Coaching Winners: How to Teach Critical Thinking

Longview Community College, Lee's Summit, Missouri

Critical Thinking
Across the
Curriculum Project

Coaching Winners: How to Teach Critical Thinking

Contributed by Bonnie W. Duldt-Battey, Ph.D. RN
2921 Bellflower Drive
Antioch, CA 94531
Phone: 925-706-0442
Fax: 925-706-0621
Email: bwbattey@comcast.net
Adjunct Professor, School of Nursing
Samuel Merritt College, Oakland, Ca.
Website: http://www.samuelmerritt.edu/depts/nursing/duldt
(Author of SmartPrim - software for teaching Critical Thinking )

Coaching Winners: How to Teach Critical Thinking

There is a new twist to the ageless issue of who is to teach what, when, how, to whom, and with what effect. The new twist is critical thinking. We, the faculty (who), are to teach critical thinking (what) throughout the curriculum (when), somehow (how) to all health care professional students (to whom) so that the new practitioners will be able to function effectively and creatively (with what effect) in the changing arena of health care after the year 2000. Somehow or other, in a manner and by a method not stated, known, or clearly understood, we, the faculty, are to do this. As faculty, we are the very ones, to a significant degree, who are alumni of an educational system which historically has omitted the very thing we are now to teach. In fact, there is some research which shows that the critical thinking ability of the faculty was not significantly higher than that of their sophomore nursing students if age is statistically controlled as a factor.⁽¹⁾ Fortunately, most teachers are "renaissance" people who are talented in researching, learning, reviving, and adapting information to meet contemporary needs. We can do this. Somehow. The purpose of this paper is to propose a plan of action for meeting this new challenge. I am not suggesting it is the final answer, but merely an initial plan or guidelines which may help in developing your own unique plan appropriate to your situational needs.

National Standards

We need to follow national standards and expectations for academia generally. Too often in the history of nursing and other health professions, the focus has been too limited and internalized, so that in the end the product of our efforts is not recognizable or understood by academia and society generally. If the future in health care is to be as chaotic and turbulent with change as predicted, our graduates need to demonstrate readily recognizable behaviors and skills in order to flourish and achieve appropriate recognition for their capabilities.

The national standards have been set and guidelines established. There has been a progressive shift in focus in education in our country. Lipman states, ". . . the shift (is) from learning to thinking. We want students to think for themselves, and not merely to learn what other people have taught."⁽²⁾ The Educational Testing Service is administratively responsible for the National Assessment of Educational Progress (NAEP), which continually surveys the quality of American education. The NAEP reported in 1980 only 5 percent of the seventeen-year-old high school graduates could synthesize and learn from specialized reading materials. According to Ashworth, a director of NAEP, this group has yet to report improvement in higher order thinking skills over the past twenty years.⁽³⁾

The critical thinking educational focus has been strongly supported in public and political sectors. In the 1980's then-Governor Bill Clinton of Arkansas led the way by incorporating critical thinking in the National Governors' Association's recommendation for national educational goals. In 1990, then-President George Bush's administration adopted National Goals 2000, including critical thinking in education. The U. S. Department of Education established goals mandating critical thinking for all college graduates by the end of the century.⁽⁴⁾ Since the literature reflected that the very definition of critical thinking appeared diffuse and muddled, the American Philosophical Association (APA) conducted and published a Delphi research project to define critical thinking.⁽⁵⁾ Centers of critical thinking have been established to meet the new educational focus. The more distinguished of these is the Center for Critical Thinking, Sonoma State University.⁽⁶⁾ Associated with this Center is the Foundation for Critical Thinking. The National Council for Excellence in Critical Thinking has developed statements of policy and principles of critical thinking in order to distinguish between "pseudo critical thinking programs" which confuse and confound the problem.⁽⁷⁾

Nursing has been at the forefront of progress in this new focus. As early as 1986, the American Association of Colleges of Nursing presented a landmark national endeavor to defining the essential knowledge, practices and values of professional nurse education at the baccalaureate level. The first essential item listed in the report is as follows:

"1. Write, read, and speak English clearly and effectively in order to acquire knowledge,
convey and discuss ideas, evaluate information, and think critically." ⁽⁸⁾

