Predicting Success in Health Science Professional Programs

Surgical nurse on working with patient in hospital

Predicting student success via critical thinking assessment

For several decades, health science educators have been working to train critical thinking in their students and clinicians. Each of the clinical specialty programs receive an extraordinary number of applicants for a limited number of training seats. Educating physical therapists, nurses, pharmacists, physicians, and other clinical specialists requires years of course work and extensive clinical practice hours.

The challenge for these programs is to admit students who will succeed in their training, pass their licensure examinations, and then transition well into jobs that immediately demand strength in problem analysis and decision-making.

Today the effort to provide thinking clinician starts with admissions.

Tested in many health science disciplines

For many years, researchers have been studying the power of critical thinking scores at admission to predict clinical ratings, degree completion and licensure rates.   Studies in Dentistry, Family Medicine, Pharmacy, Nursing, Physical Therapy, Occupational Therapy, Audiology, Midwifery, Psychology, Dental Hygiene, and other health specialties demonstrate the added value of including a critical thinking assessment in the admission protocol.

Most programs use the Health Sciences Reasoning Test (HSRT) or the California Critical Thinking Skills Test (CCTST) as their assessment tool to benchmark students or applicants against national comparison percentiles for their specialty group, and the California Critical Thinking Disposition Inventory (CCTDI) as the measure of thinking mindset attributes.  

The most effective training approaches

Assessing the effectiveness of instructional approaches is a common research focus of health sciences educators. Different training techniques have been closely studied for their effectiveness in building critical thinking skills and a thinking mindset.

Significant gains in critical thinking have been related to problem-based learning strategies, the use of patient simulators, cased-based seminars, concept-mapping strategies, experiential learning programs, peer questioning techniques, and reflective writing exercises. Here is a collection of detailed citations and summaries regarding critical thinking training techniques

Following student cohorts, over time, and collecting a second or third measure of critical thinking skills and mindset at program completion has been informative.  Researchers have discovered which skills and mindset attributes are commonly seen in admissions cohorts, which are improved in relation to specific training techniques, and which require more attention in curriculum building. Exit scores provide a baseline comparison when new curriculum is introduced

Doctors looking at file thinking and discussing options


Measurable gains in critical thinking skills & mindset

One thing is beyond doubt: assuring and improving students’ critical thinking requires explicit attention and educational effort.

This is well documented by the Abrami and colleagues (2015) meta-analysis examining “available empirical evidence on the impact of instruction on the development and enhancement of critical thinking skills and dispositions and student achievement. The review includes quasi- or true-experimental studies that used standardized measures of CT as outcome variables.”1  The cases improve, but the controls either do not or they improve less. Abrami’s work reinforces sound practices, viz. that educators make learning objectives clear to students and that educational institutions provide preservice and in-service training for educators specifically as trainers of critical thinking. There are numerous studies for review regarding learning outcomes assessment.  

Peer-reviewed studies from Hong Kong, Australia, Peoples Republic of China, Ireland, Canada, UAE, Turkey, Australia, Saudi Arabia, United Kingdom, Japan, The Netherlands, Malaysia, USA and many other areas have demonstrated the predictive power of critical thinking skills scores as indicators of an accomplished health science student and practicing clinician.2

In summary, consider the comments of another investigator, John Eigenauer, who reminds us that

“Measurable gains in critical thinking are obtainable by implementing proven methods and best practices, which always include explicit instruction in critical thinking.”3

The changes in health care delivery over recent decades have increased the complexity of care delivery for all specialties. Clinician training is matching the challenge, but each seat is critical to accomplishing the goals of the program and the needs of the patient population.

Success in curriculum and clinical settings can be predicted

An increased focus on critical thinking is helping health science education respond to these increasing demands.  They are able to continue to prepare clinicians who can reason well and maintain practice standards.  Long concerned with training strength in clinical reasoning and evidence-based practice, health science educators are taking additional steps to assess critical thinking in newly admitted students.  This allows them to evaluate each student’s ability to engage in a rigorous health science curriculum.

Reports of the success of that effort have begun to emerge in publications covering audiology, dentistry, dental hygiene, family medicine, health policy, nursing, optometry, pharmacology, physical therapy.4

Because common human reasoning errors have been well documented for several decades, some health science innovators are working toward a future where machine intelligence will make key clinical judgments, not humans. Our preferred future would be one where humans with strength in critical thinking make clinical judgments aided by a machine intelligence. This would allow us to expect that clinical judgment will improve globally, ethically balancing economics, risk management, context, and quality of life.

