examples of critical thinking during covid 19

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Covid-19 and Critical Thinking

Posted on 5/1/2020 4:48:36 PM

Written by  Sharon Schwarze, PhD , from Cabrini's  Department of Philosophy and Liberal Studies

The covid-19 crisis is very upsetting to all of us, you and me.  It has us upset because we do not know how to anticipate the future -- the world's future and our own personal futures.  We can't make plans.  Our expectations are thwarted.  We are very unhappy not knowing what the future will bring and not knowing what consequences our own actions will bring.  We want to have pleasant experiences, not unpleasant ones.  But we do not know what to anticipate.  

This is because our inductive reasoning that helps us to anticipate the future is confounded.  Remember  the principle of induction : that the future will be like the past?  The problem is that we have never had a past like this!  You should also remember that that principle has no non-circular justification.  Just because in past the future was like the past does not  guarantee  that the coming future will also be like the past.  And now it isn't.  We have never had a corona virus like this one, one that makes people so sick.  We do not know what to anticipate and therefore we do not know how to make decisions or to make plans.  It makes us anxious and unhappy.  To put it another way, we have a present that is sufficiently unlike any recent past such that our ordinary expectations for the future have been upset and we are upset.

So how can critical thinking help us in these times?  Certainly, critical thinking cannot make covid-19 and the chaos it is causing go away. What it can do is help us to understand what has happened and suggest ways to cope and improve the current situation.   Inductive reasoning  is at the heart of the problem – and is the tool our leaders and scientists are using to anticipate and improve the future.  They are collecting the  traces , that is the marks they find on the world that indicate something (new) is going on.  These include the deaths and the number of deaths, the pathogens (germs) they find on those bodies, the bodily changes in those who are sick (difficulty breathing, sore throats, fever), and the places the disease strikes.  Then they look for  patterns  among these traces.  They see that people tend to get sick after touching something that the sick person has come in contact with.  They need to know the  patterns  so they can interrupt those patterns and stop the spread of the disease.

They then use  induction , namely the three types of inductive reasoning:  

• They reason by using generalizations .  They see the pattern that older people die from covid-19 more frequently than younger people and draw the  generalization  that covid-19 is more dangerous to older people or to people with underlying conditions.  They generalize that people can catch the disease from people without symptoms, etc. These generalizations are not necessarily universal (they are not about  all , but about  some ).
• They reason using analogy.     They look at past pandemics to see how they spread.  They see that this event has similar properties to other pandemics and reason that it will share other properties as well.  They look at other corona viruses (they cause the common cold) and examine their known behavior.  They reason by analogy that this corona virus will behave somewhat similarly.  Of course, they also have to look at where the similarities stop.  For example, why does this corona virus kill more people than does the common cold?  Microscopic analysis shows some differences.  Those differences will help lead to an antidote or vaccine for covid-19.
• They reason using causal reasoning.    That is, they reason that the virus covid-19  causes  the symptoms that give so much suffering.  There is a  necessary connection  between the virus and the illness.  Whenever A happens, B happens.  Now we know that not everyone who carries the virus gets sick, but we do know that everyone who carries the virus can pass it on to someone else who will most probably get sick.  We do not know exactly why some (lucky) people do not experience symptoms but we do know that the virus is the cause of the disease.  (Just as cigarettes cause cancer but not everyone who smokes gets cancer.)   We also know that good hygiene and disinfecting can  cause  the death of the virus.  That is just as important for us to know.

We also know  using all three of these reasoning processes  that a future vaccine is a must for overcoming this scourge.  We know that most people who are vaccinated against other diseases do not get those disease or get very light cases of them.  That's using generalization and analogy and causal reasoning.   We all look forward to that day!!

Now let's use this example to talk more generally about  correlations .  A correlation is when two events repeatedly happen together, like being exposed to a sick person and later getting sick yourself.  Some correlations happen necessarily because, we assume, there is a causal relation between them.  If the first event happens then the second event  has  to happen.  E.g., if you are exposed to covid-19 you will get sick or you have a very strong immune system that can fight off this invader.  One of those two things has to happen.  There is a  necessary connection  between them.  

Some events happen together by accident.  These are  accidental correlations .  There is an accidental correlation between you're being a Cabrini University student and being healthy (at least I hope so).  It's not that you couldn't get sick, but you just happen to be both a Cabrini student and not sick.  And we hope that there continues to be a fairly high correlation between these two! This distinction is important for understanding causal reasoning.   When researchers look for a vaccine, they want to make sure that the vaccine  causes  the lack of sickness and it is not just an accident that those who received it stayed healthy.

The material in this announcement should help you to understand why inductive reasoning is so important and why critical thinking is so important.  We hope that our scientists have good inductive reasoning.  They are known for it.  Our politicians are not!

You should also keep in mind that inductive reasoning is always about  confirmation, not proof.   We will have to wait for scientists to confirm that a vaccine works.  There is never proof.  We can confirm, over and over again, that hand washing and staying away from sick can keep a person healthy.  But we cannot prove it.  Some people who ignore these prescriptions will not get sick, but they are lucky, not smart.  They are not thinking critically.

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• Principal Leadership
• Volume 21 (2020-2021)
• Principal Leadership: October 2020

Critical Thinking During COVID: October 2020

In uncertain times, it’s human to react with stress and fear. As school leaders, you’re tasked with making big decisions and providing reassurance to staff, students, and families. Crises such as the COVID-19 pandemic require us to lead by example through critical thinking. Critical thinking is a research-validated tool in crisis management because it helps us sort through information, gain an accurate view of the situation, and make decisions.

Tapping Into Critical Thinking

Critical thinking requires us to dig deep and focus on facts and credible sources. Applying critical thinking skills helps us wade through uncertainty and reach sound conclusions.

As a reference point, consider the “9 Traits of Critical Thinking™” from Mentoring Minds:

• Adapt: I adjust my actions and strategies to accomplish tasks.
• Examine: I use a variety of methods to explore and to analyze.
• Create: I use my knowledge and imagination to express new and innovative ideas.
• Communicate : I use clear language to express my thoughts and to share information.
• Collaborate: I work with others to achieve better outcomes.
• Inquire: I seek information that excites my curiosity and inspires my learning.
• Link: I apply knowledge to reach new understandings.
• Reflect: I review my thoughts and experiences to guide my actions.
• Strive: I use effort and determination to focus on challenging tasks.

These traits can help individuals of any age navigate unfamiliar circumstances. The pandemic has had an undeniable impact on education, but critical thinking can help us all cope with the changes and challenges presented by COVID-19.

To keep education moving forward during COVID-19 while also supporting your school community, consider the following tips:

• Seek out factual information, not fast information. Make reasoned, informed decisions by understanding facts, evidence-based data, and credible sources. While it is essential to gather and rely on a variety of information and data, critical thinkers know it’s necessary to check the accuracy and bias of what is read and heard. Inquire: Encourage parents, teachers, and students to ask questions. A crisis causes anxiety, stress, and fear if individuals don’t feel permitted to investigate essential questions. Here are a few examples: How will the COVID-19 pandemic impact jobs? What instructional changes might occur? How will grading procedures change? Technology allows us quick access to an abundance of information, some contradictory and misleading. If we forget to pause and carefully review information, it can be dangerous to us and others. Examine: Caution the use of believing everything that is presented in the media. Remind others of the importance of examining information first. Seek out a variety of credible sources. When information is accurate, it can be used to resolve challenges. Misinformation is common, and it’s also harmful. In fact, the U.N. Secretary-General António Guterres recently remarked that the “global ‘misinfo-demic’ is spreading … hatred is going viral, stigmatizing and vilifying people and groups.” While networking platforms such as Facebook work to combat the overabundance of false content, it’s up to us as consumers of media to assess what we read first—and then share it with others. In a crisis, information changes by the minute. A critical thinker knows updates will be forthcoming and how crucial it is to assimilate the latest facts. Because of the vast amount of content available to us, we must continuously remind ourselves to listen to those in the know and to source trusted information—such as the COVID-19 resources NASSP is compiling.
• Practice proactive planning. Be ready to adapt routines as situations change. School leaders have been tasked with hefty responsibilities. As a principal, you’re accountable for the success of your students and staff—a daunting task on the most normal of days. Link: Use your prior knowledge and experiences to problem-solve. As a school leader, you recognize the importance of making connections—if a crisis exists, then effects appear. Discuss potential barriers and challenges with staff members and identify the various ways students and their families may be impacted. We must prepare our school communities to embrace disruption as learning takes on a new image. Educators are not only trying to plan and deliver academic lessons, but they’re also addressing the social aspect of learning in an entirely new format. Collaborate: Offer guidance and support to your colleagues. Set an example by showing how collaboration can help us navigate the new modes of teaching and learning in which we currently find ourselves. Some parents or caregivers might be recently unemployed, others may be struggling to hold onto their jobs, and some may not have the right equipment for remote learning. There are even parents—and teachers—who are trying to manage their schedules while supervising nonschool-aged children. Communicate: Pave the way for two-way communication. Ensure that information sent to students and families is clear and concise. Offer a range of ways for students to interact and ask questions. Provide an avenue for open communication with parents and teachers. As leaders, we must guide our teachers to support parents in establishing new routines while welcoming flexibility in tasks and choice in activities. Remember to integrate time for reflection or downtime within home-based learning. Help parents see the importance of maintaining certain hours for completing tasks or assignments and managing workload.
• Prioritize positive relationship-building. Be confident and recognize the importance of validating the feelings and perspectives of others. Educators are going the distance to keep learning moving forward while maintaining excellence. School leaders realize the importance of retaining the human element in education. Offering reassurance to one another, our students, and their families is vital. Create: Invite faculty to contribute their ideas for the summer and fall semester. Are there instructional practices that should change? Innovative thinking will be a critical piece of successfully returning to school. Never has it been more important to connect with parents and students. We must encourage them and thank them for embracing this new partnership of virtual communication. We must recognize that all situations and classrooms at home are just as diverse as the classrooms in brick-and mortar buildings. Adapt: You have the power to guide others in adapting to new situations. Educators are teaching from their homes; students are learning in their kitchens and living rooms—diverse, at-home situations require flexibility. We can use this as an opportunity to adapt our practices. Whether it’s offering support for parents, hosting “office” hours for students, or providing devices to those in need, change may be required. Let’s work to openly communicate and collaborate, examine the pulse of others, and frequently inquire about their thoughts. We should model talking about today’s issues so we can emulate the importance of analyzing and interpreting information to solve problems—big or small. Strive: Principals recognize the importance of modeling. While planning high-quality online learning isn’t the easiest task, it is possible when you remain focused. When students see their principal and teachers demonstrating “strive,” they can follow suit. Reflect: Take time to reflect on how you can take care of yourself. Crises are draining. We can easily become impatient, weary, and reactive, which makes situations even more problematic. We must pace ourselves, taking moments to pause and consider our own needs as important. Reflecting helps us push through challenges, improve upon past actions, and face our fears. How can we make better choices? How has COVID-19 changed our lives? What support do we need? By voicing our personal experiences, we can dig deeper to reveal strengths and opportunities.

Put Critical Thinking Into Practice

No matter the crisis, the nine traits can assist individuals of any age in making important decisions about their actions or finding an approach for resolution. We all have the capacity to think skillfully. When we incorporate critical thinking into our personal and professional lives, we can better support the growth of ourselves and our school communities. A critical thinker does not give up, but instead seeks ways to improve or resolve problems. Now is the time for principals to recognize the relevancy of thinking beyond the surface.

Sandra Love, EdD, is the director of education insight and research for Mentoring Minds, an organization that provides critical thinking resources to educators. She is a former elementary principal and recipient of the National Distinguished Principal Award.

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Original research article, “fake news” or real science critical thinking to assess information on covid-19.

• 1 Department of Applied Didactics, Universidade de Santiago de Compostela (USC), Santiago de Compostela, Spain
• 2 IES Ramón Cabanillas, Xunta de Galicia, Cambados, Spain

Few people question the important role of critical thinking in students becoming active citizens; however, the way science is taught in schools continues to be more oriented toward “what to think” rather than “how to think.” Researchers understand critical thinking as a tool and a higher-order thinking skill necessary for being an active citizen when dealing with socio-scientific information and making decisions that affect human life, which the pandemic of COVID-19 provides many opportunities for. The outbreak of COVID-19 has been accompanied by what the World Health Organization (WHO) has described as a “massive infodemic.” Fake news covering all aspects of the pandemic spread rapidly through social media, creating confusion and disinformation. This paper reports on an empirical study carried out during the lockdown in Spain (March–May 2020) with a group of secondary students ( N = 20) engaged in diverse online activities that required them to practice critical thinking and argumentation for dealing with coronavirus information and disinformation. The main goal is to examine students’ competence at engaging in argumentation as critical assessment in this context. Discourse analysis allows for the exploration of the arguments and criteria applied by students to assess COVID-19 news headlines. The results show that participants were capable of identifying true and false headlines and assessing the credibility of headlines by appealing to different criteria, although most arguments were coded as needing only a basic epistemic level of assessment, and only a few appealed to the criterion of scientific procedure when assessing the headlines.