In accord with this statement, the National League for Nursing (NLN) incorporated critical thinking into the outcome criteria for accreditation of nursing educational programs. Facione notes that specific guidelines are not given in the national mandate for assessing improved critical thinking in graduates and applying it to the context of nursing practice. While development of expert judgment would logically be analogous to clinical judgment, Facione identifies some theoretical concerns about this conceptual leap. Research seems to support the idea that critical thinking is as much a habit of mind as well as a "personal disposition to open-mindedness, inquisitiveness, and willingness to reconsider in light of new information."⁽⁹⁾ So, critical thinking is not only a skill of thinking but also a personal attribute.

According to O'Sullivan, et al., however nursing faculties are only beginning to consider the implications of this national standard and the NLN accreditation outcome criteria.⁽¹⁰⁾ Which definition of critical thinking is applicable in nursing is not yet clear. Teaching methods and means of assessment are also problematic for many faculties. Less than one-fourth of the faculties surveyed by O'Sullivan, et. al. are actively helping a faculty meet the criteria, i.e., establishing task forces, consultants, literature reviews, etc. In short, we have only just begun.

Who Teaches?

We need to start with the present nursing faculty. Accreditation expectations are such that nursing faculties must develop their own definitions of critical thinking, determine criteria, measure outcomes, and revise the curriculum in light of findings. Dexter, et al. provide an excellent source information about how to do this.⁽¹¹⁾ At Indiana University School of Nursing, this group of authors were members of a task force charged with developing a program of implementing critical thinking across four levels: associate, baccalaureate, masters and doctoral educational programs. The report of their efforts is an outstanding example of an approach to incorporating critical thinking into the curriculum. It can serve as a guide to nursing faculties.

Dexter et al. propose faculty need to be unified in their understanding of critical thinking as a concept, both theoretical and operational. The faculty also needs to achieve a consensus about methods and tools to be used for evaluation of critical thinking. In each case, Dexter, et al. choose to follow the national statements of critical thinking and make application in a manner that faculty could more readily utilize the theoretical information. For example, they accepted the APA Delphi study definition of critical thinking, a theoretical composite of multi-disciplinary perspectives. They applied this definition at the operational level for the six identified components, i.e., interpretation, analysis, evaluation, inference, explanation, and self-regulation. Competency outcomes were identified for each critical thinking component and for each differentiated level for each of the four educational programs. While standards differ at each educational level, Dexter, et. al state the faculty needs to have a consensus about what behaviors demonstrate each of the six components of critical thinking. While admittedly a "cookbook" approach to teaching critical thinking, Dexter, et al state they are seeking to raise the "average level of student instruction . . . " by faculty who are not specialists in critical thinking. Future problems of health care can be anticipated to be unstructured so that there is a high probability current patterns and contrived templates of thinking will tend not to fit. The change in focus to critical thinking needs to occur in a decentralized manner so that faculties are cognitively open to new paradigms and perspectives.

What to Teach?

I believe defining concepts and debating is the core of critical thinking. If one can investigate and so completely define a phenomenon and its label or word that names it, then one has acquired a substantial bit of knowledge. If one can also consider the association between two or more concepts and figure out how different conditions might be as a result of that association, then one has developed an argument, a position, or a stand suitable for a debate. This internal and personal process of defining phenomena, establishing criteria, evaluating information, and choosing what is probably true and "safe" to believe is essential to critical thinking. This involves the use of logic and inference. There is some research to support the notion that reasoning can be taught and that it is "possible to train such foundations of reasoning as how to use dimensions to analyze and organize similarities and differences and how to identify the structure of simple propositions."⁽¹²⁾ I propose that old fashioned, even ancient, foundations of logic and reasoning are a necessary knowledge base from which to build critical thinking skills.

