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Critical Thinking Skills Toolbox

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critical thinking is purposeful judgement which result in

  • Introduction

Overview of Critical Thinking Skills

  • Teaching Observations
  • Avenues for Research
  • CTS Tools for Faculty and Student Assessment
  • Critical Thinking and Assessment
  • Conclusions
  • Bibliography
  • Helpful Links
  • Appendix A. Author's Impressions of Vignettes

What is Critical Thinking?

Many researchers, including Facione, Simpson and Courtneay, Banning, Brookfield, Ornstein and Hunkins, Sternberg, Ennis, and Lipman, have defined critical thinking (CT). Researchers debate whether critical thinking can be learned or if it's a developmental process regulated by motivations, dispositions, and personality traits. Despite differences of opinion, many researchers agree that critical thinking is "Purposeful, self-regulatory judgment which results in interpretation, analysis, evaluation, and inference, as well as explanation of the evidential, conceptual, methodological, criteriological or contextual considerations upon which judgment is based. 11

Critical thinking is also regarded as intellectually engaged, skillful, and responsible thinking that facilitates good judgment because it requires the application of assumptions, knowledge, competence, and the ability to challenge one's own thinking. Critical thinking requires the use of self-correction and monitoring to judge the rationality of thinking as well as reflexivity. When using critical thinking, individuals step back and reflect on the quality of that thinking. Simpson and Courtneay point out that critical thinking processes require active argumentation, initiative, reasoning, envisioning and analyzing complex alternatives, and making contingency-related value judgment. 12

According to Banning, critical thinking involves scrutinizing, differentiating, and appraising information as well as reflecting on information to make judgments that will inform clinical decisions. 13  Brookfield asserts that identifying and challenging assumptions and analyzing assumptions for validity are essential to critical thinking skills. He also suggested that because critical thinkers possess curiosity and skepticism, they are more likely to be motivated to provide solutions that resolve contradictions. 14

Others such as Ornstein and Hunkins suggest that critical thinking and thinking skills refer to problem-solving and other related behaviors. 15  For a number of years, dental educators thought teaching problem-solving skills was akin to teaching critical thinking skills. While teaching problem-solving skills is important to the process of learning how to use critical thinking skills, in the absence of other learning activities it may not be enough.

Sternberg, Ennis, and Lipman assert that critical thinking skills are not a fixed entity but a form of intelligence that can be taught. 16-19  The ability to develop critical thinking skills may be likened to Piaget's concrete and formal operations. If students have not yet reached the formal operations stage, their ability to use critical thinking skills may be limited by an inability to handle abstract ideas. It is important to remember that Piaget's stages of cognitive development are also linked to intellectual potential and environmental experiences. If the learning environment is crucial to the development of critical thinking skills, what instructional strategies can be used to promote critical thinking?

Sternberg asserts that critical thinking involves complex mental operations that cannot be broken into discrete styles of thinking. He claims that CT involves students' total intellectual functioning, not a narrowly defined set of skills. He postulates that there are three mental processes fostering critical thinking: meta-components, performance components, and knowledge-acquisition strategies. 20  Meta-components refer to higher-order mental processes that individuals use to plan, monitor, and evaluate what they do. Performance components refer to the actual steps taken or strategies used, while knowledge-acquisition strategies refer to the ways in which individuals relate old to new material and apply new material. Sternberg does not specify a "how" approach to teaching and learning critical thinking skills. Instead, he provides general guidelines for developing or selecting a program or curriculum that will foster CTS. Interestingly, although not surprisingly, Sternberg states that students are not adequately prepared for the problems and critical thinking tasks they will face in everyday life because they are not taught these skills in their formative years. 21  Tasks that stress right answers or truth telling or use objectively scored tests are generally removed from real-world relevance. Thus, it is particularly important that all aspects of dental educational curriculum stress real-world practice, the importance of oral health care, and the relationship of overall oral health care to systemic health by teaching students how to use critical thinking skills.

Lipman, like Sternberg, does not specify a "how to" approach. However, he makes clear distinctions between ordinary thinking and critical thinking. He explains that ordinary thinking is simplistic thinking because it does not rely upon the use of standards or criteria. Examples of ordinary thinking are guessing, believing, and supposing. Lipman describes critical thinking as a complex process based on standards of objectivity, utility, or consistency in which students can reflect upon the certainty of their thinking because critical thinking is self-correcting. 22  In order words, students can defend their thinking with evidence. Ennis asserts that to help students develop critical thinking skills, teachers must understand the cognitive processes that constitute critical thinking and use instructional activities that will develop these processes. He recommends instructors teach students how to define and clarify information, ask appropriate questions to clarify or challenge statements or beliefs, judge the credibility of sources, and solve problems by predicting probable outcomes through logic or deduction. Ennis also suggests that critical thinkers demonstrate particular attributes. Critical thinkers tend to:

Critical thinkers use these skills appropriately and usually without prompting. They are generally predisposed to think critically and to evaluate the outcome of their thought processes. 24

Instructional Strategies and Critical Thinking

Researchers have asserted that how educators teach has a direct influence on what is learned. 25  Thus, the instructional strategies selected must be appropriate to the desired outcomes. For example, strategies of inquiry are contingent upon the problem being investigated and the targeted concepts, so it is essential that they be integrated with the associated processes of inquiry in order for students to see how new knowledge evolves. 26  Researchers have also recommended eliminating superfluous activities and repetitious content and expanding learner-centered active forms of experiences to promote critical thinking skills. 27  If the goal is for students to use critical thinking skills, then the following opportunities should constitute the majority of learning activities:

     a) Engaging in problem-based learning      b) Analyzing case-based scenarios      c) Engaging in debates, role-play, argument mapping, thinking aloud, and simulation among others 28  

The benefit of engaging students in learning experiences that utilize critical thinking skills is the public nature of their thinking. When students engage in CTS, they have an opportunity to examine tacitly held knowledge of one another, make knowledge and think explicitly, respond to questions and comments, and clarify their thinking processes. 29

Several researchers stated the types of instructional strategies that may be used to promote students' critical thinking skills. Weerts suggested that working in groups might reduce students' stress while trying to answer difficult questions. She points out that working together may result in better answers than working alone. 30  Many dental educators might eschew the notion of using groups. However, it is important to acknowledge that even in classes of 80 to 100 dental students, groups of six to eight students could be developed to facilitate learning and inquiry. These groups could be responsible for answering questions about readings by being called upon randomly during class time. For example, instructors can consider writing three to four focus questions that accompany the readings to guide student comprehension. Instructors could also tell students that they should to be able to answer those questions in class. In this way, students can be held responsible for learning some of this discrete information before class. Rather than having the instructor feel responsible for "telling" students what they should know, the instructor can elicit the key concepts from students. Class time can then be used to present a case where the concept is illustrated, and students can work in groups to analyze how that concept is operationalized rather than receiving discrete knowledge through a lecture. Weerts also suggests that student groups can work together and develop critical thinking skills by:

     Identifying issues      Gathering authoritative sources      Identifying potential treatments      Presenting competing points of view      Weighing modalities in light of the presenting case and then agreeing upon the treatment plan 31  

To ensure that students are developing appropriate skills, the instructor and students can use a Likert scale to rate each other on the following criteria:

     Accuracy and relevancy of supporting evidence      Credibility of authoritative knowledge      Depth and breadth of thought      Clarity and soundness of responses

Hendricson et al. suggest several active learning strategies that can be used to develop students' critical thinking skills.

Van Gelder concurs with Hendricson et al. that critical thinking must be deliberately practiced with the intent to improve performance; however, he states that CT is hard and human beings are not naturally critical. 33  Shermer agrees and describes human beings as "pattern-seeking, story-telling animals ... [who] like things to make sense, and the kinds of sense we grasp most easily are simple familiar patterns or narratives" (p. 42). 34  This penchant for the familiar affects how curriculum is designed and implemented.

As a type of thinking that eschews the uncritical acceptance of information, critical thinking should be a deliberate part of the curriculum. Moreover, exposing students to good examples is insufficient to developing critical thinking skills. Students must demonstrate the ability to transfer critical thinking skills from one situation to another. As Kuhn writes:

"The best approach . . . may be to work from both ends at once-from a bottom-up anchoring in the regular practice [of what is being taught] so that skills are exercised, strengthened and consolidated as well as from a top-down fostering of understanding and intellectual values that play a major role in whether these skills will be used." (p. 24). 35

Kuhn's point has implications for teaching critical thinking skills in the basic science courses as well. Even though students are heavily immersed in learning a tremendous amount of information, they should still be presented with critical thinking learning experiences that embed concepts in actual practice-based scenarios. 36

Argument mapping

Van Gelder suggests that students' critical thinking skills improve faster when instruction is based upon argument mapping. He asserts that when arguments are presented in diagrammatic form, students are more capable of following critical thinking procedures. Because argument maps are visual and more transparent, they make the core operations of critical thinking more straightforward. Van Gelder cautions, however, that belief preservation is a human tendency. He states that individuals tend to make evidence secondary to beliefs. Thus, critical thinking runs counter to human tendencies. Humans tend to seek evidence that supports beliefs and ignore evidence that goes against beliefs. Ideally, critical thinkers will recognize this, put extra effort into searching for evidence that contradicts their own beliefs and cultivate a willingness to change when evidence to the contrary begins to mount. 37

To apply argument mapping to clinical reasoning, consider Case #1.

Case #1-Differing Views on Patient Treatment

A 60-year-old woman has internal resorption of the left maxillary lateral incisor. Radiographic exams reveal that saving the tooth is questionable. The student dentist recommends to Professor Marlin that the patient receive a fixed partial denture (FPD). Marlin confers with Professor James, and James recommends a removable partial denture (RPD).

  • The students are instructed to use argument mapping to explain the phenomenon.
  • Next, students are asked to write about the contradictions that differentiate viewpoints about FPD and RPD and to write about the counterarguments.
  • 3. Finally, students are to identify their treatment decisions and provide evidence that supports or justifies their assertions.

Think-aloud seminar

Lee and Ryan-Wenger recommend the use of the "think-aloud seminar" as a teaching tool. Students are presented with a case and asked relevant questions regarding symptoms and presenting signs. Using this approach, students can exclude underlying pathologies based upon the presentation. This process of excluding potential diagnoses aids students' critical thinking by encouraging them to openly verbalize the rationales behind their opinions. 38

Wong and Chung used simulation to develop diagnostic reasoning skills among nursing students. Students were asked to consider the etiological factors, presenting symptoms, and clinical signs of a patient who presented with a particular condition. As they examined the underlying patholophysiology, the CTS they developed were "assessing duration" and "frequency of symptoms and additional triggers." They also were expected to review their understanding of the possible pathophysiological significance. The next set of CTS they focused on was "considering the pros and cons of treatments" and "drug actions and the possible side effects on the patient." Finally they explored the efficacy of the outcomes. CTS developed in this phase were "determining the success of the treatment," "determining complications," "considering the time it took to resolve the clinical signs and symptoms," and "considering reasons for the development of symptoms." 39

Other strategies

Other strategies that can promote critical thinking include particular behaviors, especially asking questions.

Table 3. Strategies that Promote Critical Thinking

Asking particular types of questions also promotes critical thinking.

  Table 4. Questions that Promote Critical Thinking

Also, Facione and Facione (1996) recommend that students begin analyzing their own thinking. For example, "If you were teaching a colleague about this situation, how would you lead him or her through the issues?" 41

Logical Fallacies

While faculty strive to develop students' abilities to use critical thinking, it is also important to communicate the logical fallacies students may demonstrate in their writing or speaking. Engel provides an overview that illustrates the common fallacies. 42 Three common types of fallacies are shown in Table 5.

Table 5. Common Logical Fallacies (Adapted from Engel, 1990)

Allowing Time for Reflection

Teaching students how to use critical thinking skills shifts teaching from a model that largely ignores thinking to an approach that renders it pervasive 43 When content is didactically taught, it is treated as static and students are unlikely to question or think it through. They tend to rely on rote memorization without grasping the logic, supporting evidence and application of what they are trying to memorize. Students who learn through a critical thinking process truly learn content. At every level, students need to learn how to:

Ask questions precisely, define contexts and purposes, pursue relevant information, analyze key concepts, derive sound inferences, generate good reasons, recognize questionable assumptions, trace important implications, and think empathetically within different points of view (p. 20). 44

Critical thinking is difficult and requires overt practice using a variety of learning activities across the dental curriculum. It is also important to recognize the role that reflection plays in its development. Students need time to think about what they are learning and reflect upon that information. However, what they are learning must have an impact on their feelings in order for critical thinking to occur.

Emotions and Critical Thinking 

The role of emotion in learning to use critical thinking skills is yet another area that necessitates research inquiry. As Zull suggests, if we want students to retain concepts we must allow them to put things into their own words, verbally and in writing. 45  Give students time to think before speaking and better construct ideas in their own words. Processing information takes time; stating one's thinking correctly also takes time. If a student cannot do this alone, we can give him or her the opportunity to discuss questions with others. Giving students time to reflect is giving them time to make connections.

Zull explains the process that takes place within the brain. First, the sensory cortex receives sensory input or concrete experiences. Next, the back integrative cortex tries to create meaning and images during the human process of reflection. The frontal integrative cortex is responsible for short-term memory and problem solving, making decisions and language, and making judgments and evaluations. This activity is akin to how learners handle abstractions-manipulating images and language to create new mental arrangements. The motor cortex triggers all coordinated and voluntary muscle contractions. This matches with the action that completes the learning cycle-actively testing abstractions and converting ideas into physical actions. The brain visualizes items in small amounts and all information arrives at the same time, producing an outline of objects and features in the visual field. 46 Thus, the brain can fully see great detail and nuance. Converting ideas into images helps students learn. Images enhance recall and aid in discovery. Sometimes the best teaching is just showing the student how.

To ensure that students learn, educators need to limit the amount of information they give. Instructors should limit or condense to three or four pieces the amount of information they want students to process.

The amygdala is responsible for screening experiences. 47  If something is recognized as dangerous, the amygdale will instinctively cause the body to "freeze." When a student first encounters something new, he or she may have a somewhat negative reaction. The instructor needs to find a way for the student to move into a more positive emotional territory. 48  Making suggestions or showing examples can remind the student what he or she already knows, and then the student can hang newly acquired knowledge on that "scaffolding." The support given by the instructor allows the student some level of success. Recognizing his or her success helps the student feel more hope, interest, and curiosity. At this point, the student is able to assume more control of the learning process. Boyd (2002) concurs and states, "emotions ... constantly regulate what we experience as reality." She also points out, "The limbic system plays an important role in processing emotion and memory and therefore appears to be important in the transfer of short-term memory into long-term memory." 49  Engaging students emotionally and actively strengthens memory.

Teaching students to use CTS during instruction

There is some empirical evidence that a four-year undergraduate experience contributes to modest gains in overall CT. However, there is little scientific evidence that a single course, other than a critical thinking skills course makes a positive measurable difference. 50  Even in the case of a specific CTS course, the evidence is mixed. 51

Recent studies show that limited efforts to infuse critical thinking in instruction can lead to improved scores on the Cornell Critical Thinking Test Level Z, a test that is aimed at a sophisticated audience and measures six common critical thinking skills. 52  Allegrettti and Frederick (1995) reported pre- to post-test gains on the Cornell Z for a group of college seniors (n = 24) who took a capstone integrated psychology and philosophy course. 53  Solon (2001) found that a partial treatment group of psychology students (n = 26) improved their scores on the Cornell Z compared to a group of untreated humanities students (n = 26). The results were statistically significant (beyond .001). In 2003, Solon studied three groups to compare coursework effects and reported that the full treatment group (n = 25) significantly outscored both the partial (n = 25) and non-treatment (n = 25) groups on the Cornell Z test. 54  Solon (2007) reported that a group of introductory psychology students (n = 25) received a moderate infusion of critical thinking skills (10 hours instruction and 20 hours homework). Compared to the non-treatment group (n= 26), the experimental group significantly improved their scores on the Cornell Z test. 55  These findings suggest that even a moderate infusion of critical thinking skills instruction can result in enhanced reasoning skills without requiring a significant investment from the instructor. 56

Collins and Onwuegbuzie reported significant relationships between overall CTS and achievement in a graduate level research methodology course at the midterm (r = .34, p < .01) and final (r = .26, p < .01) stages. 57  Onwuegbuzie compared the CTS of master's and doctoral level students. He reported that doctoral level students (n = 19) obtained statistically higher overall CTS using the California Critical Thinking Skills Test than the masters' degree students (n = 101, t = -3.54, p < .01). The effect size (d = 0.92) associated with this difference was extremely large. 58

Teaching CTS requires instruction that uses higher order taxonomic skills. These skills require student demonstration or teacher usage of behaviors classified as analysis, evaluation, and creation (levels 4, 5, and 6 on Bloom's revised taxonomy). When teaching takes place at higher levels of learning, lower order behaviors such as remembering, understanding, and applying are subsumed within instruction. The following table lists behaviors common at each level of learning and examples of related dental education activities.