Introduction: Critical Thinking for Social Responsibility – An Urgent Need in the Covid-19 Pandemic

The COVID-19 pandemic is a global phenomenon that affects almost all spheres of our life, aside from its obvious direct impacts on human health and well-being. As mentioned by the UN Secretary General, in his call for solidarity, “We are facing a global health crisis unlike any in the 75-year history of the United Nations — one that is spreading human suffering, infecting the global economy and upending people’s lives.” (19 March 2020, Guterres, 2020 ). COVID-19 has revealed the vulnerability of global systems’ abilities to protect the environment, health and economy, making it urgent to provide a responsible response that involves collaboration between diverse social actors. For science education the pandemic has raised new and unthinkable challenges ( Dillon and Avraamidou, 2020 ; Jiménez-Aleixandre and Puig, 2021 ), which highlight the importance of critical thinking (CT) development in promoting responsible actions and responses to the coronavirus disease, which is the focus of this paper. Despite the general public’s respect of science and scientific advances, denial movements – such as the ones that reject the use of vaccines and advocate for alternative health therapies – are increasing during this period ( Dillon and Avraamidou, 2020 ). The rapid global spread of the coronavirus disease has been accompanied by what the World Health Organization (WHO) has described as the COVID-19 social media infodemic. The term infodemic refers to an overabundance of information (real or not) associated with a specific topic, whose growth can occur exponentially in a short period of time [ World Health Organization (WHO), 2020 ]. The case of the COVID-19 pandemic shows the crucial importance of socio-scientific instruction toward students’ development of critical thinking (CT) for citizenship.

Critical thinking is embedded within the framework of “21st century skills” and is considered one of the goals of education ( van Gelder, 2005 ). Despite its importance, there is not a clear consensus on how to better promote CT in science instruction, and teachers often find it unclear what CT means and requires from them in their teaching practice ( Vincent-Lacrin et al., 2019 ). CT is understood in this study as a set of skills and dispositions that enable students and people to take critical actions based on reasons and values, but also as independent thinking ( Jiménez-Aleixandre and Puig, 2021 ). It is also considered as a dialogic practice that students can enact and thereby become predisposed to practice ( Kuhn, 2019 ). We consider that CT has two fundamental roles in SSI instruction: one role linked to the promotion of rational arguments, cognitive skills and dispositions; and the other related to the idea of critical action and social activism, which is consistent with the characterization of CT provided by Jiménez-Aleixandre and Puig (2021) . Although research on SSIs has provided us with empirical evidence supporting the benefits of SSI instruction, particularly argumentation and students’ motivation toward learning science, there is still scarce knowledge on how CT is articulated in these contexts. One challenge with promoting CT, especially in SSIs, is linked to new forms of communication that generate a rapid increase of information and easy access to it ( Puig et al., 2020 ).

The study was developed in an unprecedented scenario, during the lockdown in Spain (March–May 2020), which forced the change of face-to-face teaching to virtual teaching, involving students in online activities that embraced the application of scientific notions related to COVID-19 and CT for assessing claims published in news headlines related to it. Previous studies have pointed out the benefits of virtual environments to foster CT among students, particularly asynchronous discussions that minimize social presence and favor all students expressing their own opinion ( Puig et al., 2020 ).

In this research, we aim to explore students’ ability to critically engage in the assessment of the credibility of COVID-19 claims during a moment in which fake news disseminated by social media was shared by the general public and disinformation on the virus was easier to access than real news.

Theoretical Framework

We will first discuss the crucial role of CT to address controversial issues and to fight against the rise of misinformation on COVID-19; and then turn attention to the role of argumentation in students’ development of CT in SSI instruction in epistemic education.

Critical Thinking on Socio-Scientific Instruction to Face the Rise of Disinformation

SSIs are compelling issues for the application of knowledge and processes contributing to the development of CT. They are multifaceted problems, as is the case of COVID-19, that involve informal reasoning and elements of critique where decisions present direct consequences to the well-being of human society and the environment ( Jiménez-Aleixandre and Puig, 2021 ). People need to balance subject matter knowledge, personal values, and societal norms when making decisions on SSIs ( Aikenhead, 1985 ) but they also have to be critical of the discourses that shape their own beliefs and practices to act responsibly ( Bencze et al., 2020 ). According to Duschl (2020) , science education should involve the creation of a dialogic discourse among members of a class that focuses on the teaching and learning of “how did we come to know?” and “why do we accept that knowledge over alternatives?” Studies on SSIs during the last decades have pointed out students’ difficulties in building arguments and making critical choices based on evidence ( Evagorou et al., 2012 ). However, literature also indicates that students find SSIs motivational for learning and increase their community involvement ( Eastwood et al., 2012 ; Evagorou, 2020 ), thus they are appropriate contexts for CT development. While research on content knowledge and different modes of reasoning on SSIs is extensive, the practice of CT is understudied in science instruction. Of particular interest in science education are SSIs that involve health controversies, since they include some of the challenges posed by the post-truth era, as the health crisis produced by coronavirus shows. The COVID-19 pandemic is affecting most countries and territories around the world, which is why it is considered the greatest challenge that humankind has faced since the 2nd World War ( Chakraborty and Maity, 2020 ). Issues like COVID-19 that affect society in multiple ways require literate citizens who are capable of making critical decisions and taking actions based on reasons. As the world responds to the COVID-19 pandemic, we face the challenge of an overabundance of information related to the virus. Some of this information may be false and potentially harmful [ World Health Organization (WHO), 2020 ]. In the context of growing disinformation related to the COVID-19 outbreak, EU institutions have worked to raise awareness of the dangers of disinformation and promoted the use of authoritative sources ( European Council of the European Union, 2020 ). Educators and science educators have been increasingly concerned with what can be done in science instruction to face the spread of misinformation and denial of well-established claims; helping students to identify what is true can be a hard task ( Barzilai and Chinn, 2020 ). As these authors suggest, diverse factors may shape what people perceive as true, such as the socio-cultural context in which people live, their personal experiences and their own judgments, that could be biased. We concur with these authors and Feinstein and Waddington (2020) , who argue that science education should not focus on achieving the knowledge, but rather on gaining appropriate scientific knowledge and skills, which in our view involves CT development. Furthermore, according to Sperber et al. (2010) , there are factors that affect the acceptance or rejection of a piece of information. These factors have to do either with the source of the information – “who to believe” – or with its content – “what to believe.” The pursuit of truth when dealing with SSIs can be facilitated by the social practices used to develop knowledge ( Duschl, 2020 ), such as argumentation understood as the evaluation of claims based on evidence, which is part of CT development.

We consider CT and argumentation as overlapping competencies in their contexts of practice; for instance, when assessing claims on COVID-19, as in this study. According to Sperber et al. (2010) , we now have almost no filters on information, and this requires a much more vigilant, knowledgeable reader. As these authors point out, individuals need to become aware of their own cognitive biases and how to avoid being victims themselves. If we want students to learn how to critically evaluate the information and claims they will encounter in social media outside the classroom, we need to engage them in the practice of argumentation and CT. This raises the question of what type of information is easier or harder for students to assess, especially when they are directly affected by the problem. In this paper we aim to explore this issue by exploring students’ arguments while assessing diverse claims on COVID-19. We think that students’ arguments reflect their ability to apply CT in this context, although this does not mean that CT skills always produce a well-reasoned argument ( Halpern, 1998 ). Students should be encouraged to express their own thoughts in SSI instruction, but also to support their views reasonably ( Puig and Ageitos, 2021 ). Specifically, when they must assess the validity of information that affects not only them as individuals but also the whole society and environment. CT may equip citizens to discard fake news and to use appropriate criteria to evaluate information. This requires the design and implementation of specific CT tasks, as this study presents.

Argumentation to Enhance Critical Thinking Development in Epistemic Education on SSIs

While the concept of CT has a long tradition and educators agree on its importance, there is a lack of agreement on what this notion involves ( Thomas and Lok, 2015 ). CT has been used with a wide range of meanings in theoretical literature ( Facione, 1990 ; Ennis, 2018 ). In 1990, The American Philosophical Association convened an authoritative panel of forty-six noted experts on CT to produce a definitive account of the concept, which was published in the Delphi Report ( Facione, 1990 ). The Delphi definition provides a list of skills and dispositions that can be useful and guide CT instruction. However, as Davies and Barnett (2015) point out, this Delphi definition does not include the phenomenon of action. We concur with these authors that CT education should involve students in “CT for action,” since decision making – a way of deciding on a course of action – is based on judgments derived from argumentation using CT. Drawing from Halpern (1998) , we also think that CT requires awareness of one’s own knowledge. CT requires, for instance, insight into what one knows and the extent and importance of what one does not know in order to assess socio-scientific news and its implications ( Puig and Ageitos, 2021 ).

Critical thinking and argumentation share core elements like rationality and reflection ( Andrews, 2015 ). Some researchers suggest understanding CT as a dialogic practice ( Kuhn, 2019 ) has implications in CT instruction and development. Argumentation on SSIs, particularly on health controversies, is receiving increasing attention in science education in the post-truth era, as the coronavirus pandemic and denial movements related to its origin, prevention, and treatment show. Science education should involve the creation of a dialogic discourse among members of a class that enable them to develop CT. One of the central features in argumentation is the development of epistemic criteria for knowledge evaluation ( Jiménez Aleixandre and Erduran, 2008 ), which is a necessary skill to be a critical thinker. We see the practice of CT as the articulation of cognitive skills through the practice of argumentation ( Giri and Paily, 2020 ).

This article argues that science education needs to explore learning experiences and ways of instruction that support CT by engaging learners in argumentation on SSIs. Despite CT being considered a seminal goal in education and the large body of research on CT supporting this ( Dominguez, 2018 ), debates still persist about the manner in which CT skills can be achieved through education ( Abrami et al., 2008 ). Niu et al. (2013) remark that educators have made a striking effort to foster CT among students, showing that the belief that CT can be taught and learned has spread and gained support. Therefore, CT has slowly made its way into general school education and specific instructional interventions. Problem-based learning is one of the most widely used learning approaches nowadays in CT instruction ( Dominguez, 2018 ) because it is motivating, challenging, and enjoyable ( Pithers and Soden, 2000 ; Niu et al., 2013 ). We see active learning methodologies and real-word problems such as SSIs as appropriate contexts for CT development.

The view that CT can be developed by engagement in argumentation practices plays a central role in this study, as Kuhn (2019) suggested. However, the post-truth condition poses some challenges to the evaluation of sources of information and scientific evidence disseminated by social media. According to Sinatra and Lombardi (2020) , the post-truth context raises the need for critical evaluation of online information about SSIs. Students need to be better prepared to assess science information they can easily find online from a variety of sources. Previous studies described by these authors emphasized the importance of source evaluation instruction to equip students toward this goal ( Bråten et al., 2019 ), however, this is not sufficient. Sinatra and Lombardi (2020) note that students should learn how to evaluate the connections between sources of information and knowledge claims. This requires, from our view, engaging students in CT and epistemic performance. If we want students to learn to think critically about the claims they will encounter on social media, they need to practice argumentation as critical evaluation.

We draw on research on epistemic education ( Chinn et al., 2018 ) which considers that learning science entails students’ participation in the science epistemic goals ( Kelly and Licona, 2018 ); in other words, placing scientific practices at the center of SSI instruction. Our study is framed in a broader research project that aims to embed CT in epistemic design and performance. In Chinn et al. (2018) AIR model, epistemic cognition has three core elements that represent the three letters of the acronym: epistemic Aims, goals related to inquiry; epistemic Ideals, standards and criteria used to evaluate epistemic products, such as explanations or arguments; and Reliable processes for attaining epistemic achievements. Of particular interest for our focus on CT is that the AIR model also proposes that epistemic cognition has a social nature, and it is situated. The purpose of epistemic education ( Barzilai and Chinn, 2017 ) should be to enable students to succeed in epistemic activities ( apt epistemic performance ), such as constructing and evaluating arguments, and to assess through meta-competence when success can be achieved. This paper attends to one aspect of epistemic performance proposed by Barzilai and Chinn (2017) , which is cognitive engagement in epistemic assessment. Epistemic assessment encompasses in our study the evaluation of the content of claims disseminated by media. Aligned with these authors we understand that this process requires cognitive and metacognitive competences. Thus, epistemic assessment needs adequate disciplinary knowledge, but also meta-cognitive competence for recognizing unsupported beliefs.

Goal and Research Questions

This paper examines students’ competence to engage in argumentation and CT in an online task that requires them to critically assess diverse information presented in media headlines on COVID-19. Competence in general can be defined as “a disposition to succeed with a certain aim” ( Sosa, 2015 , p. 43) and epistemic competence, as a special case of competence, is at its core a dispositional ability to discern the true from the false in a certain domain. For the purposes of this paper, the attention is on epistemic competence, being the research questions that drive the analysis of the following:

1. What is the competence of students to assess the credibility of COVID-19 information appearing in news headlines?

2. What is the level of epistemic assessment showed in students’ arguments according to the criteria appealed while assessing COVID-19 news headlines?

Materials and Methods

Context, participants, and design.

A teaching sequence about COVID-19 was designed at the beginning of the lockdown in Spain (Mid-March 2020) in response to the rise of misinformation about coronavirus on the internet and social media. The design process involved collaboration between the first and second author (researchers in science education) and the third author (a biology teacher in secondary education).

The participants are a group of twenty secondary students (14–15 years old), eleven of them girls, from a state public school located in a well-known seaside village in Galicia (Spain). They were mostly from middle-class families and within an average range of ability and academic achievement.

Students were from the same classroom and participated in previous online activities as part of their biology classes, taught by their biology teacher, who collaborated on previous studies on CT and learning science through epistemic practices on health controversies.

The activities were integrated in their biology curriculum and carried out when participants received instruction on the topics of health, infectious diseases, and the immune system.

Google Forms was used for the design and implementation of all activities included in the sequence. The reason to select Google Forms is that it is free and a well-known tool for online surveys. Besides, all students were familiar with its use before the lockdown and the teacher valued its usefulness for engaging them in online debates and in their own evaluation processes. This online resource provides anonymous results and statistics that the teacher could share with the students for debates. It needs to be highlighted that during the lockdown students did not have the same work conditions; particularly, quality and availability of access to the internet differed among them. Thus, all activities were asynchronous. They had 1 week to complete each task and the teacher could be consulted anytime if they had difficulties or any question regarding the activities.

