Академический Документы
Профессиональный Документы
Культура Документы
CriticalThinking
LearnedorInherent?
JakeECarroll,Th.D;M.B.A.;B.MIN;NREMTP;TNEMSInstructor/Coordinator
y, , ; / ; g
JohnSHolloway,Sr.,M.B.A.;FF/NREMTP;TNEMSProgramDirector
Disclaimer
This
Thi presentation
t ti i a compilation
is il ti off research,
h
review experience,
review, experience and professional perceptions.
perceptions
Our intention is to provide an overview of
principles, not a lone solution, but requiring
further research, review, and trial by participants
i their
in th i unique
i workk environment.
i t
CriticalThinking,Holloway/Carroll,Nov2013 2
Overview
CriticalThinking,Holloway/Carroll,Nov
3
2013
Objectives
1 U
1. Understandthethreecorecomponentsanddefinitionsof
d t d th th t d d fi iti f
criticalthinking.
2. DifferentiatebetweenanEMSTechnicianandtheEMS
Clinician.
3. Developingadifferentialdiagnosisandpatientcareplans
utilizing critical thinking.
utilizingcriticalthinking.
4. Formulatepractical,educationallysoundobjectivesto
assistwithimplementingandevaluatingcriticalthinking.
CriticalThinking,Holloway/Carroll,Nov
4
2013
Sections
1. Introduction,OverviewandDefinitions
2. TechnicianorClinician
3 DevelopingDifferentialDiagnosisand
3. l i iff i l i i d
PatientCarePlans
4. TeachingCriticalThinking
CriticalThinking,Holloway/Carroll,Nov
5
2013
SectionOne
INTRODUCTIONS,
OVERVIEWAND DEFINITIONS
CriticalThinking,Holloway/Carroll,Nov
6
2013
Definitions
CriticalThinkingisaCONCEPT(1of4)
Amodeofthinkingaboutanysubject,contentorprobleminwhich
thethinkerimprovesthequalityoftheirthinkingbyskillfullytaking
charge of the structures inherent in thinking and imposing intellectual
chargeofthestructuresinherentinthinkingandimposingintellectual
standardsuponthem
Is
Isself
selfdirected,
directed,self
selfdisciplined,
disciplined,self
selfmotivated,
motivated,andself
and selfcorrective
corrective
thinking
Involveseffectivecommunicationandproblemsolvingabilities
Involves effective communication and problem solving abilities
Ismorethanaprocess itisamindset
IsHigherLevelThinking
CriticalThinking,Holloway/Carroll,Nov2013 7
Istheintellectuallydisciplinedprocessofactively
Is the intellectually disciplined process of actively
andskillfullyconceptualizing,applying,analyzing,
synthesizing, and or evaluating information
synthesizing,andorevaluatinginformation
gatheredfromorgeneratedbyobservation,
experience, reflection, reasoning, communication,
experience,reflection,reasoning,communication,
orthepatientassessmentprocess
Isneveruniversalfromoneindividualtoanother
i di id l
individual
CriticalThinking,Holloway/Carroll,Nov
8
2013
Is
Isgreatlydependantuponthequalityanddepth
greatly dependant upon the quality and depth
ofexperienceinagivendomainofthinking
Nooneisacriticalthinkerthroughandthrough
forweallhavetendenciestodisplayirrational
thoughtorundisciplinedthoughtpatterns
g p g p
ht Critical
EExcellentinthought
ll t i th C iti l Thinking
Thi ki must
t
besystematicallycultivated
CriticalThinking,Holloway/Carroll,Nov
9
2013
It is for the aforementioned reasons, the
di
dispositions
ii is
i a lif
life-long
l endeavor.
d
CriticalThinking,Holloway/Carroll,Nov
10
2013
CriticalThinking,Holloway/Carroll,Nov
11
2013
SectionTwo
TECHNICIANORCLINICIAN?