Table 6. Revised Bloom's Taxonomy, Sample Verbs, and Related Learning Activities 59

Making Critical Thinking Explicit

Teaching for critical thinking is a rational and intentional act. Typically, instructors cannot suddenly decide to teach CTS and develop an appropriate learning activity. An instructor must have a clear understanding of what CTS is, how it is implemented during instruction, and what strategies should be used during particular classroom and predoctoral clinical learning activities. Developing a repertoire of well-honed CTS activities appropriate to your specific discipline is advisable.

Also crucial to the teaching of CTS is an educator announcing to students he or she will teach CTS, how he or she intends to do so, and what will be required of the students as learners. It is important to have an explicit conversation with students about what CTS is, what it looks like, and how educators will model it so students can differentiate the teaching of CTS from lower level learning. Effective teaching of university-age students is characterized by collegial and collaborative processes, not instruction that is ambiguous. In ambiguous instruction, the learner does not know what to expect next or have a clear understanding of what behavioral or skill changes he or she should demonstrate as a result of teacher-student interaction. Teaching explicitly helps ensure that less re-teaching will be necessary. Both teachers and students know their responsibilities as instructors and learners.

Stages of Critical Thinking

Paul and Elder claim that individuals progress through predictable stages of unreflective, challenged, beginning, practicing, advanced, and master thinking. 60  They state that unless educators help students develop an intellectual vocabulary for discussing their thought processes and challenge them to identify the problems in their thinking, the students' cognitive processes will remain invisible to them. The implication for curriculum development: If instructors want students to develop critical thinking skills, then critical thinking must be integrated into the foundations of instruction.

It is also important to recognize that when patient care is task focused, it can obscure the bigger picture and become a barrier to the development of critical thinking skills. Individual personality, background, and position might also limit one's ability to think critically. Additionally, gender, age, religion, and socioeconomic status might influence the development of critical thinking skills. One of the biggest barriers to the development of CTS is our educational system. Although it is important to recognize these attributes as potential barriers, it is more important that dental educators establish the kind of learning environments that will foster the development of CTS.

Case #2-Why Are Mrs. Connor's Teeth Yellow?

Mrs. Connor, a 74-year-old white female, comes to your office as a new patient. She presents you with a complaint that her teeth have become yellowed and unattractive. Her husband died one year prior, and since then she has been drinking 8-10 cups of coffee daily. Her internist diagnosed anemia and high blood cholesterol. She is taking iron and Lipitor. She feels better since she began taking Lipitor, but feels her teeth are too yellow. She recently met a widower who invited her to dinner next week. She is worried about the appearance of her teeth.

  • Working in groups of six, students are asked to write at least four hypotheses about why Mrs. Connor's teeth are yellow.
  • Students must also determine if whiter teeth are important to the health and well being of geriatric patients.
  • Students must discuss if there a relationship between the need of care and the use of dental services by older patients.
  • A student group will then outline its recommendations and a rationale for the treatment plan to be presented to Mrs. Connor at her next dental appointment.

Teachers must recognize that not all students will apply critical thinking skills at the same rate they learn these skills. Thus, instructional methods and objectives need to match students' cognitive and experiential abilities while trying to stretch students to their growing edge. 61  Students' capacity for self-directed learning (SDL), which is required to implement reflective judgment, underlies many of the critical thinking skill dispositions. 62  There is evidence that the students who routinely use the "learn by doing" approach to explore problems develop more sophisticated SDL than students in lecture-based curricula. 63  The reflection element of critical thinking is considered essential to clinical judgment. 64  Tanner asserts that using the skills associated with reflective thinking prepares students for ill-structured or ambiguous problems that they are likely to encounter in clinical practice. 65

Problem-based learning (PBL) is a popular instructional strategy for promoting collaboration and reflection and negotiating different and individual constructions of knowledge. Some researchers assert that PBL is best used when problems are unsolvable or when they generate many individual constructions of knowledge that appear valid. 66  However, using only problem-based learning to teach critical thinking skills may not be enough. This instructional strategy does not necessarily equip students with the ability to analyze or critique a given situation or the information with which they are been provided. A variety of instructional strategies that give students the opportunity to think aloud, role play, prioritize alternatives, communicate conclusions effectively, simulate, or defend the logical basis of their thinking is recommended to foster students' ability to use critical thinking.

Asking students to apply their understanding of dental and medical knowledge to treatment planning and diagnosis is not an example of CTS. However, asking students to determine differential diagnoses of caries and periodontal disease among patients at various stages of lung cancer requires the ability to reason and justify particular treatment plans or demonstrate critical thinking skills. Habits of the students who demonstrate critical thinking are:

Case #3-Female with Erythroplakia

Mrs. Jacklin, a 40-year-old female, presents you with a history of SLE and erythroplakia on the left lateral border of the tongue. She states she is experiencing a burning sensation on her tongue. She asks why she is having this discomfort and what she can do to make the sore on her tongue go away. The oral exam shows that Mrs. Jacklin has poor oral hygiene and mild dry mouth (xerostomia) but is otherwise not in danger for oral health concerns.

  • Working in groups of four, students are asked to locate the four most recent references on oral lesions.
  • Using those resources, they are asked to write five or six reasons that the patient is experiencing a tongue lesion and determine what questions they should ask the patient about her personal and social history.
  • Next, they identify questions to ask her about her medical history.
  • Using the information they have acquired, they are asked to generate a list of potential treatment plans and the benefits and limitations of each plan.
  • What should they tell the patient and why?

Critical thinking is not :

Critical thinking cannot be taught in a learning environment where the dental educator always lectures, tells students what ought to be undertaken during patient treatment, or shows students how to do a procedure correctly. Some habits of students who do not use critical thinking skills are:

Critical thinking skills can be developed with frequent practice and the use of ill-structured problems and situations that require the ability to recall useful knowledge quickly, use pattern recognition, discern pertinent information, think ahead, and anticipate outcomes and problems while remaining composed so that emotions do not hinder decisionmaking skills. However, it is important to recognize CTS do not develop spontaneously or with maturation. Since strong personality components underlie CT dispositions, what happens if students admitted to colleges of dentistry do not already possess these traits?

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critical thinking is purposeful judgement which result in

Logo for OPEN OKSTATE

1 Introduction to Critical Thinking

I. what is c ritical t hinking [1].

Critical thinking is the ability to think clearly and rationally about what to do or what to believe.  It includes the ability to engage in reflective and independent thinking. Someone with critical thinking skills is able to do the following:

  • Understand the logical connections between ideas.
  • Identify, construct, and evaluate arguments.
  • Detect inconsistencies and common mistakes in reasoning.
  • Solve problems systematically.
  • Identify the relevance and importance of ideas.
  • Reflect on the justification of one’s own beliefs and values.

Critical thinking is not simply a matter of accumulating information. A person with a good memory and who knows a lot of facts is not necessarily good at critical thinking. Critical thinkers are able to deduce consequences from what they know, make use of information to solve problems, and to seek relevant sources of information to inform themselves.

Critical thinking should not be confused with being argumentative or being critical of other people. Although critical thinking skills can be used in exposing fallacies and bad reasoning, critical thinking can also play an important role in cooperative reasoning and constructive tasks. Critical thinking can help us acquire knowledge, improve our theories, and strengthen arguments. We can also use critical thinking to enhance work processes and improve social institutions.

Some people believe that critical thinking hinders creativity because critical thinking requires following the rules of logic and rationality, whereas creativity might require breaking those rules. This is a misconception. Critical thinking is quite compatible with thinking “out-of-the-box,” challenging consensus views, and pursuing less popular approaches. If anything, critical thinking is an essential part of creativity because we need critical thinking to evaluate and improve our creative ideas.

II. The I mportance of C ritical T hinking

Critical thinking is a domain-general thinking skill. The ability to think clearly and rationally is important whatever we choose to do. If you work in education, research, finance, management or the legal profession, then critical thinking is obviously important. But critical thinking skills are not restricted to a particular subject area. Being able to think well and solve problems systematically is an asset for any career.

Critical thinking is very important in the new knowledge economy.  The global knowledge economy is driven by information and technology. One has to be able to deal with changes quickly and effectively. The new economy places increasing demands on flexible intellectual skills, and the ability to analyze information and integrate diverse sources of knowledge in solving problems. Good critical thinking promotes such thinking skills, and is very important in the fast-changing workplace.

Critical thinking enhances language and presentation skills. Thinking clearly and systematically can improve the way we express our ideas. In learning how to analyze the logical structure of texts, critical thinking also improves comprehension abilities.

Critical thinking promotes creativity. To come up with a creative solution to a problem involves not just having new ideas. It must also be the case that the new ideas being generated are useful and relevant to the task at hand. Critical thinking plays a crucial role in evaluating new ideas, selecting the best ones and modifying them if necessary.

Critical thinking is crucial for self-reflection. In order to live a meaningful life and to structure our lives accordingly, we need to justify and reflect on our values and decisions. Critical thinking provides the tools for this process of self-evaluation.

Good critical thinking is the foundation of science and democracy. Science requires the critical use of reason in experimentation and theory confirmation. The proper functioning of a liberal democracy requires citizens who can think critically about social issues to inform their judgments about proper governance and to overcome biases and prejudice.

Critical thinking is a   metacognitive skill . What this means is that it is a higher-level cognitive skill that involves thinking about thinking. We have to be aware of the good principles of reasoning, and be reflective about our own reasoning. In addition, we often need to make a conscious effort to improve ourselves, avoid biases, and maintain objectivity. This is notoriously hard to do. We are all able to think but to think well often requires a long period of training. The mastery of critical thinking is similar to the mastery of many other skills. There are three important components: theory, practice, and attitude.

III. Improv ing O ur T hinking S kills

If we want to think correctly, we need to follow the correct rules of reasoning. Knowledge of theory includes knowledge of these rules. These are the basic principles of critical thinking, such as the laws of logic, and the methods of scientific reasoning, etc.

Also, it would be useful to know something about what not to do if we want to reason correctly. This means we should have some basic knowledge of the mistakes that people make. First, this requires some knowledge of typical fallacies. Second, psychologists have discovered persistent biases and limitations in human reasoning. An awareness of these empirical findings will alert us to potential problems.

However, merely knowing the principles that distinguish good and bad reasoning is not enough. We might study in the classroom about how to swim, and learn about the basic theory, such as the fact that one should not breathe underwater. But unless we can apply such theoretical knowledge through constant practice, we might not actually be able to swim.

Similarly, to be good at critical thinking skills it is necessary to internalize the theoretical principles so that we can actually apply them in daily life. There are at least two ways to do this. One is to perform lots of quality exercises. These exercises don’t just include practicing in the classroom or receiving tutorials; they also include engaging in discussions and debates with other people in our daily lives, where the principles of critical thinking can be applied. The second method is to think more deeply about the principles that we have acquired. In the human mind, memory and understanding are acquired through making connections between ideas.

Good critical thinking skills require more than just knowledge and practice. Persistent practice can bring about improvements only if one has the right kind of motivation and attitude. The following attitudes are not uncommon, but they are obstacles to critical thinking:

  • I prefer being given the correct answers rather than figuring them out myself.
  • I don’t like to think a lot about my decisions as I rely only on gut feelings.
  • I don’t usually review the mistakes I have made.
  • I don’t like to be criticized.

To improve our thinking we have to recognize the importance of reflecting on the reasons for belief and action. We should also be willing to engage in debate, break old habits, and deal with linguistic complexities and abstract concepts.

The  California Critical Thinking Disposition Inventory  is a psychological test that is used to measure whether people are disposed to think critically. It measures the seven different thinking habits listed below, and it is useful to ask ourselves to what extent they describe the way we think:

  • Truth-Seeking—Do you try to understand how things really are? Are you interested in finding out the truth?
  • Open-Mindedness—How receptive are you to new ideas, even when you do not intuitively agree with them? Do you give new concepts a fair hearing?
  • Analyticity—Do you try to understand the reasons behind things? Do you act impulsively or do you evaluate the pros and cons of your decisions?
  • Systematicity—Are you systematic in your thinking? Do you break down a complex problem into parts?
  • Confidence in Reasoning—Do you always defer to other people? How confident are you in your own judgment? Do you have reasons for your confidence? Do you have a way to evaluate your own thinking?
  • Inquisitiveness—Are you curious about unfamiliar topics and resolving complicated problems? Will you chase down an answer until you find it?
  • Maturity of Judgment—Do you jump to conclusions? Do you try to see things from different perspectives? Do you take other people’s experiences into account?

Finally, as mentioned earlier, psychologists have discovered over the years that human reasoning can be easily affected by a variety of cognitive biases. For example, people tend to be over-confident of their abilities and focus too much on evidence that supports their pre-existing opinions. We should be alert to these biases in our attitudes towards our own thinking.

IV. Defining Critical Thinking

There are many different definitions of critical thinking. Here we list some of the well-known ones. You might notice that they all emphasize the importance of clarity and rationality. Here we will look at some well-known definitions in chronological order.

1) Many people trace the importance of critical thinking in education to the early twentieth-century American philosopher John Dewey. But Dewey did not make very extensive use of the term “critical thinking.” Instead, in his book  How We Think (1910), he argued for the importance of what he called “reflective thinking”:

…[when] the ground or basis for a belief is deliberately sought and its adequacy to support the belief examined. This process is called reflective thought; it alone is truly educative in value…

Active, persistent and careful consideration of any belief or supposed form of knowledge in light of the grounds that support it, and the further conclusions to which it tends, constitutes reflective thought.

There is however one passage from How We Think where Dewey explicitly uses the term “critical thinking”:

The essence of critical thinking is suspended judgment; and the essence of this suspense is inquiry to determine the nature of the problem before proceeding to attempts at its solution. This, more than any other thing, transforms mere inference into tested inference, suggested conclusions into proof.

2) The  Watson-Glaser Critical Thinking Appraisal  (1980) is a well-known psychological test of critical thinking ability. The authors of this test define critical thinking as:

…a composite of attitudes, knowledge and skills. This composite includes: (1) attitudes of inquiry that involve an ability to recognize the existence of problems and an acceptance of the general need for evidence in support of what is asserted to be true; (2) knowledge of the nature of valid inferences, abstractions, and generalizations in which the weight or accuracy of different kinds of evidence are logically determined; and (3) skills in employing and applying the above attitudes and knowledge.

3) A very well-known and influential definition of critical thinking comes from philosopher and professor Robert Ennis in his work “A Taxonomy of Critical Thinking Dispositions and Abilities” (1987):

Critical thinking is reasonable reflective thinking that is focused on deciding what to believe or do.

4) The following definition comes from a statement written in 1987 by the philosophers Michael Scriven and Richard Paul for the  National Council for Excellence in Critical Thinking (link), an organization promoting critical thinking in the US:

Critical thinking is the intellectually disciplined process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and/or evaluating information gathered from, or generated by, observation, experience, reflection, reasoning, or communication, as a guide to belief and action. In its exemplary form, it is based on universal intellectual values that transcend subject matter divisions: clarity, accuracy, precision, consistency, relevance, sound evidence, good reasons, depth, breadth, and fairness. It entails the examination of those structures or elements of thought implicit in all reasoning: purpose, problem, or question-at-issue, assumptions, concepts, empirical grounding; reasoning leading to conclusions, implications and consequences, objections from alternative viewpoints, and frame of reference.

The following excerpt from Peter A. Facione’s “Critical Thinking: A Statement of Expert Consensus for Purposes of Educational Assessment and Instruction” (1990) is quoted from a report written for the American Philosophical Association:

We understand critical thinking to be purposeful, self-regulatory judgment which results in interpretation, analysis, evaluation, and inference, as well as explanation of the evidential, conceptual, methodological, criteriological, or contextual considerations upon which that judgment is based. CT is essential as a tool of inquiry. As such, CT is a liberating force in education and a powerful resource in one’s personal and civic life. While not synonymous with good thinking, CT is a pervasive and self-rectifying human phenomenon. The ideal critical thinker is habitually inquisitive, well-informed, trustful of reason, open-minded, flexible, fairminded in evaluation, honest in facing personal biases, prudent in making judgments, willing to reconsider, clear about issues, orderly in complex matters, diligent in seeking relevant information, reasonable in the selection of criteria, focused in inquiry, and persistent in seeking results which are as precise as the subject and the circumstances of inquiry permit. Thus, educating good critical thinkers means working toward this ideal. It combines developing CT skills with nurturing those dispositions which consistently yield useful insights and which are the basis of a rational and democratic society.