The design was inspired by a previous one carried out by the authors when the first case of Ebola disease was introduced in Spain ( Puig et al., 2016 ), and follows a constructivist and scientific-based approach. The sequence began with an initial task, in which students were required to express their own views and knowledge on COVID-19 and health notions related with it, before then being progressively involved in the application of knowledge through the practice of modeling and argumentation. The third activity engaged them in critical evaluation of COVID-19 information. A more detailed description of the activities carried out in the different steps of the sequence is provided below.

Stage 1: General Knowledge on Health Notions Related to COVID-19

An individual Google Forms survey around some notions and health concepts that appear in social media during the lockdown, such as “pandemic”, “virus,” etc.

Stage 2: Previous Knowledge on Coronavirus Disease

This stage consisted of three parts: (2.1) Individual online survey on infectious diseases; (2.2) Introduction of knowledge about infectious diseases provided in the e-bugs project website 1 and activities; virtual visit to the exhibition “Outbreaks: epidemics in a connected world” available in the Natural History Museum website (blinded for review); (2.3) Building a poster with the chain of infection of the COVID-19 disease and some relevant information to consider in order to stop the spread of the disease.

Stage 3: COVID-19, Sources of Information

This stage consisted first of a virtual forum in which students shared their own habits when consulting scientific information, particularly coronavirus-related, and debated on the main media sources they used to consult for this purpose. Secondly, students had to analyze ten news headlines on COVID-19 disseminated by social media during the outbreaks; six corresponded to fake news and four were true. They were asked to critically assess them and distinguish which they thought were true, providing their arguments. Media sources were not provided until the end of the task, since the act of asking for the source was considered as part of the data analysis (see Table 1 ). The second part of this stage is the focus of our analysis.

Table 1. COVID-19 News Headlines provided to students.

Stage 4: Act and Raise Awareness on COVID-19

The sequence ended with the creation of a short video in which the students had to provide some tips to avoid the transmission of the virus. The information provided in the video must be supported and based on established scientific knowledge.

Data Corpus and Analysis

Data collection includes all individual surveys and activities developed in Google Forms. We analyzed students’ individual responses ( N = 28) presented in Stage 3. The research is designed as a qualitative study that utilizes the methods of discourse analysis in accordance with the data and the purpose of the study. Discourse analysis allows the analysis of the content (implicit or explicit) of written arguments produced by students, and so the examination of the research questions. Our analysis focuses on students’ arguments and criteria used to assess the credibility of COVID-19 headlines (ten headlines in total). It was carried out through an iterative process in which students’ responses were read and revised several times in order to develop an open-coded scheme that captures the arguments provided. To ensure the internal reliability of our codes, each student response was examined by the first and the second author separately and then contrasted and discussed until 100% agreement was achieved. The codes obtained were established according to the following criteria, summarized in Table 2 .

Table 2. Code scheme for research questions 1 and 2.

For Research Question 1, we distributed the arguments in two main categories: (1) Arguments that question the credibility of the information ; (2) Arguments that do not question the credibility of the information.

For Research Question 2, we classify arguments that question the credibility of the headline in accordance with the level of epistemic assessment into three levels (see Table 2 ). The level of epistemic assessment (basic, medium, and high) was established by the authors based on the criteria that students applied and expressed explicitly or implicitly in their arguments. These criteria emerged from the data, thus the categories were not pre-established; they were coded by the authors as the following: content (using the knowledge that each student has about the topic), source (questioning the origin of the information), evidence (appealing to empirical evidence as real live situations that students experienced), authority (justifying according to who supports or is behind the claim) and scientific procedure (drawing on the evolution of scientific knowledge).

Students’ Competence to Critically Assess the Credibility of COVID-19 Claims

In general, most students were able to distinguish fallacious from true headlines, which was an important step to assess their credibility. For those that were false, students were able to question their credibility, providing arguments against them. On the contrary, for true news headlines, as it was expected, most participants developed arguments supporting them. Thus, they did not question their content. In both cases, the arguments elaborated by students appealed to different criteria discussed in the next section of results.

As shown in Table 3 , 147 arguments were elaborated by students to question the false headlines; they created just 22 arguments to assess the true ones. This finding was expected by the authors, as arguments for questioning or criticality appear more frequently when the information presented differs from students’ opinions.

Table 3. Number of students who questioned or not each news headline on COVID-19.

Students showed a higher capacity for questioning those claims they considered false or fake news , which can be related to the need to justify properly why they consider them false and/or what should be said to counter them.

The headlines that were most controversial, meaning they created diverse positions among students, were these three: “The COVID-19 virus can be transmitted in areas with hot and humid climates,” “Skin manifestations (urticaria, chilblains, rashes…) could be among the mild symptoms of coronavirus” and “Antibiotics are effective in preventing and treating coronavirus infection.”

The first two were questioned by 11 students out of 28, despite being real headlines. According to students’ answers, they were not familiar with this information, e.g., “I think the heat is not good for the virus.” On the contrary, 17 students did not question these headlines, arguing for instance as this student did: “because it was shown that both in hot climates and in cold climates it is contagious in the same way.”

A similar situation happened with the third headline, which is false. A proportion of students (9 out of 28) accepted that antibiotics could help to treat COVID-19, showing in their answers some misunderstanding regarding the use of antibiotics and the diseases they could treat. The rest of the participants (19 out of 28) questioned this headline, affirming that “because antibiotics are used to treat bacterial infections and coronavirus is a virus,” among other justifications for why it was false.

Levels of Epistemic Assessment in Students’ Arguments on COVID-19 News Headlines

To analyze the level of epistemic assessment showed in students’ arguments when dealing with each headline, attention was focused on the criteria students applied (see Table 2 ). As Table 4 summarizes, almost all arguments included only one criterion (139 out of 169), and 28 out of 169 did not incorporate any criterion. These types of arguments can be interpreted as low epistemic assessment, or even without epistemic assessment if no criterion is included.

Table 4. Arguments used by students to assess the credibility of each COVID-19 headline.

In the category of Basic Epistemic Assessment , we include all students’ arguments that included one criterion: Content or Empirical Evidence. Students assessed the content of the claim appealing to their own knowledge about that piece of information or to empirical evidence, without posing critical questions for assessing the credibility of the source of information. These two criteria, content and evidence, were included in students’ arguments with a frequency of 86 and 23, respectively, with this category the most common (109 out of 169) when questioning false and true headlines. In the case of true headlines, arguments under this category were identified in relation to headlines 2 and 4, whose credibility were questioned by appealing to the content, such as: “those are not the symptoms (skin manifestations) ” . Examples of arguments assessing the content of false headlines are provided below:

“Because the virus is inside the body, and even if you injected alcohol into the body it would only cause intoxication”

This student rejects headline 5, appealing to the fact that alcohol causes intoxication rather than the elimination of coronavirus.

“I know a person who had coronavirus and they only gave him paracetamol”

In this example, the student rejects headline 6 and appeals to his/her own experience during the pandemic, particularly a close person who had coronavirus, as evidence against the use of antibiotics for coronavirus disease treatment.

The category Medium Epistemic Assessment gathers arguments that make critical questions, particularly those asking for information about the authority or the source of information. For us, these criteria reflect a higher level of epistemic performance since they imply questioning beyond the veracity of the headline itself to its sources and authorship. There are 20 out of 169 arguments coded within this category.

The assessment of true headlines includes arguments that question the authority and source, e.g., “because they said it on the news” (headline 2), “that news does not seem very reliable to me” (headline 4). It is also an ordinary category in questioning false headlines, since students appealed to the source (16), “because in the news they clarified that it was a fake news and because it is not credible either” (headline 10) or the authority (4), “because the professionals said they were more vulnerable (people over 70 years old) but not that it only affected them” (headline 7).

For the highest category, High Epistemic Assessment , we consider those arguments (12 out of 169) in which students appealed to the scientific procedure (11) to justify why the headline is false, which manifests students’ reliance on epistemic processes, e.g., “because treatments that protect against coronavirus are still being investigated” (headline 9). Also, under this category we include arguments that combined more than one criterion, content and scientific procedure “Because antibiotics don’t treat those kinds of infections. In addition, no medication has yet been discovered that can prevent the coronavirus” (headline 6). Students’ arguments included in this category were elaborated to assess false headlines.

Lastly, a special mention is afforded to those arguments that did not include any criteria (28), which are contained in the category Non-Epistemic Assessment. It appears more frequently in students’ answers to headlines 8 and 10, as these examples show: “I don’t think it’s true because it doesn’t make much sense to me” (headline 8) or “I never heard it and I doubt it’s true” (regarding drinking alcohol, headline 10).

The findings of our study indicate that students were able to deal with fake news , identifying it as such. They showed capacity to critically assess the content of these news headlines, considering their inconsistencies in relation to their prior knowledge ( Britt et al., 2019 ). As Evagorou (2020) pointed out, SSIs are appropriate contexts for CT development and to value the relevance of science in our lives.

The examination of RQ1 shows that a proportion of students were able to perceive the lack of evidence behind them or even identified that those statements contradict what science presents. This is a remarkable finding and an important skill to fight against attempts to diminish trust in science produced in the post-truth condition ( Dillon and Avraamidou, 2020 ). CT and argumentation are closely allied ( Andrews, 2015 ) but as the results show, knowledge domain seems to play an important role in assessing SSIs news and their implications. Specific CT requires some of the same skills as generalizable CT, but it is highly contextual and requires particular knowledge ( Jones, 2015 ).

Students’ prior knowledge influenced the critical evaluation of some of the COVID-19 headlines provided in the activity. This is particularly relevant in responses to headline 6 (false) “Antibiotics are effective in preventing and treating coronavirus infection.” A previous study on the interactions between the CT and knowledge domain on vaccination ( Ageitos and Puig, 2021 ) showed that there is a correspondence between them. This points to the importance of health literacy for CT development, although it would not be sufficient to provide students with adequate knowledge only, as judgment skills, in this case regarding the proper use of antibiotics, are also required.

We found that the level of epistemic assessment (RQ2) linked to students’ CT capacity is low. A big majority of arguments were situated in a basic epistemic assessment level, and just a few in a higher epistemic assessment. One reason that might explain these results could be related to the task design and format, in which students worked autonomously in a virtual environment. As CT studies in e-learning environments have reinforced ( Niu et al., 2013 ), cooperative or collaborative learning favors CT skills, particularly when students have to discuss and justify their arguments on real-life problems. The circumstances in which students had to work during the outbreak did not allow them to work together since internet connections were not good for all of them, so synchronous activities were not possible. This aspect is a limitation for this research.

There were differences in the use of criteria, and thus in the level of epistemic assessment, when students dealt with true and false headlines. This could be related to diverse factors, such as the language. The claims are marred by language and they are formulated in a different way. Particularly, it is quite nuanced in true statements while certain and resolute in false headlines. The practice of CT requires an understanding of the language, the content under evaluation and other cognitive skills ( Andrews, 2015 ).

In the case of false headlines, most arguments appealed to their content and less to the criteria of source, authority, and the scientific procedure, whereas in the case of true headlines most of them appealed to the authority and/or source. According to the AIR model ( Chinn and Rinehart, 2016 ), epistemic ideals are the criteria used to evaluate the epistemic products, such as claims. In the case of COVID-19 claims, students need to have an ideal of high source credibility ( Duncan et al., 2021 ). This means that students acknowledge that information should be gathered from reliable news media that themselves obtained information from reliable experts.

Only few students used the criterion of scientific procedure when assessing false headlines, which shows a high level of epistemic assessment. Promoting this type of assessment is important since online discourse in the post-truth era is affected by misinformation and by appeals to emotions and ideology.

Conclusion and Implications

This research has been conducted during a moment in which the lives of people were paralyzed, and citizens were forced to stay at home to stop the spread of the coronavirus disease. During the lockdown and even after, apart from these containment measures, citizens in Spain and in many countries had to deal with a huge amount of information about the coronavirus disease, some of it false. The outbreak of COVID-19 has been accompanied by dissemination of inaccurate information spread at high speed, making it more difficult for the public to identify verified facts and advice from trusted sources ( World Health Organization (WHO), 2020 ). As the world responds to the COVID-19 pandemic, many studies have been carried out to analyze the impact of the pandemic on the life of children from diverse views ( Cachón-Zagalaz et al., 2020 ), but not from the perspective of exploring students’ ability to engage in the epistemic assessment of information and disinformation on COVID-19 under a situation of social isolation. This is an unprecedented context in many aspects, where online learning replaced in-person teaching and science uncertainties were more visible than ever.

Participants engaged in the epistemic assessment of coronavirus headlines and were able to put into practice their CT, arguing why they considered them as true or false by appealing to different criteria. We are aware that our results have limitations. Once such limitation is that students performed the activity independently, without creating a collaborative virtual environment, understood by the authors as one of the e-learning strategies that better promote CT ( Puig et al., 2020 ). Furthermore, despite the fact that teachers were available for students to solve any questions regarding the task, the remote and asynchronous process did not allow them to guide the activity in a way that helped the students to carry out a deeper analysis. CT development and epistemic cognition depends on many factors, and teachers have an important role in achieving these goals ( Greene and Yu, 2016 ; Chinn et al., 2020 ).

The analysis of arguments allows us to identify some factors that are crucial and directly affect the critical evaluation of headlines. Some of the students did not question the use of antibiotics for coronavirus disease. This result highlights the importance of health literacy and its interdependency with CT development, as previous studies on vaccine controversies and CT show ( Puig and Ageitos, 2021 ). Although it is not the focus of this paper; the results point to the importance of making students aware of their knowledge limitations for critical assessment. A key instructional implication from this work is making e-learning activities more cooperative, as we have noted, and epistemically guided. Moreover, CT dimensions could be made explicit in instructional materials and assessments. If we want to prepare students to develop CT in order to face real/false news spread by social media, we need to engage them in deep epistemic assessment, namely in the critical analysis of the content, the source, procedures and evidence behind the claims, apart from other tasks. Promoting students’ awareness and vigilance regarding misinformation and disinformation online may also promote more careful and attentive information use ( Barzilai and Chinn, 2020 ), thus activities oriented toward these goals are necessary.

