Critical thinking: Why does it matter?

Critical thinking skills are holistic

Critical thinking skills apply to all areas of life and learning (Facione, 1998). As I mentioned in an earlier post, being able and willing to thinking critically enables to make informed decisions after considering all relevant information and my personal assumptions or biases. Life doesn't come with easy answers and rarely is the answer 100% correct. Even a "simple" choice such as where to eat for lunch may require consideration of different factors including cost, location, type of food, hours of operation, etc. Or consider a more complex situation such as politics. Everyday we can choose to be inundated with a variety of information related to current events and politics, yet the specific content varies widely based on the source (even when the content is supposedly covering the same story). This is highlighted in the opinion of Heltzel and Laurin (2020) who describe a lack of critical thinking (e.g., use of confirmation bias, suppression of alternative views, and a general disregard for facts) has contributed to the current polarization in American politics.

Assuming you agree with me so far, you may still be wondering how critical thinking applies to occupational therapy (OT). Or rather, why am I spending so much time writing about critical thinking for a profession that emphasizes "clinical reasoning". Are critical thinking and clinical reasoning the same thing? If not, how do these concepts differ and how are they related?

Critical thinking skills are also subject-specific

In addition to be holistic, critical thinking skills can be applied to a specific context (subject) using a specific set of knowledge (Facione, 1998). While we using critical thinking skills across our daily lives the reality is that these skills have slightly different meanings in different contexts. For example, the steps or skills needed to analyze a piece of historical literature are distinctly different from the analysis skills required to answer a math problem or critique a scientific report.

OT largely focuses on clinical reasoning, which is the process of making decisions throughout the OT process based on theory, storytelling, and contextual factors (Schell & Cervero, 1993). Unfortunately in the process of defining and describing clinical reasoning we have failed to define and emphasize critical thinking as its own distinct skill that can be used to support clinical reasoning (Pitonyak et al., 2020). Critical thinking skills are essential for OT practitioners as they enable us to consider how our biases and assumptions influence the client-therapist interactions and clinical reasoning process (Berg et al., 2019). Additionally, critical thinking skills help us:

• Explore and consider multiple theoretical perspectives

• Evaluate the credibility and strength of research to inform evidence-based practice

• Determine the reliability and validity of outcomes

• Recognize (and even appreciate) that multiple solutions are present in every patient (that is, there is no single "right answer" for how to treat a patient)

• Reflect on the OT process to improve patient care

Critical thinking skills require explicit instruction and deliberate practice

Evidence suggests that the most effective way to promote critical thinking is through a combination of explicit teaching and infused or immersive activities that require application of critical thinking skills (Morris et al., 2019). In OT education, this means that as educators we must go beyond a discussion of clinical reasoning and learning activities that we think will promote critical thinking (e.g., problem-or case-based learning). We must also explicitly define, describe, and demonstrate critical thinking skills to our students.

One place to start is by teaching students how to evaluate research articles and textbooks to inform their evidence-based care. This might look and sound like acknowledging that educators and textbook writers are not infallible. While they hopefully aren't out to "get you", it must be emphasized that research (science) can't prove something to be true 100% of the time. It also involves teaching students to develop a healthy, respectful skepticism that prompts them to ask questions before accepting the validity of information (for both things with which they agree AND disagree).

Some helpful questions to promote critical thinking when reading include:

• What explicit or unstated assumptions are made by the article/writer?

• From what perspective is the article written? Is it biased? Unbiased?

• What conclusions were reached by the author(s)? To what extent do you agree with the conclusions?

• What are the possible positive or negative implications of the article?

Another helpful critical thinking framework that can be applied to solve problems within the realm of OT follows the acronym IDEAS (Facione, 2020):

• I=Identify the problem and set priorities

• D=Determine relevant information and develop understanding

• E=Enumerate options and anticipate consequences

• A=Assess the situation and make a preliminary decision

• S=Scrutinize the process and self-correct as needed

What do you think?

To what extent do you hope or expect your students to develop critical thinking skills? To what extent have you made this expectation or content explicit? How will you change your approach moving forward? Would you like to learn more about subject-specific activities that can be used in OT education to promote critical thinking?

References

Facione, P. A. (1998). Critical thinking: A statement of expert consensus for purposes of educational assessment and instruction. Insight Assessment.

Facione, P. A. (2020). Critical thinking: What it is and why it counts. Insight Assessment.

Heltzel, G., & Laurin, K. (2020). Polarization in America: two possible futures. Current opinion in behavioral sciences, 34, 179–184. https://doi.org/10.1016/j.cobeha.2020.03.008

Morris, R. J., Brockner, A. E., & Coleman, S. E. (2019). Effectiveness of two methods for teaching critical thinking to communication sciences and disorders undergraduates. Canadian Journal of Speech-Language Pathology and Audiology, 43(1), 21-34.