Critical Thinking

CriticalThinking
LearnedorInherent?

JakeECarroll,Th.D;M.B.A.;B.MIN;NREMTP;TNEMSInstructor/Coordinator
y, , ; / ; g
JohnSHolloway,Sr.,M.B.A.;FF/NREMTP;TNEMSProgramDirector
 Disclaimer

This
Thi presentation
t ti i a compilation
is il ti off research,
h
review experience,
review, experience and professional perceptions.
perceptions
Our intention is to provide an overview of
principles, not a lone solution, but requiring
further research, review, and trial by participants
i their
in th i unique
i workk environment.
i t

CriticalThinking,Holloway/Carroll,Nov2013 2
 Overview

Critical Thinking is a concept and a core

element of patient management.

The terminal objective of this session is to

provide
id insight
i i ht to
t effectively
ff ti l teaching
t hi thi
this
concept to EMS professionals.
professionals

CriticalThinking,Holloway/Carroll,Nov
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2013
 Objectives
1 U
1. Understandthethreecorecomponentsanddefinitionsof
d t d th th t d d fi iti f
criticalthinking.

2. DifferentiatebetweenanEMSTechnicianandtheEMS
Clinician.

3. Developingadifferentialdiagnosisandpatientcareplans
utilizing critical thinking.
utilizingcriticalthinking.

4. Formulatepractical,educationallysoundobjectivesto
assistwithimplementingandevaluatingcriticalthinking.

CriticalThinking,Holloway/Carroll,Nov
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 Sections

1. Introduction,OverviewandDefinitions

2. TechnicianorClinician
3 DevelopingDifferentialDiagnosisand
3. l i iff i l i i d
PatientCarePlans
4. TeachingCriticalThinking

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 SectionOne

INTRODUCTIONS,
OVERVIEWAND DEFINITIONS

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 Definitions
CriticalThinkingisaCONCEPT(1of4)

Amodeofthinkingaboutanysubject,contentorprobleminwhich
thethinkerimprovesthequalityoftheirthinkingbyskillfullytaking
charge of the structures inherent in thinking and imposing intellectual
chargeofthestructuresinherentinthinkingandimposingintellectual
standardsuponthem

Is
Isself
selfdirected,
directed,self
selfdisciplined,
disciplined,self
selfmotivated,
motivated,andself
and selfcorrective
corrective
thinking

Involveseffectivecommunicationandproblemsolvingabilities
Involves effective communication and problem solving abilities

Ismorethanaprocess itisamindset

IsHigherLevelThinking

CriticalThinking,Holloway/Carroll,Nov2013 7
 Istheintellectuallydisciplinedprocessofactively
Is the intellectually disciplined process of actively
andskillfullyconceptualizing,applying,analyzing,
synthesizing, and or evaluating information
synthesizing,andorevaluatinginformation
gatheredfromorgeneratedbyobservation,
experience, reflection, reasoning, communication,
experience,reflection,reasoning,communication,
orthepatientassessmentprocess

Isneveruniversalfromoneindividualtoanother
i di id l
individual

CriticalThinking,Holloway/Carroll,Nov
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 Is
Isgreatlydependantuponthequalityanddepth
greatly dependant upon the quality and depth
ofexperienceinagivendomainofthinking

Nooneisacriticalthinkerthroughandthrough
forweallhavetendenciestodisplayirrational
thoughtorundisciplinedthoughtpatterns
g p g p

ht Critical
EExcellentinthought
ll t i th C iti l Thinking
Thi ki must
t
besystematicallycultivated
CriticalThinking,Holloway/Carroll,Nov
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 It is for the aforementioned reasons, the

development of critical thinking skills and

di
dispositions
ii is
i a lif
life-long
l endeavor.
d

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CriticalThinking,Holloway/Carroll,Nov
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 SectionTwo

TECHNICIANORCLINICIAN?

