Strengthening the Essence of Clinical Reasoning

Critical Thinking is the Essence of Clinical Reasoning

The Role of Critical Thinking in Clinical Reasoning

Critical thinking drives the continued development of new knowledge and practice competence for every clinician, clinical scientist, and organizational leader.

Five reasons demonstrate the importance of critical thinking for healthcare professional practice and training:    

  1. Critical thinking encompasses the set of cognitive skills and mindset attributes that drive diagnostic reasoning, clinical performance, and the accurate and comprehensive evaluation of clinical outcomes.
  2. Critical thinking mediates the identification of clinical options, the anticipation and prevention of clinical errors, and the evaluation of the quality of outcomes.
  3. Critical thinking is the preferred reasoning process for making an evidence-based determination of what to believe and what to do.
  4. Critical thinking is a meta-level competency, the more reflective thinking used to monitor and evaluate the effectiveness of practice behavior that has becomes automatic with the development of expertise.
  5. Critical thinking can and should continue to grow and strengthen throughout a clinician’s professional career.

Increasing the Impact of Critical Thinking in Health Sciences:

A patient’s outcomes are directly related to their clinician’s strength in critical thinking. This is why mentoring faculty strive to develop strong critical thinking in every graduate.  Critical thinking assessment data is now an essential tool for admissions, and for evaluating learning outcomes and program effectiveness.  It is further utilized for hiring, targeting professional development and in placement decisions.

Lives depend on competent clinical reasoning. Therefore, it is a moral imperative for healthcare providers to monitor and strive to improve their clinical reasoning and their care-related judgments. Knowing that this is the agreement owed to the public trust, agencies responsible for the accreditation of professional training programs and for the oversight of healthcare delivery have mandated the need to demonstrate competence in clinical reasoning. Increasingly, they have added an assessment of critical thinking skills and mindset to hiring protocols and on-boarding.

Female clinician applying critical thinking and clinical reasoning skills


Insights from 30 Years of Healthcare Critical Thinking Data

 For more than 30 years, leaders in clinical training and the mentoring of the health science professionals have been studying the critical thinking of students, interns and clinicians across the disciplines, worldwide. 

Insight: All clinicians, even trainees and newly licensed professionals, need strong reasoning skills and mindset attributes. General strength in critical thinking skills and thinking mindset is valued in students at all levels, and many programs include the assessment of these abilities and attributes in their admission process. Trainees and newly licensed professionals are most often observed to have strength in Analysis, Inference, Explanation and Induction (reasoning when conditions are probabilistic), and gaps are more likely observed for the more complex cognitive skills of Interpretation, Evaluation, Deduction and Numeracy (reasoning in quantitative contexts). A strong thinking mindset is needed to assure that clinicians will engage and systematically resolve complex, time sensitive, clinical problems. Health science students and professionals are consistently more systematic in their approach to problems, and a gap in this area is usually associated with other gaps in critical thinking skills and attributes.

Insight: A willingness to evaluate and reformulate clinical judgments should be a habit of mind. Some clinicians have less skill in evaluating the results of their clinical decisions and some lack awareness of this habit of mind, preferencing standing firm or making only incremental change in their judgment (the fallacy of anchoring with adjustment). Some clinicians are less able to listen to perspectives of patients and colleagues, particularly when these perspectives are different from their own (Open-mindedness and Truth-seeking).  Gaps in mindset attributes can be addressed through organization initiatives, group case review, and individual reflective thinking exercises.

Insight: Newly hired practitioners with strong critical thinking will be reliable faster. Individuals who lack strength in reasoning skills and mindset have weaker skills and mindset will find it difficult to transition to a workplace where they have an independent responsibility to accurately identify problems commonly managed by their professional practice group.  Some clinicians are significantly challenged when numbers, proportions or likelihood are a part of the problem (a gap in Numeracy skills).  Gaps like these can be directly addressed through the training of critical thinking skills using examples that require reasoning with numbers.

Insight: Clinicians with higher levels of decision responsibility, and those who have been placed in leadership positions, require particular strength in critical thinking. Their roles demand the cognitive skills of Evaluation, Deduction (reasoning well when conditions are inflexible/more certain) and Interpretation (the ability to determine and maintain the significance of information relevant to the problem). Gaps in these skills are associated with costly errors and poor risk management.  

Insight: Newly trained clinicians and those working in a new practice area are less adept in identifying the data relevant to clinical decisions and also slower to recognize patterns at all phases of the clinical case. More deliberate, reflective thinking (System 2 thinking) is a protection against errors (commission and omission). More experienced clinicians rely on their expertise (some aspects of this described as pattern recognition, crystalized intelligence, System 1 Thinking) for speed and accuracy of response. Even in these instances, the meta-level competence of critical thinking skills and mindset attributed provides a check on the effects of practice decisions as to whether they achieved their expected outcomes. A more thorough evaluation of decisions and outcomes is expected as time permits.   

Insight: Critical thinking cognitive skills and mindset attributes can be trained and assessed. Independent research studies of the effectiveness of a wide range of training techniques have demonstrated by trainers and teachers in workplace, military, health care and government agency settings and in educational programs from preschool to the most advanced credentialling and degree programs. Longitudinal studies of training and educational programs demonstrate that post training gains are sustained, and strong evidence has been shown for continued growth in critical thinking skills post-training once individuals become more reflective about their reasoning process.

Training and Assessing Critical Thinking in Healthcare

 Before you invest time and money into training new students or new hires, obtain the data you need to ensure that you are admitting and hiring only the candidates with the greatest potential to excel, learn and apply their training as professional clinicians.

 For over 30 years, Insight Assessment tools have provided objective assessment information about a candidate’s key clinical reasoning skills of analysis, interpretation, inference, evaluation, explanation, and provided an assessment of their reasoning when problems are concise, when they are probabilistic, and when they are highly dependent on numerical contexts. These assessment data have proven to be a powerful predictor of success in health sciences training and transition to practice at the professional, graduate and undergraduate levels.

Working with leading health scientists, practicing health care professionals, policy makers, researchers and educators, Insight Assessment testing specialists have designed assessments specifically for health science professionals, workers and students.   Our assessment tools are designed to apply key theoretical concepts to practical operational contexts.

Assessments for Health Science Professionals

Contact us today to discuss how our validated, proven, and objective critical thinking assessments are used globally.  


More about critical thinking and healthcare:
Critical Thinking Mindset for Improving Patient Outcomes

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