critical thinking in health sciences

• - Google Chrome

Intended for healthcare professionals

• My email alerts
• BMA member login
• Username * Password * Forgot your log in details? Need to activate BMA Member Log In Log in via OpenAthens Log in via your institution

Search form

• Advanced search
• Search responses
• Search blogs
• News & Views
• Critical thinking in...

Critical thinking in healthcare and education

• Related content
• Peer review
• Jonathan M Sharples , professor 1 ,
• Andrew D Oxman , research director 2 ,
• Kamal R Mahtani , clinical lecturer 3 ,
• Iain Chalmers , coordinator 4 ,
• Sandy Oliver , professor 1 ,
• Kevan Collins , chief executive 5 ,
• Astrid Austvoll-Dahlgren , senior researcher 2 ,
• Tammy Hoffmann , professor 6
• 1 EPPI-Centre, UCL Department of Social Science, London, UK
• 2 Global Health Unit, Norwegian Institute of Public Health, Oslo, Norway
• 3 Centre for Evidence-Based Medicine, Oxford University, Oxford, UK
• 4 James Lind Initiative, Oxford, UK
• 5 Education Endowment Foundation, London, UK
• 6 Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Australia
• Correspondence to: J M Sharples Jonathan.Sharples{at}eefoundation.org.uk

Critical thinking is just one skill crucial to evidence based practice in healthcare and education, write Jonathan Sharples and colleagues , who see exciting opportunities for cross sector collaboration

Imagine you are a primary care doctor. A patient comes into your office with acute, atypical chest pain. Immediately you consider the patient’s sex and age, and you begin to think about what questions to ask and what diagnoses and diagnostic tests to consider. You will also need to think about what treatments to consider and how to communicate with the patient and potentially with the patient’s family and other healthcare providers. Some of what you do will be done reflexively, with little explicit thought, but caring for most patients also requires you to think critically about what you are going to do.

Critical thinking, the ability to think clearly and rationally about what to do or what to believe, is essential for the practice of medicine. Few doctors are likely to argue with this. Yet, until recently, the UK regulator the General Medical Council and similar bodies in North America did not mention “critical thinking” anywhere in their standards for licensing and accreditation, 1 and critical thinking is not explicitly taught or assessed in most education programmes for health professionals. 2

Moreover, although more than 2800 articles indexed by PubMed have “critical thinking” in the title or abstract, most are about nursing. We argue that it is important for clinicians and patients to learn to think critically and that the teaching and learning of these skills should be considered explicitly. Given the shared interest in critical thinking with broader education, we also highlight why healthcare and education professionals and researchers need to work together to enable people to think critically about the health choices they make throughout life.

Essential skills for doctors and patients

Critical thinking …

Log in using your username and password

BMA Member Log In

If you have a subscription to The BMJ, log in:

• Need to activate
• Log in via institution
• Log in via OpenAthens

Log in through your institution

Subscribe from £184 *.

Subscribe and get access to all BMJ articles, and much more.

* For online subscription

Access this article for 1 day for: £50 / $60/ €56 ( excludes VAT )

You can download a PDF version for your personal record.

Buy this article

Critical Thinking in Health Sciences Education: Considering “Three Waves”

• January 2013
• Creative Education 4(12A):21

• McMaster University
• This person is not on ResearchGate, or hasn't claimed this research yet.

A critical issue: assessing the critical thinking skills and dispositions of undergraduate health science students

• Open access
• Published: 15 August 2023
• Volume 2 , article number  21 , ( 2023 )

Cite this article

You have full access to this open access article

• Anthony Dissen   ORCID: orcid.org/0000-0003-0828-387X 1  

2816 Accesses

Explore all metrics

Critical thinking skills and dispositions are significantly important factors that aid in one’s ability to understand and solve complex problems. Within the field of higher education, critical thinking skills and dispositions are valued and encouraged but are not always fully developed at the completion of the undergraduate degree experience. Those students who are studying to enter the healthcare field are particularly in need of strong critical thinking skills and dispositions in order to provide patients and communities with effective, evidence-based care in the midst of an ever-increasingly complex environment. What program of study a student selects, and the unique curriculum design of that program, may impact the development of these skills and dispositions during undergraduate study. This quantitative study sought to explore and understand the critical thinking skills and dispositions of undergraduate students enrolled in a BS in Health Science (BSHS) degree program, and how these skills in particular compared to the national student population. During the Spring 2022 academic semester, 140 senior-level BSHS students were given the opportunity to complete the California Critical Thinking Skills Test and the California Critical Thinking Disposition Inventory. Results show less development in critical thinking skills when compared to the national student population, with Numeracy skills being the most poorly developed, and Truth-Seeking being the most inconsistent disposition possessed by the student participants. The implications of these findings, particularly for faculty who teach students planning to enter the healthcare field, are offered, including recommendations for curricular design and modification.

Similar content being viewed by others

Chinese medical students’ disposition for critical thinking: a mixed methods exploration

Clear skies ahead: optimizing the learning environment for critical thinking from a qualitative analysis of interviews with expert teachers

A meta-analysis of the effects of non-traditional teaching methods on the critical thinking abilities of nursing students, explore related subjects.

• Artificial Intelligence

Avoid common mistakes on your manuscript.

1 Introduction

Critical thinking skills and dispositions allow students to gather, interpret, and reflect upon how new information and data can be applied to address personal and professional needs and situations [ 1 ]. While there is no one singular definition, critical thinking is often described as an active, attentive, and purposeful method by which one analyzes facts and information to form a judgment or accomplish a specific goal [ 2 ]. This is an important set of skills and attitudes for students in the health sciences to possess, as critical thinking allows one to be comfortable with the possibilities of new perspectives and ideas, which is crucial for healthcare practice. Additionally, critical thinking is necessary for the development of current and future clinical reasoning skills [ 3 ]. This is partly due to the need for students to learn to be appropriately skeptical when reviewing treatment techniques, best practice guidelines, and new research that may impact their means of practice and care delivery [ 4 ]. To be able to work effectively and rationally in the healthcare and medical fields, critical thinking skills and dispositions must be properly developed and supported in educational settings [ 5 ].

The Carnegie Foundation for Teaching and Learning [ 6 ] has proposed four major categories of recommendations for the reform of medical and health science education: Teaching and learning to promote integration, promoting habits of inquiry and improvement, individualizing learning, using standardized assessments, and supporting the progressive development of professional identity. These recommendations parallel the subsequent evolution of education and teaching theories over the past century [ 7 ], namely the dynamic nature of the learning and the teaching processes, and the importance of the teaching environment. Both undergraduate and graduate-level health science educational programs are recognizing that these reforms are needed in order to meet the current and future demands being placed upon healthcare professionals, and that the environment in which learning is taking place is as important as the content being shared. Much of the emphasis behind these proposed reforms is centered around the need for future healthcare professionals to not only know the didactic and intellectual aspects of their work, but to also be able to solve complex problems and to think critically about their work and their identities as healthcare workers.

As such, critical thinking is a fundamental aspect of quality clinical decision-making among a variety of healthcare professions. To be able to think rationally and clearly, especially when encountering problems and uncertainty at work, is a necessary skill to be effective in the kinds of environments and situations that are common in the healthcare and medical fields [ 5 ]. Undergraduate health-focused students who have critical thinking education embedded into their curriculum have shown improvements in their problem-solving skills [ 8 ], which may have particularly important outcomes in promoting patient safety. Health education programs that teach critical thinking have been found to help reduce diagnostic errors, improve overall patient safety, and reduce cognitive those biases that can lead to poorer patient outcomes and professional practice [ 9 ]. This need for critical thinking is not just present in professional practice, but during pre-professional educational experiences as well, where the ability to enhance the capacity for problem-solving and wider reasoning is necessary to perform well academically [ 10 ]. This is especially important considering the significant pressures that are placed upon students during their academic careers at the undergraduate level to perform well academically to secure spots in clinical and graduate programs after completing their baccalaureate degrees.

The consequences of not possessing critical thinking skills in healthcare and medicine can be significant. Healthcare professionals who do not possess a capacity for critical thinking and problem-solving skills have a measurable impact on the health of their patients and communities, specifically poor rates of compliance with health recommendations and treatments, as well as direct harm to the health and wellbeing of those being served [ 11 ]. Given the importance of having a healthcare workforce that can practice critical thinking as part of their professional work, it is necessary to better understand how critical thinking skills and attitudes can be instilled within healthcare professionals, both during their pre-professional education and throughout their professional careers.

By understanding the current level of critical thinking skills and attitudes of health science students before they enter their professional fields of practice, it can be possible to identify those areas of strength, those areas of weakness, and how to make changes as needed within health science education programs to better prepare students for a professional field that demands strong critical thinking skills, attitudes, and applications. In addition, by understanding how skills, attitudes, and overall academic performance relate to one another, health science education programs can be more purposeful in how they advise students, develop curriculum, and track student progress throughout their academic journey.

This study sought to answer the following research questions:

RQ1: What are the critical thinking skills of undergraduate health science students at a four-year, public, comprehensive state university? RQ2: How do the overall critical thinking skills of undergraduate health science students at a four-year, public, comprehensive state university compare to the national population of undergraduate students? RQ3: What are the dispositions towards the importance of critical thinking of undergraduate health science students at a four-year, public, comprehensive state university? RQ4: To what degree is overall academic performance as measured by grade point average (GPA) a reasonable indicator of critical thinking development?

2 Study methods

The theoretical framework for this study was heavily influenced by the work of Dr. Peter Facione, whose seminal work in the field of critical thinking assessment is utilized by educators, employers, and policymakers who recognize the need for students and alumni of institutions of higher education to be able to properly demonstrate these skills and dispositions as a result of their time in higher education [ 12 ]. An additional component to the assessment work developed by Facione is the need for not only developing critical thinking skillsets, but also the development of those dispositions and attitudes, what Facione and colleagues call the critical spirit, that are needed in order to possess the internal drive and motivation to apply critical thinking skills in various aspects of one’s personal, professional, and social spheres of life [ 13 ].

The work done by Facione in the development of this framework has been studied and utilized by other researchers, particularly around assessing the critical thinking skills and disposition of healthcare professionals and health science students. This framework has been utilized by Nair et al. [ 14 ] in the development of their Critical Thinking Self-Assessment Scale, which was built specifically to be utilized by nurses as part of their own critical thinking self-assessment. Facione’s critical thinking assessment work has also been used to evaluate the effectiveness of different educational interventions with regard to their ability to improve critical thinking in pre- and post-exposure to treatment. A 2020 study by Wu et al. [ 15 ] utilized the disposition assessment tool developed using Facione’s work to evaluate the effectiveness of mind mapping exercises to increase critical thinking inclination of students. Additionally, the assessment tools built from this framework have been used to evaluate the potential predictors of critical thinking abilities of undergraduate students, such as taking courses online or transferring courses from another college or university [ 16 ].

2.1 Population and sample selection

The participants for this study were BS in Health Science (BSHS) students enrolled at a four-year, public, comprehensive state university located on the east coast of the United States. All participants were 18 years of age or older, were enrolled in one of five sections of the senior-level BSHS research course that was offered in the Spring 2022 academic semester, and agreed to participate in this study. Two additional sections of the course were offered that did not participate in the data collection efforts of this study. Participants in this study were those students in attendance during the class period that was utilized to administer the critical thinking assessment tools.

Students had declared one of the following concentrations within the BSHS degree: General Concentration, Pre-Occupational Therapy, Pre-Physical Therapy, or Pre-Communication Disorders. Participants were given the opportunity to complete each assessment tool in a voluntary capacity and were not required to complete either or both assessments under any conditions. As the study participants were recruited as part of the senior-level research course of the BS in Health Science degree, all participants were nearing the culmination of their undergraduate career at the time of data collection. No exclusionary criteria were used in selecting study participants beyond their enrollment within the BS in Health Science degree and current enrollment in the senior-level research course. All data collection took place after obtaining all necessary approvals from the Stockton University IRB Committee, including CITI training by the researcher. IRB approval was obtained after submitting all required documentation, proof of CITI training, study procedures, and informed consent documents (Stockton University IRB Approval Number #2021.175). A total of 194 students were enrolled in the senior-level research course during the Spring 2022 semester, with 5 sections of this course agreeing to participate in data collection efforts, who in total represented 140 enrolled students or 72% of the total student population enrolled in the senior-level research course in the Spring 2022 semester.