I believe there are three sets of data teachers can use to determine the level of critical thinking of students. The most superficial level of "figuring things out" occurs at the verbal level; it's easy to say something. As faculty, we must listen to how students talk about their lessons. Next, it is a bit harder to read and understand how others "figured things out." As faculty, we must notice to how the students have interpreted what they have read. Finally, the hardest way to "figure things out" is to write what you think about something and present your thesis as a speech. As faculty we must look very carefully at the structure and substance of what students write and present orally regarding their lessons. If we are to be producing graduates who are able to function at a professional level, comparable to graduates of other scholarly disciplines, then these graduates' writing, reading, and speaking--just as indicated in the first item of the Essentials Report, and in the order cited--is of paramount importance. This provides significant information about graduates ability to critically think and needs to be considered a part of the outcome evidence necessary for curriculum evaluation. Our graduates need to be able to write well enough to be able to publish articles in our professional journals.

This means we need to provide instruction about writing and speaking skills which are specific and unique to our discipline. There is a substantial basis for this position to be

found in the literature. We can assume our nursing students are a part of our nation's decline in literacy. According to Allan, et al., literacy is defined as a "cognitive defect involving a lack of skills and strategies for managing routine tasks required by society such as reading comprehension and simple mathematical skills."⁽¹³⁾ As an author, editors have asked me to write a professional book at the ninth grade reading level to accommodate this literacy problem. I was appalled. Allan, et al., also note that writing is a means of acquiring knowledge, and in their article, they provide an extensive description of the educational paradigm of "writing to learn." It is becoming common to find that nursing faculties have already developed introductory courses which include strategies for success in nursing. One such nursing course has included reading, writing, and communication skills as well as study skills and math.

When to Teach

Since acquiring critical thinking habits and skills is generally believed to be learned over a long period of time, it would logically follow that critical thinking needs to be taught throughout the educational program. It would seem a good idea to start as early as possible in the program by requiring logic, debate, and speech courses as part of the liberal arts curriculum base. From personal experience, I know well the concern about the number of credits required for the degree, the costs per credit, and the diminishing rewards of extended programs in terms of attractiveness to potential students. It is not easy. There are advantages in incorporating the significant outcome variables within the nursing curriculum and courses in that nursing faculty are able to maintain "control" of course content vital to the profession. It is probably best to handle vital content within the discipline, particularly given the accreditation criteria and outcome evaluation processes.

How to Teach

The educational shift from learning to thinking is a shift in theories of how to teach. Paul and Binker have succinctly compared and contrasted these and use the labels didactic and critical.⁽¹⁴⁾ The dominant didactic theory of knowledge, learning and literacy is to teach students what to think so that they learn what the teachers know. In contrast, the emerging critical theory is to teach students how to think so that they can find their own way through the problems and concerns they meet in life. The students are to become individual repositories or centers for storing strategies and approaches for gathering, evaluating, and using information. This requires a new perspective of the faculty role. There are new ways to design the curriculum, courses, and teaching strategies.

While there are numerous articles and ideas about how to teach critical thinking, there is one which seems particularly outstanding. Chubinski has developed teaching strategies based on Richard Paul's theory of critical thinking.⁽¹⁵⁾ For each of the skills identified in the theory, Chubinski has developed a strategy for teaching that skill. The skills include "identifying the problem, deciphering the purpose, uncovering the assumptions, recognizing and using different paradigms, demonstrating different methods of reasoning, examining data, creating alternate solutions, and evaluating one's thinking to improve it." For example, in teaching students to uncover assumptions, Chubinski uses the "Shoe Owners" game. She presents a bunch of old work shoes to the students and asks them to describe the former owners. The students work individually first, and later in small groups to develop a description of the owners of the shoes. This is shared with the class. In the end, Chubinski reveals the real owner to the surprised students who were wrong or to the cheering correct students. The "bright red flowered, beach sandals of a nun" help dispel stereotypes. To teach how to recognize and use different paradigms, Chubinski uses "Paradigm Trades," which requires students to role play various characters in a 15 minute scene. After this, each student identifies the goal of the character played. There are other ideas found in the literature. Wink, another author, suggests using questioning.⁽¹⁶⁾ Brown and Sorrell suggest using clinical journals.⁽¹⁷⁾ Bell uses debating.⁽¹⁸⁾ Kyzer provides some excellent examples of lack of critical thinking which could be used as the basis of a class discussion.⁽¹⁹⁾

So, if faculties are to devise their own definition of critical thinking, then they might consider matching the conceptually derived and defined skill or competency required to specific teaching strategies used in their program. Theoretically, a faculty could develop a content map of critical thinking and be able to track how, when, and where critical thinking skills are being developed. This could assure achieving the desired curricula outcomes, particularly if linked to a well-designed evaluation plan. It takes a lot of work, but this kind of project is usually worth it in terms of development of faculty consensus, cohesiveness, and overall quality of education for the entire program.