Our study reinforces the need to design more CT activities that guide students in the critical assessment of diverse aspects behind controversial news as a way to fight against the rise of disinformation and develop good knowledge when dealing with SSIs. Students’ epistemological views can influence their performance on argumentation thus, if uncertainty of knowledge is explicitly address in SSI instruction and epistemic activities, students’ epistemological views may be developed, and such development may in turn influence their argumentation competence and consequently their performance on CT.

Data Availability Statement

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Ethics Statement

Written informed consent was obtained from the participants’ legal guardian/next of kin to participate in this study in accordance with the National Legislation and the Institutional Requirements.

Author Contributions

BP conducted the conceptual framework and designed the research study. PB-A conducted the data analysis and collaborated in manuscript preparation. JP-M implemented the didactical proposal and collected the data. All authors contributed to the article and approved the submitted version.

This work was supported by the project ESPIGA, funded by the Spanish Ministry of Science, Education and Universities, partly funded by the European Regional Development Fund (ERDF) Grant code: PGC2018-096581-B-C22.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

This study was carried out within the RODA research group during the lockdown in Spain due to COVID-19 pandemic. We gratefully acknowledge all the participants for their implication, despite such difficult circumstances.

• ^ https://www.e-bug.eu

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Keywords : critical thinking, argumentation, socio-scientific issues, COVID-19 disease, fake news, epistemic assessment, secondary education

Citation: Puig B, Blanco-Anaya P and Pérez-Maceira JJ (2021) “Fake News” or Real Science? Critical Thinking to Assess Information on COVID-19. Front. Educ. 6:646909. doi: 10.3389/feduc.2021.646909

Received: 28 December 2020; Accepted: 09 March 2021; Published: 03 May 2021.

Reviewed by:

Copyright © 2021 Puig, Blanco-Anaya and Pérez-Maceira. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Blanca Puig, [email protected]

This article is part of the Research Topic

Science Education for Citizenship through Socio-Scientific issues

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Peer-reviewed

Research Article

Thinking about life in COVID-19: An exploratory study on the influence of temporal framing on streams-of-consciousness

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Visualization, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation Department of Communication, University of California, Los Angeles, Los Angeles, California, United States of America

Roles Conceptualization, Formal analysis, Investigation, Methodology, Project administration, Resources, Supervision, Visualization, Writing – review & editing

• Constance M. Bainbridge, 

• Published: April 28, 2023
• https://doi.org/10.1371/journal.pone.0285200
• Peer Review
• Reader Comments

The COVID-19 global pandemic led to major upheavals in daily life. As a result, mental health has been negatively impacted for many, including college students who have faced increased stress, depression, anxiety, and social isolation. How we think about the future and adjust to such changes may be partly mediated by how we situate our experiences in relation to the pandemic. To test this idea, we investigate how temporal framing influences the way participants think about COVID life. In an exploratory study, we investigate the influence of thinking of life before versus during the pandemic on subsequent thoughts about post-pandemic life. Participants wrote about their lives in a stream-of-consciousness style paradigm, and the linguistic features of their thoughts are extracted using Linguistic Inquiry and Word Count (LIWC). Initial results suggest principal components of LIWC features can distinguish the two temporal framings just from the content of their post-pandemic-oriented texts alone. We end by discussing theoretical implications for our understanding of personal experience and self-generated narrative. We also discuss other aspects of the present data that may be useful for investigating these thought processes in the future, including document-level features, typing dynamics, and individual difference measures.

Citation: Bainbridge CM, Dale R (2023) Thinking about life in COVID-19: An exploratory study on the influence of temporal framing on streams-of-consciousness. PLoS ONE 18(4): e0285200. https://doi.org/10.1371/journal.pone.0285200

Editor: Michal Ptaszynski, Kitami Institute of Technology, JAPAN

Received: November 4, 2022; Accepted: April 18, 2023; Published: April 28, 2023

Copyright: © 2023 Bainbridge, Dale. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: The data and analysis script is available on Github: https://github.com/conbainbridge/covid_thoughts DOI: 10.5281/zenodo.7809317 .

Funding: The authors received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Introduction

What is the semantic structure of free-flowing thought? How do meanings come up in our thoughts, and how are they linked over time? Human experience is filled with this structure, while we stand in line for our groceries, wait in line at the bus station or even in a moment of mind wandering while conversing with a friend. In this paper, we explore recent events surrounding COVID as a domain to tap into this semantic structure. We devised a “stream-of-consciousness” task in which participants imagined the future beyond COVID, and quantified how their free-flowing thought varied as a function of how they were prompted before this writing. We find that if participants are prompted with the present COVID situation vs. the pre-COVID times, their structure of thought changes. Our exploratory analyses suggest language from the future-oriented responses reflects its temporal priming, i.e., the pre-pandemic vs. during the pandemic prompt that came before. These results offer hints at the semantic patterns that characterize these self-reflections, and how context is central to the forms they take. We end by arguing that a generalized notion of “self-communication” may organize phenomena such as these in intriguing ways.

When the COVID-19 global pandemic spread rapidly in late 2019 and early 2020, major life impacts reverberated globally. These effects were felt across many aspects of everyday life, from direct health impacts to more indirect effects on the economy and social life. People began referring to life before the pandemic colloquially as the “before times,” and there was a sense of a new normal. These effects were also significant in the lives of younger individuals, such as students, with virtual schooling, diminished social interaction, and limited hands-on learning (e.g., [ 1 ]). Evidence suggests an alarming impact of the pandemic on the mental health of college students, including increased stress moderated by self-regulation efficacy [ 2 ], increased depression and anxiety [ 3 ], and negative changes to student relationships [ 4 ]. The effect of perceived threat of COVID-19 on mental well-being appears to be mediated by future anxiety as well, showing the potential to impact mental health in the long run as decisions about the future may be impacted [ 5 ]. The pandemic thus provides a unique opportunity to study how major events influence perceptions of life and mental health, and their relationship to other dimensions.

To study these perceptions, we investigate how student participants construct a narrative text about their lives. Our approach is inspired by methods used in essay writing and journaling [ 6 ], self-talk [ 7 ], and think aloud [ 8 ]. These domains suggest that when we speak to ourselves, ruminate, or reflect on aspects of our lives, our linguistic styles and strategies may be a signature for underlying mental or emotional states and processes. Intriguingly, such intrapersonal communication has been frequently the topic of discussion, yet remains largely an understudied construct. Self-communication occurs when both sender and receiver of a communicative instance are contained within a single individual, such as in dialogical self-talk [ 7 ], and can include transcending across time and space [ 9 ]. Here we use this process as a source of data about these life perceptions.

While not all aspects of intrapersonal communication may be easily accessible for study, such as the seemingly endless streams-of-consciousness we engage in every day, various methods have been employed to tap into self-talk through writing or speech. Raffaelli et al. [ 8 ] used a think aloud paradigm in which individuals are instructed to speak aloud their thoughts. Negative valence in the words used correlated with a narrowing of conceptual scope, such that thoughts became more semantically similar when they were more negative. Social context may play a role, too. Oliver et al. [ 10 ] used a think aloud task to study mental health outcomes. Changing social context to more supportive environments led to greater use of positive emotion words, fewer negative emotion words, fewer swear words, and fewer first-person references compared to a control condition that lacked emotional recognition or meaningful rationale. Recent work has shown that self-talk also links to mental health outcomes during COVID-19. In a questionnaire study conducted on an Iranian sample, there were significant relationships found between self-talk, death anxiety, obsessive-compulsive disorder, and coping strategies in relation to the pandemic [ 11 ].

As noted above, the onset of COVID for some may present a distinct point in time at which everyday life changed. This temporal effect of COVID may alter the way we contextualize and think about events before, during, and after this distinct transition. Changing the temporal framing of one’s thoughts or self-talk may have an influence on the language that we use. For example, construal-level theory hypothesizes that increased psychological distances are linked to increased abstractness of hypotheticals [ 12 ]. The further away something is in time, space, or relatability (e.g., feeling similar to or different from an individual), the further the perceived psychological distance and the less concrete related thoughts become. Similarly, increasing concreteness, such as through writing about a given event, may decrease psychological distance to that event in time [ 13 ]. High-level construals, or higher abstractions when mentally representing objects or concepts, may better facilitate self-control, such as attenuating the impact of future discounting on economic decision making [ 14 ]. Following the September 11, 2001 attacks on the United States, entries in an online journaling platform used increasingly psychologically distant language in their daily writings, suggesting major events can impact our relationships with time [ 15 ]. However, prior work suggests that writing about emotional experiences such as trauma may provide benefits for both mental and physical health [ 16 ].

Considering these findings, one might expect that writing about “the before times,” pre-pandemic, would influence how one perceives their future, perhaps with increased abstraction leading to greater possibilities and allowing distance from such a troubling and disruptive event. Relatedly, a focus on life during the pandemic may have negative impacts on one’s perceptions of their future after the pandemic, with lower levels of construal leading to ruminative tendencies.

To test this idea, we collect and analyze a text-based “stream-of-consciousness” dataset. Participants carried out this open-ended response task online, typing in their thoughts about COVID-19 life under different temporal conditions. The task was designed to elicit a naturalistic and uninterrupted flow of thought. Participants were first told to consider and write about life either before or during the pandemic. This prompt (before vs. during) served as a frame for a subsequent writing prompt, where participants were instructed to share their thoughts about a post-pandemic life. This future-oriented prompt is the same for all participants and is the focus of our analysis, and participants only differed in which writing prompt preceded this one (before vs. during the pandemic). This open-ended writing task generates a large and rich dataset of text. We thus took a preliminary, exploratory approach to investigate the influence of this temporal framing on their responses. In the Analyses section, we consider prior research that frames some factors guiding our exploratory analysis, and we introduce the ways in which these texts can be measured and analyzed.

Data collection was conducted during two separate college quarters: in the first quarter (fall, 2021), classes were hybrid (both in-person and online), with students returning to campus for the first time since the pandemic began. This research was approved by the UCLA North General Institutional Review Board. 134 undergraduate students (female = 95, male = 38, other = 0) contributed data to this first phase of sampling. The second phase of sampling occurred the following quarter (winter, 2022), which had returned to online-only for the first four weeks due to the rapid spread of a particularly contagious strain of the virus, labeled “omicron.” In this phase, 91 undergraduate students (female = 70, male = 19, other = 2) contributed data. The students completed the study online for course credit in an introductory communication course. The goal of the study was to collect a rich dataset for exploratory analyses, and several aspects of the data were not included for analysis. Because of the pandemic-related constraints participants encountered at the start of the winter quarter, we first use this second phase dataset for our main analyses. We then use the fall dataset for exploratory comparison.

The experiment was built using jsPsych [ 17 ] in conjunction with https://cognition.run to store the data. First, participants encountered a consent page, then click to continue only if they agree to consent to participate in the study. After the initial consent page, participants selected on a slider where in the COVID-19 timeline they considered the current moment to be. For the main portion of the study, participants wrote in a stream-of-consciousness style manner for ten minutes per prompt, responding to three total writing prompts. The first prompt asked participants to write either as if it is before the pandemic, or as if during the pandemic. Following the initial prompt, participants responded to a similar prompt asking to write as though it is after the pandemic. The final prompt included whichever temporal framing was not responded to in the first prompt. This resulted in two possible conditions: before-after-during the pandemic, or during-after-before the pandemic. Our focus here is on how the before vs. during prompt, chosen randomly as the first temporal framing, influences the way participants write about the future, after the pandemic.

During all writing prompts, a countdown timer was visible on the screen during writing, and on multiple pages throughout the study, mental health resources were provided. After completion of the three prompts, participants responded to questions about demographics, COVID-19 experiences, journaling experience, as well as three individual difference measures: a rumination scale [ 18 ], an 18-item adaptation of the need-for-cognition scale [ 19 ], and a social connectedness and belonging scale [ 20 ].

Measures and analyses

In the analyses that follow we focus on document-wide features, taking an exploratory approach. Linguistic Inquiry and Word Count (LIWC) [ 21 ] categorizes the words in a text based on a range of concepts, including emotions, cognitive tension words, causal words. LIWC provides one methodological tool for enabling indirect inferences about mental states. The most recent version of LIWC at the time of analysis features over 100 word categories, capturing a large variable space. This version of LIWC was tested and validated using a “Test Kitchen Corpus” of around 31 million words pooled from a wide range of corpora, including blogs, emails, movie dialogues, transcribed speech, natural conversations, social media posts, and more [ 21 ]. Analysis of language data can be challenging due to the complexities at play. However, LIWC has been successful at predicting a variety of psychological and social measurements from language usage. For example, course performance has been generally predicted based on the written self-introductions of undergraduate students [ 22 ].

Several of the specific LIWC word categories also map neatly onto well-studied and meaningful dimensions of language. LIWC includes several sentiment related categories, including positive and negative emotion and tone, as well as several discrete emotions, such as sadness, anger, and anxiety. Sentiment of language may provide hints at wellbeing. In one pair of studies, improvements in physical health were linked to a greater use of positive emotion words and a moderate number of negative emotion words (neither very high nor very low), as well as increased use in both causal and insight words throughout a writing task [ 23 ]. Pronoun usage may also hint at different psychological processes. Greater use of first person singular pronouns is associated with interpersonal distress [ 24 ], as well as depressive symptoms and negative emotions [ 25 ]. LIWC additionally includes categories relating to time, such as a past or future focus, and health categories, all concepts highly relevant for the topics of interest in this dataset. Content words (e.g., nouns, regular verbs, and various adjectives and adverbs) and function words (e.g., pronouns, prepositions, articles, conjunctions, and so on) are also detectable using LIWC, and may reveal information about one’s social inclination—the use of function words often requires understanding shared knowledge between interlocutors, for example [ 26 ].