2.2 Instrumentation

The researcher used the California Critical Thinking Skills Test (CCTST) and the California Critical Thinking Disposition Inventory (CCTDI) for data collection purposes, and administered each assessment to students enrolled in the senior-level research course for the BS in Health Science degree. These tests are owned and administered by Insight Assessment and were developed in part by the work in Critical Thinking Assessment (CTA) theory as described by Peter et al. [ 12 , 13 ]. The CCTST is a 34-item, multiple-choice, non-discipline-specific test that evaluates critical thinking along 8 different subscales: Analysis, Interpretation, Inference, Evaluation, Explanation, Inductive Reasoning, Deductive Reasoning, and Numeracy. It is estimated that the CCTST takes an average of 45 min to complete. Each multiple-choice question item is related to generic situations not unique to any particular domain of work. Scores are developed using a proprietary formula, and range from low or non-manifested, weak development, moderate development, strong development, and superior development [ 17 ].

The CCTDI consists of 75 generic statements with a 6-point Likert-selected response scale that is also non-discipline specific. The CCTDI test evaluates disposition towards critical thinking along 7 different subscales: Truth Seeking, Analyticity, Open-Mindedness, Systematicity, Confidence in Reasoning, Inquisitiveness, and Maturity of Judgement. It is estimated that the CCTDI takes an average of 15–20 min to complete. Scores can range from 5 to 60 for each subscale and indicate a level of disposition ranging from weak disposition development, positive disposition development, or strong disposition development [ 18 ]. Each tool is delivered via an online web-based portal owned and operated by Insight Assessment. Both of these tools were selected due to their previously established validity and reliability in assessing the critical thinking skills and attitudes of study participants [ 13 ]. The CCTST has documented strength in both the content validity of each of the skill domains as well as construct validity. Validity has been demonstrated by correlational studies exploring critical thinking skills with additional measurements such as GPA and GRE scores, as well as for criterion (predictive) validity [ 13 , 19 , 20 ]. The CCTST has also shown strong internal reliability with documented Cronbach’s Alpha coefficients ranging from 0.60 to 0.78 on individual scales, and 0.90 or above for the overall measure [ 17 ]. See Appendix A for the breakdown of the score ranges that pertain to each level of development for the CCTST and the CCTDI.

The CCTDI has also been researched and assessed for its validity and reliability, with the inventory items being found to be valid with an internal consistency reliability score of 0.887 [ 21 ]. This has also been shown with a cross-cultural application of the CCTDI, with high content validity across cultural versions of the inventory with alpha coefficients ranging from 0.81 to 0.97 [ 22 ]. A recent meta-analysis by Orhan explored the reliability of the CCTDI using 98 alpha values across 87 unique studies of the CCTDI. Orhan found the CCTDI to be reliable across samples with an alpha value of 0.83 [ 23 ]. These studies have shown strong consistent validity and reliability for the CCTDI as an instrument for the assessment of the critical thinking dispositions of students.

To assure ongoing validity and reliability for both the CCTST and the CCTDI in this study, both tools were delivered exactly as instructed by Insight Assessment. No variations were made to either instrument, no questions or sections were added, omitted, or changed, and study participants met all requirements for participation as described by the Insight Assessment user’s manual [ 17 , 18 ].

2.3 Data collection and management

All data collection took place during the first 2 weeks of March 2022. Study participants and faculty were informed that participation in the data collection phase of this study was purely voluntary and that there would be no penalty for not participating in the study. All participant information has been kept confidential, and participants were provided with an informed consent form prior to the data collection beginning. Participants were also informed that the information collected for this study would not be shared with members of the public in any identifiable way and that all study findings would be presented as aggregated data. All data collection took place during the traditional meeting time of each confirmed section of the senior-level research course, with two sections meeting via Zoom conference, and three sections meeting face-to-face in a university computer lab.

Distribution and completion of each of the assessments took place via the online portal offered through Insight Assessment. Each class meeting allowed for adequate time for both assessments to be administered in a single class meeting. Data collection took place as an in-class activity for that day’s class meeting, and there was no course penalty for not taking part in the data collection. Should a student have declined to participate in the in-class activity during the day of data collection, they would have been provided with an assigned reading on critical thinking in the healthcare field that would be utilized for in-class discussions after the data collection activity had concluded. No student declined to participate in the study. In an effort to reduce student anxiety, students were assured that all results were purely for the purpose of assessment and that class rankings or comparisons would not be shared. Additionally, there was no additional course credit given for participation, nor were there any extra credit or similar potentially coercive incentives provided for data collection participation. To ensure each student participant had the opportunity to access the online platform, all in-person meetings took place in a university computer lab. For the 2 sections that met with the researcher via Zoom conferencing, all students had access to a laptop or computer with internet access. For these sections, the faculty member teaching the course was present in the Zoom room. It should be noted that since these meetings took place over Zoom, the continuity of the environment in which students were completing the assessment could not be guaranteed when compared to those students completing the assessment in a university computer lab.

2.4 Data analysis

All data collection took place during the first 2 weeks of March 2022, with all data being collected before the beginning of the Spring break period of the term. After all data collection was completed, reports were generated by Insight Assessment to provide results of Overall Critical Thinking Skills, Critical Thinking Skills across each Subscale, Overall Critical Thinking Dispositions, and Critical Thinking Dispositions across each Subscale. The overall critical thinking skill score population means for both the national undergraduate student population and the national health science undergraduate student population were obtained through Insight Assessment to allow for comparison between these two national populations and the study sample.

Descriptive statistics were generated for overall and subscale scores for the CCTST and the CCTDI, and frequency statistics were generated for ethnicity, gender, and declared concentration within the BSHS degree. T-tests for independent samples were conducted for gender for both the CCTST and the CCTDI. Overall student scores for the CCTST were analyzed for comparison to the national population of undergraduate students via one sample t-test. For the demographic variable of Degree Concentration, which includes General Concentration, Pre-Occupational Therapy Concentration, Pre-Physical Therapy Concentration, and Pre-Communication Disorders Concentration, the researcher conducted a one-way analysis of variance. All statistical analysis was conducted using the IBM SPSS software Version 25.

3.1 Research question 1

RQ1 sought to understand the critical thinking skills of undergraduate health science students at a four-year, public, comprehensive state university by utilizing the CCTST offered through Insight Assessment. Of the 140 total students who were invited to participate in this, 130 students completed the CCTST, as 10 students in total did not attend class on the day of data collection. Using the criteria set forward by Insight Assessment, the data results from 5 student participants were removed from the final report of the data, as they completed the CCTST in under 15 min, which would not be considered an adequate amount of time to thoughtfully respond to each question being asked. As a result, a total of 125 students completed the CCTST in full, representing approximately 89% of the potential sample. The mean age was 22 years of age, with 79% indicating female gender identity. See Table 1 for ethnicity findings and Table 2 for the frequency of each concentration identified within the BS in Health Science degree.

The CCTST is designed to assess and measure the critical thinking and numeracy skills that are used in the process of reflective reasoning in order to make an informed judgment about what to do, or what to believe, in a particular situation or setting. The CCTST provides an overall critical thinking score, as well as scores across 8 sub-domains: Analysis, Inference, Evaluation, Induction, Deduction, Interpretation, Explanation, and Numeracy. A brief description of each domain is described in Appendix B .

The CCTST scores are calculated by Insight Assessment via a proprietary formula for both the overall score and the score of each sub-domain. Study sample scores for overall critical thinking ability, as well as across each sub-domain, are shown via descriptive statistics in Table 3 . One-way analysis of variance showed no statistically significant difference ( p  = 0.708) in the Overall Critical Thinking Skills Scores of participants among the different degree concentration options (Pre-Occupational Therapy, Pre-Physical Therapy, Pre-Communication Disorders, and General) within the BS in Health Science students (see Tables 4 , 5 ).

3.2 Research question 2

RQ2 sought to answer was to understand how the overall critical thinking skills of undergraduate health science students at a four-year, public, comprehensive state university compared to the national population of undergraduate students. Aggregate data provided by Insight Assessment shows that the population mean score for overall critical thinking skills of four-year college/university undergraduate students is currently 75.3, which can be compared to the overall critical thinking skills score of 69.96 for the study’s sample. The results of the one-sample t-test showed that the overall critical thinking skills score of the study sample is significantly lower than that of the national four-year college/university undergraduate student population (see Table 6 ).

As Insight Assessment does not collect aggregate data for the sub-domain measurements, comparison between the national four-year college/university undergraduate student population and the study sample for each sub-domain was not possible.

3.3 Research question 3

RQ3 sought to understand the dispositions towards the importance of critical thinking of undergraduate health science students at a four-year, public, comprehensive state university. Of the 140 total students who were invited to participate in this, 130 students completed the CCTDI, as 10 students in total did not attend class on the day of data collection, representing approximately 93% of the potential sample. The mean age was 22 years of age, with 80% indicating female gender identity. See Table 7 for ethnicity findings, and Table 8 for frequency of each concentration identified within the BS in Health Science degree. It is important to note that the sample size is larger for RQ4 (n = 130) than for RQ1, RQ2, and RQ3 (n = 125), as all students who completed the CCTDI did so at or above the minimum amount of time deemed necessary to ensure validity and accuracy of the results.

The CCTDI is designed to assess the critical thinking mindset and attitudes of individuals toward critical thinking. The CCTDI provides scores across 7 subdomains: Truth-Seeking, Open-Mindedness, Inquisitiveness, Analyticity, Systematicity, Confidence in Reasoning, and Maturity of Judgment. A brief description of each domain is described in Appendix C .

Study sample scores for overall critical thinking dispositions, as well as across each sub-domain, are shown via descriptive statistics in Table 9 , with the sub-domain of Inquisitiveness showing the highest mean score of 46.5, and the sub-domain of Truth-Seeking showing the lowest mean score of 35.4. It is important to note that there are no national population means available for comparative purposes, as Insight Assessment does not collect this kind of national mean data for the CCTDI. The reason for this is that there is no correct or incorrect answer for each of the 6-point Likert questions asked in the CCTDI, and there is no ideal mean score for study results to be measured against.

3.4 Research question 4

RQ4 sought to understand to what degree overall academic performance, as measured by grade point average (GPA), is a reasonable indicator of critical thinking development. To help correct for multiple comparisons, a Bonferroni Correction was conducted. An adjusted p-value was computed by dividing a 0.05 level of significance by the number of correlations for both the CCTST and the CCTDI. For the CCTST, the adjusted p-value (0.05/9) was 0.005. For the CCTDI, the adjusted p-value (0.05/8) was 0.006. Tables 10 and 11 shows the correlation matrix between Critical Thinking Skills and GPA, and Critical Thinking Dispositions and GPA, respectfully, that indicated a statistically significant relationship. For both tables, relationships that are significant at the 0.05 level are marked with a single asterisk (*) and those that are significant at the adjusted p-value levels are marked with a double asterisk (**). Pearson correlation shows a statistically significant positive correlation between GPA and overall critical thinking skills (0.235, p  = 0.008), as well as across all critical thinking subscales (Table 10 ), with the subscale of numeracy showing the highest correlation with GPA (0.300, p  = 0.001). Pearson correlation shows a statistically significant positive correlation between GPA and the critical thinking disposition subscale of systematicity only (0.175, p  = 0.047), with no other subscale showing a statistically significant correlation (Table 11 ).

4 Discussion

The aim of this study was to understand the critical thinking skills and dispositions of undergraduate students enrolled in a BS in Health Science degree program at a four-year university. The findings of this study are in agreement with the published research pertaining to critical thinking skills development in undergraduate students as a whole, as some estimates have described that 45% of undergraduate students do not show meaningful improvement in their critical thinking skills upon graduation, with even this number potentially being underestimated [ 24 ]. As this study was not longitudinal in nature, it is not known to what degree critical thinking skills or dispositions did or did not improve over the course of a student’s higher education experience. Rather, this study provides a snapshot of the skills and dispositions found at the culmination of their program of study. Therefore, the findings of this study do not necessarily suggest a failure to develop critical thinking skills and dispositions of this particular Health Science undergraduate program. Instead, it provides insight into the degree to which critical thinking skills and attitudes have been developed upon the conclusion of academic study, with opportunities to evaluate ways in which to further enhance critical thinking skill and disposition development by understanding the current baseline.

Earlier research conducted by Keeley et al. [ 25 ] points to a common resistance of students to engage in critical thinking, which these authors suggest may be due to a generalized resistance to engaging in different forms of learning and studying behaviors than they have previously utilized in their education in an effort to “avoid change, work, and pain.” The authors also suggest that students who do not regularly engage in self-reflection (i.e. why am I resistant to engaging in critical thinking?) are less likely to be aware of their hesitation in the first place.

Another potential reason for this deficiency in critical thinking skill development may be pedagogical in nature. Higher education pedagogy is often content-based and seeks to imbue students and learners with deep knowledge about a series of subjects, whereas a more critical thinking-oriented pedagogy is rooted in teaching students and learners how to think complexly and across a number of different areas [ 26 ]. As a result of a heavily content-based pedagogy, undergraduate students may not be receiving the kind of complex and problem-based learning environment needed to develop a more robust critical thinking skillset. Research by Matthews & Lowe also suggests both pedagogical and environmental reasons as to why students may be resistant to engaging in more critical thinking and critically reflective mindsets [ 27 ]. Particularly, these researchers highlight the need for the development of the critical thinking disposition (the critical spirit described by Facione) in order for students to overcome resistance to both developing and utilizing critical thinking skills in their educational and professional endeavors. Without possession of a strong disposition toward critical thinking, more overt resistance to the utilization of critical thinking may remain.

