Critical Thinking _________________________________________________________

CRITICAL THINKING
The Importance of Thinking Critically for Medical Student
Nawi Ng
Department of Public Health
Faculty of Medicine
Gadjah Mada University
An example of Critical Thinking at Work: Why is a fire engine red?
A fire engine has four wheels and four firemen Four plus four is eight.
Eight inches make a rulerOne of the greatest rulers was Queen Elizabeth.
She knighted drake, who sailed the Seven Seas.
In the Seven Seas are fishesAnd fishes have fins
The Finns fought the Russians.And the Russian flag is red !!
Therefore, I conclude, the fire engine is red.
(Quoted from The Effective Student, National University of Singapore)

Objective
1. To understand critical thinking and its application in medical
setting.
2. To identify critical thinking characteristics
3. To comprehend critical thinking and clinical reasoning skills and
their relation to evidence-based medicine.

What is Critical Thinking?

In problem-based-learning (PBL) approach, tutorial should be viewed as
a process of developing and enhancing students ability to learn. A tutor
is not designated to transmit information, but to serve as a facilitator
for learning. This role involves creating and managing meaningful
learning experiences and stimulating students thinking through real
world problems. Students are assigned to work in small discussion
groups. The soul of PBL is seven jumps strategy by which mean
students will work through and discuss a scenario. Throughout the
scenario students will be exposed to facts and problems. As the
discussion progresses, students are expected to come up with several
hypotheses which they have to prioritize and decide upon. All these
processes require critical thinking and reasoning skills.

Solving problems in
problem-based-learning
approach needs critical
thinking and reasoning
skills.

Critical thinking is not essentially the same as reasoning skills.

Reasoning skills is necessary for the development of critical thinking
skills, but it is not sufficient. Reasoning skills is defined as the ability to
use facts, evidence, logical conclusions, and good common sense to
justify a decision or course of action, while critical thinking is defined as
skills to carefully considering a problem, question or situation to
determine the best solution (Chelsa, 1999). For different definitions of
critical thinking, see Tices paper.

Critical thinking is a
decision-making process.

Reasoning skills will guide us to use our good common sense and base
our reasons to do things in facts, evidence, and logical conclusion
rather than our emotion. Medical students are of no doubt need to
practice their reasoning skills. Any decision made should be based
objectively on facts, problems, and evidence from patients. Decision on
patient management should be taken logically instead of emotionally.

A reason is a justification
for thoughts, actions, and
opinions.

Medical students need to

develop their clinical
reasoning skills.

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Therefore, specifically medical students need to practice their clinical
reasoning skills from their earliest year.
By thinking critically, it means that students have to consider all sides
of a problem, carefully evaluate any evidence available, and
hypothesize different possible scenarios and outcomes. Critical thinking
will help us determine how to get from the problem to the solution,
while reasoning skills ensure that our solution makes good and logical
sense (Chelsa, 1999).

We need critical thinking

and reasoning skill to
come up with a good and
logical solution.

What are The Characteristics of Critical Thinker?

Ennis (1987) described several characteristics of a critical thinker:

Seeks a clear statement of the thesis or question. A critical thinker

A critical thinker is willing to examine beliefs, assumptions, and
opinions and weigh them against facts

Seeks reasons and suspends judgment until all facts have been
gathered and considered. A critical thinker always looks for
evidence to support assumption and beliefs. He looks for proof and
examines problems closely

Tries to be well informed and use and mention credible sources.

Takes into account the total situation. Being critical means that one
is able to clearly define a set of criteria for analyzing ideas

Tries to remain relevant to the main point and always ask pertinent
questions. A critical thinker is able to reject information that is
incorrect or irrelevant and always keep in mind the original concern

Looks for alternatives or new solution and always being curious.

Be open-minded and able to admit a lack of understanding or

information. A critical thinker listens carefully to others and is able
to give feedback

Takes a position (and change a position) when the evidence and

reasons are sufficient to do so.

Seeks as much precision as the subject permits

Deals in an orderly manner with the parts of a complex whole

Uses one's critical thinking abilities, a critical thinker always assess

statements and arguments.