For each future-oriented text produced by participants, LIWC generates a set of semantic category measures that reflect the percentage of these categories represented in that text. This can be understood as a multivariate vector of measurements of how positive, negative, etc., a text is based on a calculation of the percentage of words that fall under these categories. To evaluate the influence of temporal framing (i.e., writing about pre-pandemic or during pandemic life in the first prompt) on writing about life after the pandemic, we evaluated the LIWC features present in the post-pandemic documents (the LIWC data for all documents and the analyses script are available at https://github.com/conbainbridge/covid_thoughts ). Because LIWC has over 100 of these categories, we face the challenge of multivariate analysis without simply deploying an analysis pipeline on each of the 100 separate dimensions. To conduct a more global analysis of LIWC features, we used principal components analysis (PCA) to determine components that best predict the temporal framing condition. PCA permits the analysis of many intercorrelated variables, characterizing the structure of both the observations in the dataset and the variables themselves (for a detailed explanation, see [ 27 ]). PCA has been used successfully in prior work to reduce LIWC dimensions [ 22 , 28 , 29 ].

PCA thus extracts a conceptual space across all LIWC dimensions, but at a lower dimensionality. Another way to think of this process is that PCA reveals this lower dimensionality based on how normalized LIWC scores cluster across students’ writing. For example, instead of the three LIWC features “positive tone,” “negative tone,” and “emotion,” the PCA model may infer that these three features load onto just one principal component (PC). This example is intuitive, but finding clusters across texts and many features yields subtler and more complex patterns of correlation. Our main test is whether these lower-dimensional PCs distinguish temporal prompts at all. This analysis is done based solely on the post-pandemic-oriented texts, to see how the framing of a preceding prompt may echo into thoughts about the future. Put simply: It would show that participants primed by the past or present (pre- and during pandemic) alter the way they think (or write about) the future.

The PCA recovers as many PCs as there are variables, ranked by the strongest component to the weakest. In cases where the number of participants is less than the number of variables, the number of PCs is limited to match this sample size. Because the winter dataset’s sample size ( n = 91) is less than the total LIWC variables (117), the PCA yields 91 total PCs. The LIWC features cluster across texts as we found a nonlinear rise in PC strength, expressed through cumulative proportion of variance accounted for ( Fig 1 ). The first 20 PCs account for almost 70% of the cumulative variance in the dataset.

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Of the 91 total PCs, a subset of 20 accounting for approximately 69% of the cumulative variance was taken to determine the most significant PCs.

https://doi.org/10.1371/journal.pone.0285200.g001

As noted above, we tested whether these LIWC PCA components from the future-oriented prompt relate to the temporal frame of the prior prompt (before vs. during the pandemic). With a logistic regression predicting prior condition from these 20 components, we found seven PCs that were significant or approached significance. We chose a liberal initial threshold of p = 0.1 to ensure we captured a wide range of possible semantic structures in the future-oriented writing. In a secondary generalized linear model, six of these remained significant (PCs 1, 4, 5, 10, 11, and 13). We also included the seventh (PC18) in our selected components because it trended towards significance in that follow-up model alone. Note that these results reflect coefficients from a single regression model–not independent tests.

The p -values for each PC in the model, and the top ten most influential LIWC features per PC (i.e., highest absolute values in loading scores, ordered from most to least influential) are in Table 1 . LIWC categories in bold, italic font feature positive loading scores, indicating their tendency to characterize the during -pandemic framing, while negative (normal font) loading scores characterize the pre -pandemic framing. Loading scores are available in the S1 Table . For details on what the different LIWC categories entail, see [ 21 ].

The top ten LIWC features for each PC, ordered from most-to-least influential (i.e., highest absolute loading scores), clustered by the condition they characterize. Features in bold, italic font have positive loading scores and characterize the during-pandemic condition, while the features in normal font have negative loading scores and characterize the pre-pandemic condition. Loading scores for these LIWC features are available in the S1 Table .

https://doi.org/10.1371/journal.pone.0285200.t001

PC5 is the most significant component of the selected components from the generalized linear model. By itself, it is able to predict which temporal framing preceded the post-pandemic prompt, based solely on the linguistic characteristics in that post-pandemic prompt ( p = .011, Fig 2 ). PC5 shows that positive emotion, tone, want, and discrepancy are found more in post-pandemic contemplations when they are preceded by reflections about during the pandemic. Conversely, when prompted with before the pandemic, PC5 shows focus on the past and use of personal pronouns. Interpreting LIWC loadings may be subjectively influenced, and interpretive assessment must be done with caution. In this particular case, PC5 indicates that thoughts about experience during the pandemic prompt positivity (i.e., the presence of the “positive tone” and “positive emotion” LIWC categories) that is desired (“want”, “tone,” “emotion,” and “discrepancy”–which includes words like would, can, and want). On the other hand, the pre-pandemic priming may focus on what was lacking (“lack”) in the past (“past focus”) and may be expressing themselves more spontaneously (“authenticity”).

The temporal framing of during-pandemic represents the reference condition in green, while the pre-pandemic condition is in red. The difference in explanatory power for PC5 between the two conditions is significant at p = .011.

https://doi.org/10.1371/journal.pone.0285200.g002

An interpretation of PC1 could indicate people think more negatively (“negative tone”) and analytically (“analytic”) about health (“health”) as a result of thinking about the experience of the pandemic (e.g., “illness” and “article”, perhaps the result of noting “ the pandemic”). Other PCs may hint at pre-pandemic priming leading to thinking enthusiastically about social life (PC4 –“fulfill,” “prosocial,” “exclamation,” “social behavior”), expressing sadness over remembering one’s lifestyle from the past (PC 10 –“memory,” sad emotion,” “leisure,” “lifestyle,”), or perhaps more episodically inspired thoughts guiding future projections (PC13 –“mental,” “visual,” “perception,” “past focus”). The during pandemic priming may lead to frustration (PC10 –“risk” and “swear”) and one’s needs and their justifications (PC13 –“Cause,” inclusive of words like how, because, and why, and “Need”). Importantly, participants were not prompted to contrast the future and the present/past; the temporal prompt simply alters the semantic patterns in their writing, revealed by the PCs shown in Table 1 .

One way to quantify these overall linguistic trends is to assess them using network analysis [ 30 – 32 ]. This method takes the PCs and visualizes the relationships among the LIWC categories. These more visual, geometric relationships among the dimensions may help to interpret the overall shift taking place in participant writing after the prompts. We built a network model using the “igraph” R package to explore which LIWC features are shared across the selected principal components ( Fig 3 ). The nodes represent the top 50 most influential LIWC features across the selected components (i.e., PCs 1, 4, 5, 10, 11, 13, 18). Edges are formed as the result of shared presence of the linked LIWC features across components, suggesting recurring themes in distinguishing the conditions. The color represents the level of influence that feature has in distinguishing conditions, such that the lighter the purple, the greater the influence across these components. This influence is calculated as the sum of the loading score absolute values for a given LIWC feature across components, and rather than being specific to the condition captures that feature’s overall distinguishing influence.

LIWC features are plotted such that an edge is drawn if the features are shared across principal components 1–50. The redder the node is, the more influential the feature is in the loading scores of the main selected components (PCs 1, 4, 5, 10, 11, 13, 18).

https://doi.org/10.1371/journal.pone.0285200.g003

Therefore, the lighter purple nodes represent features that are more influential across the semantic landscape. The manner in which features cluster may then represent the distinctive set of semantic factors that are combined during our particular task. For example, positive emotion, positive tone, want, tone, emotion, and discrepancy, all features found to characterize the during-pandemic condition in PC5, cluster together even across these components and appear to hint at longing for better times. Other clusters suggest livelihood elements (work, tech, lifestyle, culture), health (health, illness, physical), and sociality (she/he, friend, affiliation). When a feature within a cluster also exhibits a lighter tone, it may be the case that feature is particularly unifying of the cluster’s concepts (e.g., “perception” being linked to “visual” as well as “motion”), although the feature itself may merely have more influence independently. Because semantic graphs of this kind can represent how one “moves” through meaning space (cf. [ 33 ]), a potential future application of this network-based technique is to visualize and characterize the set of potential semantic paths induced by a given prompt or frame of mind [ 34 ]. In our case, thoughts about COVID induce particular sorts of ideas, such as health and social connection. When we prompt participants with a prior temporal frame (i.e., pre-pandemic or during), they appear to take different paths on this network. Such methods may facilitate characterization of the streams-of-consciousness and internal thought processes that open this paper. Importantly though, any such graph structure should be compared to a baseline to ensure that we are not interpreting a chance outcome.

To test whether this network was structured meaningfully relative to a baseline, we extracted some measures and performed a permutation. We analyzed the mean degree (number of adjacent edges), mean betweenness (number of shortest paths going through a vertex or edge), and clustering coefficient (probability that adjacent vertices of a vertex are also connected) of the network. The mean degree is 1.92, mean betweenness 29.02, and transitivity 0.49. We then ran the same network analyses on 10,000 random permutations of the normalized LIWC data to see where the original data falls on this random distribution. This is to confirm whether such semantic structure arises specifically as a result of condition, as opposed to random clustering. The probability of the mean degree in the permutations distribution is .038,.185 for mean betweenness, and.004 for the clustering coefficient. Given both the mean degree and clustering coefficient are outside a 95% confidence interval, this suggests structure meaningfully departs from what would be expected by chance.

We next conducted a PCA on the fall (first phase) dataset. Our initial focus on the winter dataset was because we expect a more intensive response from participants–students who just had another disruption to their class activities during more lock down. To match the winter dataset, we ran a generalized linear model on the first 20 components, which account for 66% of the cumulative variance. Of these 20 components, only PC4 is significant (p = .008). The top ten loading scores for LIWC features characterizing PC4 are word count (-0.205), positive tone (0.182), impersonal pronouns (-0.181), death (-0.179), conversation (-0.17), conflict (-0.169), social references (-0.168), anger (-0.161), social (-0.157), and technology (-0.156), with each associated with the past-primed condition with the exception of positive tone. Because there is only one significant PC, we did not conduct network analysis on this dataset. In general, there are some small effects in the fall dataset but far less pronounced than the structure we find in the winter. We return to this below.

Conclusions and discussion

These exploratory analyses showcase the influence of temporal framing on college students as they envision their post-pandemic lives. Based only on what participants wrote when imagining their post-pandemic lives, LIWC features reduced into principal components can predict which temporal framing participants received. A few significant components hint at different categories of words that aid in making these distinctions. A tentative interpretation suggests that there is an extra focus on health (PC1) and a longing for better times (PC5) when primed by pandemic life, and more socially-oriented thinking (PC4) when primed by pre-pandemic life. In a network analysis, a semantic structure appears to arise, particularly in comparison to a distribution of random permutations of the original LIWC data. Interpretive assessment of the semantic network confirms the results on individual components. This visualization also reinforces the idea that the temporal framing leading into a stream-of-consciousness might shape the conceptual structures that participants work with. These explorations offer an initial foundation for understanding the influence of temporal thinking, and in this particular study on construing imagined futures after a major global crisis. While interpretations of the components are speculative, the LIWC categories may inform deeper studies into the specific ways COVID-19 has shaped the content of students’ imagined futures. Regardless of the meaning behind these semantic spaces, this work highlights that shifts in life triggered by COVID-19 can have an impact on immediate thoughts about the future. With this in mind, interventions may be developed to explore how re-framing thoughts, such as temporally, can encourage shifts where future thoughts may be more hopeful and positive, and less dire or pessimistic.

When conducting PCA on the comparison fall dataset, we find only one component is significant. This could suggest that the winter dataset induced more complex semantics due to the emotional experiences associated with the constricted context, when students returned to remote learning due to the pandemic. Indeed this was our expectation, and motivated our initial focus on that winter data set. However, there are several factors that limit any strong conclusions. First, such environmental contextual influences need to be studied in more depth in future work. These represent just two time points, and a wider sample of data from multiple timepoints may suggest these differences were due to noise. Second, the datasets do have slightly different properties. While the winter dataset had a limited sample size, constraining the total components in the PCA, the fall dataset had a larger sample size, enabling the number of components to match the number of LIWC variables. Because of limited prior work using such methods, we did not have strong priors for an optimal sample size, which may additionally limit power in these analyses. Given our analyses were exploratory in nature, future work will benefit from taking insights gained here to formulate a priori hypotheses and planned analyses.

Priming participants to write in a stream-of-consciousness style seems less common in the literature in favor of journal paradigms, where more editing and refining of language may limit inferences about inner psychological and emotional processes, perhaps especially their dynamics. Nevertheless there are some important limitations to our own design that should be acknowledged. One limitation of the data collection using this paradigm was the online context of the study, which may include extraneous variables that would be valuable to measure and control for in future work. For example, this could include aspects of their state in the moment (e.g., exhaustion, mood), ease of technology use, and the environment when completing the task (such as presence of others in the room). Participants may also have still performed some editing, or struggled to understand or adhere to a free-flowing style of writing. To overcome these issues, it may be useful to integrate content analysis like this with typing dynamics (e.g., [ 35 ]). Indeed, we collected individual keypresses and timings, including the use of the delete key. It may thus be possible to reconstruct some deleted content, and give a full portrait of the stream-of-consciousness exercise. These typing data may also be used to validate and refine this paradigm to study finer-grained psychological events.