Participants in this study showed the strongest development in Inference and Induction skills. Inference, the ability to draw logical conclusions based on presented data, is an important subdomain of critical thinking skills. Healthcare practice and research both require the utilization of inferential reasoning in order to appropriately draw conclusions and make recommendations in situations and environments that are not always pristine or ideal [ 28 ]. This allows for the greater development of a “what if?” mindset that can be of significant importance in health-related environments. The similar level of development found within induction is interesting to note, as induction can be seen as a sub-category of inferential reasoning. Clinical reasoning requires the development and application of inductive reasoning in order to make larger generalizations and conclusions based on the individual clinical scenarios or patterns that are being witnessed and observed [ 29 ]. While development in the areas of Inference and Induction was only at a moderate level, as opposed to strong or superior development as described by the CCTST, it is still important to note that these areas are of significant importance when it comes to future work in the healthcare field.

What starts to become more concerning are the areas within critical thinking skillsets that were more weakly developed and demonstrated in this study. Weak development in the area of evaluation is worthy of special attention, as the healthcare field is riddled with dubious claims, misinformation campaigns, and conspiracy theories. Recent research done by Lantian, Bagneux, Delouvée, & Gauvrit provided insight into the link between evaluative and critical thinking abilities and subscribing to conspiratorial beliefs and theories [ 30 ]. Courses that emphasize evaluation skills have been shown to reduce adherence to pseudoscientific beliefs while also building a more skeptical frame of mind when coming across new information or claims [ 31 ].

The skillset with the lowest level of development was numeracy, with weak to no development in this area being shown by the CCTST. This is, in some ways, not surprising, as adults in the United States have been found to perform well below average in numeracy skills when compared to adults in other developed nations according to the Organization for Economic Cooperation and Development [ 32 ]. However, in this present study, it must be noted that not only was numeracy the most poorly developed critical thinking skillset, numeracy mean scores fell within the weak to not developed range. This is a finding of great importance, as numeracy is a required skill within the field of healthcare. Regarding critical thinking as a whole, the study sample’s mean score was 69.96 for overall critical thinking skills, which was statistically significantly lower than the overall critical thinking skills of 4-year college/university undergraduate students’ mean score of 75.3. Utilizing the criteria provided in the CCTST, the study sample mean shows weak to moderate development, whereas the national student population shows moderate development at the higher end of the moderate development range. This shows that not only do the study participants show lower development in their critical thinking skills when compared to the national population, but that the study participants are a full category of development lower.

Results show that the majority of dispositions assessed in the CCTDI showed positive development among the study participants. Open-Mindedness, Inquisitiveness, Analyticity, and Confidence in Reasoning were all found to fall within the positive range of personal development. Higher scores on the CCTDI have been found to be associated with greater problem-solving skills, showing that these affective qualities are important in the overall critical thinking attributes of students [ 33 ]. Open-mindedness and inquisitiveness are especially important dispositions to possess, as they are paramount to supporting the desire to learn and to enhance personal knowledge within students, which has further been associated with better student performance in higher education [ 34 ].

Particularly with students pursuing health-related careers, open-mindedness again has been found to be associated with academic success and graded work in courses [ 35 ]. While these other domains of analyticity and confidence in reasoning are associated with problem-solving overall, they are not as predictive of student success and readiness as open-mindedness and inquisitiveness [ 36 ], although higher dispositions overall are an important aspect of building problem-based learning skills.

What is perhaps most concerning amongst the findings pertaining to this research question is that Truth-Seeking showed the lowest disposition development, with results showing inconsistent to ambivalent demonstration. Truth-seeking is a necessary disposition to possess in order to seek out the best possible evidence and information to understand a situation or issue. As such, truth-seeking behavior has been described as the main predictive dispositional factor of an individual possessing a robust overall critical thinking behavior [ 37 ]. In particular, truth-seeking allows one to question their previously held beliefs or ideas about a topic, which is critical in the healthcare field, as new information and science are always coming forward. This new information often may displace or change previously held theories or practices, and a truth-seeking disposition is required in order to critically evaluate and accept new information that is found to be factually based.

Part of the reason why dispositions and attitudes towards Truth-Seeking may be so hard to foster is the subjective and often abstract nature of what constitutes truth, which is then further compounded by the copious amounts of information that students are tasked with processing when attempting to determine factualness. As described by Arth et al. [ 38 ], “…information is available to people in unrecordable amounts and insurmountable ways.” The sheer amount of information that students are being confronted with is only increasing, and without proper information literacy preparation, and particularly digital information literacy, students may be both unprepared and unmotivated to seek out that information which would point towards the truth. This point is reinforced by Gibbs [ 39 ], who emphasizes the additional consideration of trust in self. Without a level of trust in one’s own ability to both seek out true information and simultaneously recognize false or misleading information, students may not possess the confidence necessary to develop a stronger attitudes towards truth-seeking as a behavior.

Regarding the findings pertaining to correlations between GPA and critical thinking skills and dispositions, academic performance and GPA have been shown to be associated with greater critical thinking skill development [ 40 ]. And while GPA is not the only indicator of skill development, overall academic performance and success may be one way of measuring the potential for critical thinking skillset enhancement. The finding of numeracy being the most positively correlated subscale with GPA is an important one, given the overall poor development of numeracy skill development in this study sample. However, numeracy as a skill that was shown to be poorly developed in this study may be impacted by more than overall GPA and academic development. Within the research seeking to understanding why mathematics and numeracy skills are often poorly developed in American students, negative stereotypes, stigma, and poor sense of self have been identified as significant influences. The psychological impact of negative self-stereotyping can be a double-edged sword, both in terms of instructor biases towards what kind of student tends to be better at mathematics, as well as student self-belief regarding whether or not they are the kind of student who is good at math [ 41 ]. The impact of stereotype threat on mathematics and numeracy achievement has been identified as a potential key factor in the overall lack of mathematics development across student groups and demographics [ 42 ], with female-identifying students in particular being highly vulnerable to these stereotyping images and messages [ 43 ]. Considering the high percentage of female-identifying students within this study, the potential impact of stereotyping and stereotype threat, particularly its role in mathematics and numeracy skill development and utilization, cannot be ignored.

With critical thinking dispositions, the fact that systematicity was the only subscale found to be associated with GPA is in some ways not surprising, as systematicity is the tendency to approach problems in an ordered, disciplined, and systematic way. Those with higher GPAs may naturally be inclined to a more systematic way of approaching their work and studies, which may explain this correlation. However, it should also be noted that no other disposition subscale was found to be correlated with GPA, which brings attention to the fact that GPA and academic grade achievement may not be an indicator of disposition and attitude towards critical thinking. This highlights the limitation of using GPA as a barometer for critical thinking development, as it cannot fully capture or predict how a student will conceptualize and utilize critical thinking in their personal or professional lives.

However, this finding does highlight the phenomenon that students may possess critical thinking skills but not possess the disposition necessary to put these skills into use, which may in part be influenced by the dispositions of the educators who are teaching these students. A recent study by Shin et al. [ 44 ] explored the role of a critical reflection competency program for nurse educators in improving the educators’ dispositions. Participation in a 4-week critical reflection competency program was found to improve the critical thinking dispositions and teaching efficacy of nurse educators, which simultaneously allows for greater opportunity for nursing educators to imbue these dispositions and attitudes within their students. How an educator is projecting their own attitudes towards the importance of critical thinking utilization may have a significant impact on how they are not only designing curriculum and teaching methods, but also in how they are creating a general environment that fosters a curious mind and a stronger disposition towards employing critical thinking skills in work.

An additional influential factor on the development of critical thinking dispositions may be the opportunity for a student to explore and utilize creativity in their classroom. Qiang et al. [ 45 ] found that a student’s critical thinking disposition was positively related to their self-concepts of creativity and scientific creativity in particular. This was further emphasized by Khoshgoftar et al. [ 46 ], who found a direct relationship with critical thinking dispositions and reflective creative capacities. The significance of these findings are two-fold. First, that classroom learning opportunities that emphasize creativity and reflection opportunities may help to further bolster critical thinking dispositions within students, and secondly, that a student’s ability to be reflective and creative may not always be properly captured in GPA scoring. Educators, particularly those working with students in the health sciences, may find benefit in not only improving their own dispositions towards critical thinking, but also find opportunities to properly assign, assess, and capture reflection and creative capacity in their students to further enhance student disposition development.

4.1 Implications for practice

The findings of this study are of great importance, as future healthcare professionals need to possess the critical thinking skills and dispositions necessary to perform their work accurately and safely, especially given a work environment that is ever-increasing in its complexity. As this study was conducted with pre-professional health science students, the ways in which the findings of this study may be applied to the field of health pre-professional education are specific to the development of these skills and dispositions before clinical education and/or encounters with patients or community members begins. This speaks specifically to the general development of cognitive skills and attitudes versus clinical skills and attitudes, which would be developed during their post-baccalaureate education and training.

An important area to note is the correlational relationship that exists between the different subscales of both the CCTST and the CCTDI, particularly those correlations that showed the strongest relationship to one another. Overall critical thinking skill was most strongly correlated with analysis, inference, induction, and deduction skills, which provides insight into ways to focus potential curricular and pedagogical changes that may work to increase overall critical thinking skills within students. Course assignments, projects, educational lessons, and readings that require students to utilize analytical, inferential, and both inductive and deductive skills may be of particular benefit to shaping an overall improvement and strengthening of critical thinking within students. Numeracy skills, which were the most poorly developed, were most positively correlated with explanatory skills. This is an important finding, as strengthening explanatory skills, which refers to a student’s ability to defend and justify a belief or a response to a question, may have a simultaneous benefit of supporting a student’s development in numeracy.

Regarding critical thinking dispositions, while truth-seeking was the most poorly developed attitude, it also showed the strongest correlation with overall critical thinking dispositions. Therefore, in an effort to improve truth-seeking dispositions within students, exposing students to opportunities that will overall strengthen and support their dispositions towards critical thinking may have the added benefit of supporting their desires to seek out the truth. Maturity of judgment also showed a higher correlation with truth-seeking, which again provides helpful insight. As maturity of judgment allows a student to understand and accept that multiple solutions or options may be possible when approaching a question or issue, and that complexity is an inherent aspect of many problems and issues, fostering this disposition within students may again help to support their development within truth-seeking.

In an effort to put these findings into practical use, the first and most immediate practice-based recommendation based on the findings of this study is to evaluate programmatic curriculum and teaching approaches that have been shown to promote critical thinking skill development in higher education settings. Mahmoud & Mohamed [ 47 ] provide several evidence-based recommendations for the enhancement of critical thinking skills and abilities. While a few of these recommendations are described below, readers are encouraged to read the paper by Mahmoud & Mohamed in its entirety, particularly those educators who work with health-oriented students, in order to fully recognize the breadth of curricular and teaching approaches recommended.

Problem-Based Learning A major component of pre-health profession education should be problem-based learning, which is a student-centered approach to the learning process that focuses on solving open-ended problems through collaborative engagement with other learners in a group setting.

Programmatic Orientation Students often do not fully understand the philosophy and core concepts of the programs they are selecting to study. As students are often oriented to their college or university after admittance, so too should they be fully orientated to the program of study they are choosing as their major.

Clinical Scenarios Context-dependent activities ask the learner to bring their life experiences, prior learning, and personal skills into the classroom. In this way, improved recall and application of knowledge have been shown to be enhanced, allowing students to encode information learned in such a way that it can be easily retrieved when they are in a specific scenario.

An additional recommendation is to encourage faculty members of pre-health educational programs to adjust their curriculum and teaching styles, such as the utilization of a flipped classroom model, to promote critical thinking dispositions. This may be particularly helpful in developing the disposition of truth-seeking, which was not only found to be poorly developed in this study but in other studies that have sought to understand the dispositions of students in the healthcare field [ 48 ]. However, as previously shared, resistance to new methods of teaching can influence how effective a flipped-classroom approach can be in fostering critical thinking skills and dispositions. Oudbier, Spaai, Timmermans, & Boerboom highlight how student self-regulation, the motivation of the faulty member, and variation in assessment approaches can all play a significant role in whether a flipped classroom approach will be effective [ 48 ]. To increase the positive possible outcomes of such an approach, Arth et al. [ 38 ] provide valuable insights and recommendations made by professors on how to encourage critical thinking and truth-seeking dispositions within undergraduate students. Selected examples of their recommendations are particularly linked with curricular design and teaching strategies.