V. Two F eatures of C ritical T hinking

A. how not what .

Critical thinking is concerned not with what you believe, but rather how or why you believe it. Most classes, such as those on biology or chemistry, teach you what to believe about a subject matter. In contrast, critical thinking is not particularly interested in what the world is, in fact, like. Rather, critical thinking will teach you how to form beliefs and how to think. It is interested in the type of reasoning you use when you form your beliefs, and concerns itself with whether you have good reasons to believe what you believe. Therefore, this class isn’t a class on the psychology of reasoning, which brings us to the second important feature of critical thinking.

B. Ought N ot Is ( or Normative N ot Descriptive )

There is a difference between normative and descriptive theories. Descriptive theories, such as those provided by physics, provide a picture of how the world factually behaves and operates. In contrast, normative theories, such as those provided by ethics or political philosophy, provide a picture of how the world should be. Rather than ask question such as why something is the way it is, normative theories ask how something should be. In this course, we will be interested in normative theories that govern our thinking and reasoning. Therefore, we will not be interested in how we actually reason, but rather focus on how we ought to reason.

In the introduction to this course we considered a selection task with cards that must be flipped in order to check the validity of a rule. We noted that many people fail to identify all the cards required to check the rule. This is how people do in fact reason (descriptive). We then noted that you must flip over two cards. This is how people ought to reason (normative).

  • Section I-IV are taken from http://philosophy.hku.hk/think/ and are in use under the creative commons license. Some modifications have been made to the original content. ↵

Critical Thinking Copyright © 2019 by Brian Kim is licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted.

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Critical Thinking in Reading and Composition

Glossary of Grammatical and Rhetorical Terms

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  • An Introduction to Punctuation
  • Ph.D., Rhetoric and English, University of Georgia
  • M.A., Modern English and American Literature, University of Leicester
  • B.A., English, State University of New York

Critical thinking is the process of independently analyzing, synthesizing, and evaluating information as a guide to behavior and beliefs.

The American Philosophical Association has defined critical thinking as "the process of purposeful, self-regulatory judgment. The process gives reasoned consideration to evidence , contexts , conceptualizations, methods, and criteria" (1990). Critical thinking is sometimes broadly defined as "thinking about thinking."

Critical thinking skills include the ability to interpret, verify, and reason, all of which involve applying the principles of logic . The process of using critical thinking to guide writing is called critical writing .

Observations

  • " Critical Thinking is essential as a tool of inquiry. As such, Critical Thinking is a liberating force in education and a powerful resource in one’s personal and civic life. While not synonymous with good thinking, Critical Thinking is a pervasive and self-rectifying human phenomenon. The ideal critical thinker is habitually inquisitive, well-informed, trustful of reason, open-minded, flexible, fair-minded in evaluation, honest in facing personal biases, prudent in making judgments, willing to reconsider, clear about issues, orderly in complex matters, diligent in seeking relevant information, reasonable in the selection of criteria, focused in inquiry, and persistent in seeking results which are as precise as the subject and the circumstances of inquiry permit." (American Philosophical Association, "Consensus Statement Regarding Critical Thinking," 1990)
  • Thought and Language "In order to understand reasoning [...], it is necessary to pay careful attention to the relationship between thought and language . The relationship seems to be straightforward: thought is expressed in and through language. But this claim, while true, is an oversimplification. People often fail to say what they mean. Everyone has had the experience of having their \ misunderstood by others. And we all use words not merely to express our thoughts but also to shape them. Developing our critical thinking skills, therefore, requires an understanding of the ways in which words can (and often fail to) express our thoughts." (William Hughes and Jonathan Lavery, Critical Thinking: An Introduction to the Basic Skills , 4th ed. Broadview, 2004)
  • Dispositions That Foster or Impede Critical thinking "Dispositions that foster critical thinking include [a] facility in perceiving irony , ambiguity , and multiplicity of meanings or points of view; the development of open-mindedness, autonomous thought, and reciprocity (Piaget's term for the ability to empathize with other individuals, social groups, nationalities, ideologies, etc.). Dispositions that act as impediments to critical thinking include defense mechanisms (such as absolutism or primary certitude, denial, projection), culturally conditioned assumptions, authoritarianism, egocentrism, and ethnocentrism, rationalization, compartmentalization, stereotyping and prejudice." (Donald Lazere, "Invention, Critical Thinking, and the Analysis of Political Rhetoric." Perspectives on Rhetorical Invention , ed. by Janet M. Atwill and Janice M. Lauer. University of Tennessee Press, 2002)
  • Critical Thinking and Composing - "[T]he most intensive and demanding tool for eliciting sustained critical thought is a well-designed writing assignment on a subject matter problem. The underlying premise is that writing is closely linked with thinking and that in presenting students with significant problems to write about—and in creating an environment that demands their best writing—we can promote their general cognitive and intellectual growth. When we make students struggle with their writing, we are making them struggle with thought itself. Emphasizing writing and critical thinking , therefore, generally increases the academic rigor of a course. Often the struggle of writing, linked as it is to the struggle of thinking and to the growth of a person's intellectual powers, awakens students to the real nature of learning." (John C. Bean,  Engaging Ideas: The Professor's Guide to Integrating Writing, Critical Thinking, and Active Learning in the Classroom , 2nd ed. Wiley, 2011) - "Finding a fresh approach to a writing assignment means that you must see the subject without the blinders of preconception. When people expect to see a thing in a certain way, it usually appears that way, whether or not that is its true image. Similarly, thinking based on prefabricated ideas produces writing that says nothing new, that offers nothing important to the reader. As a writer, you have a responsibility to go beyond the expected views and present your subject so that the reader sees it with fresh eyes. . . . [C]ritical thinking is a fairly systematic method of defining a problem and synthesizing knowledge about it, thereby creating the perspective you need to develop new ideas. . . . " Classical rhetoricians used a series of three questions to help focus an argument . Today these questions can still help writers understand the topic about which they are writing. An sit? (Is the problem a fact?); Quid sit (What is the definition of the problem?); and Quale sit? (What kind of problem is it?). By asking these questions, writers see their subject from many new angles before they begin to narrow the focus to one particular aspect." (Kristin R. Woolever, About Writing: A Rhetoric for Advanced Writers . Wadsworth, 1991)

Logical Fallacies

Ad Misericordiam

Appeal to Authority

Appeal to Force

Appeal to Humor

Appeal to Ignorance

Appeal to the People

Begging the Question

Circular Argument

Complex Question

Contradictory Premises

Dicto Simpliciter , Equivocation

False Analogy

False Dilemma

Gambler's Fallacy

Hasty Generalization

Name-Calling

Non Sequitur

Poisoning the Well

Red Herring

Slippery Slope

Stacking the Deck

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  • Definition and Examples of Plain English
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  • What to Do When the Technology Fails in Class

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What is Critical Thinking?

Critical Thinking Definition

September 2, 2005, by The Critical Thinking Co. Staff

The Critical Thinking Co.™ "Critical thinking is the identification and evaluation of evidence to guide decision making. A critical thinker uses broad in-depth analysis of evidence to make decisions and communicate their beliefs clearly and accurately."

Other Definitions of Critical Thinking: Robert H. Ennis , Author of The Cornell Critical Thinking Tests "Critical thinking is reasonable, reflective thinking that is focused on deciding what to believe and do."

A SUPER-STREAMLINED CONCEPTION OF CRITICAL THINKING Robert H. Ennis, 6/20/02

Assuming that critical thinking is reasonable reflective thinking focused on deciding what to believe or do, a critical thinker:

1. Is open-minded and mindful of alternatives 2. Tries to be well-informed 3. Judges well the credibility of sources 4. Identifies conclusions, reasons, and assumptions 5. Judges well the quality of an argument, including the acceptability of its reasons, assumptions, and evidence 6. Can well develop and defend a reasonable position 7. Asks appropriate clarifying questions 8. Formulates plausible hypotheses; plans experiments well 9. Defines terms in a way appropriate for the context 10. Draws conclusions when warranted, but with caution 11. Integrates all items in this list when deciding what to believe or do

Critical Thinkers are disposed to:

1. Care that their beliefs be true, and that their decisions be justified; that is, care to "get it right" to the extent possible. This includes the dispositions to

a. Seek alternative hypotheses, explanations, conclusions, plans, sources, etc., and be open to them b. Endorse a position to the extent that, but only to the extent that, it is justified by the information that is available c. Be well informed d. Consider seriously other points of view than their own

2. Care to present a position honestly and clearly, theirs as well as others'. This includes the dispositions to

a. Be clear about the intended meaning of what is said, written, or otherwise communicated, seeking as much precision as the situation requires b. Determine, and maintain focus on, the conclusion or question c. Seek and offer reasons d. Take into account the total situation e. Be reflectively aware of their own basic beliefs

3. Care about the dignity and worth of every person (a correlative disposition). This includes the dispositions to

a. Discover and listen to others' view and reasons b. Avoid intimidating or confusing others with their critical thinking prowess, taking into account others' feelings and level of understanding c. Be concerned about others' welfare

Critical Thinking Abilities:

Ideal critical thinkers have the ability to (The first three items involve elementary clarification.)

1. Focus on a question

a. Identify or formulate a question b. Identify or formulate criteria for judging possible answers c. Keep the situation in mind

2. Analyze arguments

a. Identify conclusions b. Identify stated reasons c. Identify unstated reasons d. Identify and handle irrelevance e. See the structure of an argument f. Summarize

3. Ask and answer questions of clarification and/or challenge, such as,

a. Why? b. What is your main point? c. What do you mean by…? d. What would be an example? e. What would not be an example (though close to being one)? f. How does that apply to this case (describe a case, which might well appear to be a counter example)? g. What difference does it make? h. What are the facts? i. Is this what you are saying: ____________? j. Would you say some more about that?

(The next two involve the basis for the decision.)

4. Judge the credibility of a source. Major criteria (but not necessary conditions):

a. Expertise b. Lack of conflict of interest c. Agreement among sources d. Reputation e. Use of established procedures f. Known risk to reputation g. Ability to give reasons h. Careful habits

5. Observe, and judge observation reports. Major criteria (but not necessary conditions, except for the first):

a. Minimal inferring involved b. Short time interval between observation and report c. Report by the observer, rather than someone else (that is, the report is not hearsay) d. Provision of records. e. Corroboration f. Possibility of corroboration g. Good access h. Competent employment of technology, if technology is useful i. Satisfaction by observer (and reporter, if a different person) of the credibility criteria in Ability # 4 above.

(The next three involve inference.)

6. Deduce, and judge deduction

a. Class logic b. Conditional logic c. Interpretation of logical terminology in statements, including (1) Negation and double negation (2) Necessary and sufficient condition language (3) Such words as "only", "if and only if", "or", "some", "unless", "not both".

7. Induce, and judge induction

a. To generalizations. Broad considerations: (1) Typicality of data, including sampling where appropriate (2) Breadth of coverage (3) Acceptability of evidence b. To explanatory conclusions (including hypotheses) (1) Major types of explanatory conclusions and hypotheses: (a) Causal claims (b) Claims about the beliefs and attitudes of people (c) Interpretation of authors’ intended meanings (d) Historical claims that certain things happened (including criminal accusations) (e) Reported definitions (f) Claims that some proposition is an unstated reason that the person actually used (2) Characteristic investigative activities (a) Designing experiments, including planning to control variables (b) Seeking evidence and counter-evidence (c) Seeking other possible explanations (3) Criteria, the first five being essential, the sixth being desirable (a) The proposed conclusion would explain the evidence (b) The proposed conclusion is consistent with all known facts (c) Competitive alternative explanations are inconsistent with facts (d) The evidence on which the hypothesis depends is acceptable. (e) A legitimate effort should have been made to uncover counter-evidence (f) The proposed conclusion seems plausible

8. Make and judge value judgments: Important factors:

a. Background facts b. Consequences of accepting or rejecting the judgment c. Prima facie application of acceptable principles d. Alternatives e. Balancing, weighing, deciding

(The next two abilities involve advanced clarification.)

9. Define terms and judge definitions. Three dimensions are form, strategy, and content.

a. Form. Some useful forms are: (1) Synonym (2) Classification (3) Range (4) Equivalent expression (5) Operational (6) Example and non-example b. Definitional strategy (1) Acts (a) Report a meaning (b) Stipulate a meaning (c) Express a position on an issue (including "programmatic" and "persuasive" definitions) (2) Identifying and handling equivocation c. Content of the definition

10. Attribute unstated assumptions (an ability that belongs under both clarification and, in a way, inference)

(The next two abilities involve supposition and integration.)

11. Consider and reason from premises, reasons, assumptions, positions, and other propositions with which they disagree or about which they are in doubt -- without letting the disagreement or doubt interfere with their thinking ("suppositional thinking")

12. Integrate the other abilities and dispositions in making and defending a decision

(The first twelve abilities are constitutive abilities. The next three are auxiliary critical thinking abilities: Having them, though very helpful in various ways, is not constitutive of being a critical thinker.)

13. Proceed in an orderly manner appropriate to the situation. For example:

a. Follow problem solving steps b. Monitor one's own thinking (that is, engage in metacognition) c. Employ a reasonable critical thinking checklist

14. Be sensitive to the feelings, level of knowledge, and degree of sophistication of others

15. Employ appropriate rhetorical strategies in discussion and presentation (orally and in writing), including employing and reacting to "fallacy" labels in an appropriate manner.

Examples of fallacy labels are "circularity," "bandwagon," "post hoc," "equivocation," "non sequitur," and "straw person."

Dewey, John Critical thinking is "active, persistent, and careful consideration of any belief or supposed form of knowledge in the light of the grounds that support it and the further conclusions to which it tends (Dewey 1933: 118)."

Glaser (1) an attitude of being disposed to consider in a thoughtful way the problems and subjects that come within the range of one's experiences, (2) knowledge of the methods of logical inquiry and reasoning, and (3) some skill in applying those methods. Critical thinking calls for a persistent effort to examine any belief or supposed form of knowledge in the light of the evidence that supports it and the further conclusions to which it tends. (Glaser 1941, pp. 5-6).

Abilities include: "(a) to recognize problems, (b) to find workable means for meeting those problems, (c) to gather and marshal pertinent information, (d) to recognize unstated assumptions and values, (e) to comprehend and use language with accuracy, clarity and discrimination, (f) to interpret data, (g) to appraise evidence and evaluate statements, (h) to recognize the existence of logical relationships between propositions, (i) to draw warranted conclusions and generalizations, (j) to put to test the generalizations and conclusions at which one arrives, (k) to reconstruct one's patterns of beliefs on the basis of wider experience; and (l) to render accurate judgments about specific things and qualities in everyday life." (p.6)

MCC General Education Initiatives "Critical thinking includes the ability to respond to material by distinguishing between facts and opinions or personal feelings, judgments and inferences, inductive and deductive arguments, and the objective and subjective. It also includes the ability to generate questions, construct, and recognize the structure of arguments, and adequately support arguments; define, analyze, and devise solutions for problems and issues; sort, organize, classify, correlate, and analyze materials and data; integrate information and see relationships; evaluate information, materials, and data by drawing inferences, arriving at reasonable and informed conclusions, applying understanding and knowledge to new and different problems, developing rational and reasonable interpretations, suspending beliefs and remaining open to new information, methods, cultural systems, values and beliefs and by assimilating information."

Nickerson, Perkins and Smith (1985) "The ability to judge the plausibility of specific assertions, to weigh evidence, to assess the logical soundness of inferences, to construct counter-arguments and alternative hypotheses."

Moore and Parker , Critical Thinking Critical Thinking is "the careful, deliberate determination of whether we should accept, reject, or suspend judgment about a claim, and the degree of confidence with which we accept or reject it."