What the critical thinking data tell usThis post was excerpted and edited from the 2020 white paper by Peter A. Facione, Ph.D., Noreen C. Facione Ph.D., and Carol Ann Gittens, Ph.D., “What Critical Thinking Data Tells Us.” click on the title to download the full PDF.  


1 Abrami, P. C., Bernard, R., Borokhovski, E., Waddington, D., Wade, C. A., & Persson, T. (2015). Strategies for teaching students to think critically: A meta-analysis. Review of Educational Research, 85, 275–314. Page 275.

2 Campbell, F. B. (2017). Assessment of critical chinking as a predictor of success in completion of an Associate Degree Respiratory Care Program. Northeastern University Dissertation, Library Dissertations Archive. Cox, W. C., & McLaughlin, J. (2014). Association of health sciences reasoning test scores with academic and experiential performance. American Journal of Pharmaceutical Education, 78(3), 73.ff. Paans, W., Sermeus, W., Niewsg, R., & van  der Schans, C. (2010). Determinants of the accuracy of nursing diagnoses: Influence of ready knowledge, knowledge sources, disposition toward critical thinking and reasoning skills. Journal of Professional Nursing, 26(4), 232-241. Tiwari, A., Lai, P., So, M., & Yuen, K. (2006). A comparison of the effects of problem-based learning and lecturing on the development of students’ critical thinking. Medical Education, 40, 547-554.

3 Eigenauer, J. (2016). Targeted instruction in critical thinking improves dispositions. Inquiry: Critical Thinking Across the Disciplines, 31(2), 27-36. p 2.

4 Allaire, J. L. (2015). Assessing critical thinking outcomes of dental hygiene students utilizing virtual patient simulation: A mixed methods study. Journal of Dental Education, 79, 1082-1092. Denial, A. (2008). Association of critical thinking skills with clinical performance in fourth year optometry students. Optometry Education, 33(3), 103-106. Hunter, S., Pitt, V., Croce, N., & Roche J.  (2014). Critical thinking skills of undergraduate nursing students: Description and demographic predictors. Nurse Education Today, 34, 809-814.  Ng, S. L et al. (2013). Exploring the utility of measures of critical thinking dispositions and professional behavior development in an audiology education program. Journal of the American Academy of Audiology, 24(5), 354-364.  Pitt, V. Powis, D., Levett-Jones, T., & Hunter, S.  (2015). The influence of critical thinking skills on performance and progression in a pre-registration nursing program. Nurse Education Today, 35(1), 125-131.  Profetto-McGrath, J., Smith, K. B.,. Hugo, K., Patel, A., & Dussault, B. (2008). Nurse educators’ critical thinking dispositions and research utilization. Nurse Education in Practice, 9(3), 199-208.  Ross, D. et al. (2016). Examining critical thinking skills in family medicine residents. Family Medicine, 48(2), 121-126.  Snyder, J. J., & Wiles, J. R. (2015). Peer led team learning in introductory biology: Effects on peer leader critical thinking skills. PloS ONE 10(1).  Sorensen, H. A., Yankech, L. R. (2008). Precepting in the fast lane: improving critical thinking in new graduate nurses. A comparison of preceptor ratings and critical thinking scores. Journal of Continuing Education in Nursing, 39(5), 208-216.  Suckow, D. W., Brahler, C. J., Donahoe-Fillmore, B., Fisher, M. I., & Anloague, P. A. (2015). The association between critical thinking and scholastic aptitude on first-time pass rate of the national physical therapy examination. Journal of Student Physician Therapy Research, 8(3) Issue 1. Available at University of Dayton ecommons   Wangensteen, S., Johansson, I. S., Björkström, M. E., & Nordström, G. (2011). Research utilisation and critical thinking among newly graduated nurses: predictors for research use. A quantitative cross-sectional study. Journal of Clinical Nursing, 20(17-18), 2436-2437.

5 Janis, I. L., & Mann, L. (1977). Decision making. New York, NY: Free Press. Kahneman, D., Slovic, P., & Tversky, A. (1982). Judgment under uncertainty: Heuristics and Biases. New York, NY: Cambridge University Press. 

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