Research Information Skills The ability to properly seek out and evaluate information should be incorporated throughout the curriculum in a variety of classes versus localizing these skills in a research-specific course. Specifically, students need to learn the difference between researching information via the scientific method versus simply looking up information.

Belief Bias & Skepticism An important aspect of developing a critically oriented mindset is to understand one’s own biases, and how these personal biases can influence the way in which information is sought out and interpreted. In this way, confirmation bias can be avoided, and a healthy level of skepticism can be maintained.

Discernment of Good vs. Bad Information Avoiding belief bias and maintaining a skeptical mindset also links to the desire to find reliable information and to be able to discern good quality from poor quality information. Given the proliferation of questionable claims that are found through online sources, educators need to be teaching the necessary skills to determine the reliability of the information that is obtained during the research process.

The Constant Pursuit of Truth Although it may initially seem counterintuitive, one of the most important ways to encourage a truth-seeking disposition in undergraduate students is to design a curriculum that reinforces the idea that nothing can ever be known with complete certainty, particularly in the health sciences. Not only because of the abundance of information of questionable validity and reliability, but also due to the fact that information is constantly changing as new research is conducted and new evidence is gathered. As previously shared in the research by Arth et al. [ 38 ], students need to be encouraged to see the pursuit of truth as an ever evolving behavior due to the plethora of new information that is being shared, particularly via digital platforms. This requires students to be comfortable with a lack of finality when it comes to the pursuit of truthful and factual information. Students who are exposed to educational environments that encourage comfortability with the ever-present need to seek out truth through purposefully designed learning experiences, modeling techniques, and reflection time from their faculty have been shown to improve in both their critical thinking skills as well as their attitudes towards seeking out truth [ 49 , 50 ].

It should be noted that this study serves as an internal review and assessment of a single academic program within the field of health science. While this may lead to a reduction in generalizability to other educational program, what this study can contribute is the necessity for higher education programs to engage in this very kind of assessment and evaluation of critical thinking skills and attitudes of their students. Without engaging in an internal assessment and audit of student critical thinking skills and attitudes, educators and curriculum developers will not have the information and data needed to determine whether or not their curricular program, as well as the pedagogical methods being employed by faculty, is leading to a robust development in critical thinking skills and attitudes. These methods are not currently in place in meaningful levels within the current program of study that the students within this study were enrolled in, and it is the hope of this researcher that these methods will be increased in an effort to increase critical thinking skills and dispositions over time.

4.2 Study strengths and weaknesses

As with any scholarly research, there are limitations to the methods of research design and data collection that influence the results of the study itself. First, the collection of data for this study utilized a sample of convenience. This researcher is a faculty member in this BS in Health Science program and therefore was able to focus data collection solely on students with which he had easy and convenient access. Since all students who responded were a part of this single program, it is difficult to be able to fully generalize the results of the CCTST and the CCTDI to the undergraduate health science population as a whole. While this does allow for a more specific analysis of this particular cohort of students, it does introduce limitations into how study findings can be then expanded to additional institutions of higher education.

A second limitation of this study is the lack of ability to compare the critical thinking skills and dispositions of BS in Health Science students to other undergraduate students at the same university who are enrolled in other programs of study. While a comparison to national population means was possible for overall critical thinking scores, it would have been illuminating to be able to compare the mean scores across each subdomain of critical thinking skill as well. Since these data are not collected or stored by Insight Assessment, being able to draw data from other students at the same university would have made this kind of comparison possible. Given the logistical and financial constraints that existed, it would not have been possible to collect data from an adequate number of non-health science students, leaving this kind of subdomain comparison absent from this particular study. It should also be noted that 2 sections of students did complete the assessment over Zoom versus being in an in-person computer lab setting. While there is no evidence to suggest a significant difference in student performance or adherence to assessment guidelines between those completing the assessment online versus those in person, nonetheless it may have played a role in impacting student outcomes.

An additional consideration is the comparison of data from the study sample to the national population of students providing Overall Critical Thinking Skill scores. Since the exact demographic breakdown and program of study breakdown of this national population of students is not known, there is a natural limit to what degree this comparison is helpful. Future research hoping to compare a study sample to another sample or population would benefit from knowing more specific details pertaining to the demographic and educational descriptors in order to extrapolate greater findings.

Lastly, data collection took place amongst a group of senior-level students who had spent the previous 2 years of their undergraduate-level education in the COVID-19 global pandemic environment. The impact of COVID-19, and especially the way in which it significantly impacted the field of higher education and of learning as a whole, is still being assessed and understood. For the purposes of this study, it would not have been possible to control for the ways in which COVID-19 may have temporarily or permanently impacted critical thinking skills and dispositions. As such, the results of this study must be viewed through this lens, as it is possible that the scores for skills and dispositions would have been different in a non-COVID-impacted learning environment.

5 Conclusion

Undergraduate health science students within this study population show low to moderate development of critical thinking skills, with numeracy skills being particularly poorly developed, and grade point average being moderately but significantly associated with critical thinking skill development across all subscales. And while students show positive development across most critical thinking disposition subscales, they also show inconsistent and ambivalent dispositions towards truth-seeking, with grade point average not being a significant indicator of attitudes and dispositions. Health science education programs that hope to enhance and strengthen both critical thinking skill and disposition development may wish to implement evidence-based pedagogical practices to ensure students are prepared for professional practice within the field of health science that require strong critical thinking development.

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Arnott SR. Evidence beyond the rules: a critical thinking approach to teaching evidence law to undergraduate students. J Scholarsh Teach Learn. 2018. https://doi.org/10.14434/josotl.v18i4.22812 .

Article   Google Scholar  

Hitchcock D. Stanford encyclopedia of philosophy—critical thinking. 2018. https://plato.stanford.edu/entries/critical-thinking . Accessed Jan 15 2023.

Allen DD, Toth-Cohen S. Use of case studies to promote critical thinking in occupational therapy students. J Occup Ther Ed. 2019. https://doi.org/10.26681/jote.2019.030309 .

Morris RJ, Gorham-Rowan MM, Robinson RJ, Scholz K. Assessing and teaching critical thinking in communication science and disorders. Teach Learn Commun Sci Dsord. 2018. https://doi.org/10.30707/TLCSD2.1Morris .

Sharples JM, et al. Critical thinking in healthcare and education. Brit Med J. 2017. https://doi.org/10.1136/bmj.j2234 .

Irby D, Cooke M, O’Brien B. Calls for reform of medical education by the carnegie foundation for the advancement of teaching: 1910 and 2010. Ac Med. 2010. https://doi.org/10.1097/ACM.0b013e3181c88449 .

Mann KV. Theoretical perspective in medical education: past experience and future possibilities. Med Ed. 2011. https://doi.org/10.1111/j.1365-2923.2010.03757.x .

Kanbay Y, Okanlı A. The effect of critical thinking education on nursing students’ problem-solving skills. Contemp Nurs. 2017. https://doi.org/10.1080/10376178.2017.1339567 .

Chacon JA, Janssen H. Teaching critical thinking and problem-solving skills to healthcare professionals. Med Sci Ed. 2021. https://doi.org/10.1007/s40670-020-01128-3 .

Hanley P, Slavin RE, Elliot L. Thinking, doing, talking science. Evaluation report and executive summary: Education endowment foundation. 2015. https://educationendowmentfoundation.org.uk/projects-and-evaluation/projects/thinking-doing-talking-science/ . Accessed Jan 15 2023.

Cummings L. Critical thinking in medicine and health. Fall in Med Health. 2020. https://doi.org/10.1007/978-3-030-28513-5_1 .

Facione NC, Facione PA. Externalizing the critical thinking in clinical judgment. NursOutlook. 1996. https://doi.org/10.1016/S0029-6554(06)80005-9 .

Facione NC, Facione PA, Sanchez C. Critical thinking disposition as a measure of competent clinical judgment: the development of the California critical thinking disposition inventory. J Nurs Ed. 1994. https://doi.org/10.3928/0148-4834-19941001-05 .

Nair GG, Stambler LL. A conceptual framework for developing a critical thinking self-assessment scale. J Nurs Ed. 2013. https://doi.org/10.3928/01484834-20120215-01 .

Wu HZ, Wu QT. Impact of mind mapping on the critical thinking ability of clinical nursing students and teaching application. J Int Med Res. 2020. https://doi.org/10.1177/0300060519893225 .

Terry N, Ervin B. Student performance on the California critical thinking skills test. Acad Ed Lead J. 2012;16:S25.

Google Scholar  

CCTST User Manual and Resource Guide. Insight assessment. Oakland: The California Academic Press; 2021.

CCTDI User Manual and Resource Guide. Insight assessment. Oakland: The California Academic Press; 2021.

Denia A. Association of critical thinking skills with clinical performance in fourth-year optometry students. Optom Ed. 2008;33:103–6.

Paans W, Sermeus W, Niewsg R, van der Schans C. Determinants of the accuracy of nursing diagnoses: Influence of ready knowledge, knowledge sources, disposition toward critical thinking and reasoning skills. J Prof Nurs. 2010. https://doi.org/10.1016/j.profnurs.2009.12.006 .

Redhana I, Sudria IBN. Validity and reliability of critical thinking disposition inventory. Proceedings of the 3rd International Conference on Innovative Research Across Disciplines. 2020. https://doi.org/10.2991/assehr.k.200115.046 .

İskïfglu G. Cross-cultural equivalency of the California critical thinking disposition inventory. Ed Sci Theory Prac. 2013. https://doi.org/10.12738/estp.2014.1.1840 .

Orhan A. California critical thinking disposition inventory: reliability generalization meta-analysis. J Psychoeduc. 2022. https://doi.org/10.1177/07342829211048962 .

Lane D, Oswald FL. Do 45% of college students lack critical thinking skills? Revisiting a central conclusion of academically adrift. Ed Meas Iss Pract. 2016. https://doi.org/10.1111/emip.12120 .

Keeley SM, Shemberg KM, Cowell BS, Zinnbauer BJ. Coping with student resistance to critical thinking. Coll Teach. 1995. https://doi.org/10.1080/87567555.1995.9925537 .

Flores KL, Matkin GS, Burbach ME, Quinn CE, Harding H. Deficient critical thinking skills among college graduates: implications for leadership. Ed Phil Theory. 2012. https://doi.org/10.1111/j.1469-5812.2010.00672.x .

Mathews SR, Lowe K. Classroom environments that foster a disposition for critical thinking. Learn Envir Res. 2011. https://doi.org/10.1007/s10984-011-9082-2 .

Moser A, Puhan MA, Zwahlen M. The role of causal inference in health services research I: tasks in health services research. Int J Pub Health. 2020. https://doi.org/10.1007/s00038-020-01333-2 .

Shin HS. Reasoning processes in clinical reasoning: from the perspective of cognitive psychology. Korean J Med Ed. 2019. https://doi.org/10.3946/kjme.2019.140 .

Lantian A, Bagneux V, Delouvée S, Gauvrit N. Maybe a free thinker but not a critical one: high conspiracy belief is associated with low critical thinking ability. Appl Cog Psych. 2021. https://doi.org/10.1002/acp.3790 .

Wilson JA. Reducing pseudoscientific and paranormal beliefs in university students through a course in science and critical thinking. Sci Ed. 2018. https://doi.org/10.1007/s11191-018-9956-0 .

OECD—Skills matter: additional results from the survey of adult skills—United States. 2019. https://www.oecd.org/skills/piaac/publications/countryspecificmaterial/PIAAC_Country_Note_USA.pdf . Accessed 25 Jan 2023.

Tümkaya S, et al. An investigation of university student’s critical thinking disposition and perceived problem solving skills. Euras J Ed Res. 2009;36:57–74.

Comer RD, Schweiger TA, Shelton P. Impact of students’ strengths, critical thinking skills and disposition on academic success in the first year of a PharmD program. Amer J Pharm Ed. 2019. https://doi.org/10.5688/ajpe6499 .

Ozcan H, Elkoca A. Critical thinking skills of nursing candidates. Int J Car Sci. 2019;12:1600–6.

Pu D, et al. Influence of critical thinking disposition on the learning efficiency of problem-based learning in undergraduate medical students. BMC Med Ed. 2019. https://doi.org/10.1186/s12909-018-1418-5 .

Rahmawati M, Kurniati D, Trapsilasiwi D, Osman S. Students’ truth-seeking behaviour in solving problems with no specified universal set given. Kreano. 2021. https://doi.org/10.15294/kreano.v12i2.32549 .

Arth A, Griffin D, Earnest W. Professors’ perspectives on truth-seeking and new literacy. J Med Lit Ed. 2019. https://doi.org/10.23860/JMLE-2019-11-3-6 .

Gibbs P. Why academics should have a duty of truth telling in an epoch of post-truth? High Ed. 2019. https://doi.org/10.1007/s10734-018-0354-y .