Delphi Report "We understand critical thinking to be purposeful, self-regulatory judgment which results in interpretation, analysis, evaluation, and inference, as well as explanation of the evidential, conceptual, methodological, criteriological, or contextual considerations upon which that judgment is based. CT is essential as a tool of inquiry. As such, CT is a liberating force in education and a powerful resource in one's personal and civic life. While not synonymous with good thinking, CT is a pervasive and self-rectifying human phenomenon. The ideal critical thinker is habitually inquisitive, well-informed, trustful of reason, open-minded, flexible, fair-minded in evaluation, honest in facing personal biases, prudent in making judgments, willing to reconsider, clear about issues, orderly in complex matters, diligent in seeking relevant information, reasonable in the selection of criteria, focused in inquiry, and persistent in seeking results which are as precise as the subject and the circumstances of inquiry permit. Thus, educating good critical thinkers means working toward this ideal. It combines developing CT skills with nurturing those dispositions which consistently yield useful insights and which are the basis of a rational and democratic society."

A little reformatting helps make this definition more comprehensible:

We understand critical thinking to be purposeful, self-regulatory judgment which results in

  • interpretation

as well as explanation of the

  • methodological
  • criteriological

considerations upon which that judgment is based.

Francis Bacon (1605) "For myself, I found that I was fitted for nothing so well as for the study of Truth; as having a mind nimble and versatile enough to catch the resemblances of things … and at the same time steady enough to fix and distinguish their subtler differences; as being gifted by nature with desire to seek, patience to doubt, fondness to meditate, slowness to assert, readiness to consider, carefulness to dispose and set in order; and as being a man that neither affects what is new nor admires what is old, and that hates every kind of imposture."

A shorter version is "the art of being right."

Or, more prosaically: critical thinking is "the skillful application of a repertoire of validated general techniques for deciding the level of confidence you should have in a proposition in the light of the available evidence."

HELPFUL REFERENCE: http://plato.stanford.edu/entries/logic-informal/

[C03] Defining critical thinking

Module: Critical thinking

  • C01. What is critical thinking?
  • C02. Improve our thinking skills
  • C04. Teaching critical thinking
  • C05. Beyond critical thinking
  • C06. The Cognitive Reflection Test
  • C07. Critical thinking assessment
  • C08. Videos and courses on critical thinking
  • C09. Famous quotes
  • C10. History of critical thinking

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There are many different definitions of critical thinking. Here we list some of the well-known ones. It can be seen that they all emphasize the importance of clarity and rationality. Here we will look at some well-known definitions in chronological order.

... [when] the ground or basis for a belief is deliberately sought and its adequacy to support the belief examined. This process is called reflective thought; it alone is truly educative in value ...
Active, persistent and careful consideration of any belief or supposed form of knowledge in light of the grounds that support it, and the further conclusions to which it tends, constitutes reflective thought.

There is however one passage where Dewey explicitly uses the term "critical thinking":

The essence of critical thinking is suspended judgment; and the essence of this suspense is inquiry to determine the nature of the problem before proceeding to attempts at its solution. This, more than any other thing, transforms mere inference into tested inference, suggested conclusions into proof. Dewey (1910) How We Think , p74.

The Watson-Glaser Critical Thinking Appraisal (1980) is a well-known psychological test of critical thinking ability. The authors of this test define critical thinking as :

... a composite of attitudes, knowledge and skills. This composite includes: (1) attitudes of inquiry that involve an ability to recognize the existence of problems and an acceptance of the general need for evidence in support of what is asserted to be true; (2) knowledge of the nature of valid inferences, abstractions, and generalizations in which the weight or accuracy of different kinds of evidence are logically determined; and (3) skills in employing and applying the above attitudes and knowledge.

A very well-known and influential definition of critical thinking is from Robert Ennis (1987):

Critical thinking is reasonable reflective thinking that is focused on deciding what to believe or do. Ennis (1987) A taxonomy of critical thinking dispositions and abilities. In Baron and Sternberg (Eds.) Teaching thinking skills: Theory and practice . NY: W.H. Freeman, pp. 9-26.

This definition comes from a statement written in 1987 by Michael Scriven and Richard Paul, National Council for Excellence in Critical Thinking , an organization promoting critical thinking in the US.

Critical thinking is the intellectually disciplined process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and/or evaluating information gathered from, or generated by, observation, experience, reflection, reasoning, or communication, as a guide to belief and action. In its exemplary form, it is based on universal intellectual values that transcend subject matter divisions: clarity, accuracy, precision, consistency, relevance, sound evidence, good reasons, depth, breadth, and fairness. It entails the examination of those structures or elements of thought implicit in all reasoning: purpose, problem, or question-at-issue, assumptions, concepts, empirical grounding; reasoning leading to conclusions, implications and consequences, objections from alternative viewpoints, and frame of reference.
"We understand critical thinking to be purposeful, self-regulatory judgment which results in interpretation, analysis, evaluation, and inference, as well as explanation of the evidential, conceptual, methodological, criteriological, or contextual considerations upon which that judgment is based. CT is essential as a tool of inquiry. As such, CT is a liberating force in education and a powerful resource in one's personal and civic life. While not synonymous with good thinking, CT is a pervasive and self-rectifying human phenomenon. The ideal critical thinker is habitually inquisitive, well-informed, trustful of reason, open-minded, flexible, fairminded in evaluation, honest in facing personal biases, prudent in making judgments, willing to reconsider, clear about issues, orderly in complex matters, diligent in seeking relevant information, reasonable in the selection of criteria, focused in inquiry, and persistent in seeking results which are as precise as the subject and the circumstances of inquiry permit. Thus, educating good critical thinkers means working toward this ideal. It combines developing CT skills with nurturing those dispositions which consistently yield useful insights and which are the basis of a rational and democratic society."

Here are some other people trying to explain critical thinking. Evaluate their claims in light of what you have read above.

  • In this Wall Street Journal article, someone defined critical thinking as "forming your own opinion from a variety of different sources." hint Surely it is possible to think critically without consulting other sources? It is also possible to think uncritically by reacting in a biased way to the sources that you come across!
  • "Actually, the essence of critical thinking lies in asking questions and to keep asking them until you are satisfied with the answer." Ho Lok-sang, Director of the Centre for Public Policy Studies at Lingnan University. China Daily, Tuesday, December 30, 2014

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Reflective thinking is like the crock pot of the mind. It encourages thoughts to simmer until they are done.John C. Maxwell

What is Reflective Judgment?

Critical thinking is "thinking about thinking." To apply critical thinking skills, skills to a particular problem implies a reflective sensibility and the capacity for reflective judgment (King & Kitchener, 1994). The simplest description of reflective judgment is that of ‘taking a step back.’ ( Dwyer, 2017)

Reflective judgment is the ability to evaluate and process information in order to draw plausible conclusions. 

It can be defined more concisely in the video below:

Video Source and Credit: Bill Garris, Ph.D

Source: King, P.M. & Kitchener, K.S. (1994). Developing Reflective Judgment. San Francisco: Jossey-Bass Publishers, pp. 14-16. Source hosted by Univerity of Michigan

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Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr.

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Patient Safety and Quality: An Evidence-Based Handbook for Nurses.

Chapter 6 clinical reasoning, decisionmaking, and action: thinking critically and clinically.

Patricia Benner ; Ronda G. Hughes ; Molly Sutphen .

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This chapter examines multiple thinking strategies that are needed for high-quality clinical practice. Clinical reasoning and judgment are examined in relation to other modes of thinking used by clinical nurses in providing quality health care to patients that avoids adverse events and patient harm. The clinician’s ability to provide safe, high-quality care can be dependent upon their ability to reason, think, and judge, which can be limited by lack of experience. The expert performance of nurses is dependent upon continual learning and evaluation of performance.

  • Critical Thinking

Nursing education has emphasized critical thinking as an essential nursing skill for more than 50 years. 1 The definitions of critical thinking have evolved over the years. There are several key definitions for critical thinking to consider. The American Philosophical Association (APA) defined critical thinking as purposeful, self-regulatory judgment that uses cognitive tools such as interpretation, analysis, evaluation, inference, and explanation of the evidential, conceptual, methodological, criteriological, or contextual considerations on which judgment is based. 2 A more expansive general definition of critical thinking is

. . . in short, self-directed, self-disciplined, self-monitored, and self-corrective thinking. It presupposes assent to rigorous standards of excellence and mindful command of their use. It entails effective communication and problem solving abilities and a commitment to overcome our native egocentrism and sociocentrism. Every clinician must develop rigorous habits of critical thinking, but they cannot escape completely the situatedness and structures of the clinical traditions and practices in which they must make decisions and act quickly in specific clinical situations. 3

There are three key definitions for nursing, which differ slightly. Bittner and Tobin defined critical thinking as being “influenced by knowledge and experience, using strategies such as reflective thinking as a part of learning to identify the issues and opportunities, and holistically synthesize the information in nursing practice” 4 (p. 268). Scheffer and Rubenfeld 5 expanded on the APA definition for nurses through a consensus process, resulting in the following definition:

Critical thinking in nursing is an essential component of professional accountability and quality nursing care. Critical thinkers in nursing exhibit these habits of the mind: confidence, contextual perspective, creativity, flexibility, inquisitiveness, intellectual integrity, intuition, openmindedness, perseverance, and reflection. Critical thinkers in nursing practice the cognitive skills of analyzing, applying standards, discriminating, information seeking, logical reasoning, predicting, and transforming knowledge 6 (Scheffer & Rubenfeld, p. 357).

The National League for Nursing Accreditation Commission (NLNAC) defined critical thinking as:

the deliberate nonlinear process of collecting, interpreting, analyzing, drawing conclusions about, presenting, and evaluating information that is both factually and belief based. This is demonstrated in nursing by clinical judgment, which includes ethical, diagnostic, and therapeutic dimensions and research 7 (p. 8).

These concepts are furthered by the American Association of Colleges of Nurses’ definition of critical thinking in their Essentials of Baccalaureate Nursing :

Critical thinking underlies independent and interdependent decision making. Critical thinking includes questioning, analysis, synthesis, interpretation, inference, inductive and deductive reasoning, intuition, application, and creativity 8 (p. 9).
Course work or ethical experiences should provide the graduate with the knowledge and skills to:
  • Use nursing and other appropriate theories and models, and an appropriate ethical framework;
  • Apply research-based knowledge from nursing and the sciences as the basis for practice;
  • Use clinical judgment and decision-making skills;
  • Engage in self-reflective and collegial dialogue about professional practice;
  • Evaluate nursing care outcomes through the acquisition of data and the questioning of inconsistencies, allowing for the revision of actions and goals;
  • Engage in creative problem solving 8 (p. 10).

Taken together, these definitions of critical thinking set forth the scope and key elements of thought processes involved in providing clinical care. Exactly how critical thinking is defined will influence how it is taught and to what standard of care nurses will be held accountable.

Professional and regulatory bodies in nursing education have required that critical thinking be central to all nursing curricula, but they have not adequately distinguished critical reflection from ethical, clinical, or even creative thinking for decisionmaking or actions required by the clinician. Other essential modes of thought such as clinical reasoning, evaluation of evidence, creative thinking, or the application of well-established standards of practice—all distinct from critical reflection—have been subsumed under the rubric of critical thinking. In the nursing education literature, clinical reasoning and judgment are often conflated with critical thinking. The accrediting bodies and nursing scholars have included decisionmaking and action-oriented, practical, ethical, and clinical reasoning in the rubric of critical reflection and thinking. One might say that this harmless semantic confusion is corrected by actual practices, except that students need to understand the distinctions between critical reflection and clinical reasoning, and they need to learn to discern when each is better suited, just as students need to also engage in applying standards, evidence-based practices, and creative thinking.

The growing body of research, patient acuity, and complexity of care demand higher-order thinking skills. Critical thinking involves the application of knowledge and experience to identify patient problems and to direct clinical judgments and actions that result in positive patient outcomes. These skills can be cultivated by educators who display the virtues of critical thinking, including independence of thought, intellectual curiosity, courage, humility, empathy, integrity, perseverance, and fair-mindedness. 9

The process of critical thinking is stimulated by integrating the essential knowledge, experiences, and clinical reasoning that support professional practice. The emerging paradigm for clinical thinking and cognition is that it is social and dialogical rather than monological and individual. 10–12 Clinicians pool their wisdom and multiple perspectives, yet some clinical knowledge can be demonstrated only in the situation (e.g., how to suction an extremely fragile patient whose oxygen saturations sink too low). Early warnings of problematic situations are made possible by clinicians comparing their observations to that of other providers. Clinicians form practice communities that create styles of practice, including ways of doing things, communication styles and mechanisms, and shared expectations about performance and expertise of team members.

By holding up critical thinking as a large umbrella for different modes of thinking, students can easily misconstrue the logic and purposes of different modes of thinking. Clinicians and scientists alike need multiple thinking strategies, such as critical thinking, clinical judgment, diagnostic reasoning, deliberative rationality, scientific reasoning, dialogue, argument, creative thinking, and so on. In particular, clinicians need forethought and an ongoing grasp of a patient’s health status and care needs trajectory, which requires an assessment of their own clarity and understanding of the situation at hand, critical reflection, critical reasoning, and clinical judgment.

Critical Reflection, Critical Reasoning, and Judgment

Critical reflection requires that the thinker examine the underlying assumptions and radically question or doubt the validity of arguments, assertions, and even facts of the case. Critical reflective skills are essential for clinicians; however, these skills are not sufficient for the clinician who must decide how to act in particular situations and avoid patient injury. For example, in everyday practice, clinicians cannot afford to critically reflect on the well-established tenets of “normal” or “typical” human circulatory systems when trying to figure out a particular patient’s alterations from that typical, well-grounded understanding that has existed since Harvey’s work in 1628. 13 Yet critical reflection can generate new scientifically based ideas. For example, there is a lack of adequate research on the differences between women’s and men’s circulatory systems and the typical pathophysiology related to heart attacks. Available research is based upon multiple, taken-for-granted starting points about the general nature of the circulatory system. As such, critical reflection may not provide what is needed for a clinician to act in a situation. This idea can be considered reasonable since critical reflective thinking is not sufficient for good clinical reasoning and judgment. The clinician’s development of skillful critical reflection depends upon being taught what to pay attention to, and thus gaining a sense of salience that informs the powers of perceptual grasp. The powers of noticing or perceptual grasp depend upon noticing what is salient and the capacity to respond to the situation.

Critical reflection is a crucial professional skill, but it is not the only reasoning skill or logic clinicians require. The ability to think critically uses reflection, induction, deduction, analysis, challenging assumptions, and evaluation of data and information to guide decisionmaking. 9 , 14 , 15 Critical reasoning is a process whereby knowledge and experience are applied in considering multiple possibilities to achieve the desired goals, 16 while considering the patient’s situation. 14 It is a process where both inductive and deductive cognitive skills are used. 17 Sometimes clinical reasoning is presented as a form of evaluating scientific knowledge, sometimes even as a form of scientific reasoning. Critical thinking is inherent in making sound clinical reasoning. 18

An essential point of tension and confusion exists in practice traditions such as nursing and medicine when clinical reasoning and critical reflection become entangled, because the clinician must have some established bases that are not questioned when engaging in clinical decisions and actions, such as standing orders. The clinician must act in the particular situation and time with the best clinical and scientific knowledge available. The clinician cannot afford to indulge in either ritualistic unexamined knowledge or diagnostic or therapeutic nihilism caused by radical doubt, as in critical reflection, because they must find an intelligent and effective way to think and act in particular clinical situations. Critical reflection skills are essential to assist practitioners to rethink outmoded or even wrong-headed approaches to health care, health promotion, and prevention of illness and complications, especially when new evidence is available. Breakdowns in practice, high failure rates in particular therapies, new diseases, new scientific discoveries, and societal changes call for critical reflection about past assumptions and no-longer-tenable beliefs.

Clinical reasoning stands out as a situated, practice-based form of reasoning that requires a background of scientific and technological research-based knowledge about general cases, more so than any particular instance. It also requires practical ability to discern the relevance of the evidence behind general scientific and technical knowledge and how it applies to a particular patient. In dong so, the clinician considers the patient’s particular clinical trajectory, their concerns and preferences, and their particular vulnerabilities (e.g., having multiple comorbidities) and sensitivities to care interventions (e.g., known drug allergies, other conflicting comorbid conditions, incompatible therapies, and past responses to therapies) when forming clinical decisions or conclusions.