Dynamic typing data may also reveal memory search, rumination through recurrent themes or word sequences. These data may also reveal document-wide typing rates that signal cognitive signatures that relate to global features such as overall sentiment and mood. In addition to word categories such as the LIWC dictionaries, other natural language processing techniques and analyses may reveal further insights. LIWC-22 also includes a measure called “narrative arc.” Narrative arc includes proposed stages of composition such as staging, plot progression, and cognitive tension, and appears to follow different patterns depending on text or transcription formats, such as fictional-style writing versus New York Times science articles [ 36 ]. Whether journalistic or stream-of-consciousness writing follows certain narrative arc patterns, or varies depending on the topic, sentiment, or other features, remains an open question. Topic modeling or recurrence analyses can explore how possibilities become constrained (or not) by temporal framing [ 37 , 38 ]. Further explorations into associations across LIWC categories could also contribute to understanding meaningful differences caused by temporal framings.

Individual differences in the experience of COVID-19 life would seem to be a critical ingredient here that we do not yet explore. Future analyses may consider such differences in more detail, such as comparing the framing texts to the post-pandemic texts. If an individual writes particularly optimistically about their life during the pandemic, they may be more likely to then write positively about the future, while greater negativity may similarly bleed into perceptions of the future. A rumination scale [ 18 ], a need-for-cognition scale [ 19 ], and a social connectedness and belonging scale [ 20 ] were included in data collection, though these measures were not factored into the present exploratory analyses. First-person singular pronoun use is increased in the self-focused attention typical of rumination [ 39 ], and thus may have potential for predicting rumination levels based on streams-of-consciousness. The interplay between language and rumination may result in, for example, pervasive use of such pronouns in future-oriented texts regardless of temporal framing. The need-for-cognition scale may also predict how much semantic space one covered in their streams-of-consciousness to begin with, and may inform language-oriented interventions if one temporal framing or the other encouraged greater cognitive exploration. Aside from the social connectedness and belonging measure, we asked questions about actual social experience during COVID-19. Taken together, these measures may explain some of the semantic space that the PCA revealed (e.g., PC4, which included the LIWC categories of “prosocial” and “social behavior” characterizing the pre-pandemic condition).

Given that this dataset was a college sample, factors such as age or other demographics remain open for study as they relate to global crises. For example, experiences of age-related change appear to influence perceptions of the future, and in turn mental health [ 40 ]. Age also appears to be a factor in influencing in-the-moment perceptions of COVID-19, although it may not have had as much influence on perceptions of the future [ 41 ]. While the pandemic marked a sudden major lifestyle shift globally, it will be valuable to evaluate similarities and differences to other health concerns experienced personally, such as chronic health issues, injury, or a terminal illness diagnosis. Whether the global, collective experience of COVID-19, or concern about one’s own experiences drive differences in future projections remains an open question. Understanding the relationships between personal health, global health, and how perceptions of their impact on the future change across the lifespan may clarify how different kinds of interventions may perform better or worse for different health profiles.

This study examines the effects of temporal framing on perception of the future, all within individuals; however, undoubtedly many external factors will also shape how individuals have experienced the COVID-19 pandemic. The media landscape and how the pandemic has been framed to different audiences will certainly have some influence. Indeed, psychological distance has been found to influence the evolution of misinformation regarding COVID-19 when the threats appear more distant [ 42 ]. Future work may examine the effects of the media on self-talk relating to global crises. Additionally, COVID-19 panned out to be a highly politically polarizing event. Political affiliation and intensity of an individual’s antagonistic views will shape how this global event influences thoughts of a post-pandemic life. Social media usage and the makeup of one’s social network both on- and off-line likely moderate perceptions of pandemic life. The language of social media posts across different styles of platforms and through different media (e.g., written such as in a tweet versus video, such as on TikTok) may show differences in socially oriented communication, which may then turn inwards when engaging in self-talk. How inter- and intra-personal communication are linked appears to be a ripe area for research [ 7 , 43 ].

Our findings suggest that streams-of-consciousness could have rich dynamic properties. In broader terms, the contexts of a person’s present thoughts offer a kind of momentum, propelling them into the next stream-of-consciousness. In the language of dynamical systems, there is hysteresis , when “the subject remains longer in the initially perceived interpretation” [ 44 ] (p. 373). This hysteresis property characterizes psychological dwell time in many domains, from motor control to categorization [ 45 ]. Even high levels of cognitive complexity, like streams-of-consciousness, may be given to these properties of complex, dynamic systems. The results here suggest this hysteresis occurs in temporal framings. When participants engage in thought about the past vs. the present, it may set their mind on a given trajectory, giving it some momentum and remaining longer in the initial perceived interpretation. Importantly though, the effects of such framings are confounded with the psychological boundary of a major global event. How context and psychological distance in the temporal domain interact or differently influence hysteresis could be the subject of future work. The global nature of COVID-19 may provide a valuable comparison point to other world events or disasters, such as the findings from Cohn, Mehl, and Pennebaker [ 15 ] of language shifts after the September 11, 2001 attacks on the United States. Future stream-of-consciousness prompts may also explore open-ended thoughts rather than anchoring on a specific event, to further clarify the temporal element alone, instead manipulating how far back or forward in time one is projecting their thoughts.

In the particular study presented here, we took an exploratory step into how streams-of-consciousness may color our views as we look towards the future. Our conscious thoughts, once expressed, are not divorced from measurable effects of thoughts that came before. The words we write and the things we think of before considering the future have a non-trivial influence on the way we frame that future to ourselves, and this can be seen even when considering a global crisis that has shaken our worlds as we knew them.

Supporting information

S1 table. loading scores for the top ten most influential liwc features for each selected component..

The table below features the seven selected components, the ten most influential LIWC features (ordered from most to least influential, based on their absolute values), and their raw loading scores. Positive loading scores best characterize the during-pandemic condition, while negative loading scores best characterize the pre-pandemic condition.

https://doi.org/10.1371/journal.pone.0285200.s001

Acknowledgments

We thank Greg Bryant and Anne Warlaumont for feedback on the project and writing, as well as the participants for contributing their streams-of-consciousness.

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From ‘deadly enemy’ to ‘covidiots’: Words matter when talking about  COVID-19

PhD, Philosophy of Language, Faculty of Applied Science, Emeritus, University of British Columbia

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So much has been said and written about the COVID-19 pandemic. We’ve been flooded with metaphors, idioms, symbols, neologisms, memes and tweets. Some have referred to this deluge of words as an infodemic .

And the words we use matter. To paraphrase the philosopher Ludwig Wittgenstein: the limits of our language are the limits of our world . Words place parameters around our thoughts.

These parameters are the lenses we look through. According to literary theorist Kenneth Burke, “ terministic screens ” are defined as the language through which we perceive our reality. The screen creates meaning for us, shaping our perspective of the world and our actions within it. The language acting as a screen then determines what our mind selects and what it deflects.

This selective action has the capacity to enrage us or engage us. It can unite us or divide us, like it has during COVID-19.

Metaphors shape our understanding

Think about the effect of seeing COVID-19 through the terministic screen of war. Using this military metaphor , U.K. Prime Minister Boris Johnson has described COVID-19 as an “enemy to be beaten.” He asserts that this “enemy can be deadly,” but the “fight must be won.”

Read more: War metaphors used for COVID-19 are compelling but also dangerous

The effect of this military language conflicts with the perpetuated myth that “we are all in this together.” But rather, it invokes aggressive combat against an enemy. It signals an us-versus-them divide, promoting the creation of a villain through scapegoating and racist attitudes . Naming COVID-19 as the “China virus,” “Wuhan virus” or “Kung Flu” places the blame directly on China and increases racism. Attacks against Asian people have dramatically increased globally.

Read more: The Atlanta attacks were not just racist and misogynist, they painfully reflect the society we live in

Conversely, what would be the effect of a replacing the terministic screen of war with a tsunami? A metaphor that encourages “waiting out the storm?” Or working to help a neighbour? What would be the effect if the metaphor of “soldiers” were replaced with “ fire fighters ?” This could increase our perception of working together. Re-framing COVID-19 in this way has the capacity to convince us that we actually are “all in this together.”

An inspiring initiative, #ReframeCovid , is an open collective intended to promote alternative metaphors to describe COVID-19. The profound effect of altering the language is clear – to reduce division and generate unity.

Taking away our critical thinking

In a blog post, linquist Brigitte Nerlich compiled a list of metaphors used during the pandemic .

Although the metaphors of war and battle are foremost, others include bullet trains, an evil trickster, a petri dish, a hockey game, a football match, Whack-a-mole and even a grey rhino. Then there is the omnipresent light at the end of the tunnel .

And while they offer a way to re-frame our reality, helping the unfamiliar become familiar and rationalize our perceptions, there is danger lurking. Metaphors can substitute for critical thinking by offering easy answers to complex issues. Ideas can remain unchallenged if glossed over, falling prey to the trap of metaphors .

But metaphors also have the capacity to augment insight and understanding. They can foster critical thinking. One such example is the dance metaphor . It has been effectively used to describe the longer term effort and evolving global collaboration needed to keep COVID-19 controlled until vaccines are widely distributed.

COVID-19 buzzwords

Besides metaphors, other linguistic structures act as our terministic screens as well. Buzzwords related to the current pandemic have also increased.

We grimace or laugh at covidiot , covideo party and covexit . Then there is Blursday , zoom-bombing and quaran-teams .

According to a British language consultant, the pandemic has fostered more than 1,000 new words .

Why has this happened? According to a socio-linguistic analysis, new words can bond us like “ a lexical social glue .” Language can unite us in a common struggle of expressing our anxiety and facing the chaos. Common linguistic expressions decrease isolation and increase our engagement with others.

In a similar way, memes can reduce the space between us and foster social engagement. Most often sarcastic or ironic, memes about COVID-19 have been plentiful. Like metaphors, these buzzwords, puns and images embody symbols that invoke responses and motivate social action.

More recently, resisters of COVID language have flooded social media sites. Frustrated with the never-ending ordeal, online contributors refuse to name the pandemic. Instead they use absurd “pan-words”; calling it a panini, a pantheon, a pajama or even a pasta dish. These ludicrous words frolic with the terministic screen of “pandemic,” deconstructing the word to expose the bizarre meaningless nature of the virus and the heightened frustration with it.

Read more: How to cope with pandemic fatigue by imagining metaphors

The language used in relation to COVID-19 matters. As the effects of the pandemic intensify, so does the importance of the choice of language. Words, as terministic screens, can enable our perceptions in remarkable ways – they can unite us or divide us, enrage us or engage us, all while moving us to action.

• Coronavirus

Faculty of Law - Academic Appointment Opportunities

Operations Manager

Senior Education Technologist

Audience Development Coordinator (fixed-term maternity cover)

Lecturer (Hindi-Urdu)

8.4 Annotated Student Sample: "U.S. Response to COVID-19" by Trevor Garcia

Learning outcomes.

By the end of this section, you will be able to:

• Identify the genre conventions of an informal analytical report.
• Analyze the organizational structure of a report and how writers develop ideas.
• Recognize how writers use evidence and objectivity to build credibility.
• Identify sources of evidence within a text and in source citations.

Introduction

The analytical report that follows was written by a student, Trevor Garcia, for a first-year composition course. Trevor’s assignment was to research and analyze a contemporary issue in terms of its causes or effects. He chose to analyze the causes behind the large numbers of COVID-19 infections and deaths in the United States in 2020. The report is structured as an essay, and its format is informal.

Living by Their Own Words

Successes and failures.

student sample text With more than 83 million cases and 1.8 million deaths at the end of 2020, COVID-19 has turned the world upside down. By the end of 2020, the United States led the world in the number of cases, at more than 20 million infections and nearly 350,000 deaths. In comparison, the second-highest number of cases was in India, which at the end of 2020 had less than half the number of COVID-19 cases despite having a population four times greater than the U.S. (“COVID-19 Coronavirus Pandemic,” 2021). How did the United States come to have the world’s worst record in this pandemic? An examination of the U.S. response shows that a reduction of experts in key positions and programs, inaction that led to equipment shortages, and inconsistent policies were three major causes of the spread of the virus and the resulting deaths. end student sample text

annotated text Introduction. Informal reports follow essay structure and open with an overview. end annotated text

annotated text Statistics as Evidence. The writer gives statistics about infection rates and numbers of deaths; a comparison provides context. end annotated text

annotated text Source Citation in APA Style: No Author. A web page without a named author is cited by the title and the year. end annotated text

annotated text Thesis Statement. The rhetorical question leads to the thesis statement in the last sentence of the introduction. The thesis statement previews the organization and indicates the purpose—to analyze the causes of the U.S. response to the virus. end annotated text