CriticalThinking,Holloway/Carroll,Nov
12
2013
TheCriticalThinker
Raisesvitalquestionsandproblems,formulatingthemclearly
and precisely
andprecisely
Gathersandassessrelevantinformation,usingabstractideas
tointerpretiteffectivelycomestowellreasonedconclusions
andsolutions,testingthemagainstrelevantcriteriaand
standards
Thinksopenmindedlywithinalternativesystemsofthought,
recognizingandassessing,asneedbe,theirassumptions,
implications,andpracticalconsequences;and
Communicateseffectivelywithothersinfiguringoutsolutions
tocomplexproblems
CriticalThinking,Holloway/Carroll,Nov
13
2013
EMT As A Technician
EMTAsATechnician
Notexpectedtousehighlevelsofreasoning
skills
Protocoldriven linearfollowers
Responds
Respondstopatientwhencertainoragroupofsignsor
to patient when certain or a group of signs or
symptomsarepresent
Examples:
E l
CriticalThinking,Holloway/Carroll,Nov
14
2013
EMT As A Clinician ACriticalThinker
EMTAsAClinician A Critical Thinker
Appliesclinicalreasoningtoapatient
DifferentialDiagnosis
g
UsesAnalysisoftheeventbaseduponknowledge,
comprehension and application of sound medical
comprehensionandapplicationofsoundmedical
principles
CriticalThinking,Holloway/Carroll,Nov
15
2013
In Essence
InEssence.
The critical thinker uses the differential diagnosis
process:
considers a variety of possible causes, to
determine a number of intervention possibilities waying
the expected outcomes against the potential risks/side
effects then
effects,
formulates the most beneficial intervention that will best
improve the patient outcome
CriticalThinking,Holloway/Carroll,Nov
16
2013
The Critical Thinking Process
TheCriticalThinkingProcess
ISNOT:
limitedtoadvancedlevelproviders,or
basedonlicenselevel
IS:
Drivenbysoundinitialtraining,followedupwith
Fundamentalclinicalmentoring,and
Fundamental clinical mentoring and
Qualitycontinuingeducation,plus
Fieldexperienceand
Fi ld i d apositivecontinuousquality
iti ti lit
improvementprogram
CriticalThinking,Holloway/Carroll,Nov
17
2013
SectionThree
DEVELOPING
DIFFERENTIALDIAGNOSIS
AND
PATIENT CARE PLANS
PATIENTCAREPLANS
CriticalThinking,Holloway/Carroll,Nov
18
2013
Critical Thinking V Care Plans
CriticalThinkingV.CarePlans
FourStepstoDevelopingCriticalThinking
Knowledge
Comprehension
p
Application
Analysis
CriticalThinking,Holloway/Carroll,Nov
19
2013
FourStepstoDevelopingCriticalThinkingHabits
1 Knowledge
1.Knowledge
Identificationandrecall
Signsandsymptomsofchestpain
d f h
Midsternal chestpressure
Dyspnea
Nausea
Painradiatingdownthearm
g
Onsetandduration
CriticalThinking,Holloway/Carroll,Nov
20
2013
FourStepstoDevelopingCriticalThinkingHabits
2 Comprehension
2.Comprehension
Abilitytointerpretandparaphrase
Ex:abilitytointerpretthesignsandsymptomsand
bl h d d
explainthephysiologicalprocess
WHY
WHYthepatientisdisplayingthesignsandsymptoms
the patient is displaying the signs and symptoms
ExplainthedifferencebetweenHeartAttack,Angina,Anxiety,
Indigestion,
CriticalThinking,Holloway/Carroll,Nov
21
2013
FourStepstoDevelopingCriticalThinkingHabits
3 Application
3.Application
Useallknowledge,information,andexperienceto
d t
determineadditionalinformation,solveany
i dditi li f ti l
problemsandexplainactions
PrescribedNTGandmaxd
b d d d out,extensivecardiacHx,is
d
obese,withdiabetes,HTN,CVA6yrsago,COPD,
smoker regular use of alcohol and has no feeling in
smoker,regularuseofalcohol,andhasnofeelingin
rightfoot.
CriticalThinking,Holloway/Carroll,Nov
22
2013
FourStepstoDevelopingCriticalThinkingHabits
4 Analysis
4.Analysis
Prioritizeandinitiateappropriatetreatment
PrescribedNTGandmaxd
b d d d out,extensivecardiacHx,is
d
obese,diabetes,HTN,priorCVA,COPD,smoker,regular
use of alcohol and has no feeling in right foot
useofalcohol,andhasnofeelinginrightfoot.