Ghazivakili Z, Norouzi NR, Panahi F, Karimi M, Gholsorkh H, Ahmadi Z. The role of critical thinking skills and learning styles of university students in their academic performance. J Advanc Med Ed Prof. 2014;2:95–102.

Reyna C. Lazy, dumb, or industrious: when stereotypes convey attribution information in the classroom. Educ Psych Rev. 2000. https://doi.org/10.1023/A:1009037101170 .

Appel M, Kronberger N. Stereotypes and the achievement gap: stereotype threat prior to test taking. Educ Psych Rev. 2012. https://doi.org/10.1007/s10648-012-9200-4 .

Chang F, Luo M, Walton G, Aguilar L, Bailenson J. Stereotype threat in virtual learning environments: effects of avatar gender and sexist behavior on women’s math learning outcomes. Cyberpsych Behav Soc Net. 2019. https://doi.org/10.1089/cyber.2019.0106 .

Shin S, Lee I, Kim J, Oh E, Hong E. Effectiveness of a critical reflection competency program for clinical nurse educators: a pilot study. BMC Nurs. 2023. https://doi.org/10.1186/s12912-023-01236-6 .

Qiang R, Han Q, Guo Y, Bai J, Karwowski M. Critical thinking disposition and scientific creativity: the mediating role of creative self-efficacy. J Cret Behav. 2020. https://doi.org/10.1002/jocb.347 .

Khoshgoftar Z, Barkhordari-Sharifabad M. Medical students’ reflective capacity and its role in their critical thinking disposition. BMC Med Ed. 2023. https://doi.org/10.1186/s12909-023-04163-x .

Mahmoud SA, Mohamed HA. Critical thinking disposition among nurses working in public hospitals at port-said governorate. Int J Nurs Sci. 2017. https://doi.org/10.1016/j.ijnss.2017.02.006 .

Oudbier J, Spaai G, Timmermans K, Boerboom T. Enhancing the effectiveness of flipped classroom in health science education: a state-of-the-art review. BMC Med Ed. 2022. https://doi.org/10.1186/s12909-021-03052-5 .

Medina MS, Castleberry AN, Persky AM. Strategies for improving learner metacognition in health professional education. Am J Pharm Ed. 2017. https://doi.org/10.5688/ajpe81478 .

Abiogu GC, et al. Cognitive-behavioral reflective training for improving critical thinking disposition of nursing students. Medicine. 2020. https://doi.org/10.1097/MD.0000000000022429 .

Download references

Author information

Authors and affiliations.

School of Health Sciences, Stockton University, 101 Vera King Farris Dr., Galloway, NJ, 08205, USA

Anthony Dissen

You can also search for this author in PubMed   Google Scholar

Contributions

Author completed all data collection, analysis, table formatting, literature review, and manuscript writing.

Corresponding author

Correspondence to Anthony Dissen .

Ethics declarations

Ethics approval and consent to participate.

The research instruments and research methods for this study were approved by the Stockton University Institutional Review Board. All data collection took place after obtaining all necessary approvals from the Stockton University IRB Committee, including CITI training by the researcher. IRB approval was obtained after submitting all required documentation, proof of CITI training, study procedures, and informed consent documents (Stockton University IRB Approval Number #2021.175). All research activities were carried out following the guidelines set forth by the Stockton University IRB.

Competing interests

The author received no funding as part of this study, nor does he have any Competing interests related to the design or implementation of this study.

Additional information

Publisher's note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendix A: Score ranges for CCTST and CCTDI

1.1 cctst score ranges.

1.2 CCTDI score ranges

Appendix B: California critical thinking skills test domain descriptions

Overall critical thinking skills score overall ability and strength of a student to use reflective judgement and reasoning about how to make choices regarding a particular set of actions or how to develop an informed belief or opinion. This predicts capacities for success in educational and professional settings that require reasoned decision making and complex problem-solving.

Analysis score a measurement of overall analytical skill. This score is used to identify reasons, themes, assumptions, and evidence present that all must be considered and utilized when making an argument or offering explanation for phenomena.

Inference score refers to those skills and abilities that allow one to draw conclusions from the evidence, experiences, and observations being presented. In addition, Inference Scores show how one uses their personal values, beliefs, and reasoning skills to draw conclusions.

Evaluation scores the ability of someone to assess the credibility of claims and assertions being made by others, as well as their ability to assess the quality of the reasoning being used by others when an argument is being made or an explanation is being given.

Induction skill score one’s ability to estimate the likely outcomes of certain decisions or choices. Inductive reasoning and decision making is often assessed after reviewing case studies, reflecting upon prior life experiences, performing statistical analyses, participating in simulations, reviewing hypothetical situations, or studying patterns that emerge in a set of events.

Deduction critical thinking skills score the ability to engage in logical decision making that is based on a given set of rules, beliefs, conditions, values, principles, and/or policies.

Interpretation critical thinking skills score the development in the process of discovering and assigning meaning to information or events. Interpretive skills can be applied to verbal information, written text, and graphical and/or pictorial information.

Explanation critical thinking skills score the development in the process of justifying a decision that has been made or a belief that has been stated. Strong skills in this sub-domain rely upon the ability to provide evidence and to explain the methods used to explain the decision that has been made.

Numeracy critical thinking skills score the ability to make judgments and decisions based on quantitative information within a variety of different environments and contexts. This can include description on how quantitative information is gathered, adjusted, manipulated, represented, and explained.

Appendix C: California critical thinking disposition inventory domain descriptions

Truth-seeking score the habit and desire to seek out the best possible understanding of any given situation or issue. Truth-Seeking requires the goal of following the best available evidence to come to an informed conclusion, even if this leads one to question previously held beliefs or ideas.

Open-mindedness score the tendency to give space to others to voice their views, opinions, and beliefs, even when one may not personally agree with what is being shared. Open-Mindedness is a necessary disposition to be able to regard the opinions of others, and to understand the complexities that exist in a pluralistic and intersectional society.

Inquisitiveness score a curiosity at the intellectual level that is motivated by a desire to know and understand. Inquisitiveness is particularly related to an inherent desire to know this information, even if it does not appear to be immediately useful or relevant.

Analyticity Score the tendency to be actively aware of the next stage of actions that occur during an occurrence or event. Analyticity involves anticipating both positive and negative outcomes, and the various choices, plans, and proposals that can be considered at any given time.

Systematicity score the tendency to strive to approach issues or problems in an ordered, disciplined, and systematic way. Systematicity provides one with the desire to approach questions and uncertain situations in a purposeful manner, even when they do not possess a strong background or skill in using a particular approach.

Confidence in reasoning score the tendency and habit to solve problems and make decisions by trusting in reflective thinking and assessment. This relates to not only the confidence in one’s own reasoning process, but also in the reasoning that is utilized by groups and teams.

Maturity of judgment score refers to the habit and desire to be able to make timely decisions when confronted with complex issues and situations. Possessing an attitude that emphasizes Maturity of Judgment allows one to understand and accept that multiple solutions or options may be possible when approaching a question or issue and recognize that black-and-white thinking is not appropriate.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ .

Reprints and permissions

About this article

Dissen, A. A critical issue: assessing the critical thinking skills and dispositions of undergraduate health science students. Discov Educ 2 , 21 (2023). https://doi.org/10.1007/s44217-023-00044-z

Download citation

Received : 01 March 2023

Accepted : 02 August 2023

Published : 15 August 2023

DOI : https://doi.org/10.1007/s44217-023-00044-z

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Critical thinking
• Educational assessment
• Health science education
• Undergraduate education
• Find a journal
• Publish with us
• Track your research

• Update librarian
• Give feedback

Key Features

New features, about the author.

Potter, Perry, Stockert, Hall, A

Please verify your email.

We've sent you an email. Please follow the link to reset your password.

You can now close this window.

Edits have been made. Are you sure you want to exit without saving your changes?

Thinking critically on critical thinking: why scientists’ skills need to spread

Lecturer in Psychology, University of Tasmania

Disclosure statement

Rachel Grieve does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

University of Tasmania provides funding as a member of The Conversation AU.

View all partners

MATHS AND SCIENCE EDUCATION: We’ve asked our authors about the state of maths and science education in Australia and its future direction. Today, Rachel Grieve discusses why we need to spread science-specific skills into the wider curriculum.

When we think of science and maths, stereotypical visions of lab coats, test-tubes, and formulae often spring to mind.

But more important than these stereotypes are the methods that underpin the work scientists do – namely generating and systematically testing hypotheses. A key part of this is critical thinking.

It’s a skill that often feels in short supply these days, but you don’t necessarily need to study science or maths in order gain it. It’s time to take critical thinking out of the realm of maths and science and broaden it into students’ general education.

What is critical thinking?

Critical thinking is a reflective and analytical style of thinking, with its basis in logic, rationality, and synthesis. It means delving deeper and asking questions like: why is that so? Where is the evidence? How good is that evidence? Is this a good argument? Is it biased? Is it verifiable? What are the alternative explanations?

Critical thinking moves us beyond mere description and into the realms of scientific inference and reasoning. This is what enables discoveries to be made and innovations to be fostered.

For many scientists, critical thinking becomes (seemingly) intuitive, but like any skill set, critical thinking needs to be taught and cultivated. Unfortunately, educators are unable to deposit this information directly into their students’ heads. While the theory of critical thinking can be taught, critical thinking itself needs to be experienced first-hand.

So what does this mean for educators trying to incorporate critical thinking within their curricula? We can teach students the theoretical elements of critical thinking. Take for example working through [statistical problems](http://wdeneys.org/data/COGNIT_1695.pdf](http://wdeneys.org/data/COGNIT_1695.pdf) like this one:

In a 1,000-person study, four people said their favourite series was Star Trek and 996 said Days of Our Lives. Jeremy is a randomly chosen participant in this study, is 26, and is doing graduate studies in physics. He stays at home most of the time and likes to play videogames. What is most likely? a. Jeremy’s favourite series is Star Trek b. Jeremy’s favourite series is Days of Our Lives

Some critical thought applied to this problem allows us to know that Jeremy is most likely to prefer Days of Our Lives.

Can you teach it?

It’s well established that statistical training is associated with improved decision-making. But the idea of “teaching” critical thinking is itself an oxymoron: critical thinking can really only be learned through practice. Thus, it is not surprising that student engagement with the critical thinking process itself is what pays the dividends for students.

As such, educators try to connect students with the subject matter outside the lecture theatre or classroom. For example, problem based learning is now widely used in the health sciences, whereby students must figure out the key issues related to a case and direct their own learning to solve that problem. Problem based learning has clear parallels with real life practice for health professionals.

Critical thinking goes beyond what might be on the final exam and life-long learning becomes the key. This is a good thing, as practice helps to improve our ability to think critically over time .

Just for scientists?

For those engaging with science, learning the skills needed to be a critical consumer of information is invaluable. But should these skills remain in the domain of scientists? Clearly not: for those engaging with life, being a critical consumer of information is also invaluable, allowing informed judgement.

Being able to actively consider and evaluate information, identify biases, examine the logic of arguments, and tolerate ambiguity until the evidence is in would allow many people from all backgrounds to make better decisions. While these decisions can be trivial (does that miracle anti-wrinkle cream really do what it claims?), in many cases, reasoning and decision-making can have a substantial impact, with some decisions have life-altering effects. A timely case-in-point is immunisation.

Pushing critical thinking from the realms of science and maths into the broader curriculum may lead to far-reaching outcomes. With increasing access to information on the internet, giving individuals the skills to critically think about that information may have widespread benefit, both personally and socially.

The value of science education might not always be in the facts, but in the thinking.

This is the sixth part of our series Maths and Science Education .

• Maths and science education

University Relations Manager

2024 Vice-Chancellor's Research Fellowships

Head of Research Computing & Data Solutions

Community member RANZCO Education Committee (Volunteer)

Director of STEM

Faculty perceptions of critical thinking at a health sciences university

Article sidebar, main article content.

The fostering of critical thinking skills has become an expectation of faculty, especially those teaching in the health sciences. The manner in which critical thinking is defined by faculty impacts how they will address the challenge to promote critical thinking among their students. This study reports the perceptions of critical thinking held by health sciences faculty representing multiple disciplines. The results provide a working definition of critical thinking and its components, and indicate the importance that critical thinking is given in the education of health care students. Implications of these results for teaching and learning are presented.

