Teaching critical thinking skills

Patrina Caldwell, Dave Crick, Lesley Dawson, Janet Healey,

Olufemi Olowookere

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© PRIME Partnerships in International Medical Education

Today we will cover…

• How do we make decisions as health care professionals (HCP)?
• What is evidence-based practice (EBP)?
• How evidence-based practice promotes critical thinking
• Teaching evidence-based practice in different cultures
• How does evidence-based practice promote Kingdom values?

Why?

• In health care, why do we believe what we believe?
• Why do we do what we do (in assessment, diagnosis and management etc) ?

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• What is (or isn’t) Evidence-Based Practice?

(In pairs, discuss this for 5 minutes and put it on a “Post-it” note)

History of evidence- based practice

• The term ‘evidence-based medicine’ (Gordon Guyatt, 1991): shifted “emphasis in clinical decision-making from ‘intuition, unsystematic clinical experience, and pathophysiologic rationale’ to scientific, clinically relevant research” https://journalofethics.ama-assn.org/article/evidence-based-medicine-short-history-modern-medical-movement/2013-01
• EBM = asking + searching for best evidence + appraising + put in practice
• EBP = incorporating clinical expertise, patient values and scientific evidence.
• In 1996, Sackett used the term “evidence-based medicine” and “evidence-based practice” interchangeably. https://doi.org/10.1136/bmj.312.7023.71
• Today “evidence-based medicine”, “evidence-based practice” and “evidence-based healthcare” are used interchangeably to denote the interdisciplinary nature of the concept used in the fields of allied health, psychology and education.

https://www.ciap.health.nsw.gov.au/training/ebp-learning-modules/module1/history-of-evidence-based-practice.html

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Why is critical thinking important?

• Evidence-based practice (EBP) leads to critical thinking.
• Particularly in today’s world of generative AI and ChatGPT, there is a growing need for critical thinking by health care professionals (HCP).
• Why is critical thinking important? (call out)

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Evidence based practice

• The Sicily Statement summarises the 5 steps of evidence-based practice as:
• 1. Translation of uncertainty to an answerable question;
• 2. Systematic retrieval of best evidence available;
• 3. Critical appraisal of evidence for validity, clinical relevance and applicability;
• 4. Application of results in practice and
• 5. evaluation of performance

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Dawes M, Summerskill W, Glasziou P, Cartabellotta A, Martin J, Hopayian K, et al. Sicily statement on evidence-based practice. BMC Med Educ. 2005;5:1-7.

Translation of uncertainty to an answerable question + systematic retrieval of best evidence

• PICO (Population, Intervention, Comparitor, Outcome)
• In Pubmed > 36 million citations for biomedical literature from MEDLINE, life science journals, and online books.
• using Boolean terms such as AND, OR, NOT

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Using PICO to search Pubmed find the answer to a clinical question: (live demo)

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https://pubmed.ncbi.nlm.nih.gov/

• Demonstration

children with gastroenteritis and dehydration in Africa AND oral rehydration solution AND intravenous

Evidence based practice

• The Sicily Statement summarises the 5 steps of evidence-based practice as:
• 1. Translation of uncertainty to an answerable question;
• 2. Systematic retrieval of best evidence available;
• 3. Critical appraisal of evidence for validity, clinical relevance and applicability;
• 4. Application of results in practice and
• 5. evaluation of performance

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Dawes M, Summerskill W, Glasziou P, Cartabellotta A, Martin J, Hopayian K, et al. Sicily statement on evidence-based practice. BMC Med Educ. 2005;5:1-7.

Critical appraisal tools

• CASP (Critical appraisal skills program) checklists for 8 different study types (SR, qualitative studies, RCTs, Case Control Studies, diagnostic studies, cohort studies, economic evaluation, clinical prediction rule)
• Joanna Briggs Institute: Critical Appraisal Tools for 13 different studies types including analytical cross- sectional studies, case report and case series, prevalence studies, quasi-experimental studies, texts and opinions.

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• ROBINS – I – tool (risk of bias tool in non-randomised studies of interventions)
• NOS (Newcastle-Ottawa Scale) – for observational studies (eg case control, cohort studies)
• AMSTAR (A measurement tool to assess systematic reviews) – appraises systematic review of RCTs
• AMSTAR2 – appraises systematic review including SR of non-randomised studies
• Cochrane RoB tool, RoB 2.0 tool – for RCTs

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Many settings have hierarchical teaching cultures that are unwilling to adapt to new ideas

Discuss in small groups your experience with this issue

Teaching in different cultures

• In different cultures, we often encounter:
• different ways health care professional (HCP) students are taught
• didactic lecture style, problem-based learning, interactive group work
• Students’ acceptance of what they have been told
• Honour-shame culture (fear of shame)
• Secular, individualistic approach
• Hierarchical structure

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Why promote critical thinking

• In places where health care is didactically taught, the practice of health care is rules driven rather than evidence based
• The Lancet report recommends that “memorisation of facts be replaced with critical reasoning that can guide the capacity to search, analyse, assess and synthesize information for decision-making”
• Can improving health care professionals’ competency in critical thinking result in better healthcare?
• What do you think could be the results of promoting critical thinking?

Group work

• Discuss in small groups how people may respond to learning about evidence-based practice and critical thinking and suggestions to address these issues? (10 minutes)
• (Femi share then Nominal group feedback – 10 minutes)

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How does teaching EBP promote kingdom values?

• Truth seeking – evidence base for action
• Application of knowledge – wisdom
• Stewardship of resources
• Valuing people – made in God’s image
• Pursue of excellence

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Thank you

Any questions?