Situated in a practice setting, clinical reasoning occurs within social relationships or situations involving patient, family, community, and a team of health care providers. The expert clinician situates themselves within a nexus of relationships, with concerns that are bounded by the situation. Expert clinical reasoning is socially engaged with the relationships and concerns of those who are affected by the caregiving situation, and when certain circumstances are present, the adverse event. Halpern 19 has called excellent clinical ethical reasoning “emotional reasoning” in that the clinicians have emotional access to the patient/family concerns and their understanding of the particular care needs. Expert clinicians also seek an optimal perceptual grasp, one based on understanding and as undistorted as possible, based on an attuned emotional engagement and expert clinical knowledge. 19 , 20

Clergy educators 21 and nursing and medical educators have begun to recognize the wisdom of broadening their narrow vision of rationality beyond simple rational calculation (exemplified by cost-benefit analysis) to reconsider the need for character development—including emotional engagement, perception, habits of thought, and skill acquisition—as essential to the development of expert clinical reasoning, judgment, and action. 10 , 22–24 Practitioners of engineering, law, medicine, and nursing, like the clergy, have to develop a place to stand in their discipline’s tradition of knowledge and science in order to recognize and evaluate salient evidence in the moment. Diagnostic confusion and disciplinary nihilism are both threats to the clinician’s ability to act in particular situations. However, the practice and practitioners will not be self-improving and vital if they cannot engage in critical reflection on what is not of value, what is outmoded, and what does not work. As evidence evolves and expands, so too must clinical thought.

Clinical judgment requires clinical reasoning across time about the particular, and because of the relevance of this immediate historical unfolding, clinical reasoning can be very different from the scientific reasoning used to formulate, conduct, and assess clinical experiments. While scientific reasoning is also socially embedded in a nexus of social relationships and concerns, the goal of detached, critical objectivity used to conduct scientific experiments minimizes the interactive influence of the research on the experiment once it has begun. Scientific research in the natural and clinical sciences typically uses formal criteria to develop “yes” and “no” judgments at prespecified times. The scientist is always situated in past and immediate scientific history, preferring to evaluate static and predetermined points in time (e.g., snapshot reasoning), in contrast to a clinician who must always reason about transitions over time. 25 , 26

Techne and Phronesis

Distinctions between the mere scientific making of things and practice was first explored by Aristotle as distinctions between techne and phronesis. 27 Learning to be a good practitioner requires developing the requisite moral imagination for good practice. If, for example, patients exercise their rights and refuse treatments, practitioners are required to have the moral imagination to understand the probable basis for the patient’s refusal. For example, was the refusal based upon catastrophic thinking, unrealistic fears, misunderstanding, or even clinical depression?

Techne, as defined by Aristotle, encompasses the notion of formation of character and habitus 28 as embodied beings. In Aristotle’s terms, techne refers to the making of things or producing outcomes. 11 Joseph Dunne defines techne as “the activity of producing outcomes,” and it “is governed by a means-ends rationality where the maker or producer governs the thing or outcomes produced or made through gaining mastery over the means of producing the outcomes, to the point of being able to separate means and ends” 11 (p. 54). While some aspects of medical and nursing practice fall into the category of techne, much of nursing and medical practice falls outside means-ends rationality and must be governed by concern for doing good or what is best for the patient in particular circumstances, where being in a relationship and discerning particular human concerns at stake guide action.

Phronesis, in contrast to techne, includes reasoning about the particular, across time, through changes or transitions in the patient’s and/or the clinician’s understanding. As noted by Dunne, phronesis is “characterized at least as much by a perceptiveness with regard to concrete particulars as by a knowledge of universal principles” 11 (p. 273). This type of practical reasoning often takes the form of puzzle solving or the evaluation of immediate past “hot” history of the patient’s situation. Such a particular clinical situation is necessarily particular, even though many commonalities and similarities with other disease syndromes can be recognized through signs and symptoms and laboratory tests. 11 , 29 , 30 Pointing to knowledge embedded in a practice makes no claim for infallibility or “correctness.” Individual practitioners can be mistaken in their judgments because practices such as medicine and nursing are inherently underdetermined. 31

While phronetic knowledge must remain open to correction and improvement, real events, and consequences, it cannot consistently transcend the institutional setting’s capacities and supports for good practice. Phronesis is also dependent on ongoing experiential learning of the practitioner, where knowledge is refined, corrected, or refuted. The Western tradition, with the notable exception of Aristotle, valued knowledge that could be made universal and devalued practical know-how and experiential learning. Descartes codified this preference for formal logic and rational calculation.

Aristotle recognized that when knowledge is underdetermined, changeable, and particular, it cannot be turned into the universal or standardized. It must be perceived, discerned, and judged, all of which require experiential learning. In nursing and medicine, perceptual acuity in physical assessment and clinical judgment (i.e., reasoning across time about changes in the particular patient or the clinician’s understanding of the patient’s condition) fall into the Greek Aristotelian category of phronesis. Dewey 32 sought to rescue knowledge gained by practical activity in the world. He identified three flaws in the understanding of experience in Greek philosophy: (1) empirical knowing is the opposite of experience with science; (2) practice is reduced to techne or the application of rational thought or technique; and (3) action and skilled know-how are considered temporary and capricious as compared to reason, which the Greeks considered as ultimate reality.

In practice, nursing and medicine require both techne and phronesis. The clinician standardizes and routinizes what can be standardized and routinized, as exemplified by standardized blood pressure measurements, diagnoses, and even charting about the patient’s condition and treatment. 27 Procedural and scientific knowledge can often be formalized and standardized (e.g., practice guidelines), or at least made explicit and certain in practice, except for the necessary timing and adjustments made for particular patients. 11 , 22

Rational calculations available to techne—population trends and statistics, algorithms—are created as decision support structures and can improve accuracy when used as a stance of inquiry in making clinical judgments about particular patients. Aggregated evidence from clinical trials and ongoing working knowledge of pathophysiology, biochemistry, and genomics are essential. In addition, the skills of phronesis (clinical judgment that reasons across time, taking into account the transitions of the particular patient/family/community and transitions in the clinician’s understanding of the clinical situation) will be required for nursing, medicine, or any helping profession.

Thinking Critically

Being able to think critically enables nurses to meet the needs of patients within their context and considering their preferences; meet the needs of patients within the context of uncertainty; consider alternatives, resulting in higher-quality care; 33 and think reflectively, rather than simply accepting statements and performing tasks without significant understanding and evaluation. 34 Skillful practitioners can think critically because they have the following cognitive skills: information seeking, discriminating, analyzing, transforming knowledge, predicating, applying standards, and logical reasoning. 5 One’s ability to think critically can be affected by age, length of education (e.g., an associate vs. a baccalaureate decree in nursing), and completion of philosophy or logic subjects. 35–37 The skillful practitioner can think critically because of having the following characteristics: motivation, perseverance, fair-mindedness, and deliberate and careful attention to thinking. 5 , 9

Thinking critically implies that one has a knowledge base from which to reason and the ability to analyze and evaluate evidence. 38 Knowledge can be manifest by the logic and rational implications of decisionmaking. Clinical decisionmaking is particularly influenced by interpersonal relationships with colleagues, 39 patient conditions, availability of resources, 40 knowledge, and experience. 41 Of these, experience has been shown to enhance nurses’ abilities to make quick decisions 42 and fewer decision errors, 43 support the identification of salient cues, and foster the recognition and action on patterns of information. 44 , 45

Clinicians must develop the character and relational skills that enable them to perceive and understand their patient’s needs and concerns. This requires accurate interpretation of patient data that is relevant to the specific patient and situation. In nursing, this formation of moral agency focuses on learning to be responsible in particular ways demanded by the practice, and to pay attention and intelligently discern changes in patients’ concerns and/or clinical condition that require action on the part of the nurse or other health care workers to avert potential compromises to quality care.

Formation of the clinician’s character, skills, and habits are developed in schools and particular practice communities within a larger practice tradition. As Dunne notes,

A practice is not just a surface on which one can display instant virtuosity. It grounds one in a tradition that has been formed through an elaborate development and that exists at any juncture only in the dispositions (slowly and perhaps painfully acquired) of its recognized practitioners. The question may of course be asked whether there are any such practices in the contemporary world, whether the wholesale encroachment of Technique has not obliterated them—and whether this is not the whole point of MacIntyre’s recipe of withdrawal, as well as of the post-modern story of dispossession 11 (p. 378).

Clearly Dunne is engaging in critical reflection about the conditions for developing character, skills, and habits for skillful and ethical comportment of practitioners, as well as to act as moral agents for patients so that they and their families receive safe, effective, and compassionate care.

Professional socialization or professional values, while necessary, do not adequately address character and skill formation that transform the way the practitioner exists in his or her world, what the practitioner is capable of noticing and responding to, based upon well-established patterns of emotional responses, skills, dispositions to act, and the skills to respond, decide, and act. 46 The need for character and skill formation of the clinician is what makes a practice stand out from a mere technical, repetitious manufacturing process. 11 , 30 , 47

In nursing and medicine, many have questioned whether current health care institutions are designed to promote or hinder enlightened, compassionate practice, or whether they have deteriorated into commercial institutional models that focus primarily on efficiency and profit. MacIntyre points out the links between the ongoing development and improvement of practice traditions and the institutions that house them:

Lack of justice, lack of truthfulness, lack of courage, lack of the relevant intellectual virtues—these corrupt traditions, just as they do those institutions and practices which derive their life from the traditions of which they are the contemporary embodiments. To recognize this is of course also to recognize the existence of an additional virtue, one whose importance is perhaps most obvious when it is least present, the virtue of having an adequate sense of the traditions to which one belongs or which confront one. This virtue is not to be confused with any form of conservative antiquarianism; I am not praising those who choose the conventional conservative role of laudator temporis acti. It is rather the case that an adequate sense of tradition manifests itself in a grasp of those future possibilities which the past has made available to the present. Living traditions, just because they continue a not-yet-completed narrative, confront a future whose determinate and determinable character, so far as it possesses any, derives from the past 30 (p. 207).

It would be impossible to capture all the situated and distributed knowledge outside of actual practice situations and particular patients. Simulations are powerful as teaching tools to enable nurses’ ability to think critically because they give students the opportunity to practice in a simplified environment. However, students can be limited in their inability to convey underdetermined situations where much of the information is based on perceptions of many aspects of the patient and changes that have occurred over time. Simulations cannot have the sub-cultures formed in practice settings that set the social mood of trust, distrust, competency, limited resources, or other forms of situated possibilities.

One of the hallmark studies in nursing providing keen insight into understanding the influence of experience was a qualitative study of adult, pediatric, and neonatal intensive care unit (ICU) nurses, where the nurses were clustered into advanced beginner, intermediate, and expert level of practice categories. The advanced beginner (having up to 6 months of work experience) used procedures and protocols to determine which clinical actions were needed. When confronted with a complex patient situation, the advanced beginner felt their practice was unsafe because of a knowledge deficit or because of a knowledge application confusion. The transition from advanced beginners to competent practitioners began when they first had experience with actual clinical situations and could benefit from the knowledge gained from the mistakes of their colleagues. Competent nurses continuously questioned what they saw and heard, feeling an obligation to know more about clinical situations. In doing do, they moved from only using care plans and following the physicians’ orders to analyzing and interpreting patient situations. Beyond that, the proficient nurse acknowledged the changing relevance of clinical situations requiring action beyond what was planned or anticipated. The proficient nurse learned to acknowledge the changing needs of patient care and situation, and could organize interventions “by the situation as it unfolds rather than by preset goals 48 (p. 24). Both competent and proficient nurses (that is, intermediate level of practice) had at least two years of ICU experience. 48 Finally, the expert nurse had a more fully developed grasp of a clinical situation, a sense of confidence in what is known about the situation, and could differentiate the precise clinical problem in little time. 48

Expertise is acquired through professional experience and is indicative of a nurse who has moved beyond mere proficiency. As Gadamer 29 points out, experience involves a turning around of preconceived notions, preunderstandings, and extends or adds nuances to understanding. Dewey 49 notes that experience requires a prepared “creature” and an enriched environment. The opportunity to reflect and narrate one’s experiential learning can clarify, extend, or even refute experiential learning.

Experiential learning requires time and nurturing, but time alone does not ensure experiential learning. Aristotle linked experiential learning to the development of character and moral sensitivities of a person learning a practice. 50 New nurses/new graduates have limited work experience and must experience continuing learning until they have reached an acceptable level of performance. 51 After that, further improvements are not predictable, and years of experience are an inadequate predictor of expertise. 52

The most effective knower and developer of practical knowledge creates an ongoing dialogue and connection between lessons of the day and experiential learning over time. Gadamer, in a late life interview, highlighted the open-endedness and ongoing nature of experiential learning in the following interview response:

Being experienced does not mean that one now knows something once and for all and becomes rigid in this knowledge; rather, one becomes more open to new experiences. A person who is experienced is undogmatic. Experience has the effect of freeing one to be open to new experience … In our experience we bring nothing to a close; we are constantly learning new things from our experience … this I call the interminability of all experience 32 (p. 403).

Practical endeavor, supported by scientific knowledge, requires experiential learning, the development of skilled know-how, and perceptual acuity in order to make the scientific knowledge relevant to the situation. Clinical perceptual and skilled know-how helps the practitioner discern when particular scientific findings might be relevant. 53

Often experience and knowledge, confirmed by experimentation, are treated as oppositions, an either-or choice. However, in practice it is readily acknowledged that experiential knowledge fuels scientific investigation, and scientific investigation fuels further experiential learning. Experiential learning from particular clinical cases can help the clinician recognize future similar cases and fuel new scientific questions and study. For example, less experienced nurses—and it could be argued experienced as well—can use nursing diagnoses practice guidelines as part of their professional advancement. Guidelines are used to reflect their interpretation of patients’ needs, responses, and situation, 54 a process that requires critical thinking and decisionmaking. 55 , 56 Using guidelines also reflects one’s problem identification and problem-solving abilities. 56 Conversely, the ability to proficiently conduct a series of tasks without nursing diagnoses is the hallmark of expertise. 39 , 57

Experience precedes expertise. As expertise develops from experience and gaining knowledge and transitions to the proficiency stage, the nurses’ thinking moves from steps and procedures (i.e., task-oriented care) toward “chunks” or patterns 39 (i.e., patient-specific care). In doing so, the nurse thinks reflectively, rather than merely accepting statements and performing procedures without significant understanding and evaluation. 34 Expert nurses do not rely on rules and logical thought processes in problem-solving and decisionmaking. 39 Instead, they use abstract principles, can see the situation as a complex whole, perceive situations comprehensively, and can be fully involved in the situation. 48 Expert nurses can perform high-level care without conscious awareness of the knowledge they are using, 39 , 58 and they are able to provide that care with flexibility and speed. Through a combination of knowledge and skills gained from a range of theoretical and experiential sources, expert nurses also provide holistic care. 39 Thus, the best care comes from the combination of theoretical, tacit, and experiential knowledge. 59 , 60

Experts are thought to eventually develop the ability to intuitively know what to do and to quickly recognize critical aspects of the situation. 22 Some have proposed that expert nurses provide high-quality patient care, 61 , 62 but that is not consistently documented—particularly in consideration of patient outcomes—and a full understanding between the differential impact of care rendered by an “expert” nurse is not fully understood. In fact, several studies have found that length of professional experience is often unrelated and even negatively related to performance measures and outcomes. 63 , 64

In a review of the literature on expertise in nursing, Ericsson and colleagues 65 found that focusing on challenging, less-frequent situations would reveal individual performance differences on tasks that require speed and flexibility, such as that experienced during a code or an adverse event. Superior performance was associated with extensive training and immediate feedback about outcomes, which can be obtained through continual training, simulation, and processes such as root-cause analysis following an adverse event. Therefore, efforts to improve performance benefited from continual monitoring, planning, and retrospective evaluation. Even then, the nurse’s ability to perform as an expert is dependent upon their ability to use intuition or insights gained through interactions with patients. 39

Intuition and Perception

Intuition is the instant understanding of knowledge without evidence of sensible thought. 66 According to Young, 67 intuition in clinical practice is a process whereby the nurse recognizes something about a patient that is difficult to verbalize. Intuition is characterized by factual knowledge, “immediate possession of knowledge, and knowledge independent of the linear reasoning process” 68 (p. 23). When intuition is used, one filters information initially triggered by the imagination, leading to the integration of all knowledge and information to problem solve. 69 Clinicians use their interactions with patients and intuition, drawing on tacit or experiential knowledge, 70 , 71 to apply the correct knowledge to make the correct decisions to address patient needs. Yet there is a “conflated belief in the nurses’ ability to know what is best for the patient” 72 (p. 251) because the nurses’ and patients’ identification of the patients’ needs can vary. 73

A review of research and rhetoric involving intuition by King and Appleton 62 found that all nurses, including students, used intuition (i.e., gut feelings). They found evidence, predominately in critical care units, that intuition was triggered in response to knowledge and as a trigger for action and/or reflection with a direct bearing on the analytical process involved in patient care. The challenge for nurses was that rigid adherence to checklists, guidelines, and standardized documentation, 62 ignored the benefits of intuition. This view was furthered by Rew and Barrow 68 , 74 in their reviews of the literature, where they found that intuition was imperative to complex decisionmaking, 68 difficult to measure and assess in a quantitative manner, and was not linked to physiologic measures. 74

Intuition is a way of explaining professional expertise. 75 Expert nurses rely on their intuitive judgment that has been developed over time. 39 , 76 Intuition is an informal, nonanalytically based, unstructured, deliberate calculation that facilitates problem solving, 77 a process of arriving at salient conclusions based on relatively small amounts of knowledge and/or information. 78 Experts can have rapid insight into a situation by using intuition to recognize patterns and similarities, achieve commonsense understanding, and sense the salient information combined with deliberative rationality. 10 Intuitive recognition of similarities and commonalities between patients are often the first diagnostic clue or early warning, which must then be followed up with critical evaluation of evidence among the competing conditions. This situation calls for intuitive judgment that can distinguish “expert human judgment from the decisions” made by a novice 79 (p. 23).