Be sensitive to the feelings, level of knowledge, and degree of

sophistication of others

A critical thinker :
Make judgment on
evidence instead of
emotion
Ask question and being
curious
Intellectually independent
Being honest and openminded
Explore all possibilities
and connection between
situations
Never oversimplify
complex problems
Is able to argue and
present sound point of
view

Source: Robert H. Ennis. "A Taxonomy of Critical Thinking Dispositions and

Abilities" in Teaching Thinking Skills: Theory and Practice; eds. Joan Boykoff
Baron and Robert J. Sternberg. Freeman, 1987.

Collaborative learning has been proven as a better learning method for

students to reach their academic goal compared to individual learning.
In an experimental study comparing individual learning and
collaborative learning, Gokhale (1995) found that collaborative learning
enhanced students achievement in test comprised of both drill-andpractice and critical-thinking items. Drill-and-practice items are items
that pertain to factual knowledge and comprehension of the concepts.
Critical-thinking items are items that involve analysis, synthesis, and
evaluation of the concepts. Though both learning strategies were found
to be equally effective in gaining factual knowledge, collaborative
learning is more superior to foster the development of critical thinking

Collaborative learning is
superior to individual
learning.
Collaborative learning
enhances drill-and
practice and critical
thinking skills.

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and problem-solving skills through discussion, clarification of ideas, and
evaluation of others idea.

Components of Critical Thinking

Different learning theorists present different activities that comprise
critical thinking. There are series of activities that lead one to think
critically, among which are:

Activities lead to think

critically:

1. Observation. Being aware of a phenomenon, we do a series of

observation from which we can establish facts.

Exploring facts

Doing observation
Making inferences

2. Facts. Whether the facts are either present or absent, we make

inferences.

Stating assumptions

3. Inferences. When we try to generalize our inferences, we are

actually testing the validity of our inferences. By making
inferences we can make assumptions.

Developing arguments

4. Assumptions. Based on our assumptions, we form our opinions.

Forming opinions
Analyze arguments
critically

5. Opinions. Taking our opinions and based on the principle of

logic, we develop arguments.
6. Arguments. Confronting our arguments with others, we have to
analyze all the arguments critically.
7. Critical analysis. With critically analysis we challenge any
observations, facts, inferences, assumptions, opinions, and
arguments.

Blooms Taxonomy of Higher Level of Thinking

There are different models of critical thinking proposed by different
learning theorists. One of the most well-known models is model
proposed by Bloom (Blooms Taxonomy of Higher Level of Thinking).
Bloom categorized high level of thinking into six different processes:

Blooms Taxonomy of
Higher Level of Thinking:

1. Knowledge. To know something means to identify and to recall

information or facts. When we know something, we can answer
the descriptive questions such as where, when, how, etc.

Application

2. Comprehension. To comprehend something means to organize

different facts and ideas in order to understand them. When we
comprehend something, we can retell the phenomenon and can
state the main idea/problems.
3. Application. To apply something means to find some practical
use of facts, rules, and principles.

Knowledge
Comprehension
Analysis
Synthesis
Evaluation
These higher levels of
thinking are hierarchal in
order.

4. Analysis. To analyze means to break down ideas/problems into

component parts.
5. Synthesis. To synthesize means to combine the whole ideas to
form a new whole, and to connect prior knowledge that we
have with other knowledge.
6. Evaluation. To evaluate means to develop opinions, judgments,
or decisions.
These levels of thinking are hierarchal in order, meaning that one must
master and experience one process before he can move on to the next.

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Therefore one should practice lower critically thinking skill before moves
to the more difficult or higher thinking level.
Almost everyone exposes to problems everyday. Problems can arise
from crisis or conflict on any issues. One has to have the skills to solve
problem. Medical student and medical doctor will expose to problem in
their daily activities, and in that situation a decision should be made.
Decision making and clinical reasoning are important skills that every
medical undergraduate should be proficient. Problem solving is basically
a decision making process.
Problem solving can be structured into following steps:

Problem solving is
basically a decision
making process.

