Critical Thinking

OVERVIEW

From Jenicek et al, 2011:

• According to Sackett and colleagues, evidence based medicine (EBM) as ‘… the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients’, and its integration with individual clinical expertise’
• Critical thinking is a core skill that helps link evidence to clinical expertises, the patient’s individual circumstances and environmental influences
• Critical thinking has been defined as ‘purposeful self-regulatory judgment which results in interpretation, analysis, evaluation and inference, as well as explanation of the evidential, conceptual, methodological, criteriological, or contextual considerations upon which that judgement is based’ (numerous definitions exist)
• Critical thinking is a learned process that can be developed through teaching and guided practice

SPECIFIC ABILITIES UNDERLYING CRITICAL THINKING IN MEDICINE

From Jenicek et al, 2011:

• Understanding the principles of argumentation
• Knowing and understanding dual System 1 and System 2 thinking processes and their interaction (see below)
• Awareness and understanding of evolutionary influences on decision making
• Recognizing distracting stimuli, propaganda, bias, irrelevance
• Identifying, analyzing, and challenging assumptions in arguments
• Awareness and understanding of cognitive fallacies and poor reasoning
• Awareness and understanding of the impact of major cognitive and affective biases on thinking
• Recognizing deception, deliberate or otherwise
• Capacity for assessing credibility of information
• Understanding the need for monitoring and control of one’s own thought processes
• Understanding of the importance of monitoring and control of one’s own affective state
• Awareness of the critical impact of fatigue and sleep deprivation on decision making
• Imagining and exploring alternatives
• Capacity for effectively working through problems
• Understanding of the importance of the context in which decisions are made
• Systematic and effective decision making
• Understanding the dynamics and properties of individual vs. group decision making
• Capacity for anticipating the consequences of decisions

LOGICAL FALLACIES

• See LogicalFallacies.info for an overview of logical fallacies and examples of the different types

VIDEO

References and Links

Journal articles

• Croskerry P. Diagnostic Failure: A Cognitive and Affective Approach. In: Henriksen K, Battles JB, Marks ES, Lewin DI, editors. Advances in Patient Safety: From Research to Implementation (Volume 2: Concepts and Methodology). Rockville (MD): Agency for Healthcare Research and Quality (US); 2005 Feb. [PMID 21249816]
  
• Croskerry P, Petrie DA, Reilly JB, Tait G. Deciding about fast and slow decisions. Acad Med. 2014;89:(2)197-200. [PMID 24362398]
• Croskerry P, Singhal G, Mamede S. Cognitive debiasing 2: impediments to and strategies for change. BMJ Qual Saf. 2013;22 Suppl 2:ii65-ii72. [PMC3786644]
• Jenicek M, Croskerry P, Hitchcock DL. Evidence and its uses in health care and research: the role of critical thinking. Med Sci Monit. 2011;17:(1)RA12-7. [PMC3524675]
• Sackett DL, Rosenberg WMC, Muir Gray JA, et al. Evidence based medicine: what it is and what it isn’t. BMJ. 1996;312:71–72. [PMC2349778]
• Sutherland WJ, et al. Twenty tips for interpreting scientific claims. Nature 2013;503:335–337 [Free Full Text]

FOAM and web resources

• Skeptical medicine
• Clinical Reasoning Toolkit
• LogicalFallacies.info
• Skeptics Guide to the Universe – Logical Fallacies