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

VIDEO

“How Doctor’s Think” by Pat Croskerry

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

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SMILE

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Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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