Article Details

• Authors retain copyright and grant the Journal of the Scholarship of Teaching and Learning (JoSoTL) right of first publication with the work simultaneously licensed under a Creative Commons Attribution License, (CC-BY) 4.0 International, allowing others to share the work with proper acknowledgement and citation of the work's authorship and initial publication in the Journal of the Scholarship of Teaching and Learning.  
• Authors are able to enter separate, additional contractual agreements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in the Journal of the Scholarship of Teaching and Learning.
• In pursuit of manuscripts of the highest quality, multiple opportunities for mentoring, and greater reach and citation of JoSoTL publications, JoSoTL encourages authors to share their drafts to seek feedback from relevant communities unless the manuscript is already under review or in the publication queue after being accepted. In other words, to be eligible for publication in JoSoTL, manuscripts should not be shared publicly (e.g., online), while under review (after being initially submitted, or after being revised and resubmitted for reconsideration), or upon notice of acceptance and before publication. Once published, authors are strongly encouraged to share the published version widely, with an acknowledgement of its initial publication in the Journal of the Scholarship of Teaching and Learning.

Accreditation Council for Occupational Therapy Education. (2008). Accreditation Standards for a Doctoral-Degree-Level Educational Program for the Occupational Therapist. Retrieved from http://www.aota.org/Educate/Accredit/StandardsReview.aspx

Accreditation Council for Pharmacy Education. (2011). Accreditation Standards and Guidelines for the Professional Program in Pharmacy Leading to the Doctor of Pharmacy Degree. Retrieved from https://www.acpe-accredit.org/pdf/FinalS2007Guidelines2.0.pdf

Allen, G. D., Rubenfeld, M. G., & Scheffer, B. K. (2004). Reliability of assessment of critical thinking. Journal of Professional Nursing, 20(1), 15-22.

American Association of Colleges of Nursing. (2008). The Essentials of Baccalaureate Education for Professional Nursing Practice. Retrieved from http://www.aacn.nche.edu/education-resources/BaccEssentials08.pdf

American Dental Education Association. (2008). Competencies for the New General Dentist. Retrieved from http://www.adea.org/about_adea/governance/Pages/Competencies-for-the-NewGeneral-Dentist.aspx

Appleby, D. C. (2005). Defining, teaching, and assessing critical thinking in Introductory Psychology. In D. S. Dunn & S. L. Chew (Eds.), Best Practices for Teaching Introduction to Psychology: Psychology Press.

Association of American Colleges and Universities. (2011). The LEAP Vision for Learning: Outcomes, Practices, Impact, and Employers’ Views. Retrieved from http://www.aacu.org/leap/documents/leap_vision_summary.pdf

Blouin, R. A., Riffee, W. H., Robinson, E. T., Beck, D. E., Green, C., Joyner, P. U., … Pollack, G. M. (2009). Roles of innovation in education delivery. American Journal of Pharmaceutical Education, 73(8).

Busch, C., De Maret, P.S., Flynn, T., Kellum, R., Le, S., Meyers, B., … Palmquist, M. (1994 2012). Writing guide: Content Analysis. (Colorado State University). Retrieved from http://writing.colostate.edu/guides/guide.cfm?guideid=61

Council On Podiatric Medical Education. (2011). Standards and Requirements for Accrediting Colleges of Podiatric Medicine. Retrieved from http://www.cpme.org/files/FileDownloads/CPME%20120%20November%202011.pdf

Creswell, J. W. (2009). Research design: Qualitative, quantitative, and mixed methods approaches (3rd ed.). Thousand Oaks, CA: Sage Publications.

DeAngelo, L., Hurtado, S., Pryor, J. H., Kelly, K. R., & Santos, J. L. (2009). The American College Teacher: National Norms for the 2007-2008 HERI Faculty Survey. Retrieved from http://heri.ucla.edu/PDFs/pubs/briefs/brief-pr030508-08faculty.pdf

Ennis, R. H. (1996). Critical thinking dispositions: Their nature and assessability. Informal Logic, 18(2 & 3), 165-182.

Facione, N. A., & Facione, P. A. (2008). Critical thinking and clinical judgment. In N. C. Facione & P. A. Facione (Eds.), Critical Thinking and Clinical Reasoning in the Health Sciences: An International Multidisciplinary Teaching Anthology. Millbrae, CA: The California Academic Press.

Facione, P. A. (1990). Critical thinking: A statement of expert consensus for purposes of educational assessment and instruction. Retrieved from http://www.insightassessment.com/CTResources/Expert-Consensus-on-Critical-Thinking/Delphi-Consensus-Report-ExecutiveSummary-PDF

Gordon, J. M. (2000). Congruency in defining critical thinking by nurse educators and non-nurse scholars. Journal of Nursing Education, 39(8), 340-351.

Halpern, D. S. (1999). Teaching for critical thinking: Helping college students develop the skills and dispositions of a critical thinker. New Directions For Teaching and Learning, 80, 69-74.

Hatcher, D. L. (2000). Arguments for another definition of critical thinking. Inquiry: Critical Thinking Across the Disciplines, 20(1), 3-8.

Jenicek, M., Croskerry, P., & Hitchcock, D. L. (2011). Evidence and its uses in health care and research: the role of critical thinking. Medical Science Monitor, 17(1), RA12-17.

Jones, J. H. (2010). Developing critical thinking in the perioperative environment. Association of Perioperative Registered Nurses Journal, 91(2), 248-256.

Kennedy, M., Fisher, M. B., & Ennis, R. H. (1991). Critical thinking: Literature review and needed research. In L. Idol & B. F. Jones (Eds.), Educational Values and Cognitive Instruction: Implications for Reform. (pp. 11-40). Hillsdale, N.J.: Erlbaum.

Krupat, E., Sprague, J. M., Wolpaw, D., Haidet, P., Hatem, D., & O'Brien, B. (2011). Thinking critically about critical thinking: Ability, disposition or both? Medical Education, 45(6), 625635.

Liaison Committee on Medical Education. (2012). Functions and Structure of a Medical School: Standards for Accreditation of Medical Education Programs Leading to the MD Degree. Retrieved from http://www.lcme.org/functions.pdf

Midwestern University Catalog. (2012). Downers Grove, IL.

Oderda, G. M., Zavod, R. M., Carter, J. T., Early, J. L., Joyner, P. U., Kirschenbaum, H., … Plaza, C. M. (2011). An environmental scan on the status of critical thinking and problem solving skills in colleges/ schools of pharmacy: Report of the 2009-2010 academic affairs standing committee. American Journal of Pharmaceutical Education, 74(10), S6.

Paul, R., & Elder, L. (2006). Critical Thinking: Tools for Taking Charge of Your Learning and Your Life (2nd ed.). Upper Saddle River, NJ: Pearson Prentice Hall.

Paul, R., & Elder, L. (2008). The Miniature Guide to Critial Thinking Concepts and Tools (5th ed.): The Foundation for Critical Thinking.

Paul, R., Elder, L., & Bartell, T. (1995). Study of 38 Public Universities and 28 Private Universities to Determine Faculty Emphasis on Critical Thinking in Instruction. Retrieved from http://www.criticalthinking.org/pages/study-of-38-public-universities-and-28-privateuniversities-to-determine-faculty-emphasis-on-critical-thinking-in-instruction/598

Scheffer, B. K., & Rubenfeld, M. G. (2000). A consensus statement on critical thinking in nursing. Journal of Nursing Education, 39(8), 352-359.

• ADEA Connect

• Communities
• Career Opportunities
• New Thinking
• ADEA Governance
• House of Delegates
• Board of Directors
• Advisory Committees
• Sections and Special Interest Groups
• Governance Documents and Publications
• Dental Faculty Code of Conduct
• ADEAGies Foundation
• About ADEAGies Foundation
• ADEAGies Newsroom
• Gies Awards
• Press Center
• Strategic Directions
• 2023 Annual Report
• ADEA Membership
• Institutions
• Faculty and Staff
• Individuals
• Corporations
• ADEA Members
• Predoctoral Dental
• Allied Dental
• Nonfederal Advanced Dental
• U.S. Federal Dental
• Students, Residents and Fellows
• Corporate Members
• Member Directory
• Directory of Institutional Members (DIM)
• 5 Questions With
• ADEA Member to Member Recruitment
• Students, Residents, and Fellows
• Information For
• Deans & Program Directors
• Current Students & Residents
• Prospective Students
• Educational Meetings
• Upcoming Events
• 2025 Annual Session & Exhibition
• eLearn Webinars
• Past Events
• Professional Development
• eLearn Micro-credentials
• Leadership Institute
• Leadership Institute Alumni Association (LIAA)
• Faculty Development Programs
• ADEA Scholarships, Awards and Fellowships
• Academic Fellowship
• For Students
• For Dental Educators
• For Leadership Institute Fellows
• Teaching Resources
• ADEA weTeach®
• MedEdPORTAL

Critical Thinking Skills Toolbox

• Resources for Teaching
• Policy Topics
• Task Force Report
• Opioid Epidemic
• Financing Dental Education
• Holistic Review
• Sex-based Health Differences
• Access, Diversity and Inclusion
• ADEA Commission on Change and Innovation in Dental Education
• Tool Resources
• Campus Liaisons
• Policy Resources
• Policy Publications
• Holistic Review Workshops
• Leading Conversations Webinar Series
• Collaborations
• Summer Health Professions Education Program
• Minority Dental Faculty Development Program
• Federal Advocacy
• Dental School Legislators
• Policy Letters and Memos
• Legislative Process
• Federal Advocacy Toolkit
• State Information
• Opioid Abuse
• Tracking Map
• Loan Forgiveness Programs
• State Advocacy Toolkit
• Canadian Information
• Dental Schools
• Provincial Information
• ADEA Advocate
• Books and Guides
• About ADEA Publications
• 2023-24 Official Guide
• Dental School Explorer
• Dental Education Trends
• Ordering Publications
• ADEA Bookstore
• Newsletters
• About ADEA Newsletters
• Bulletin of Dental Education
• Charting Progress
• Subscribe to Newsletter
• Journal of Dental Education
• Subscriptions
• Submissions FAQs
• Data, Analysis and Research
• Educational Institutions
• Applicants, Enrollees and Graduates
• Dental School Seniors
• ADEA AADSAS® (Dental School)
• AADSAS Applicants
• Admissions Officers
• Health Professions Advisors
• ADEA CAAPID® (International Dentists)
• CAAPID Applicants
• Program Finder
• ADEA DHCAS® (Dental Hygiene Programs)
• DHCAS Applicants
• Program Directors
• ADEA PASS® (Advanced Dental Education Programs)
• PASS Applicants
• PASS Evaluators
• DentEd Jobs
• Information For:

• Introduction
• Overview of Critical Thinking Skills
• Teaching Observations
• Avenues for Research

CTS Tools for Faculty and Student Assessment

• Critical Thinking and Assessment
• Conclusions
• Bibliography
• Helpful Links
• Appendix A. Author's Impressions of Vignettes

A number of critical thinking skills inventories and measures have been developed:

     Watson-Glaser Critical Thinking Appraisal (WGCTA)      Cornell Critical Thinking Test      California Critical Thinking Disposition Inventory (CCTDI)      California Critical Thinking Skills Test (CCTST)      Health Science Reasoning Test (HSRT)      Professional Judgment Rating Form (PJRF)      Teaching for Thinking Student Course Evaluation Form      Holistic Critical Thinking Scoring Rubric      Peer Evaluation of Group Presentation Form

Excluding the Watson-Glaser Critical Thinking Appraisal and the Cornell Critical Thinking Test, Facione and Facione developed the critical thinking skills instruments listed above. However, it is important to point out that all of these measures are of questionable utility for dental educators because their content is general rather than dental education specific. (See Critical Thinking and Assessment .)

Table 7. Purposes of Critical Thinking Skills Instruments

  Reliability and Validity

Reliability means that individual scores from an instrument should be the same or nearly the same from one administration of the instrument to another. The instrument can be assumed to be free of bias and measurement error (68). Alpha coefficients are often used to report an estimate of internal consistency. Scores of .70 or higher indicate that the instrument has high reliability when the stakes are moderate. Scores of .80 and higher are appropriate when the stakes are high.

Validity means that individual scores from a particular instrument are meaningful, make sense, and allow researchers to draw conclusions from the sample to the population that is being studied (69) Researchers often refer to "content" or "face" validity. Content validity or face validity is the extent to which questions on an instrument are representative of the possible questions that a researcher could ask about that particular content or skills.

Watson-Glaser Critical Thinking Appraisal-FS (WGCTA-FS)

The WGCTA-FS is a 40-item inventory created to replace Forms A and B of the original test, which participants reported was too long.70 This inventory assesses test takers' skills in:

     (a) Inference: the extent to which the individual recognizes whether assumptions are clearly stated      (b) Recognition of assumptions: whether an individual recognizes whether assumptions are clearly stated      (c) Deduction: whether an individual decides if certain conclusions follow the information provided      (d) Interpretation: whether an individual considers evidence provided and determines whether generalizations from data are warranted      (e) Evaluation of arguments: whether an individual distinguishes strong and relevant arguments from weak and irrelevant arguments

Researchers investigated the reliability and validity of the WGCTA-FS for subjects in academic fields. Participants included 586 university students. Internal consistencies for the total WGCTA-FS among students majoring in psychology, educational psychology, and special education, including undergraduates and graduates, ranged from .74 to .92. The correlations between course grades and total WGCTA-FS scores for all groups ranged from .24 to .62 and were significant at the p < .05 of p < .01. In addition, internal consistency and test-retest reliability for the WGCTA-FS have been measured as .81. The WGCTA-FS was found to be a reliable and valid instrument for measuring critical thinking (71).