Developatreatmentcareplanbaseduponcritical
thinking skills/applications
thinkingskills/applications
CriticalThinking,Holloway/Carroll,Nov
23
2013
CriticalThinking,Holloway/Carroll,Nov
24
2013
SectionFour
TEACHINGCRITICALTHINKING
CriticalThinking,Holloway/Carroll,Nov
25
2013
Simulation and Scenarios
SimulationandScenarios
Includeroleplayingofrealisticsituations
l d l l i f li i i i
Realpatientactorswithmoulage,makeup,
b k
backgroundnoise,bystanders
d i b t d
Realprops
Respondingcrewwithequipment,supplies,and
R di ih i li d
radios
Realisticenvironments
Realistic environments
Elevators,stairwells
Cars,trucks,trains,busses,ATVs,etc
Cars trucks trains busses ATVs etc
Allowsstudentstomakemistakesinaclean
environment
CriticalThinking,Holloway/Carroll,Nov
26
2013
Classroom
Beginclasswithcasestudiesorscenarios
Askstudentstosummarizelessons
Ask students to summarize lessons
Assignorallowstudenttochooseatopic,
researchit,presentiteitherfromaproorcon,
hi i ih f
andhavethemdefendchoice.
Onetopicfortwostudents;onepro,theothercon
Summative
Summativeevaluations:allchoicesshouldbe
evaluations: all choices should be
reasonablyclosebutonlyoneismostcorrect.
CriticalThinking,Holloway/Carroll,Nov
27
2013
Socratic Method
SocraticMethod
Constantuseandimplementation
Presentacasewhereaconceptisillustrated
Studentsworktooperationalize
Students work to operationalize
Whataretheissues?
Whatareotheroptions?
Wh t th ti ?
Whydidthestudentchoose____?
Canthestudentproveorprovideevidencefor
theirdecision?
Howcanthisbeevaluatedfor
correctness/accuracy?
CriticalThinking,Holloway/Carroll,Nov
28
2013
Summary
Criticalthinkingisaconcept
Issystematicallycultivatedfrominitialtrainingthrough
field experience with QA/CQI followthrough
fieldexperiencewithQA/CQIfollow through
Acriticalthinkerisselfdirected,selfdisciplined,self
, p ,
motivated,andselfcorrective
EMSeducatorsandinstructorsshouldin fusethe
educationstandardswithcomplexscenariosand
problems to stimulate students'criticalthinkingand
problemstostimulatestudents critical thinking and
problemsolving development.
CriticalThinking,Holloway/Carroll,Nov
29
2013
Questions?
CriticalThinking,Holloway/Carroll,Nov
30
2013
References
NationalGuidelinesforeducatingEMSInstructors,August2002.
FoundationsofEducation:AnEMSApproach,2nd Edition,National
AssociationofEMSEducators.
Amuradha,G.(1995).Collaborativelearningenhancescriticalthinking.
JournalofTechnologyEducation,7(1),2230
Croskerry,P.(2000).Thecognitiveimperative:Thinkingabouthowethink.
A d i E
AcademicEmergencyMedicine,7(11),12231231.
M di i 7(11) 1223 1231
Croskerry,P.(2003).Cognitiveforcingstrategiesinclinicaldecisionmaking.
AnnalsofEmergencyMedicine,41(1),160167.
Duron,R.,Limbach,B.,&Waugh,W.(2006).Criticalthinkingframework
D R Li b h B & W h W (2006) C iti l thi ki f k
foranydiscipline.InternationalJournalofTeachingandLearninginHigher
Education,17(2),160166.
Gilboy,N.,&Kane,D.(2004).Unfoldingcasebasedscenarios:Amethodof
Gilboy N & Kane D (2004) Unfolding case based scenarios: A method of
teachingandtestingthecriticalthinkingskillsofnewlylicensednurses.
NurseEducator,30(1),8385.
Wagner,D.,Bear,M,.&Sander,J.(2009).Turningsimulationintoreality:
Wagner, D., Bear, M,. & Sander, J. (2009). Turning simulation into reality:
Increasingstudentcompetenceandconfidence.JournalofNursing
education,48(8),465467.
CriticalThinking,Holloway/Carroll,Nov
31
2013