Reductions in Expert Personnel and Preparedness Programs

annotated text Headings. This heading and those that follow mark sections of the report. end annotated text

annotated text Body. The three paragraphs under this heading support the first main point in the thesis statement. end annotated text

student sample text Epidemiologists and public health officials in the United States had long known that a global pandemic was possible. end student sample text

annotated text Topic Sentence. The paragraph opens with a sentence stating the topic. The rest of this paragraph and the two that follow develop the topic chronologically. end annotated text

student sample text In 2016, the National Security Council (NSC) published Playbook for Early Response to High-Consequence Emerging Infectious Disease Threats and Biological Incidents , a 69-page document on responding to diseases spreading within and outside of the United States. On January 13, 2017, the joint transition teams of outgoing president Barack Obama and then president-elect Donald Trump performed a pandemic preparedness exercise based on the playbook; however, it was never adopted by the incoming administration (Goodman & Schulkin, 2020). A year later, in February 2018, the Trump administration began to cut funding for the Prevention and Public Health Fund at the Centers for Disease Control and Prevention, leaving key positions unfilled. Other individuals who were fired or resigned in 2018 were the homeland security adviser, whose portfolio included global pandemics; the director for medical and biodefense preparedness; and the top official in charge of a pandemic response. None of them were replaced, thus leaving the White House with no senior person who had experience in public health (Goodman & Schulkin, 2020). Experts voiced concerns, among them Luciana Borio, director of medical and biodefense preparedness at the NSC, who spoke at a symposium marking the centennial of the 1918 influenza pandemic in May 2018: “The threat of pandemic flu is the number one health security concern,” she said. “Are we ready to respond? I fear the answer is no” (Sun, 2018, final para.). end student sample text

annotated text Audience. The writer assumes that his readers have a strong grasp of government and agencies within the government. end annotated text

annotated text Synthesis. The paragraph synthesizes factual evidence from two sources and cites them in APA style. end annotated text

annotated text Expert Quotation as Supporting Evidence. The expert’s credentials are given, her exact words are placed in quotation marks, and the source is cited in parentheses. end annotated text

annotated text Source Citation in APA Style: No Page Numbers. Because the source of the quotation has no page numbers, the specific paragraph within the source (“final para.”; alternatively, “para. 18”) is provided in the parenthetical citation. end annotated text

student sample text Cuts continued in 2019, among them a maintenance contract for ventilators in the federal emergency supply and PREDICT, a U.S. agency for international development designed to identify and prevent pandemics (Goodman & Schulkin, 2020). In July 2019, the White House eliminated the position of an American public health official in Beijing, China, who was working with China’s disease control agency to help detect and contain infectious diseases. The first case of COVID-19 emerged in China four months later, on November 17, 2019. end student sample text

annotated text Development of First Main Point. This paragraph continues the chronological development of the first point, using a transitional sentence and evidence to discuss the year 2019. end annotated text

student sample text After the first U.S. coronavirus case was confirmed in 2020, the secretary of the Department of Health and Human Services (HHS) was named to lead a task force on a response, but after several months, he was replaced when then vice president Mike Pence was officially charged with leading the White House Coronavirus Task Force (Ballhaus & Armour, 2020). Experts who remained, including Dr. Deborah Birx and Dr. Anthony Fauci of the National Institutes of Health, were sidelined. Turnover of personnel in related government departments and agencies continued throughout 2020, leaving the country without experts in key positions to lead the pandemic response. end student sample text

annotated text Development of First Main Point. This paragraph continues the chronological development of the first point, using a transitional sentence and evidence to discuss the start of the pandemic in 2020. end annotated text

Inaction and Equipment Shortages

annotated text Body. The three paragraphs under this heading support the second main point in the thesis statement. end annotated text

student sample text In January and February of 2020, the president’s daily brief included more than a dozen detailed warnings, based on wire intercepts, computer intercepts, and satellite images by the U.S. intelligence community (Miller & Nakashima, 2020). Although senior officials began to assemble a task force, no direct action was taken until mid-March. end student sample text

annotated text Topic Sentences. The paragraph opens with two sentences stating the topic that is developed in the following paragraphs. end annotated text

student sample text The stockpile of medical equipment and personal protective equipment was dangerously low before the pandemic began. Although the federal government had paid $9.8 million to manufacturers in 2018 and 2019 to develop and produce protective masks, by April 2020 the government had not yet received a single mask (Swaine, 2020). Despite the low stockpile, a request by the head of the Food and Drug Administration (FDA) in early 2020 to begin contacting companies about possible shortages of necessary medical equipment, including personal protective equipment, was denied. This decision was made to avoid alarming the industry and the public and to avoid giving the impression that the administration was not prepared for the pandemic (Ballhaus & Armour, 2020). end student sample text

annotated text Topic Sentence. The paragraph opens with a sentence stating the topic that is developed in the paragraph. end annotated text

annotated text Objective Stance. The writer presents evidence (facts, statistics, and examples) in mostly neutral, unemotional language, which builds trustworthiness, or ethos , with readers. end annotated text

annotated text Synthesis. The paragraph synthesizes factual evidence from two sources. end annotated text

student sample text When former President Trump declared a national emergency on March 13, federal agencies began placing bulk orders for masks and other medical equipment. These orders led to critical shortages throughout the nation. In addition, states were instructed to acquire their own equipment and found themselves bidding against each other for the limited supplies available, leading one head of a coronavirus team composed of consulting and private equity firms to remark that “the federal stockpile was . . . supposed to be our stockpile. It’s not supposed to be states’ stockpiles that they then use” (Goodman & Schulkin, 2020, April 2, 2020). end student sample text

Policy Decisions

annotated text Body. The paragraph under this heading addresses the third main point in the thesis statement. end annotated text

student sample text Policy decisions, too, hampered the U.S. response to the pandemic. end student sample text

student sample text Although the HHS and NSC recommended stay-at-home directives on February 14, directives and guidelines for social distancing were not announced until March 16, and guidelines for mask wearing were inconsistent and contradictory (Goodman & Schulkin, 2020). Implementing the recommendations was left to the discretion of state governors, resulting in uneven stay-at-home orders, business closures, school closures, and mask mandates from state to state. The lack of a consistent message from the federal government not only delegated responsibility to state and local governments but also encouraged individuals to make their own choices, further hampering containment efforts. Seeing government officials and politicians without masks, for example, led many people to conclude that masks were unnecessary. Seeing large groups of people standing together at political rallies led people to ignore social distancing in their own lives. end student sample text

annotated text Synthesis. The paragraph synthesizes factual evidence from a source and examples drawn from the writer’s observation. end annotated text

student sample text Although the first cases of COVID-19 were detected in the United States in January, genetic researchers later determined that the viral strain responsible for sustained transmission of the disease did not enter the country until around February 13 (Branswell, 2020), providing further evidence that the failed U.S. response to the pandemic could have been prevented. Cuts to public health staff reduced the number of experts in leadership positions. Inaction in the early months of the pandemic led to critical shortages of medical equipment and supplies. Mixed messages and inconsistent policies undermined efforts to control and contain the disease. Unfortunately, the response to the disease in 2020 cannot be changed, but 2021 looks brighter. Most people who want the vaccine—nonexistent at the beginning of the pandemic and unavailable until recently—will have received it by the end of 2021. Americans will have experienced two years of living with the coronavirus, and everyone will have been affected in some way. end student sample text

annotated text Conclusion. The report concludes with a restatement of the main points given in the thesis and points to the future. end annotated text

Ballhaus, R., & Armour, S. (2020, April 22). Health chief’s early missteps set back coronavirus response. Wall Street Journal . https://www.wsj.com/articles/health-chiefs-early-missteps-set-back-coronavirus-response-11587570514

Branswell, H. (2020, May 26). New research rewrites history of when COVID-19 took off in the U.S.—and points to missed chances to stop it . STAT. https://www.statnews.com/2020/05/26/new-research-rewrites-history-of-when-covid-19-arrived-in-u-s-and-points-to-missed-chances-to-stop-it/

COVID-19 coronavirus pandemic . (2021, January 13). Worldometer. https://www.worldometers.info/coronavirus/#countries

Goodman, R., & Schulkin, D. (2020, November 3). Timeline of the coronavirus pandemic and U.S. response . Just Security. https://www.justsecurity.org/69650/timeline-of-the-coronavirus-pandemic-and-u-s-response/

Miller, G., & Nakashima, E. (2020, April 27). President’s intelligence briefing book repeatedly cited virus threat. Washington Post . https://www.washingtonpost.com/national-security/presidents-intelligence-briefing-book-repeatedly-cited-virus-threat/2020/04/27/ca66949a-8885-11ea-ac8a-fe9b8088e101_story.html

Sun, L. H. (2018, May 10). Top White House official in charge of pandemic response exits abruptly. Washington Post . https://www.washingtonpost.com/news/to-your-health/wp/2018/05/10/top-white-house-official-in-charge-of-pandemic-response-exits-abruptly/

Swaine, J. (2020, April 3). Federal government spent millions to ramp up mask readiness, but that isn’t helping now. Washington Post . https://www.washingtonpost.com/investigations/federal-government-spent-millions-to-ramp-up-mask-readiness-but-that-isnt-helping-now/2020/04/03/d62dda5c-74fa-11ea-a9bd-9f8b593300d0_story.html

annotated text References Page in APA Style. All sources cited in the text of the report, and only those sources, are listed in alphabetical order with full publication information. See the Handbook for more on APA documentation style. end annotated text

Discussion Questions

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Critical Thinking During a Pandemic

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Using Rapid Design Thinking to Overcome COVID-19 Challenges in Medical Education

Anupam thakur.

1 A. Thakur is assistant professor, Department of Psychiatry, University of Toronto, and psychiatrist, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.

Sophie Soklaridis

2 S. Soklaridis is associate professor, Department of Psychiatry, University of Toronto, and senior scientist in education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.

Allison Crawford

3 A. Crawford is associate professor, Department of Psychiatry, University of Toronto, and scientist and associate chief, Virtual Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.

Benoit Mulsant

4 B. Mulsant is professor and chair, Department of Psychiatry, University of Toronto, and scientist, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.

Sanjeev Sockalingam

5 S. Sockalingam is professor and vice chair, Education, Department of Psychiatry, University of Toronto, and scientist and vice president, Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.

The rapid rise of cases of coronavirus disease 2019 (COVID-19) has led to the implementation of public health measures on an unprecedented scale. These measures have significantly affected the training environment and the mental health of health care providers and learners. Design thinking offers creative and innovative solutions to emergent complex problems, including those related to training and patient care that have arisen as a result of the COVID-19 pandemic. Design thinking can accelerate the development and implementation of solution prototypes through a process of inspiration, ideation, and implementation. Digital technology can be leveraged as part of this process to provide care and education in new or enhanced ways. Online knowledge hubs, videoconference-based interactive sessions, virtual simulations, and technology-enhanced coaching for health care providers are potential solutions to address identified issues. Limitations of this model include inherent bias toward utilitarian instead of egalitarian principles and the subsequent threat to diversity, equity, and inclusion in solutions. Although medical educators have embraced digital transformation during the COVID-19 pandemic, there is a need to ensure that these changes are sustained.

The rapid rise of cases of coronavirus disease 2019 (COVID-19) has led to the implementation of public health measures on an unprecedented scale to “flatten the curve” and reduce mortality. 1 These measures (e.g., home quarantine, social isolation, physical distancing, curfews, closures of schools and universities) have significantly affected the training environment and the mental health of learners across the continuum of education. As the demand for some health services increases exponentially and the morbidity of patients with COVID-19 rises, the pandemic is also causing unprecedented psychological distress in health care providers (HCPs) and health professions students, including burnout 2 , 3 and moral injury, the latter of which is exacerbated by shortages in specific health services (e.g., access to ventilators) in the face of growing needs. 4 Now, the lives of frontline HCPs are characterized not only by loss and stress but also by volatility, uncertainty, complexity, and ambiguity. Moreover, stress can lead to learner disengagement and interrupt the consolidation of memory, which can be detrimental to learning.

In parallel, the nature and setting of clinical work have changed for many HCPs and learners. They must adapt to physical distancing and social isolation by rapidly integrating the virtual delivery of health services. Similar to adaptations made during the 2003 severe acute respiratory syndrome (SARS) pandemic, the changes made during COVID-19 are leading HCPs to rethink medical education delivery and its focus. 5 As noted by Torous and colleagues, 6 the COVID-19 pandemic is an opportunity to accelerate the use of digital technology to provide access to quality care for people with complex health needs. The unpredictable scale and timing of the COVID-19 pandemic, paired with evolving digital innovation in medicine, have created a propitious environment for improving both education and patient care.

Medical educators require new models for generating solutions to address the complex training and care needs that have emerged as a result of COVID-19. Design thinking offers creative and innovative solutions to complex problems, 7 including those related to volatility, uncertainty, complexity, and ambiguity. 8 Design thinking principles have been applied in medical education to create educational strategies and programs. 5 , 7 , 9 , 10 With this approach, solutions can be developed or implemented both to sustain existing education and training resources and to enhance existing methods and content to meet the new needs presented by COVID-19. Finally, design thinking can support innovation in response to new competencies and needs that have arisen during the current public health crisis.

In this article, we discuss the role of rapid design thinking during the COVID-19 pandemic to generate innovative solutions to address unique medical education challenges. Using this lens, we share insights into the role digital solutions can play to address these challenges. Finally, we identify potential limitations of rapid design thinking in today’s care and education environments.

Using Rapid Design Thinking to Generate Innovations During COVID-19

Design thinking is a process that involves observation, collaboration, fast learning, the visualization of ideas, rapid prototyping, feedback gathering, and redesign. 11 The stepwise strategies used in design thinking are: (1) empathize: use a needs assessment process to identify the problem and opportunities by observing, engaging, and empathizing with users; (2) define: frame the problem in a user-centered manner; (3) ideate: identify a broad range of ideas and potential solutions; (4) prototype: use an iterative process of testing scaled down versions of solutions with users; and (5) test: implement and refine the chosen solution with user feedback. 12 This last step includes the consideration of such issues as compatibility in a dynamically changing context over time. 7

Similar to plan–do–study–act cycles, design thinking is an iterative process with cycles of improvement. 13 It is perfectly suited to a rapidly changing environment because it gives users the ability to innovate and it acts as a vehicle for organizational change. 14 Design thinking can accelerate the development of prototypes and their implementation in the current COVID-19 environment, where there is rapidly evolving information and quick and wide dissemination is necessary. Apart from accelerated solutions, the goal of design thinking is to develop human-centered solutions and to enhance the user experience; both are critical to improving the uptake of innovations. 5

Design thinking has distinct features compared with other common innovation frameworks, such as agile project management. 15 Design thinking involves deep content analysis, opportunity mapping, and problem framing as well as problem solving. In comparison, agile project management is more implementation focused and generally smaller in scale. Design thinking is an ideal framework for identifying and implementing solutions to COVID-19 challenges that are highly complex, larger in scope, and involving multiple stakeholders.