Shaw 80 equates intuition with direct perception. Direct perception is dependent upon being able to detect complex patterns and relationships that one has learned through experience are important. Recognizing these patterns and relationships generally occurs rapidly and is complex, making it difficult to articulate or describe. Perceptual skills, like those of the expert nurse, are essential to recognizing current and changing clinical conditions. Perception requires attentiveness and the development of a sense of what is salient. Often in nursing and medicine, means and ends are fused, as is the case for a “good enough” birth experience and a peaceful death.

  • Applying Practice Evidence

Research continues to find that using evidence-based guidelines in practice, informed through research evidence, improves patients’ outcomes. 81–83 Research-based guidelines are intended to provide guidance for specific areas of health care delivery. 84 The clinician—both the novice and expert—is expected to use the best available evidence for the most efficacious therapies and interventions in particular instances, to ensure the highest-quality care, especially when deviations from the evidence-based norm may heighten risks to patient safety. Otherwise, if nursing and medicine were exact sciences, or consisted only of techne, then a 1:1 relationship could be established between results of aggregated evidence-based research and the best path for all patients.

Evaluating Evidence

Before research should be used in practice, it must be evaluated. There are many complexities and nuances in evaluating the research evidence for clinical practice. Evaluation of research behind evidence-based medicine requires critical thinking and good clinical judgment. Sometimes the research findings are mixed or even conflicting. As such, the validity, reliability, and generalizability of available research are fundamental to evaluating whether evidence can be applied in practice. To do so, clinicians must select the best scientific evidence relevant to particular patients—a complex process that involves intuition to apply the evidence. Critical thinking is required for evaluating the best available scientific evidence for the treatment and care of a particular patient.

Good clinical judgment is required to select the most relevant research evidence. The best clinical judgment, that is, reasoning across time about the particular patient through changes in the patient’s concerns and condition and/or the clinician’s understanding, are also required. This type of judgment requires clinicians to make careful observations and evaluations of the patient over time, as well as know the patient’s concerns and social circumstances. To evolve to this level of judgment, additional education beyond clinical preparation if often required.

Sources of Evidence

Evidence that can be used in clinical practice has different sources and can be derived from research, patient’s preferences, and work-related experience. 85 , 86 Nurses have been found to obtain evidence from experienced colleagues believed to have clinical expertise and research-based knowledge 87 as well as other sources.

For many years now, randomized controlled trials (RCTs) have often been considered the best standard for evaluating clinical practice. Yet, unless the common threats to the validity (e.g., representativeness of the study population) and reliability (e.g., consistency in interventions and responses of study participants) of RCTs are addressed, the meaningfulness and generalizability of the study outcomes are very limited. Relevant patient populations may be excluded, such as women, children, minorities, the elderly, and patients with multiple chronic illnesses. The dropout rate of the trial may confound the results. And it is easier to get positive results published than it is to get negative results published. Thus, RCTs are generalizable (i.e., applicable) only to the population studied—which may not reflect the needs of the patient under the clinicians care. In instances such as these, clinicians need to also consider applied research using prospective or retrospective populations with case control to guide decisionmaking, yet this too requires critical thinking and good clinical judgment.

Another source of available evidence may come from the gold standard of aggregated systematic evaluation of clinical trial outcomes for the therapy and clinical condition in question, be generated by basic and clinical science relevant to the patient’s particular pathophysiology or care need situation, or stem from personal clinical experience. The clinician then takes all of the available evidence and considers the particular patient’s known clinical responses to past therapies, their clinical condition and history, the progression or stages of the patient’s illness and recovery, and available resources.

In clinical practice, the particular is examined in relation to the established generalizations of science. With readily available summaries of scientific evidence (e.g., systematic reviews and practice guidelines) available to nurses and physicians, one might wonder whether deep background understanding is still advantageous. Might it not be expendable, since it is likely to be out of date given the current scientific evidence? But this assumption is a false opposition and false choice because without a deep background understanding, the clinician does not know how to best find and evaluate scientific evidence for the particular case in hand. The clinician’s sense of salience in any given situation depends on past clinical experience and current scientific evidence.

Evidence-Based Practice

The concept of evidence-based practice is dependent upon synthesizing evidence from the variety of sources and applying it appropriately to the care needs of populations and individuals. This implies that evidence-based practice, indicative of expertise in practice, appropriately applies evidence to the specific situations and unique needs of patients. 88 , 89 Unfortunately, even though providing evidence-based care is an essential component of health care quality, it is well known that evidence-based practices are not used consistently.

Conceptually, evidence used in practice advances clinical knowledge, and that knowledge supports independent clinical decisions in the best interest of the patient. 90 , 91 Decisions must prudently consider the factors not necessarily addressed in the guideline, such as the patient’s lifestyle, drug sensitivities and allergies, and comorbidities. Nurses who want to improve the quality and safety of care can do so though improving the consistency of data and information interpretation inherent in evidence-based practice.

Initially, before evidence-based practice can begin, there needs to be an accurate clinical judgment of patient responses and needs. In the course of providing care, with careful consideration of patient safety and quality care, clinicians must give attention to the patient’s condition, their responses to health care interventions, and potential adverse reactions or events that could harm the patient. Nonetheless, there is wide variation in the ability of nurses to accurately interpret patient responses 92 and their risks. 93 Even though variance in interpretation is expected, nurses are obligated to continually improve their skills to ensure that patients receive quality care safely. 94 Patients are vulnerable to the actions and experience of their clinicians, which are inextricably linked to the quality of care patients have access to and subsequently receive.

The judgment of the patient’s condition determines subsequent interventions and patient outcomes. Attaining accurate and consistent interpretations of patient data and information is difficult because each piece can have different meanings, and interpretations are influenced by previous experiences. 95 Nurses use knowledge from clinical experience 96 , 97 and—although infrequently—research. 98–100

Once a problem has been identified, using a process that utilizes critical thinking to recognize the problem, the clinician then searches for and evaluates the research evidence 101 and evaluates potential discrepancies. The process of using evidence in practice involves “a problem-solving approach that incorporates the best available scientific evidence, clinicians’ expertise, and patient’s preferences and values” 102 (p. 28). Yet many nurses do not perceive that they have the education, tools, or resources to use evidence appropriately in practice. 103

Reported barriers to using research in practice have included difficulty in understanding the applicability and the complexity of research findings, failure of researchers to put findings into the clinical context, lack of skills in how to use research in practice, 104 , 105 amount of time required to access information and determine practice implications, 105–107 lack of organizational support to make changes and/or use in practice, 104 , 97 , 105 , 107 and lack of confidence in one’s ability to critically evaluate clinical evidence. 108

When Evidence Is Missing

In many clinical situations, there may be no clear guidelines and few or even no relevant clinical trials to guide decisionmaking. In these cases, the latest basic science about cellular and genomic functioning may be the most relevant science, or by default, guestimation. Consequently, good patient care requires more than a straightforward, unequivocal application of scientific evidence. The clinician must be able to draw on a good understanding of basic sciences, as well as guidelines derived from aggregated data and information from research investigations.

Practical knowledge is shaped by one’s practice discipline and the science and technology relevant to the situation at hand. But scientific, formal, discipline-specific knowledge are not sufficient for good clinical practice, whether the discipline be law, medicine, nursing, teaching, or social work. Practitioners still have to learn how to discern generalizable scientific knowledge, know how to use scientific knowledge in practical situations, discern what scientific evidence/knowledge is relevant, assess how the particular patient’s situation differs from the general scientific understanding, and recognize the complexity of care delivery—a process that is complex, ongoing, and changing, as new evidence can overturn old.

Practice communities like individual practitioners may also be mistaken, as is illustrated by variability in practice styles and practice outcomes across hospitals and regions in the United States. This variability in practice is why practitioners must learn to critically evaluate their practice and continually improve their practice over time. The goal is to create a living self-improving tradition.

Within health care, students, scientists, and practitioners are challenged to learn and use different modes of thinking when they are conflated under one term or rubric, using the best-suited thinking strategies for taking into consideration the purposes and the ends of the reasoning. Learning to be an effective, safe nurse or physician requires not only technical expertise, but also the ability to form helping relationships and engage in practical ethical and clinical reasoning. 50 Good ethical comportment requires that both the clinician and the scientist take into account the notions of good inherent in clinical and scientific practices. The notions of good clinical practice must include the relevant significance and the human concerns involved in decisionmaking in particular situations, centered on clinical grasp and clinical forethought.

The Three Apprenticeships of Professional Education

We have much to learn in comparing the pedagogies of formation across the professions, such as is being done currently by the Carnegie Foundation for the Advancement of Teaching. The Carnegie Foundation’s broad research program on the educational preparation of the profession focuses on three essential apprenticeships:

To capture the full range of crucial dimensions in professional education, we developed the idea of a three-fold apprenticeship: (1) intellectual training to learn the academic knowledge base and the capacity to think in ways important to the profession; (2) a skill-based apprenticeship of practice; and (3) an apprenticeship to the ethical standards, social roles, and responsibilities of the profession, through which the novice is introduced to the meaning of an integrated practice of all dimensions of the profession, grounded in the profession’s fundamental purposes. 109

This framework has allowed the investigators to describe tensions and shortfalls as well as strengths of widespread teaching practices, especially at articulation points among these dimensions of professional training.

Research has demonstrated that these three apprenticeships are taught best when they are integrated so that the intellectual training includes skilled know-how, clinical judgment, and ethical comportment. In the study of nursing, exemplary classroom and clinical teachers were found who do integrate the three apprenticeships in all of their teaching, as exemplified by the following anonymous student’s comments:

With that as well, I enjoyed the class just because I do have clinical experience in my background and I enjoyed it because it took those practical applications and the knowledge from pathophysiology and pharmacology, and all the other classes, and it tied it into the actual aspects of like what is going to happen at work. For example, I work in the emergency room and question: Why am I doing this procedure for this particular patient? Beforehand, when I was just a tech and I wasn’t going to school, I’d be doing it because I was told to be doing it—or I’d be doing CPR because, you know, the doc said, start CPR. I really enjoy the Care and Illness because now I know the process, the pathophysiological process of why I’m doing it and the clinical reasons of why they’re making the decisions, and the prioritization that goes on behind it. I think that’s the biggest point. Clinical experience is good, but not everybody has it. Yet when these students transition from school and clinicals to their job as a nurse, they will understand what’s going on and why.

The three apprenticeships are equally relevant and intertwined. In the Carnegie National Study of Nursing Education and the companion study on medical education as well as in cross-professional comparisons, teaching that gives an integrated access to professional practice is being examined. Once the three apprenticeships are separated, it is difficult to reintegrate them. The investigators are encouraged by teaching strategies that integrate the latest scientific knowledge and relevant clinical evidence with clinical reasoning about particular patients in unfolding rather than static cases, while keeping the patient and family experience and concerns relevant to clinical concerns and reasoning.

Clinical judgment or phronesis is required to evaluate and integrate techne and scientific evidence.

Within nursing, professional practice is wise and effective usually to the extent that the professional creates relational and communication contexts where clients/patients can be open and trusting. Effectiveness depends upon mutual influence between patient and practitioner, student and learner. This is another way in which clinical knowledge is dialogical and socially distributed. The following articulation of practical reasoning in nursing illustrates the social, dialogical nature of clinical reasoning and addresses the centrality of perception and understanding to good clinical reasoning, judgment and intervention.

Clinical Grasp *

Clinical grasp describes clinical inquiry in action. Clinical grasp begins with perception and includes problem identification and clinical judgment across time about the particular transitions of particular patients. Garrett Chan 20 described the clinician’s attempt at finding an “optimal grasp” or vantage point of understanding. Four aspects of clinical grasp, which are described in the following paragraphs, include (1) making qualitative distinctions, (2) engaging in detective work, (3) recognizing changing relevance, and (4) developing clinical knowledge in specific patient populations.

Making Qualitative Distinctions

Qualitative distinctions refer to those distinctions that can be made only in a particular contextual or historical situation. The context and sequence of events are essential for making qualitative distinctions; therefore, the clinician must pay attention to transitions in the situation and judgment. Many qualitative distinctions can be made only by observing differences through touch, sound, or sight, such as the qualities of a wound, skin turgor, color, capillary refill, or the engagement and energy level of the patient. Another example is assessing whether the patient was more fatigued after ambulating to the bathroom or from lack of sleep. Likewise the quality of the clinician’s touch is distinct as in offering reassurance, putting pressure on a bleeding wound, and so on. 110

Engaging in Detective Work, Modus Operandi Thinking, and Clinical Puzzle Solving

Clinical situations are open ended and underdetermined. Modus operandi thinking keeps track of the particular patient, the way the illness unfolds, the meanings of the patient’s responses as they have occurred in the particular time sequence. Modus operandi thinking requires keeping track of what has been tried and what has or has not worked with the patient. In this kind of reasoning-in-transition, gains and losses of understanding are noticed and adjustments in the problem approach are made.

We found that teachers in a medical surgical unit at the University of Washington deliberately teach their students to engage in “detective work.” Students are given the daily clinical assignment of “sleuthing” for undetected drug incompatibilities, questionable drug dosages, and unnoticed signs and symptoms. For example, one student noted that an unusual dosage of a heart medication was being given to a patient who did not have heart disease. The student first asked her teacher about the unusually high dosage. The teacher, in turn, asked the student whether she had asked the nurse or the patient about the dosage. Upon the student’s questioning, the nurse did not know why the patient was receiving the high dosage and assumed the drug was for heart disease. The patient’s staff nurse had not questioned the order. When the student asked the patient, the student found that the medication was being given for tremors and that the patient and the doctor had titrated the dosage for control of the tremors. This deliberate approach to teaching detective work, or modus operandi thinking, has characteristics of “critical reflection,” but stays situated and engaged, ferreting out the immediate history and unfolding of events.

Recognizing Changing Clinical Relevance

The meanings of signs and symptoms are changed by sequencing and history. The patient’s mental status, color, or pain level may continue to deteriorate or get better. The direction, implication, and consequences for the changes alter the relevance of the particular facts in the situation. The changing relevance entailed in a patient transitioning from primarily curative care to primarily palliative care is a dramatic example, where symptoms literally take on new meanings and require new treatments.

Developing Clinical Knowledge in Specific Patient Populations

Extensive experience with a specific patient population or patients with particular injuries or diseases allows the clinician to develop comparisons, distinctions, and nuanced differences within the population. The comparisons between many specific patients create a matrix of comparisons for clinicians, as well as a tacit, background set of expectations that create population- and patient-specific detective work if a patient does not meet the usual, predictable transitions in recovery. What is in the background and foreground of the clinician’s attention shifts as predictable changes in the patient’s condition occurs, such as is seen in recovering from heart surgery or progressing through the predictable stages of labor and delivery. Over time, the clinician develops a deep background understanding that allows for expert diagnostic and interventions skills.

Clinical Forethought

Clinical forethought is intertwined with clinical grasp, but it is much more deliberate and even routinized than clinical grasp. Clinical forethought is a pervasive habit of thought and action in nursing practice, and also in medicine, as clinicians think about disease and recovery trajectories and the implications of these changes for treatment. Clinical forethought plays a role in clinical grasp because it structures the practical logic of clinicians. At least four habits of thought and action are evident in what we are calling clinical forethought: (1) future think, (2) clinical forethought about specific patient populations, (3) anticipation of risks for particular patients, and (4) seeing the unexpected.

