1. Development of Critical Thinking among Health Professions Students: a
meta-analysis of longitudinal studies
Matthew C. Reale1, Benjamin A. Witt1, Daniel M. Riche2, William L. Baker3, Michael J. Peeters1
1University of Toledo College of Pharmacy & Pharmaceutical Sciences, Toledo, OH
2University of Mississippi School of Pharmacy, Oxford, MS
3University of Connecticut School of Pharmacy, Storrs, CT
Background
Results
Results (continued)
The importance of critical thinking has been emphasized in the health professions
Pharmacy education: PharmD reports,1 prior guidelines2 and prior standards3 had all included critical thinking as a desired outcome
An abundance of definitions of critical thinking have been proposed,
Agree that it involves interpretation or analysis followed by evaluation or judgement4
This underlying diversity of definitions has created difficulty in assessment and evaluation of critical thinking
Major assessment tools include the California Critical Thinking Skills test (CCTST), the Health Science Reasoning Test (HSRT), and the Defining Issues Test (DIT)
70 studies were included in the quantitative and qualitative synthesis of the meta-analysis
403 potential studies identified
After abstracts were reviewed, 88 full text articles were assessed for eligibility
Of the 70 studies included, 36 utilized the CCTST, 20 utilized the DIT, and 14 utilized the HSRT
6340 students were analyzed
Inter-rater kappa=0.82, strong agreement
DIT Forest Plot
Profession
Difference
In means
Lower
limit
Upper
Total
Nursing
685
3.643
2.120
5.166
Dental
1001
4.697
2.888
6.506
Pharmacy
1148
-2.695
-9.744
4.354
Allied Health 55
6.170
5.083
7.257
Medicine 20
2.840
1.459
4.221
Physical Therapy 37
4.500
3.175
5.825
Composite
2946
3.658
2.374
4.942
-8.00
-4.00
0.00
4.00
8.00
Lower Score
Higher Score
I2 = 98.9%
Cochrane p<0.001
Egger’s p=0.03
CCTST Forest Plot
Profession
Difference
Lower
Upper
Total
in means
limit
Nursing
1919
1.638
0.897
2.379
Dental 76
0.200
0.024
0.376
Pharmacy
407
1.005
0.231
1.779
Occupational 25
1.920
1.656
2.184
Veterinary 23
1.224
-0.210
2.658
Physical Therapy
268
2.349
0.034
4.664
Composite
2718
1.588
1.030
2.146
-4.00
-2.00
0.00
2.00
4.00
Lower Score
Higher Score
I2 = 99.6%
Cochrane p<0.001
Egger’s p=0.31
Objective
Conclusions & Implications
We systematically summarized the available evidence for critical thinking development (CTd) among health professions students
Among health profession programs, students’ performances on critical thinking assessments were variable and depended on the assessment instrument
CCTST and DIT showed evidence of CTd
HSRT did not show CTd
CCTST and DIT may be helpful in programmatic assessment of CTd
Methods
SEARCH
Longitudinal studies of CTd using standardized tests of critical thinking
[California Critical Thinking Skills Test (CCTST), Health Science Reasoning Test (HSRT), and Defining Issues Test (DIT)]
Multiple databases (Pubmed, EMBASE, CINAHL, PsychINFO, ERIC, Academic Search Complete, Google Scholar), through September 2014
English and non-English articles obtained
Non-English translations done
META-ANALYSIS
A random-effects model was used
Mean changes in test scores were reported as weighted mean differences (WMDs) and accompanying 95% confidence intervals (CIs) were pooled
Statistical heterogeneity and publication bias were assessed using the I2 statistic and Egger’s weighted regression statistic, respectively
Random-effects meta-regression was performed to characterize a potential relationship between time of assessments (in months) and change in test scores
References
HSRT Forest Plot
Profession
Difference
Lower
Upper
Total
in means
limit
Nursing
389
0.092
-0.442
0.626
Dental 98
-1.450
-1.873
-1.027
Dental Hygiene 58
1.191
0.711
1.671
Medical
131
-0.020
-0.287
0.247
Composite
676
0.107
-0.341
0.555
-4.00
-2.00
0.00
2.00
4.00
I2 = 89.7%
Cochrane p<0.001
Egger’s p=0.24
Lower Score
Higher Score
Oderda GM, Zavod RM, Carter JT, et al. An environmental scan on the status of critical thinking and problem solving skills in colleges/schools of pharmacy; report of the academic affairs standing committee. Am J Pharm Educ. 2010; 74(10):article S6.
American Association of Colleges of Pharmacy Center for Advancement of Pharmaceutical Education. Educational Outcomes, 1998.
Accreditation Council for Pharmacy Education. Accreditation standards and guidelines for the professional program in pharmacy leading to the doctor of pharmacy degree. Version 2.0 Effective February 14,
Nilson LB. Unlocking the mystery of critical thinking. Faculty Focus. December 1, 2014.
Acknowledgements
We sincerely thank the following people for their assistance with this systematic review
Translators: Drs. Gladys Yacila, Fatemah Karbaschi, Elias Bassil, Jisun Hwang
Librarian: Ms. Jodi Jameson, MLIS, AHIP
Significant heterogeneity was demonstrated in each composite group
(I2 >25% for all, which is expected with programs from different professions)
There were no significant findings from meta-regression of change with time