How to Evaluate

The total plan for an evaluation of a curriculum or program has not changed too much in terms of pattern. One needs to start with the philosophy, theories, objectives, and major concepts. Critical thinking represents only one of many concepts which are trailed or interwoven throughout a total curriculum. Each concept may be subdivided into a set of elements or terms for specific application, and this seems to be true for critical thinking. The general principle here is to follow the theoretical definition of the concept and be consistent. As in most sports, in stepping out of bounds, points may be lost and penalties imposed. If you start with Benner's theory, then the categorized behavioral responses to nursing problems need to be used consistently throughout the teaching as well as evaluating.⁽²⁰⁾ These responses are, according to Facione, automatic, scripted, or reflective.⁽²¹⁾ However, if these are used, it is important to note that the automatic responses are just that, and the scripted are responses which have been well defined. Only the reflective response is relevant to critical thinking. If Benner's conceptual definitions are chosen, then the faculty need to stay within the boundaries of this. If, however, a faculty cannot tolerate defining clinical practice or judgment as consisting to a large degree of rote behaviors, then it would be appropriate to choose a different theory for critical thinking and clinical judgment.

In my own judgment, it will be best in the long term to go with the Delphi definition, which briefly is as follows:

"Critical thinking is the process of purposeful, self-regulatory judgment. This process gives reasoned consideration to evidence, contexts, conceptualizations, methods, and criteria."⁽²²⁾

In its complete document, this definition identifies two major areas of critical thinking. One is personal dispositions: truth seeking, open-mindedness, analyticity, systematicity, self-confidence, inquisitiveness and maturity. The second is that of skills: analysis, evaluation, inference, deductive and inductive reasoning. In the research and problem solving components of nursing there is a set of elements to be added: purpose, question or problem, evidence, conceptualization, interpretation, assumptions, perspectives, implications and consequences. And there is also a set of criteria for self/other evaluation of critical thinking: clarity, precision, specificity, accuracy, relevance, depth, breadth, and logical. Colucciello has combined the dispositions and skills with elements of research and criteria into a proposed conceptual model for evaluation of critical thinking in a program.⁽²³⁾ Colucciello also compares and contrasts tools for assessing critical thinking and ultimately uses the California Critical Thinking Skills Test (CCTST) and the California Critical Thinking Disposition Inventory (CCTDI) in her research. Her conceptual model for evaluation of critical thinking seems to me to have melded into one conceptually consistent approach the Delphi definition, the essential knowledge and values identified in the Essentials Report, and the CCTST and CCTDI evaluation tools. If most nursing education programs used this approach from implementation to evaluation of critical thinking, the outcome data would tend to be meaningful from a conceptual perspective as well as allowing easier comparisons between programs and groups.

Conclusion

The purpose of this paper is to propose a plan of action for meeting this current challenge in nursing education--teaching students not to learn, but to think. I have merely suggested an initial plan and perhaps some guidelines which may be useful in constructing a plan appropriate to your faculty's needs. Sending a faculty member off to critical thinking "charm school" workshops or using a computer assisted instructional program (CAI) and manuals such as SmartPrim will help. However, the administrators, individual faculty members and students, the books and CAI's, and even a consultant and an evaluation expert cannot stand alone. Faculties need time to study and plan together to achieve consensus and cohesiveness. They need to support and applaud one another as each one succeeds in the necessary revisions of courses and changes in their own teaching paradigms and perspectives.

References

1. Saarman, L., Freitas, L., Rapps, J., and Riegel, B. (1992). The relationship of education to critical thinking ability and values among nurses: Socialization into professional nursing. Journal of Professional Nursing, 8(1), 26-34.

2. Lipman, Matthew, Director, Institute for the Advancement of Philosophy for Children, as quoted in: Ashworth Kent (1990). FOCUS: Critical thinking: Critical issues (24 ed.). Princeton, New Jersey: Educational Testing Services., p. 1.