Future think

Future think is the broadest category of this logic of practice. Anticipating likely immediate futures helps the clinician make good plans and decisions about preparing the environment so that responding rapidly to changes in the patient is possible. Without a sense of salience about anticipated signs and symptoms and preparing the environment, essential clinical judgments and timely interventions would be impossible in the typically fast pace of acute and intensive patient care. Future think governs the style and content of the nurse’s attentiveness to the patient. Whether in a fast-paced care environment or a slower-paced rehabilitation setting, thinking and acting with anticipated futures guide clinical thinking and judgment. Future think captures the way judgment is suspended in a predictive net of anticipation and preparing oneself and the environment for a range of potential events.

Clinical forethought about specific diagnoses and injuries

This habit of thought and action is so second nature to the experienced nurse that the new or inexperienced nurse may have difficulty finding out about what seems to other colleagues as “obvious” preparation for particular patients and situations. Clinical forethought involves much local specific knowledge about who is a good resource and how to marshal support services and equipment for particular patients.

Examples of preparing for specific patient populations are pervasive, such as anticipating the need for a pacemaker during surgery and having the equipment assembled ready for use to save essential time. Another example includes forecasting an accident victim’s potential injuries, and recognizing that intubation might be needed.

Anticipation of crises, risks, and vulnerabilities for particular patients

This aspect of clinical forethought is central to knowing the particular patient, family, or community. Nurses situate the patient’s problems almost like a topography of possibilities. This vital clinical knowledge needs to be communicated to other caregivers and across care borders. Clinical teaching could be improved by enriching curricula with narrative examples from actual practice, and by helping students recognize commonly occurring clinical situations in the simulation and clinical setting. For example, if a patient is hemodynamically unstable, then managing life-sustaining physiologic functions will be a main orienting goal. If the patient is agitated and uncomfortable, then attending to comfort needs in relation to hemodynamics will be a priority. Providing comfort measures turns out to be a central background practice for making clinical judgments and contains within it much judgment and experiential learning.

When clinical teaching is too removed from typical contingencies and strong clinical situations in practice, students will lack practice in active thinking-in-action in ambiguous clinical situations. In the following example, an anonymous student recounted her experiences of meeting a patient:

I was used to different equipment and didn’t know how things went, didn’t know their routine, really. You can explain all you want in class, this is how it’s going to be, but when you get there … . Kim was my first instructor and my patient that she assigned me to—I walked into the room and he had every tube imaginable. And so I was a little overwhelmed. It’s not necessarily even that he was that critical … . She asked what tubes here have you seen? Well, I know peripheral lines. You taught me PICC [peripherally inserted central catheter] lines, and we just had that, but I don’t really feel comfortable doing it by myself, without you watching to make sure that I’m flushing it right and how to assess it. He had a chest tube and I had seen chest tubes, but never really knew the depth of what you had to assess and how you make sure that it’s all kosher and whatever. So she went through the chest tube and explained, it’s just bubbling a little bit and that’s okay. The site, check the site. The site looked okay and that she’d say if it wasn’t okay, this is what it might look like … . He had a feeding tube. I had done feeding tubes but that was like a long time ago in my LPN experiences schooling. So I hadn’t really done too much with the feeding stuff either … . He had a [nasogastric] tube, and knew pretty much about that and I think at the time it was clamped. So there were no issues with the suction or whatever. He had a Foley catheter. He had a feeding tube, a chest tube. I can’t even remember but there were a lot.

As noted earlier, a central characteristic of a practice discipline is that a self-improving practice requires ongoing experiential learning. One way nurse educators can enhance clinical inquiry is by increasing pedagogies of experiential learning. Current pedagogies for experiential learning in nursing include extensive preclinical study, care planning, and shared postclinical debriefings where students share their experiential learning with their classmates. Experiential learning requires open learning climates where students can discuss and examine transitions in understanding, including their false starts, or their misconceptions in actual clinical situations. Nursing educators typically develop open and interactive clinical learning communities, so that students seem committed to helping their classmates learn from their experiences that may have been difficult or even unsafe. One anonymous nurse educator described how students extend their experiential learning to their classmates during a postclinical conference:

So for example, the patient had difficulty breathing and the student wanted to give the meds instead of addressing the difficulty of breathing. Well, while we were sharing information about their patients, what they did that day, I didn’t tell the student to say this, but she said, ‘I just want to tell you what I did today in clinical so you don’t do the same thing, and here’s what happened.’ Everybody’s listening very attentively and they were asking her some questions. But she shared that. She didn’t have to. I didn’t tell her, you must share that in postconference or anything like that, but she just went ahead and shared that, I guess, to reinforce what she had learned that day but also to benefit her fellow students in case that thing comes up with them.

The teacher’s response to this student’s honesty and generosity exemplifies her own approach to developing an open community of learning. Focusing only on performance and on “being correct” prevents learning from breakdown or error and can dampen students’ curiosity and courage to learn experientially.

Seeing the unexpected

One of the keys to becoming an expert practitioner lies in how the person holds past experiential learning and background habitual skills and practices. This is a skill of foregrounding attention accurately and effectively in response to the nature of situational demands. Bourdieu 29 calls the recognition of the situation central to practical reasoning. If nothing is routinized as a habitual response pattern, then practitioners will not function effectively in emergencies. Unexpected occurrences may be overlooked. However, if expectations are held rigidly, then subtle changes from the usual will be missed, and habitual, rote responses will inappropriately rule. The clinician must be flexible in shifting between what is in background and foreground. This is accomplished by staying curious and open. The clinical “certainty” associated with perceptual grasp is distinct from the kind of “certainty” achievable in scientific experiments and through measurements. Recognition of similar or paradigmatic clinical situations is similar to “face recognition” or recognition of “family resemblances.” This concept is subject to faulty memory, false associative memories, and mistaken identities; therefore, such perceptual grasp is the beginning of curiosity and inquiry and not the end. Assessment and validation are required. In rapidly moving clinical situations, perceptual grasp is the starting point for clarification, confirmation, and action. Having the clinician say out loud how he or she is understanding the situation gives an opportunity for confirmation and disconfirmation from other clinicians present. 111 The relationship between foreground and background of attention needs to be fluid, so that missed expectations allow the nurse to see the unexpected. For example, when the background rhythm of a cardiac monitor changes, the nurse notices, and what had been background tacit awareness becomes the foreground of attention. A hallmark of expertise is the ability to notice the unexpected. 20 Background expectations of usual patient trajectories form with experience. Tacit expectations for patient trajectories form that enable the nurse to notice subtle failed expectations and pay attention to early signs of unexpected changes in the patient's condition. Clinical expectations gained from caring for similar patient populations form a tacit clinical forethought that enable the experienced clinician to notice missed expectations. Alterations from implicit or explicit expectations set the stage for experiential learning, depending on the openness of the learner.

Learning to provide safe and quality health care requires technical expertise, the ability to think critically, experience, and clinical judgment. The high-performance expectation of nurses is dependent upon the nurses’ continual learning, professional accountability, independent and interdependent decisionmaking, and creative problem-solving abilities.

This section of the paper was condensed and paraphrased from Benner, Hooper-Kyriakidis, and Stannard. 23 Patricia Hooper-Kyriakidis wrote the section on clinical grasp, and Patricia Benner wrote the section on clinical forethought.

  • Cite this Page Benner P, Hughes RG, Sutphen M. Clinical Reasoning, Decisionmaking, and Action: Thinking Critically and Clinically. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 6.
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  • Nurses' reasoning process during care planning taking pressure ulcer prevention as an example. A think-aloud study. [Int J Nurs Stud. 2007] Nurses' reasoning process during care planning taking pressure ulcer prevention as an example. A think-aloud study. Funkesson KH, Anbäcken EM, Ek AC. Int J Nurs Stud. 2007 Sep; 44(7):1109-19. Epub 2006 Jun 27.
  • Registered nurses' clinical reasoning skills and reasoning process: A think-aloud study. [Nurse Educ Today. 2016] Registered nurses' clinical reasoning skills and reasoning process: A think-aloud study. Lee J, Lee YJ, Bae J, Seo M. Nurse Educ Today. 2016 Nov; 46:75-80. Epub 2016 Aug 15.
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Ryan M. Niemiec Psy.D.

How to Build Your Judgment and Critical Thinking

Blessed are the critical thinkers: for they help us understand and find truth..

Posted April 28, 2022 | Reviewed by Lybi Ma

  • Each person has the strength of judgment they can tap into.
  • A critical thinking blessing is one practical strategy you can use for building this strength.
  • Observing the processes of good critical thinkers can help you enhance this strength.

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Us vs. them. In-group vs. out-group. Good guys vs. bad guys. Polarization is at an all-time high. What might be an antidote?

One step in the right direction is to increase our character strength of judgment , also called critical thinking . This strength is about the pursuit of truth. It reminds us that truth is not found in impressions, stereotypes, quick glances, and preconceived notions. It is found with a persevering and always-evolving process of reflection, introspection, analysis, and open-mindedness to other views. It is found not by flipping on a political news program but by flipping on your thinking in new ways. It is found not by surfing through social media headlines but by looking for exceptions to your existing views.

How can we build this character strength? One strategy is to observe, study, and learn from those who express the strength well. What does an exemplar of critical thinking say about this strength? How do they act? Let’s find out.

Davis, an accomplished musician and decorated police chief, was a master critical thinker. He has been known throughout his community for his logic and good judgment. He has loved looking at every detail of a situation, especially his beliefs about things. He has been analytical about anything potentially controversial such as spirituality , politics , family life, and personal problems. He doesn't take his beliefs about things for granted. Rather, he goes deeper. He has sought out universal truths (and never took those for granted either).

When interviewed about his critical thinking, Davis offered several insights and practical strategies for appreciating and building this strength.

You are known as a great critical thinker. How do you use this strength of character?

When I am faced with a dilemma or controversy, I ask myself several questions:

  • How is my belief or what I’m thinking about now not true ?
  • What are the exceptions to my belief?
  • What would someone from a different culture or lived experience say about my ideas?
  • What am I missing, forgetting, or not including?
  • If I wouldn’t stake my life on my conclusion or my belief, what part of it makes me most hesitant?
  • If I was to become just a little bit more accurate or get a bit more detail on the situation, what would it be?

Wow, you really have a solid approach of “drilling down” to get to the core of that which is most essential.

I think of it like I am peeling layers of veneer in my mind. I try to peel away my first impression and I peel away my biases such as the automatic tendency to look for support for my beliefs. I peel away the layer of expectations I have of society. I peel away my automatic reactions to please or to impress others. I just keep going in the pursuit of a greater truth. Then, I remind myself that that greater truth I find is not perfect and absolute and finished, but it is better than what I started with.

Judgment or critical thinking is the ultimate “mind strength.” Doesn’t that mean you get lost in your head and miss the heart?

I see the mind and heart as one. They are completely interconnected. Each offers a different lens or starting point. A good critical thinker sees and experiences both of these lenses and others. My typical approach is to start with the analyses I mentioned to get past the multitude of biases I am subject to. I know that when I get closer to a truth I am touching my heart. I can feel it in my chest. Some people do this process in reverse and start with the heart. Each person makes their own decision on what’s best for them.

Spoken like a true critical thinker. Who takes the reverse process? Can you offer an example?

Actually, I do. As a critical thinker, I don’t want to get locked into one approach. It behooves me to be open to different analyses and ways of interacting. For example, when a person is very locked into a particular way of thinking that I perceive to be unhealthy or have negative consequences, my first step is to “appeal to their heart.” I empathize with them; I show them understanding, even though I may not agree with them. I can always offer that gift of understanding. I might also share with them how their views do not seem to align with their values. From there, my critical thinking helps me provide details and logical reasons for the misalignment I perceive. Still, I maintain an open-mindedness to be wrong, to be challenged, to be corrected.

What you are describing seems to have implications that go far beyond you and the people you interact with. How would you describe the potential of your approach?

I think of the pursuit of truth as very spiritual. A universal truth provides connection and sustenance between people. It reaches and expresses our common humanity. This is of great importance to philosophers, proponents of religion, and people across nations. When a truth is identified, there is greater acceptance within a divided group and across groups. This reminds us of some of the spiritual truths of the human condition that we are more alike than different, genetically speaking 99.9 percent the same, and also that all of us on the planet are all in this together.

Getting Practical: Use the Critical Thinking Blessing

You can use the critical thinking-judgment beatitude, "Blessed are the critical thinkers: for they help us understand and find truth" (Niemiec, 2021), to appreciate the depth of this strength of critical thinking-judgment in yourself and in others.

critical thinking is purposeful judgement which result in

  • In yourself : In what situations has this beatitude been a reality for you?
  • In others : Identify someone in your life who is high in critical thinking-judgment. Explain to them how you have benefitted from observing and experiencing this strength from them.

This article is part of an exclusive blog series on the 24 character strengths blessings/beatitudes. See the new, scientific article, called Character Strengths Beatitudes: A Secular Application of Ancient Wisdom to Appreciate Strengths for Spiritual Happiness and Spiritual Growth (Niemiec, 2021), published in the journal Religions .

Judgment/critical thinking is one of 24 universal character strengths found across countries, cultures, and beliefs, as uncovered by modern-day scientists.

Ryan M. Niemiec Psy.D.

Ryan M. Niemiec, Psy.D. , is the education director at the VIA Institute on Character.

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Enhancing Critical Thinking Skills through Decision-Based Learning

  • Published: 09 March 2022
  • Volume 47 , pages 711–734, ( 2022 )

Cite this article

  • Kenneth J. Plummer   ORCID: orcid.org/0000-0001-8946-4140 1 ,
  • Mansureh Kebritchi   ORCID: orcid.org/0000-0003-4074-2546 2 ,
  • Heather M. Leary   ORCID: orcid.org/0000-0002-2487-578X 3 &
  • Denise M. Halverson   ORCID: orcid.org/0000-0001-5825-2217 4  

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One of the major issues related to critical thinking in higher education consists of how educators teach and inspire students to develop greater critical thinking. skills. The current study was conducted to explore whether Decision-based Learning (DBL), an innovative teaching method, can enhance students’ critical thinking skills. This mixed methods ex-post facto study aimed to identify the areas of overlap between DBL and critical thinking components based on an empirically tested framework. The study was conducted at a large, private university in the western United States with two instructors and 89 undergraduate students. Data were collected via DBL publications, course midterm exam scores, and instructor interviews. Since this was an ex post facto study, the exam items were not initially written to target critical thinking skills as defined by the critical thinking framework we chose. An analysis was done on the cognitive processes elicited by the exam items after the fact, and it was found that they elicited three of the six skills described in this framework. In addition, participation in DBL activities related to statistically significant higher exam scores on these items after controlling for a standardized pre-test taken by both treatment and control groups prior to beginning the course. The effect size was large in favor of the DBL courses. In addition, two instructors reported their perspectives on the critical thinking skills exhibited by their students using DBL. The evidence collected across these three sources of information supports a connection between DBL and four of the six critical thinking components within the framework we selected.

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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Kenneth J. Plummer, Heather M. Leary, and Denise M. Halverson. The literature review, abstract, introduction, discussion sections were prepared by Mansureh Kebritchi and Ken Plummer. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Plummer, K.J., Kebritchi, M., Leary, H.M. et al. Enhancing Critical Thinking Skills through Decision-Based Learning. Innov High Educ 47 , 711–734 (2022). https://doi.org/10.1007/s10755-022-09595-9

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Critical Thinking

Critical thinking is a widely accepted educational goal. Its definition is contested, but the competing definitions can be understood as differing conceptions of the same basic concept: careful thinking directed to a goal. Conceptions differ with respect to the scope of such thinking, the type of goal, the criteria and norms for thinking carefully, and the thinking components on which they focus. Its adoption as an educational goal has been recommended on the basis of respect for students’ autonomy and preparing students for success in life and for democratic citizenship. “Critical thinkers” have the dispositions and abilities that lead them to think critically when appropriate. The abilities can be identified directly; the dispositions indirectly, by considering what factors contribute to or impede exercise of the abilities. Standardized tests have been developed to assess the degree to which a person possesses such dispositions and abilities. Educational intervention has been shown experimentally to improve them, particularly when it includes dialogue, anchored instruction, and mentoring. Controversies have arisen over the generalizability of critical thinking across domains, over alleged bias in critical thinking theories and instruction, and over the relationship of critical thinking to other types of thinking.