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 TheCriticalThinker
Raisesvitalquestionsandproblems,formulatingthemclearly
and precisely
andprecisely

Gathersandassessrelevantinformation,usingabstractideas
tointerpretiteffectivelycomestowellreasonedconclusions
andsolutions,testingthemagainstrelevantcriteriaand
standards

Thinksopenmindedlywithinalternativesystemsofthought,
recognizingandassessing,asneedbe,theirassumptions,
implications,andpracticalconsequences;and

Communicateseffectivelywithothersinfiguringoutsolutions
tocomplexproblems
CriticalThinking,Holloway/Carroll,Nov
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 EMT As A Technician
EMTAsATechnician
Notexpectedtousehighlevelsofreasoning
skills
Protocoldriven linearfollowers
Responds
Respondstopatientwhencertainoragroupofsignsor
to patient when certain or a group of signs or
symptomsarepresent
Examples:
E l

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 EMT As A Clinician ACriticalThinker
EMTAsAClinician A Critical Thinker

Appliesclinicalreasoningtoapatient
DifferentialDiagnosis
g
UsesAnalysisoftheeventbaseduponknowledge,
comprehension and application of sound medical
comprehensionandapplicationofsoundmedical
principles

CriticalThinking,Holloway/Carroll,Nov
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 In Essence
InEssence.
The critical thinker uses the differential diagnosis
process:
considers a variety of possible causes, to
determine a number of intervention possibilities waying
the expected outcomes against the potential risks/side
effects then
effects,
formulates the most beneficial intervention that will best
improve the patient outcome

CriticalThinking,Holloway/Carroll,Nov
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 The Critical Thinking Process
TheCriticalThinkingProcess

ISNOT:
limitedtoadvancedlevelproviders,or
basedonlicenselevel
IS:
Drivenbysoundinitialtraining,followedupwith
Fundamentalclinicalmentoring,and
Fundamental clinical mentoring and
Qualitycontinuingeducation,plus
Fieldexperienceand
Fi ld i d apositivecontinuousquality
iti ti lit
improvementprogram

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 SectionThree
DEVELOPING
DIFFERENTIALDIAGNOSIS
AND
PATIENT CARE PLANS
PATIENTCAREPLANS

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 Critical Thinking V Care Plans
CriticalThinkingV.CarePlans
FourStepstoDevelopingCriticalThinking
Knowledge

Comprehension
p

Application

Analysis

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 FourStepstoDevelopingCriticalThinkingHabits

1 Knowledge
1.Knowledge
Identificationandrecall
Signsandsymptomsofchestpain
d f h
Midsternal chestpressure
Dyspnea
Nausea
Painradiatingdownthearm
g
Onsetandduration

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 FourStepstoDevelopingCriticalThinkingHabits

2 Comprehension
2.Comprehension
Abilitytointerpretandparaphrase
Ex:abilitytointerpretthesignsandsymptomsand
bl h d d
explainthephysiologicalprocess
WHY
WHYthepatientisdisplayingthesignsandsymptoms
the patient is displaying the signs and symptoms
ExplainthedifferencebetweenHeartAttack,Angina,Anxiety,
Indigestion,

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 FourStepstoDevelopingCriticalThinkingHabits

3 Application
3.Application
Useallknowledge,information,andexperienceto
d t
determineadditionalinformation,solveany
i dditi li f ti l
problemsandexplainactions
PrescribedNTGandmaxd
b d d d out,extensivecardiacHx,is
d
obese,withdiabetes,HTN,CVA6yrsago,COPD,
smoker regular use of alcohol and has no feeling in
smoker,regularuseofalcohol,andhasnofeelingin
rightfoot.

