC visit to University of Wales’ School of Medicine in : 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

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

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

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

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?

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?

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?

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): Kamin, C.S. et al (2001) Measuring critical thinking in problem-based learning discourse. Teaching and Learning in Medicine. 13 (1): 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): McCrorie, P. (2005) In From here to where: GMC Medical Education Conference. uk.org/education/med_ed/9_may_2005_education_conference.pdf [accessed ] uk.org/education/med_ed/9_may_2005_education_conference.pdf 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. uk.org/education/undergraduate/undergraduate_qa/reports/Cardiff_2006.pdf [accessed ] uk.org/education/undergraduate/undergraduate_qa/reports/Cardiff_2006.pdf Report of the Visiting Team to the University of Leeds Medical School for 2004/05. General Medical Council. uk.org/education/undergraduate/undergraduate_qa/reports/Leeds_2005.pdf [accessed ] uk.org/education/undergraduate/undergraduate_qa/reports/Leeds_2005.pdf The Scottish Deans’ Medical Curriculum Group. (2000) The Scottish doctor: Learning outcomes. [accessed ]

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) voting Kamin CS, O’Sullivan PS, Younger M, Deterding R. Measuring critical thinking in problem-based learning discourse. Teach Learn Med. 2001;13:27