Given that there are numerous rapid design thinking models, we chose to focus on 3 essential stages and their relevance in medical education during the COVID-19 pandemic (see Figure ​ Figure1 1 and below). 5 The first stage (define) draws inspiration from the problem or opportunity at hand. The second stage (ideate) is ideation, during which innovative educational ideas are generated. Finally, the third stage (test) deals with implementation (i.e., putting innovations into practice). 5

Rapid design thinking approach to overcoming COVID-19 challenges in medical education. Abbreviations: UME, undergraduate medical education; PGME, postgraduate medical education; CPD, continuing professional development.

One core component of rapid design thinking is accelerated prototyping, which can be particularly helpful during times of large-scale disruption. Accelerated prototyping involves implementing, testing, and refining user-driven solutions in an iterative manner. 16 This approach is well suited to the rapidly changing COVID-19 environment and the impact of the pandemic on health professions training and education delivery.

In the following sections, we explore how these 3 stages of rapid design thinking may be used to address the challenges of COVID-19 in medical education.

Inspiration stage

COVID-19 presents a unique tripartite set of challenges for medical education and training. First, information is abundant and in a constant state of flux. 17 Due to the evolving nature of the pandemic, new information is being generated within a short period of time. 18 This information needs to be curated and presented to a diverse range of learners and HCPs to share with patients, their caregivers, and the general public. The process of learning new skills and updating medical knowledge to provide safe and effective care highlights the need for both lifelong learning and narrowing the gap from research to practice.

Second, physical distancing has disrupted training programs, creating uncertainty for learners. COVID-19 mitigation interventions also have interrupted in-person education events, large classroom sessions, and traditional clinical teaching methods. In addition, virtual means of delivering clinical care, such as telemedicine, are increasing the need for proficiency in the use of digital tools. Given social distancing requirements, additional efforts are needed to maintain team connection and integrate services in a constantly changing environment.

Third, COVID-19 has affected HCPs’ ability to teach, mentor, and sustain engagement in academic activities. The possibility of redeployment to meet pandemic care needs has caused anxiety in HCPs, limited their availability for teaching, and negatively affected the learner experience. Emerging reports from teaching hospitals affected by COVID-19 suggest that HCPs, especially those directly involved in assessing and managing COVID-19 patients, are at a high risk of developing psychological distress and other mental health symptoms. 19 – 21 For example, anxiety, depression, insomnia, 20 , 22 and burnout 3 have been reported in these individuals. In addition, quarantining and social isolation have been associated with negative psychological consequences, such as post-traumatic stress symptoms, confusion, and anger. 23 , 24 HCPs also can experience stress-related responses, fear of contagion, and concern for their family’s health. 25 , 26

Although, understandably, the current focus is on controlling and acutely managing the COVID-19 pandemic, supporting HCPs and community members to build resilience and coping strategies is imperative. Online interactive tools, COVID-19 awareness resources, and training using simulations can help HCPs working with COVID-19 learn new medical skills that improve their well-being.

Ideation stage

The pandemic has presented many opportunities to use new digital tools to deliver clinical care, access credible COVID-19 resources and training, and support HCPs’ and learners’ well-being. Design thinking can help HCPs develop a mechanism for rapidly gathering ideas related to these activities. Planning teams with representation from key stakeholder groups should function as “education command centers” that initiate idea generation. Virtual focus groups, team meetings, and online discussion forums also can inform this ideation phase.

Digital solutions have already emerged to bridge the care gaps created by social isolation and travel restrictions during COVID-19. Torous and colleagues 6 observed an increase in video care visits, and they emphasize the need to train HCPs and patients so they can participate fully in this type of virtual care. Building capacity in telemedicine, and virtual care more broadly, requires a range of education interventions to ensure competency, including online education modules; videoconference-based sessions; and longitudinal, technology-enhanced coaching for HCPs. 27

Both HCPs and learners require curated (i.e., reliable) online sources to access updated information and tools to manage both the physical and mental health consequences of COVID-19. Online “knowledge hubs” could distill information for learners and guide them to “just-in-time” resources, while balancing cognitive load. Learners need to develop critical appraisal skills to effectively assess the credibility of the gray literature, online resources, and social media related to COVID-19. For instance, the donning and doffing of personal protective equipment (PPE) is a key procedure related to COVID-19 care; HCPs need to develop virtual simulations delivered via videoconferencing to allow learners to practice these procedures safely (i.e., without the risks of exposure to the virus) without wasting limited PPE supplies. 28

Computer-based simulations can help HCPs and learners practice challenging scenarios in a nonthreatening (“low stake”) environment, for example, making complex decisions about the allocation of resources. HCPs also need to provide training in end-of-life care, as they and learners will be managing patients who may not have access to life-sustaining equipment like ventilators. 29 They urgently need enhanced communication skills to have these difficult discussions with patients and families.

HCPs and learners are already adapting to new ways of working during COVID-19. Similar to innovations in clinical practice, they must learn to attend to their self-care in innovative ways. An integrated pathway, consisting of self-assessment tools and access to mental health resources (ranging from resilience building exercises to formal psychotherapies), is needed to support the psychological well-being of HCPs and learners. Early during the pandemic in China, HCPs with mild distress were interested in online resources, while those with more severe symptoms sought help from mental health professionals. 30 An online platform is ideal to integrate these resources, provide easy access, and create virtual communities of practice and support.

Steps to Consider When Implementing an Educational Innovation During the COVID-19 Pandemic

It is important to reflect on why the organization does the work it does and to align educational innovations with the vision, core values, and organizational strategy.

The degree of success of an innovation depends on the extent to which existing skill sets and resources are harnessed.

Stakeholder engagement (including faculty, learners, and patients) and the co-creation of innovation products are crucial to alignment with purpose and add value.

A design thinking approach to developing and implementing educational innovations should be efficient, impact driven, and build on existing solutions, especially given the rapidly changing landscape of the COVID-19 pandemic.

Priority setting should be driven by goals, value to stakeholders, and the resource capacity of the organization.

Organizing, eliminating waste, pruning, and prioritizing innovations are important steps in implementation. Decision-making tools can be used.

Decisive leadership is necessary to strike a balance by encouraging coproduction, collaboration, and scalability.

Implementation stage

During a crisis like the COVID-19 pandemic, the implementation stage in rapid design thinking is contingent on accelerated prototyping with iterative feedback during testing. 16 The engagement of HCPs and learners during this stage is crucial for prototyping driven by end users. Continuous conversations with these and other stakeholders help to contextualize their needs, elicit preferences, and identify “on-the-fly” education strategies that can be integrated into local settings. Due to physical distancing, soliciting timely feedback during each prototyping cycle can be facilitated by digital technology. List 1 summarizes several factors to consider when implementing an educational innovation during COVID-19.

Sustaining innovations in medical education during a pandemic that could last for months has unique implementation needs. Sustainability efforts should involve existing networks, communities of practice, and various methods for curriculum delivery (e.g., existing online education platforms). Innovations also can leverage existing curricula and competency frameworks (e.g., the Accreditation Council for Graduate Medical Education core competencies, 31 CanMEDS roles 32 ) to quickly build new training opportunities.

In the following sections, we consider the unique factors associated with the rapid implementation of virtual care, knowledge hubs and online training, and self-care and mental health support for HCPs and learners.

Rapid implementation of virtual care.

If properly executed, the scope of the digital revolution ushered in by COVID-19 could transform the educational ecosystem. 33 The rapid explosion of virtual care has created new opportunities for training in telemedicine. In addition, residents and students displaced from traditional care environments may now undergo clinical training in new virtual care rotations and placements.

However, fear of novel digital technology, limited telemedicine capacity, lack of end users’ involvement, lack of awareness of digital tools, and lack of trust in these tools have been shown to impede the implementation of such resources. 34 , 35 Therefore, the rapid scaling of virtual care offerings during COVID-19 should follow a compassionate virtual care model, 36 address medico-legal privacy issues, and meet documentation requirements. Going beyond virtual learning sessions, workplace-based training supported by virtual coaching for learners is needed to continue rapid prototyping within clinical settings.

Rapid implementation of knowledge hubs and online training.

The creation of online knowledge hubs can help HCPs and learners access the most up-to-date information when they need it. In turn, HCPs and learners can provide real-time feedback on their knowledge needs and modify the content to ensure it remains useful and up to date. For example, crowd sourcing can be used to identify new resources and solicit feedback. These processes will facilitate iterative user-driven solutions, a key aspect of rapid design thinking. 16 Establishing clear processes, stable online platforms, and streamlined workflows supported by an information curation and development team is necessary for rapid review, revision, and dissemination of constantly changing information and educational resources to support HCPs and learners. At the same time, newer platforms, mechanisms, and experiences must be established. For example, other key virtual learning opportunities, such as those offered by social media, webinars, and podcasts, can be leveraged.

As the growing number of patients with COVID-19 threatens to overwhelm health care systems, rapid upskilling and redeployment of HCPs and learners are needed. Implementation strategies should quickly identify gaps based on a review of discipline-specific core competencies, online assessments of knowledge, and virtual simulations to assess procedural skills. Simulation is a critical component to skills-based training, specifically when dealing with high-risk or rare situations related to COVID-19. Virtual simulations can build on existing experiences from surgical residency programs, which can be adapted to address training needs during the pandemic. 37

Rapid implementation of self-care and mental health support for HCPs and learners.

There is extensive literature on self-care and mental health support for HCPs and learners. 38 However, the rapid upscaling of programs to support the unique needs of providers during COVID-19 requires adaptation and implementation for this context. This process can start with an environmental scan of existing virtual communities of practice. These networks can provide the necessary infrastructure and bring together HCPs and learners for training and the navigation of online self-help resources. For example, Project Extension for Community Healthcare Outcomes has demonstrated capacity to virtually connect HCPs around the world. This model could be used to support HCPs and learners in addressing their mental health needs during COVID-19. 39 – 42

For direct mental health support, emerging evidence indicates that online self-help interventions using artificial intelligence improve the user experience. 19 In China, online psychological counseling (using WeChat) has been offered 24 hours a day, free of cost, during the COVID-19 pandemic. 43 Counseling by telephone, online psychological support tools, and app-based counseling have also been used and can be expanded to other settings. 19

Iterative data collection from HCPs and learners as they access these educational and support resources is a critical component of the implementation stage, as the content should be congruent with phase-specific needs during the pandemic.

Limitations of a Rapid Design Thinking Model

General limitations.

The deployment of solutions to address the educational challenges of COVID-19 comes with significant risks. First, virtual design thinking solutions may not remedy the risks related to social isolation between learners and their peers and teachers. Second, there is a lack of data on the efficiency and efficacy of these new learning modalities and approaches; therefore, interventions should be firmly anchored in learning theories and examine educational outcomes. Third, many organizations are reducing their educational budgets, which may constrain their ability to respond with new technological and other solutions to meet rapidly changing needs post pandemic. In addition, design thinkers will need to mitigate the financial stress anticipated for organizations during and after COVID-19. Fourth, design thinking innovations could potentially accelerate the need for emerging health professions, such as medical virtualists, 44 HCPs with expertise in artificial intelligence, 45 and the use of predictive analytics. Therefore, competency in these areas may be needed sooner than anticipated.

Bias and threats to equity, diversity, and inclusion

Another potential limitation of rapid design thinking is inherent in its very methodology. In times of rapid change and scarce resources, utilitarian principles are usually favored as a way to maximize the overall health and well-being of a society. 46 Less popular are the egalitarian principles that purport that all individuals are equal and that inequalities between groups should be addressed. 29 If rapid design thinking is used to inspire, ideate, and implement innovative educational strategies, then a concomitant effort is needed to ensure these processes address inequity.

All individuals, whether they believe themselves to be prejudiced or not, hold mental schemas that classify people into categories based on gender, race, ethnicity, age, sexual orientation, and religion, to name a few; this categorization often leads to bias and stereotyping. 47 Although the design thinking process was conceived to include feedback from multiple stakeholders, it must include strategies to identify inherent biases. Strategies can be implemented at each stage of the process to address equity, diversity, and inclusion. For example, designers can challenge their assumptions and become aware of their biases by taking the implicit bias test. 48 Creating opportunities for the design team to become aware of their implicit biases forces them to shift how they identify problems and understand proposed solutions.

Testing proposed innovations during each of the 3 design thinking stages against the common goals and values of the team to ensure alignment with diverse perspectives should not be a symbolic effort. Including screening questions can prompt designers to ensure they are addressing inequity. For example, access to care is key to addressing inequity, and research shows that access to broadband Internet and smartphones depends on the racial, ethnic, and socioeconomic status of individuals. 49 Designers would need to respond to these issues during the rapid design thinking process.

Increasing the diversity of the design team alone will not reduce bias and discrimination. 50 The process itself must include ways to address the issues of power and privilege within a team. For example, if the organizational leadership decides that a utilitarian approach is needed during a pandemic to maximize communal well-being, then all decisions, regardless of the diversity of the team, will be affected by this ideology. However, research shows that ideological influences can be challenged when groups share common goals and values. 51

Like in all aspects of society, the COVID-19 pandemic has triggered considerable change in medical education. Rapid design thinking can be used to develop and implement solutions to overcome COVID-19-related barriers in medical education. It can help educators transform the COVID-19 crisis into an opportunity for positive and sustained change. We must ensure that the digital transformation gained during the COVID-19 pandemic continues, instead of reverting back to the pre-COVID status quo.

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.