3. Ashworth Kent (1990). FOCUS: Critical thinking: Critical issues (24 ed.). Princeton, New Jersey: Educational Testing Services.

4. National Goals for Education (1990). State of the union address: President George Bush. Washington D.C.: United States Department of Education Goal for the year 2000.

5. The American Philosophical Association (APA) (1990). Critical thinking: A statement of expert consensus for purposes of educational assessment and instruction, recommendations prepared for the committee on pre-college philosophy. : ERIC Doc. No. ED 315-423.

6. Paul, Richard (1994). What are intellectual standards? Educational Vision: The Magazine for Critical Thinking, 2(1), 10.

7. See Appendix D, pp 370-38 of the SmartPrim Instructor's Manual for the NCECT statement.

8. Johnson, Betty M., Project Director (1986). Essentials of College and University Education for Professional Nursing: Final Report. Washington, D. C.: American Association of Colleges of Nursing.

9. Facione, Noreen C. (1995). Critical thinking and clinical judgment: Goals 2000 for nursing science. A paper presented at the Annual Meeting of the Western Institute of Nursing., San Diego, California. (http://www.calpress/nurse2000.html.com)

10. O'Sullivan, P.S., Blevins-Stephens, W. L., Smith, F. M., & Vaughan-Wrobel, B. (1997). Addressing the National League for Nursing critical-thinking outcome. Nurse Educator, 22(1), 23-29.

11. Dexter, P., Applegate, M., Backer, J., Claytor, K, Keffer, J., Norton, B., and Ross, B. (1997). A proposed framework for teaching and evaluating critical thinking in nursing.. Journal of Professional Nursing, 13(3), 160-167.

12. Nisbett, Richard E., Fong, Geoffrey T., Lehman, Darrin R., and Cheng, Patricia W. (1987). Teaching Reasoning. Science, 238, 625-631.

13. Allen, David G., Bowers, Barbara, and Diekelmann, Nancy (1989). Writing to learn: A reconceptualization of thinking and writing in the nursing curriculum. Journal of Nursing Education, 28(1), 6-11.

14. Paul, Richard W. and Binker, A. J. A. (1992). Two conflicting theories of knowledge, learning, and literacy: The didactic and the critical. The Twelfth International Conference on Critical Thinking and Educational Reform, Center for Critical Thinking & Moral Critique, Sonoma State University, Rohnert Park, Ca.

(Note: See their statement in this manual, Appendix G.)

15. Chubinski, Suzanne (1996). Creative critical-thinking strategies. Nurse Educator, 21(6), 23-27.

16. Wink, Diane M. (1993). Using Questioning as a Teaching Strategy. Nurse Educator, 18(5), 11-15.

17. Brown, Hazel N., and Sorrell, Jeanne M. (1993). Use of Clinical Journals to Enhance Critical Thinking. Nurse Educator, 18(5), 16-19.

18. Bell, Eunice A. (1991). Debate: A Strategy for Teaching Critical Thinking. Nurse Educator, 16(2), 6-7.

19. Kyzer, Susan Park (1996). Sharpening your critical thinking skills. Orthopaedic Nursing, 15(6), 96-75.

20. Benner, Patricia. (1984). From novice to expert. Menlo Park, California: Addison-Wesley Publishing Company.

21. Facione, Noreen C. (1995). Critical thinking and clinical judgment: Goals 2000 for nursing science, p. 4.

22. American Philosophical Association (1990). Critical thinking: A statement of expert consensus. . . .

23. Colucciello, Margaret L. (1997). Critical thinking skills and dispositions of baccalaureate nursing students--a conceptual model for evaluation.. Journal of Professional Nursing, 13(4), 236-245.

Copyright © 1997, Bonnie Weaver Duldt, PhD., RN.
Critical Thinking Across the Curriculum Project
Longview Community College , Lee's Summit, Missouri - U.S.A.
One of the Metropolitan Community Colleges
"Where a Smart Future Begins"
An Equal Opportunity/Affirmative Action Employer
Inquiries to: connelly@longview.cc.mo.us or bduldt@rma.edu

Last modified: 8/175/04