Cornell Critical Thinking Test (CCTT)

There are two forms of the CCTT, X and Z. Form X is for students in grades 4-14. Form Z is for advanced and gifted high school students, undergraduate and graduate students, and adults. Reliability estimates for Form Z range from .49 to .87 across the 42 groups who have been tested. Measures of validity were computed in standard conditions, roughly defined as conditions that do not adversely affect test performance. Correlations between Level Z and other measures of critical thinking are about .50.72 The CCTT is reportedly as predictive of graduate school grades as the Graduate Record Exam (GRE), a measure of aptitude, and the Miller Analogies Test, and tends to correlate between .2 and .4.73

California Critical Thinking Disposition Inventory (CCTDI)

Facione and Facione have reported significant relationships between the CCTDI and the CCTST. When faculty focus on critical thinking in planning curriculum development, modest cross-sectional and longitudinal gains have been demonstrated in students' CTS.74 The CCTDI consists of seven subscales and an overall score. The recommended cut-off score for each scale is 40, the suggested target score is 50, and the maximum score is 60. Scores below 40 on a specific scale are weak in that CT disposition, and scores above 50 on a scale are strong in that dispositional aspect. An overall score of 280 shows serious deficiency in disposition toward CT, while an overall score of 350 (while rare) shows across the board strength. The seven subscales are analyticity, self-confidence, inquisitiveness, maturity, open-mindedness, systematicity, and truth seeking (75).

In a study of instructional strategies and their influence on the development of critical thinking among undergraduate nursing students, Tiwari, Lai, and Yuen found that, compared with lecture students, PBL students showed significantly greater improvement in overall CCTDI (p = .0048), Truth seeking (p = .0008), Analyticity (p =.0368) and Critical Thinking Self-confidence (p =.0342) subscales from the first to the second time points; in overall CCTDI (p = .0083), Truth seeking (p= .0090), and Analyticity (p =.0354) subscales from the second to the third time points; and in Truth seeking (p = .0173) and Systematicity (p = .0440) subscales scores from the first to the fourth time points (76). California Critical Thinking Skills Test (CCTST)

Studies have shown the California Critical Thinking Skills Test captured gain scores in students' critical thinking over one quarter or one semester. Multiple health science programs have demonstrated significant gains in students' critical thinking using site-specific curriculum. Studies conducted to control for re-test bias showed no testing effect from pre- to post-test means using two independent groups of CT students. Since behavioral science measures can be impacted by social-desirability bias-the participant's desire to answer in ways that would please the researcher-researchers are urged to have participants take the Marlowe Crowne Social Desirability Scale simultaneously when measuring pre- and post-test changes in critical thinking skills. The CCTST is a 34-item instrument. This test has been correlated with the CCTDI with a sample of 1,557 nursing education students. Results show that, r = .201, and the relationship between the CCTST and the CCTDI is significant at p< .001. Significant relationships between CCTST and other measures including the GRE total, GRE-analytic, GRE-Verbal, GRE-Quantitative, the WGCTA, and the SAT Math and Verbal have also been reported. The two forms of the CCTST, A and B, are considered statistically significant. Depending on the testing, context KR-20 alphas range from .70 to .75. The newest version is CCTST Form 2000, and depending on the testing context, KR-20 alphas range from .78-.84.77

The Health Science Reasoning Test (HSRT)

Items within this inventory cover the domain of CT cognitive skills identified by a Delphi group of experts whose work resulted in the development of the CCTDI and CCTST. This test measures health science undergraduate and graduate students' CTS. Although test items are set in health sciences and clinical practice contexts, test takers are not required to have discipline-specific health sciences knowledge. For this reason, the test may have limited utility in dental education (78).

Preliminary estimates of internal consistency show that overall KR-20 coefficients range from .77 to .83.79 The instrument has moderate reliability on analysis and inference subscales, although the factor loadings appear adequate. The low K-20 coefficients may be result of small sample size, variance in item response, or both (see following table).

Table 8. Estimates of Internal Consistency and Factor Loading by Subscale for HSRT

Professional Judgment Rating Form (PJRF)

The scale consists of two sets of descriptors. The first set relates primarily to the attitudinal (habits of mind) dimension of CT. The second set relates primarily to CTS.

A single rater should know the student well enough to respond to at least 17 or the 20 descriptors with confidence. If not, the validity of the ratings may be questionable. If a single rater is used and ratings over time show some consistency, comparisons between ratings may be used to assess changes. If more than one rater is used, then inter-rater reliability must be established among the raters to yield meaningful results. While the PJRF can be used to assess the effectiveness of training programs for individuals or groups, the evaluation of participants' actual skills are best measured by an objective tool such as the California Critical Thinking Skills Test.

Teaching for Thinking Student Course Evaluation Form

Course evaluations typically ask for responses of "agree" or "disagree" to items focusing on teacher behavior. Typically the questions do not solicit information about student learning. Because contemporary thinking about curriculum is interested in student learning, this form was developed to address differences in pedagogy and subject matter, learning outcomes, student demographics, and course level characteristic of education today. This form also grew out of a "one size fits all" approach to teaching evaluations and a recognition of the limitations of this practice. It offers information about how a particular course enhances student knowledge, sensitivities, and dispositions. The form gives students an opportunity to provide feedback that can be used to improve instruction.

Holistic Critical Thinking Scoring Rubric

This assessment tool uses a four-point classification schema that lists particular opposing reasoning skills for select criteria. One advantage of a rubric is that it offers clearly delineated components and scales for evaluating outcomes. This rubric explains how students' CTS will be evaluated, and it provides a consistent framework for the professor as evaluator. Users can add or delete any of the statements to reflect their institution's effort to measure CT. Like most rubrics, this form is likely to have high face validity since the items tend to be relevant or descriptive of the target concept. This rubric can be used to rate student work or to assess learning outcomes. Experienced evaluators should engage in a process leading to consensus regarding what kinds of things should be classified and in what ways.80 If used improperly or by inexperienced evaluators, unreliable results may occur.

Peer Evaluation of Group Presentation Form

This form offers a common set of criteria to be used by peers and the instructor to evaluate student-led group presentations regarding concepts, analysis of arguments or positions, and conclusions.81 Users have an opportunity to rate the degree to which each component was demonstrated. Open-ended questions give users an opportunity to cite examples of how concepts, the analysis of arguments or positions, and conclusions were demonstrated.

Table 8. Proposed Universal Criteria for Evaluating Students' Critical Thinking Skills 

Aside from the use of the above-mentioned assessment tools, Dexter et al. recommended that all schools develop universal criteria for evaluating students' development of critical thinking skills (82).

Their rationale for the proposed criteria is that if faculty give feedback using these criteria, graduates will internalize these skills and use them to monitor their own thinking and practice (see Table 4).

• Application Information
• ADEA GoDental
• ADEA AADSAS
• ADEA CAAPID
• Events & Professional Development
• Scholarships, Awards & Fellowships
• Publications & Data
• Official Guide to Dental Schools
• Data, Analysis & Research
• Follow Us On:

• ADEA Privacy Policy
• Terms of Use
• Website Feedback
• Website Help

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings
• My Bibliography
• Collections
• Citation manager

Save citation to file

Email citation, add to collections.

• Create a new collection
• Add to an existing collection

Add to My Bibliography

Your saved search, create a file for external citation management software, your rss feed.

• Search in PubMed
• Search in NLM Catalog
• Add to Search

Mind mapping to enhance critical thinking skills in respiratory therapy education

Affiliations.

• 1 Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
• 2 King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
• 3 Seton Hall University, Nutley, NJ.
• 4 Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
• 5 King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
• 6 Department of Respiratory Therapy, Batterjee Medical College, Jeddah, Saudi Arabia.
• 7 Department of Respiratory Therapy, College of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.
• PMID: 39268420
• PMCID: PMC11392321
• DOI: 10.4103/jehp.jehp_1816_23

Background: The objective of this study was to investigate the use of mind maps as an active teaching strategy to enhance critical thinking skills (CTSs) among respiratory therapy (RT) students in Saudi Arabia.

Materials and methods: A total of 86 participants from two RT programs in Saudi Arabian Universities, King Saud bin Abdulaziz University for Health Sciences and The Batterjie Medical College, were randomly assigned to either the mind map group (MMG) or the standard note-taking group (SNTG). With the quasi-experimental design and quantitative method, mean comparisons were made between the groups using an independent t -test.

Results: There was no significant change between the pre-SNTG and post-SNTG as measured by the health sciences reasoning test (HSRT) after 15 weeks of standard note-taking (SNT). However, it showed the difference between the pre-MMG and post-MMG ( P = .02) as measured by the HSRT after 15 weeks of intervention. There was also a significant change between the post-MMG and SNTG ( P = .04) as measured by the HSRT, where the MMG had higher scores. However, the study had limitations, which conceded to the failure of participants in the test and the subjectivity of respondents where they were excluded from the study; also, for generalizability of the result, the study should have been taken beyond Riyadh and Jeddah.

Conclusion: Prior to this study, the effectiveness of mind mapping (MM) in the respiratory discipline has not yet been explored. It found that mind mapping was effective at improving CTS, while SNT was not, as measured by pre- and post-test HSRT scores. This was the first investigation into MM's impact on CTS within respiratory therapy education.

Keywords: Active learning; learning strategy; mind mapping; respiratory care; respiratory therapy; standard note-taking.

Copyright: © 2024 Journal of Education and Health Promotion.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest.

Quantitative approach – A quasi-experimental…

Quantitative approach – A quasi-experimental pre-test–post-test design. (Source: Author)

Study process (Source: Author)

Study sample (Source: Author)

Participants’ age. (Source: Author)

Overall critical thinking scores of…

Overall critical thinking scores of RT students at baseline (pre) (Author: Source)

• Fox RE. Determining the Relationship Between First Time Therapist Multiple Choice Exam High Cut and Clinical Simulation Exam Pass Rates of Recent Respiratory Therapy Graduates From an Ohio University and Their Well-Being and Persistence. Doctoral Dissertations and Projects. 2023. Available from: https://digitalcommons.liberty.edu/doctoral/4626 .
• Kacmarek RM, Heuer AJ, Stoller JK. Egan’s Fundamentals of Respiratory Care E-Book. Elsevier Health Sciences; Amsterdam, The Netherlands: 2019. Early history of respiratory care; p. 1.
• Lubken TA. Washington, USA: Walden University; 2021. Effect of Professional Exclusion Among Respiratory Therapists in the ICU.
• Kacmarek RM, Stoller JK, Heuer AJ. Egan’s Fundamentals of Respiratory Care E-Book. Elsevier Health Sciences. 2019
• Jaswal P, Behera B. Blended matters: Nurturing critical thinking. E-Learning and Digital Media. 2023 20427530231156184. doi: 10.1177/20427530231156184.
• Citation Manager

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Am J Pharm Educ
• v.78(4); 2014 May 15

Association of Health Sciences Reasoning Test Scores With Academic and Experiential Performance

Objectives. To assess the association of scores on the Health Sciences Reasoning Test (HSRT) with academic and experiential performance in a doctor of pharmacy (PharmD) curriculum.

Methods. The HSRT was administered to 329 first-year (P1) PharmD students. Performance on the HSRT and its subscales was compared with academic performance in 29 courses throughout the curriculum and with performance in advanced pharmacy practice experiences (APPEs).

Results. Significant positive correlations were found between course grades in 8 courses and HSRT overall scores. All significant correlations were accounted for by pharmaceutical care laboratory courses, therapeutics courses, and a law and ethics course.

Conclusion. There was a lack of moderate to strong correlation between HSRT scores and academic and experiential performance. The usefulness of the HSRT as a tool for predicting student success may be limited.