CriticalThinking,Holloway/Carroll,Nov
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 FourStepstoDevelopingCriticalThinkingHabits

4 Analysis
4.Analysis
Prioritizeandinitiateappropriatetreatment
PrescribedNTGandmaxd
b d d d out,extensivecardiacHx,is
d
obese,diabetes,HTN,priorCVA,COPD,smoker,regular
use of alcohol and has no feeling in right foot
useofalcohol,andhasnofeelinginrightfoot.
Developatreatmentcareplanbaseduponcritical
thinking skills/applications
thinkingskills/applications

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CriticalThinking,Holloway/Carroll,Nov
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 SectionFour

TEACHINGCRITICALTHINKING

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 Simulation and Scenarios
SimulationandScenarios
Includeroleplayingofrealisticsituations
l d l l i f li i i i
Realpatientactorswithmoulage,makeup,
b k
backgroundnoise,bystanders
d i b t d
Realprops
Respondingcrewwithequipment,supplies,and
R di ih i li d
radios
Realisticenvironments
Realistic environments
Elevators,stairwells
Cars,trucks,trains,busses,ATVs,etc
Cars trucks trains busses ATVs etc
Allowsstudentstomakemistakesinaclean
environment
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 Classroom
Beginclasswithcasestudiesorscenarios
Askstudentstosummarizelessons
Ask students to summarize lessons
Assignorallowstudenttochooseatopic,
researchit,presentiteitherfromaproorcon,
hi i ih f
andhavethemdefendchoice.
Onetopicfortwostudents;onepro,theothercon
Summative
Summativeevaluations:allchoicesshouldbe
evaluations: all choices should be
reasonablyclosebutonlyoneismostcorrect.
CriticalThinking,Holloway/Carroll,Nov
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 Socratic Method
SocraticMethod
Constantuseandimplementation
Presentacasewhereaconceptisillustrated
Studentsworktooperationalize
Students work to operationalize
Whataretheissues?
Whatareotheroptions?
Wh t th ti ?
Whydidthestudentchoose____?
Canthestudentproveorprovideevidencefor
theirdecision?
Howcanthisbeevaluatedfor
correctness/accuracy?
CriticalThinking,Holloway/Carroll,Nov
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 Summary
Criticalthinkingisaconcept

Issystematicallycultivatedfrominitialtrainingthrough
field experience with QA/CQI followthrough
fieldexperiencewithQA/CQIfollow through

Acriticalthinkerisselfdirected,selfdisciplined,self
, p ,
motivated,andselfcorrective

EMSeducatorsandinstructorsshouldin fusethe
educationstandardswithcomplexscenariosand
problems to stimulate students'criticalthinkingand
problemstostimulatestudents critical thinking and
problemsolving development.

CriticalThinking,Holloway/Carroll,Nov
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Questions?

CriticalThinking,Holloway/Carroll,Nov
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 References
NationalGuidelinesforeducatingEMSInstructors,August2002.
FoundationsofEducation:AnEMSApproach,2nd Edition,National
AssociationofEMSEducators.
Amuradha,G.(1995).Collaborativelearningenhancescriticalthinking.
JournalofTechnologyEducation,7(1),2230
Croskerry,P.(2000).Thecognitiveimperative:Thinkingabouthowethink.
A d i E
AcademicEmergencyMedicine,7(11),12231231.
M di i 7(11) 1223 1231
Croskerry,P.(2003).Cognitiveforcingstrategiesinclinicaldecisionmaking.
AnnalsofEmergencyMedicine,41(1),160167.
Duron,R.,Limbach,B.,&Waugh,W.(2006).Criticalthinkingframework
D R Li b h B & W h W (2006) C iti l thi ki f k
foranydiscipline.InternationalJournalofTeachingandLearninginHigher
Education,17(2),160166.
Gilboy,N.,&Kane,D.(2004).Unfoldingcasebasedscenarios:Amethodof
Gilboy N & Kane D (2004) Unfolding case based scenarios: A method of
teachingandtestingthecriticalthinkingskillsofnewlylicensednurses.
NurseEducator,30(1),8385.
Wagner,D.,Bear,M,.&Sander,J.(2009).Turningsimulationintoreality:
Wagner, D., Bear, M,. & Sander, J. (2009). Turning simulation into reality:
Increasingstudentcompetenceandconfidence.JournalofNursing
education,48(8),465467.

CriticalThinking,Holloway/Carroll,Nov
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