Steps in Problem Solving:

1. Identifying problem - Problem at hand should be identified in

order to focus on primary issues.

1. Identifying
problems

2. Breaking problem into its part - Identified problem should be

broken into smaller pieces in order to make the problem more
manageable and to address things that need to be done. One
have to separate different issues dealt with.

2. Breaking problem
into its part

3. Prioritizing issues - One should list and rank issues that need to
be addressed. Ranking issues will enable one to see if there is
any issue that should be dealt with before others.

3. Prioritizing issues
4. Relevance of
issues

4. Relevance of issues - One should see the relevance of issues

based on common sense and ones ability to see any logical
connections between issues.
In order to be able to solve problem effectively, a medical student
should know at least comprehend three following items: critical
thinking, clinical reasoning and evidence based medicine.
Thinking critically means that one should adopt an inquisitive and
questioning attitude and apply rational processes in thinking. One
should also be open-minded, and always balance the importance of
his value judgments and those of patients.
Clinical reasoning means one should be able to recognize and define
the problem, analyze and interpret information and cope with
limitations of information and personal limitations.
Practicing evidence based medicine means one should seek the best
available evidence and keep up-to-date. Based on evidence-based
medicine one should recognize facts and variation in clinical
practice. Medical student should be able to analyze and interpret
clinical evidence and works with guidelines and protocols.

Conclusion: Critical thinking is skillful, responsible thinking that

facilitates good judgment because it (1) relies upon criteria, (2) is selfcorrecting, and (3) is sensitive to context. It is well-founded, structured,
and reinforced thinking. Medical student should be able to think
critically and make clinical reasoning. The ability to do so will enhance
their capability in teaching and learning process, and their practice in
evidence-based medicine.

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Exercise (Brain-teaser: Critical thinking and Logical reasoning)

1. Three women--named Dana, Alex, and Jean, all Business majors--signed up for a critical
thinking class at San Jose State at the same time as three men--also named Dana, Alex, and
Jean--did. The three men are majoring in English, Engineering, and Nursing, though not
necessarily in that order. Given the following information, can you assign the correct name to
each of those majors?
Jean lives in San Francisco with her mother.
The Engineering major lives on the peninsula, exactly halfway between San Jose and
San Francisco.
Alex is joined in studying at San Jose State by both of her brothers.
The woman who lives nearest the Engineering major has three times as many
brothers as he does.
The women with the same name as the Engineering major lives in San Jose.
Dana says he is smarter than the English major.
2. The newspaper listed the daily high and low temperatures for four cities (Philadelphia, New
York City, Helsinki, and Atlanta). The high temperatures were: eight degrees Celsius,
seventeen degrees Celsius, twenty-three degrees Celsius, and negative nine degrees Celsius.
The low temperatures were: one degree Celsius, negative sixteen degrees Celsius, fifteen
degrees Celsius, and nineteen degrees Celsius. Figure out the high and low temperature for
each city.
Helsinki had the lowest low temperature of the day.
Philadelphia's low temperature of the day was thirty-one degrees Celsius warmer than
Helsinki's low temperature of the day.
Philadelphia's high temperature of the day was warmer than eight degrees Celsius.
The difference between New York City's high and low temperature was seven degrees
Celsius.
Atlanta's high temperature was not negative nine degrees Celsius.
Atlanta's high temperature was not seventeen degrees Celsius.
3. Triangulating on Triangles.

How many triangles are there in this figure?

Reference

C
I

1. Gokhale AA.. 1995. Collaborative Learning Enhances Critical Thinking. Journal of Technology
Education 7(1). Available at http://scholar.lib.vt.edu.
2. Tice ET. What is Critical Thinking? University of Phoenix.
3. Chelsa E. 1999. Critical Thinking and Logic Skills for College Students. Prentice Hall, London.
4. National University of Singapore. 2001. The Effective Student: A Guide to Higher Education at
NUS. 8th Edition. Centre for Development of Teaching and Learning. National University of
Singapore. Singapore.

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5. Scannell EE and Newstrom JW. 1991. Still More Games Trainers Play. Mc. Graw-Hill, Inc. New
York.

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