INTRODUCTION

Critical thinking has been defined as “the process of purposeful, self-regulatory, judgment [which] gives reasoned consideration to evidence, context, conceptualizations, methods, and criteria.” 1 Ongoing advances in technology and changes in necessary workplace skills have placed a growing emphasis on the need for pharmacists to possess critical-thinking skills in order to solve complex patient-care problems and work in multidisciplinary interprofessional teams. As a result, significant interest exists among pharmacy educators concerning the measurement and development of these skills. This interest was highlighted by: the 2009 American Association of Colleges of Pharmacy (AACP) Curricular Change Summit, which identified the ability to think critically as one of the key outcomes that pharmacy graduates should possess; the 2009-2010 AACP Academic Affairs Standing Committee, which published an environmental scan of critical thinking and problem solving in pharmacy schools; and the Summit to Advance Experiential Education in Pharmacy, which emphasized the importance of enhancing admissions criteria and screening tools to include problem solving and critical thinking. 2-4

Critical-thinking skills can significantly impact student outcomes. College graduates with lower gains in critical thinking, for example, have higher unemployment rates, amass higher credit card debt, and report lower lifestyle satisfaction than their more accomplished peers. 5 A meta-analysis of studies evaluating critical-thinking test scores and academic success of health professions trainees, including 5 studies from pharmacy education, found that critical thinking and academic success were moderately correlated (r=0.31). 6 In pharmacy education, a study by Allen and Bond 7 found that the California Critical Thinking Skills Test (CCTST) was a predictor of practice-related courses and clerkship success, while Kidd and Latif 8 found the CCTST to be a predictor of performance in APPEs. When looking at specific coursework, Miller 9 found a correlation between CCTST scores and grades in a drug literature evaluation course and Adamcik 10 reported strong correlations between the Watson-Glaser Critical Thinking Appraisal (WGCTA) and performance in therapeutics coursework. Given the importance of critical thinking to pharmacy practice and student outcomes, identifying measures and tools that effectively capture the critical-thinking ability of students at the point of admissions could significantly improve the ability of colleges and schools of pharmacy to identify qualified students capable of excelling in a pharmacy curriculum and ultimately meeting the complex needs of 21 st century health care.

The HSRT is a validated critical-thinking skills test with questions stated in a health sciences context. It is intended for use in health sciences educational programs and with professional practitioners in health sciences fields. It was developed by Insight Assessment, who also developed the CCTST and California Critical Thinking Disposition Inventory. The HSRT consists of 33 multiple-choice questions from 5 critical-thinking domains categorized to match the constructs of the American Philosophical Association Delphi Consensus Definition of critical thinking: analysis, inference, evaluation, induction, and deduction. 11 The test is usually administered over a 50-minute period, and no previous knowledge of science or health sciences is required, nor is it beneficial in answering the questions. An overall score of 15 to 20 is indicative of moderate critical-thinking abilities, 21 to 25 is indicative of strong critical-thinking abilities, and ≥26 is indicative of superior critical-thinking abilities. Subscale scores above 5 are considered strong for analysis, inference, and evaluation, and subscale scores above 8 are considered strong for induction and deduction. 12

A limited number of studies could be found in the literature evaluating the association of HSRT scores and course grades (didactic or experiential) for health sciences students. An association was not found between scores on the HSRT and academic performance in the first and second year of classroom-based coursework within the pharmacy curriculum at the University of Mississippi. 13 While the HSRT may provide insight into the critical-thinking skills of students at the point of admissions, 14 it is unclear whether this test may be useful for predicting student performance within a pharmacy curriculum. The objective of our study was to assess the association of scores on the HSRT with classroom and APPE performance in the PharmD curriculum. If an association were found, the HSRT could serve as an additional admissions tool to select students who may excel in coursework and pharmacy practice experiences that rely heavily on critical-thinking skills. This study is an extension of a previous study that explored the correlation between typical cognitive admission criteria and HSRT scores. 14

The HSRT test administration methods have been described in a previous paper exploring the correlation of the HSRT with student admission variables. 14 The HSRT was administered to 329 of 459 (71.6%) P1 students enrolled at the UNC Eshelman School of Pharmacy from fall 2007 to fall 2009 ( Table 1 ). Response rates were 87% for the class of 2011 (135 of 155), 72% for the class of 2012 (108 of 151), and 56% for the class 2013 (86 of 153). The test was administered during the students’ first year of the curriculum in either the fall or spring semester.

Demographic Data for First-Year Pharmacy Students Who Completed the Health Sciences Reasoning Test

Following completion of the test, an overall HSRT score and 5 subscale scores (analysis, inference, evaluation, deductive reasoning, and inductive reasoning) were calculated for each participant. Each student’s final course grades, measured on a scale from 1 to 4 (4=A, 3=B, 2=C, 1=F ), were obtained for all 29 classroom-based courses offered during the first 3 years of the curriculum. In addition, each student’s performance on APPEs, measured on a scale of 0 to 100, was obtained. For the purposes of analysis, each APPE was coded as 1 of 6 types: ambulatory care, advanced community, advanced hospital, adult acute care, clinical specialty, and elective. To interpret the findings, each course was categorized as basic science (Pharmaceutics I and II, Biochemistry I and II, Medicinal Chemistry I, II and III, and Physiology), therapeutics, pharmaceutical care laboratories, or other (Nonprescription Drugs and Self-Care, Pharmacy Practice Management, Law and Ethics, Pharmacokinetics I and II, Pharmacodynamics, Health Systems, Immunizations, and Drug Literature and Evaluation). This study was a continuation of a previous study and considered exempt by the University of North Carolina at Chapel Hill Institutional Review Board.

All data were de-identified prior to statistical analysis. Characteristics of study participants are presented using descriptive statistics (eg, means, standard deviations, percentages). Pearson correlation was used to determine the relationship between HSRT scores and all continuous variables, including student performance in each of the 29 classroom-based courses and on each of the 6 types of APPEs. Any -0.20 < r p <0.20 was considered to demonstrate no relationship or negligible relationship. The t test for independent samples was used to compare groups (ie, gender, class). Continuous data were presented as mean and standard deviation. Statistical significance was established at α=0.05. All quantitative data analysis was conducted in SPSS for Windows, version 20 (IBM Corp, Armonk, NY). 15

Table 1 details the characteristics of the study participants. The HSRT was completed by 329 of 459 (71.6%) P1 students over 3 years. One hundred thirty-five students from the class of 2011 participated in fall 2007, 108 students from the class of 2012 participated in fall 2008, and 86 students from the class of 2013 participated in fall 2009 and spring (January) 2010.

The average overall HSRT score for all participants was 24.4±3.5 (of 33 possible points). Average scores on the subscales were 4.9±1.0 points on HSRT analysis, 4.0±1.3 points on HSRT inference, 5.2±0.9 points on HSRT evaluation, 8.1±1.2 points on HSRT induction, and 7.9±1.7 points on HSRT deduction. Female students scored significantly higher on the inference subscale than male students (4.2±1.2 vs 3.8±1.4, p =0.046). There was no significant difference on the overall HSRT score or the other 5 subscales for gender or racial-ethnic group. There were no significant differences in any scores between each class year.

Nine courses demonstrated a significant relationship with the HSRT and its subscales ( Table 2 ). Significant correlations with r p ≥0.20 were found between the HSRT overall score and 2 (out of 7) therapeutics courses, 4 (out of 5) pharmaceutical care laboratories (PCLs), Law & Ethics, and the Nonprescription Drugs & Self-Care course. While some of these courses were also significantly correlated with the HSRT analysis, evaluation, induction, and deduction subscales, no courses or APPEs presented significant associations with the HSRT inference subscale. The strongest significant correlations were associated with Law & Ethics and PCL 3 (the third laboratory course in the PCL sequence) ( Table 3 ). The strongest 5 correlations for the HSRT overall and its subscales were between Law & Ethics and HSRT overall (r p =0.27), PCL 3 and HSRT overall (r p =0.26), PCL 3 and HSRT deduction (r p =0.26), Law & Ethics and HSRT deduction (r p =0.25), and PCL 3 and HSRT induction (r p =0.23). There were no significant correlations found between HSRT scores and grades from basic science courses or from APPEs. All significant correlations found were positive and weak (r p <0.3).

Number of Courses Significantly Correlated with Health Sciences Reasoning Test Scores a

Correlation of Health Sciences Reasoning Test Overall Score with Course Grades a

This study examined the association between performance on the HSRT and academic performance at the University of North Carolina at Chapel Hill Eshelman School of Pharmacy. This is one of the first studies in pharmacy education to examine the relationship between the HSRT and classroom and APPE grades. The major finding was that 9 courses were significantly correlated with HSRT scores: 4 pharmaceutical care laboratory courses, 3 therapeutics courses, Law and Ethics, and Nonprescription Drugs & Self-Care course. However, because of the lack of moderate to strong correlations between HSRT scores and academic performance, the usefulness of the HSRT as an admissions instrument may be limited.

Significant correlations between the HSRT and courses were found in more applied courses, as opposed to foundational courses, although the correlations were weak. Law and Ethics and PCL 3 presented the strongest associations with the HSRT and its subscales. This may be because of the activities and content of these courses. For example, neither of these courses are traditional lecture-based courses and both promote strategies that have been shown to facilitate critical thinking. Traditional lecture is not as effective a method to teach critical thinking compared with other strategies such as problem-based learning, reading assignments, reflection, self-assessment, and experiential learning. 16-18 Although the PharmD curriculum has changed over the past few years to include teaching and learning strategies other than traditional lectures, most of the classroom-based courses examined in this study were conducted in a traditional lecture format. It is surprising then that the HSRT was derived from the same study format as the CCTST, which makes it likely that the HSRT does measure critical thinking. 19 Research by Cox and colleagues 14 suggests that the HSRT is likely measuring something absent in standard cognitive admission criteria.

This study found only weak correlations between HSRT and academic performance in some of the courses and no association in the remaining courses. While these findings support Baseck’s 13 study of HSRT and classroom grades in the first and second years of a pharmacy curriculum, they are in direct contrast to numerous studies demonstrating strong and significant relationships between academic performance and critical-thinking scores from other tests like the CCTST and WGCTA. 7-10 A possible explanation for the discrepancies among these studies is the institutional and course-level variability associated with grading. While grades are often considered a proxy for critical thinking, they are comprised of varying criteria influenced, in part, by course content, format, assignments, learning objectives, and instructor preferences. Taken together, these studies highlight the challenges associated with measuring critical thinking and using those measures to inform pharmacy curricula in a meaningful way.

At the point of admissions, other tools and instruments may be useful in capturing constructs or skills that are more strongly correlated with success in the pharmacy curriculum. While critical thinking is clearly a vital skill for pharmacy students, our students are also graded on other critical constructs, including communication, collaboration, content mastery, and professionalism. Using approaches in admissions that account for the knowledge, skills, and abilities on which our students are assessed within the curriculum, including critical thinking, may be a more effective approach to identifying students who will excel in the curriculum and pharmacy practice. As a result, our institution is reevaluating our admissions model and incorporating more measures of noncognitive as well as cognitive constructs in the process. One instrument that may be helpful in identifying noncognitive traits, including critical thinking and problem solving, is the multiple-mini interview. 20 This tool enables schools to evaluate multiple skills at the point of admissions. Additionally, institutions may want to admit students who demonstrate strong critical-thinking skills upon admission as changes in critical-thinking skills over the course of study have been variable in previous studies and often do not improve dramatically. 21-25

Given the emphasis on critical thinking and problem solving in pharmacy education, institutions should consider systematically and explicitly assessing critical thinking at regular intervals throughout the curriculum using valid, reliable measures. Critical thinking may be most effectively practiced and measured in courses like PCL, which rely heavily on applied activities that integrate learning across the curriculum. However, the usefulness of the HSRT as a tool for predicting student success may be limited.

The limitations of this study included the sample size and time of test. The HSRT was administered during a professional development course, which had variable attendance and resulted in differences in response rates between the 3 years of test administration. Informed consent was used with no incentives offered to students who participated in the study. Recruitment strategies did not differ between the years. While the test was not administered to the entire cohort of students within each year, the results were analyzed as a single cohort because there were no significant differences between the cohorts. This resulted in a 71.6% response rate, which was felt to be sufficiently high. In addition, the sample for this study was limited to a single institution. Future studies examining the relationship between the HSRT and academic performance of pharmacy students should be extended to include other institutions. Additionally, the HSRT was administered to some students early in the spring semester of the P1 year as opposed to the fall semester upon entrance to the program. Critical-thinking ability could have varied depending on the point in the P1 year when it was administered; however, this likely did not significantly impact the results because the administration times of the HSRT during the first year only differed by 4 months at most. Two studies exploring changes in critical-thinking skills throughout 4 years of a pharmacy curriculum showed only small changes. A smaller time period may not lead to changes in critical thinking or detectable differences in critical-thinking assessment. 9,23

All associations examined between the HSRT and academic performance in the current PharmD program were weak or negligible. While in theory the HSRT is an attractive instrument to predict academic performance, its use may be limited by the lack of moderate to strong correlation between scores and course performance in the first through the third years and with APPEs. This is likely because of the multiple factors that contribute to academic and experiential success and the lack of critical-thinking assessment in current evaluation tools. Given the emphasis on critical thinking and problem solving in pharmacy education, institutions should consider systematically and explicitly assessing critical thinking at regular intervals throughout their pharmacy curriculum using valid, reliable measures; however, other approaches for determining student qualifications and strengths at the point of admissions should be considered.