2.1 Dewey’s Three Main Examples

2.2 dewey’s other examples, 2.3 further examples, 2.4 non-examples, 3. the definition of critical thinking, 4. its value, 5. the process of thinking critically, 6. components of the process, 7. contributory dispositions and abilities, 8.1 initiating dispositions, 8.2 internal dispositions, 9. critical thinking abilities, 10. required knowledge, 11. educational methods, 12.1 the generalizability of critical thinking, 12.2 bias in critical thinking theory and pedagogy, 12.3 relationship of critical thinking to other types of thinking, other internet resources, related entries.

Use of the term ‘critical thinking’ to describe an educational goal goes back to the American philosopher John Dewey (1910), who more commonly called it ‘reflective thinking’. He defined it as

active, persistent and careful consideration of any belief or supposed form of knowledge in the light of the grounds that support it, and the further conclusions to which it tends. (Dewey 1910: 6; 1933: 9)

and identified a habit of such consideration with a scientific attitude of mind. His lengthy quotations of Francis Bacon, John Locke, and John Stuart Mill indicate that he was not the first person to propose development of a scientific attitude of mind as an educational goal.

In the 1930s, many of the schools that participated in the Eight-Year Study of the Progressive Education Association (Aikin 1942) adopted critical thinking as an educational goal, for whose achievement the study’s Evaluation Staff developed tests (Smith, Tyler, & Evaluation Staff 1942). Glaser (1941) showed experimentally that it was possible to improve the critical thinking of high school students. Bloom’s influential taxonomy of cognitive educational objectives (Bloom et al. 1956) incorporated critical thinking abilities. Ennis (1962) proposed 12 aspects of critical thinking as a basis for research on the teaching and evaluation of critical thinking ability.

Since 1980, an annual international conference in California on critical thinking and educational reform has attracted tens of thousands of educators from all levels of education and from many parts of the world. Also since 1980, the state university system in California has required all undergraduate students to take a critical thinking course. Since 1983, the Association for Informal Logic and Critical Thinking has sponsored sessions in conjunction with the divisional meetings of the American Philosophical Association (APA). In 1987, the APA’s Committee on Pre-College Philosophy commissioned a consensus statement on critical thinking for purposes of educational assessment and instruction (Facione 1990a). Researchers have developed standardized tests of critical thinking abilities and dispositions; for details, see the Supplement on Assessment . Educational jurisdictions around the world now include critical thinking in guidelines for curriculum and assessment. Political and business leaders endorse its importance.

For details on this history, see the Supplement on History .

2. Examples and Non-Examples

Before considering the definition of critical thinking, it will be helpful to have in mind some examples of critical thinking, as well as some examples of kinds of thinking that would apparently not count as critical thinking.

Dewey (1910: 68–71; 1933: 91–94) takes as paradigms of reflective thinking three class papers of students in which they describe their thinking. The examples range from the everyday to the scientific.

Transit : “The other day, when I was down town on 16th Street, a clock caught my eye. I saw that the hands pointed to 12:20. This suggested that I had an engagement at 124th Street, at one o'clock. I reasoned that as it had taken me an hour to come down on a surface car, I should probably be twenty minutes late if I returned the same way. I might save twenty minutes by a subway express. But was there a station near? If not, I might lose more than twenty minutes in looking for one. Then I thought of the elevated, and I saw there was such a line within two blocks. But where was the station? If it were several blocks above or below the street I was on, I should lose time instead of gaining it. My mind went back to the subway express as quicker than the elevated; furthermore, I remembered that it went nearer than the elevated to the part of 124th Street I wished to reach, so that time would be saved at the end of the journey. I concluded in favor of the subway, and reached my destination by one o’clock.” (Dewey 1910: 68-69; 1933: 91-92)

Ferryboat : “Projecting nearly horizontally from the upper deck of the ferryboat on which I daily cross the river is a long white pole, having a gilded ball at its tip. It suggested a flagpole when I first saw it; its color, shape, and gilded ball agreed with this idea, and these reasons seemed to justify me in this belief. But soon difficulties presented themselves. The pole was nearly horizontal, an unusual position for a flagpole; in the next place, there was no pulley, ring, or cord by which to attach a flag; finally, there were elsewhere on the boat two vertical staffs from which flags were occasionally flown. It seemed probable that the pole was not there for flag-flying.

“I then tried to imagine all possible purposes of the pole, and to consider for which of these it was best suited: (a) Possibly it was an ornament. But as all the ferryboats and even the tugboats carried poles, this hypothesis was rejected. (b) Possibly it was the terminal of a wireless telegraph. But the same considerations made this improbable. Besides, the more natural place for such a terminal would be the highest part of the boat, on top of the pilot house. (c) Its purpose might be to point out the direction in which the boat is moving.

“In support of this conclusion, I discovered that the pole was lower than the pilot house, so that the steersman could easily see it. Moreover, the tip was enough higher than the base, so that, from the pilot's position, it must appear to project far out in front of the boat. Morevoer, the pilot being near the front of the boat, he would need some such guide as to its direction. Tugboats would also need poles for such a purpose. This hypothesis was so much more probable than the others that I accepted it. I formed the conclusion that the pole was set up for the purpose of showing the pilot the direction in which the boat pointed, to enable him to steer correctly.” (Dewey 1910: 69-70; 1933: 92-93)

Bubbles : “In washing tumblers in hot soapsuds and placing them mouth downward on a plate, bubbles appeared on the outside of the mouth of the tumblers and then went inside. Why? The presence of bubbles suggests air, which I note must come from inside the tumbler. I see that the soapy water on the plate prevents escape of the air save as it may be caught in bubbles. But why should air leave the tumbler? There was no substance entering to force it out. It must have expanded. It expands by increase of heat, or by decrease of pressure, or both. Could the air have become heated after the tumbler was taken from the hot suds? Clearly not the air that was already entangled in the water. If heated air was the cause, cold air must have entered in transferring the tumblers from the suds to the plate. I test to see if this supposition is true by taking several more tumblers out. Some I shake so as to make sure of entrapping cold air in them. Some I take out holding mouth downward in order to prevent cold air from entering. Bubbles appear on the outside of every one of the former and on none of the latter. I must be right in my inference. Air from the outside must have been expanded by the heat of the tumbler, which explains the appearance of the bubbles on the outside. But why do they then go inside? Cold contracts. The tumbler cooled and also the air inside it. Tension was removed, and hence bubbles appeared inside. To be sure of this, I test by placing a cup of ice on the tumbler while the bubbles are still forming outside. They soon reverse” (Dewey 1910: 70–71; 1933: 93–94).

Dewey (1910, 1933) sprinkles his book with other examples of critical thinking. We will refer to the following.

Weather : A man on a walk notices that it has suddenly become cool, thinks that it is probably going to rain, looks up and sees a dark cloud obscuring the sun, and quickens his steps (1910: 6–10; 1933: 9–13).

Disorder : A man finds his rooms on his return to them in disorder with his belongings thrown about, thinks at first of burglary as an explanation, then thinks of mischievous children as being an alternative explanation, then looks to see whether valuables are missing, and discovers that they are (1910: 82–83; 1933: 166–168).

Typhoid : A physician diagnosing a patient whose conspicuous symptoms suggest typhoid avoids drawing a conclusion until more data are gathered by questioning the patient and by making tests (1910: 85–86; 1933: 170).

Blur : A moving blur catches our eye in the distance, we ask ourselves whether it is a cloud of whirling dust or a tree moving its branches or a man signaling to us, we think of other traits that should be found on each of those possibilities, and we look and see if those traits are found (1910: 102, 108; 1933: 121, 133).

Suction pump : In thinking about the suction pump, the scientist first notes that it will draw water only to a maximum height of 33 feet at sea level and to a lesser maximum height at higher elevations, selects for attention the differing atmospheric pressure at these elevations, sets up experiments in which the air is removed from a vessel containing water (when suction no longer works) and in which the weight of air at various levels is calculated, compares the results of reasoning about the height to which a given weight of air will allow a suction pump to raise water with the observed maximum height at different elevations, and finally assimilates the suction pump to such apparently different phenomena as the siphon and the rising of a balloon (1910: 150–153; 1933: 195–198).

Diamond : A passenger in a car driving in a diamond lane reserved for vehicles with at least one passenger notices that the diamond marks on the pavement are far apart in some places and close together in others. Why? The driver suggests that the reason may be that the diamond marks are not needed where there is a solid double line separating the diamond line from the adjoining lane, but are needed when there is a dotted single line permitting crossing into the diamond lane. Further observation confirms that the diamonds are close together when a dotted line separates the diamond lane from its neighbour, but otherwise far apart.

Rash : A woman suddenly develops a very itchy red rash on her throat and upper chest. She recently noticed a mark on the back of her right hand, but was not sure whether the mark was a rash or a scrape. She lies down in bed and thinks about what might be causing the rash and what to do about it. About two weeks before, she began taking blood pressure medication that contained a sulfa drug, and the pharmacist had warned her, in view of a previous allergic reaction to a medication containing a sulfa drug, to be on the alert for an allergic reaction; however, she had been taking the medication for two weeks with no such effect. The day before, she began using a new cream on her neck and upper chest; against the new cream as the cause was mark on the back of her hand, which had not been exposed to the cream. She began taking probiotics about a month before. She also recently started new eye drops, but she supposed that manufacturers of eye drops would be careful not to include allergy-causing components in the medication. The rash might be a heat rash, since she recently was sweating profusely from her upper body. Since she is about to go away on a short vacation, where she would not have access to her usual physician, she decides to keep taking the probiotics and using the new eye drops but to discontinue the blood pressure medication and to switch back to the old cream for her neck and upper chest. She forms a plan to consult her regular physician on her return about the blood pressure medication.

Candidate : Although Dewey included no examples of thinking directed at appraising the arguments of others, such thinking has come to be considered a kind of critical thinking. We find an example of such thinking in the performance task on the Collegiate Learning Assessment (CLA+), which its sponsoring organization describes as

a performance-based assessment that provides a measure of an institution’s contribution to the development of critical-thinking and written communication skills of its students. (Council for Aid to Education 2017)

A sample task posted on its website requires the test-taker to write a report for public distribution evaluating a fictional candidate’s policy proposals and their supporting arguments, using supplied background documents, with a recommendation on whether to endorse the candidate.

Immediate acceptance of an idea that suggests itself as a solution to a problem (e.g., a possible explanation of an event or phenomenon, an action that seems likely to produce a desired result) is “uncritical thinking, the minimum of reflection” (Dewey 1910: 13). On-going suspension of judgment in the light of doubt about a possible solution is not critical thinking (Dewey 1910: 108). Critique driven by a dogmatically held political or religious ideology is not critical thinking; thus Paulo Freire (1968 [1970]) is using the term (e.g., at 1970: 71, 81, 100, 146) in a more politically freighted sense that includes not only reflection but also revolutionary action against oppression. Derivation of a conclusion from given data using an algorithm is not critical thinking.

What is critical thinking? There are many definitions. Ennis (2016) lists 14 philosophically oriented scholarly definitions and three dictionary definitions. Following Rawls (1971), who distinguished his conception of justice from a utilitarian conception but regarded them as rival conceptions of the same concept, Ennis maintains that the 17 definitions are different conceptions of the same concept. Rawls articulated the shared concept of justice as

a characteristic set of principles for assigning basic rights and duties and for determining… the proper distribution of the benefits and burdens of social cooperation. (Rawls 1971: 5)

Bailin et al. (1999b) claim that, if one considers what sorts of thinking an educator would take not to be critical thinking and what sorts to be critical thinking, one can conclude that educators typically understand critical thinking to have at least three features.

  • It is done for the purpose of making up one’s mind about what to believe or do.
  • The person engaging in the thinking is trying to fulfill standards of adequacy and accuracy appropriate to the thinking.
  • The thinking fulfills the relevant standards to some threshold level.

One could sum up the core concept that involves these three features by saying that critical thinking is careful goal-directed thinking. This core concept seems to apply to all the examples of critical thinking described in the previous section. As for the non-examples, their exclusion depends on construing careful thinking as excluding jumping immediately to conclusions, suspending judgment no matter how strong the evidence, reasoning from an unquestioned ideological or religious perspective, and routinely using an algorithm to answer a question.

If the core of critical thinking is careful goal-directed thinking, conceptions of it can vary according to its presumed scope, its presumed goal, one’s criteria and threshold for being careful, and the thinking component on which one focuses As to its scope, some conceptions (e.g., Dewey 1910, 1933) restrict it to constructive thinking on the basis of one’s own observations and experiments, others (e.g., Ennis 1962; Fisher & Scriven 1997; Johnson 1992) to appraisal of the products of such thinking. Ennis (1991) and Bailin et al. (1999b) take it to cover both construction and appraisal. As to its goal, some conceptions restrict it to forming a judgment (Dewey 1910, 1933; Lipman 1987; Facione 1990a). Others allow for actions as well as beliefs as the end point of a process of critical thinking (Ennis 1991; Bailin et al. 1999b). As to the criteria and threshold for being careful, definitions vary in the term used to indicate that critical thinking satisfies certain norms: “intellectually disciplined” (Scriven & Paul 1987), “reasonable” (Ennis 1991), “skillful” (Lipman 1987), “skilled” (Fisher & Scriven 1997), “careful” (Bailin & Battersby 2009). Some definitions specify these norms, referring variously to “consideration of any belief or supposed form of knowledge in the light of the grounds that support it and the further conclusions to which it tends” (Dewey 1910, 1933); “the methods of logical inquiry and reasoning” (Glaser 1941); “conceptualizing, applying, analyzing, synthesizing, and/or evaluating information gathered from, or generated by, observation, experience, reflection, reasoning, or communication” (Scriven & Paul 1987); the requirement that “it is sensitive to context, relies on criteria, and is self-correcting” (Lipman 1987); “evidential, conceptual, methodological, criteriological, or contextual considerations” (Facione 1990a); and “plus-minus considerations of the product in terms of appropriate standards (or criteria)” (Johnson 1992). Stanovich and Stanovich (2010) propose to ground the concept of critical thinking in the concept of rationality, which they understand as combining epistemic rationality (fitting one’s beliefs to the world) and instrumental rationality (optimizing goal fulfillment); a critical thinker, in their view, is someone with “a propensity to override suboptimal responses from the autonomous mind” (2010: 227). These variant specifications of norms for critical thinking are not necessarily incompatible with one another, and in any case presuppose the core notion of thinking carefully. As to the thinking component singled out, some definitions focus on suspension of judgment during the thinking (Dewey 1910; McPeck 1981), others on inquiry while judgment is suspended (Bailin & Battersby 2009), others on the resulting judgment (Facione 1990a), and still others on the subsequent emotive response (Siegel 1988).

In educational contexts, a definition of critical thinking is a “programmatic definition” (Scheffler 1960: 19). It expresses a practical program for achieving an educational goal. For this purpose, a one-sentence formulaic definition is much less useful than articulation of a critical thinking process, with criteria and standards for the kinds of thinking that the process may involve. The real educational goal is recognition, adoption and implementation by students of those criteria and standards. That adoption and implementation in turn consists in acquiring the knowledge, abilities and dispositions of a critical thinker.

Conceptions of critical thinking generally do not include moral integrity as part of the concept. Dewey, for example, took critical thinking to be the ultimate intellectual goal of education, but distinguished it from the development of social cooperation among school children, which he took to be the central moral goal. Ennis (1996, 2011) added to his previous list of critical thinking dispositions a group of dispositions to care about the dignity and worth of every person, which he described as a “correlative” (1996) disposition without which critical thinking would be less valuable and perhaps harmful. An educational program that aimed at developing critical thinking but not the correlative disposition to care about the dignity and worth of every person, he asserted, “would be deficient and perhaps dangerous” (Ennis 1996: 172).

Dewey thought that education for reflective thinking would be of value to both the individual and society; recognition in educational practice of the kinship to the scientific attitude of children’s native curiosity, fertile imagination and love of experimental inquiry “would make for individual happiness and the reduction of social waste” (Dewey 1910: iii). Schools participating in the Eight-Year Study took development of the habit of reflective thinking and skill in solving problems as a means to leading young people to understand, appreciate and live the democratic way of life characteristic of the United States (Aikin 1942: 17–18, 81). Harvey Siegel (1988: 55–61) has offered four considerations in support of adopting critical thinking as an educational ideal. (1) Respect for persons requires that schools and teachers honour students’ demands for reasons and explanations, deal with students honestly, and recognize the need to confront students’ independent judgment; these requirements concern the manner in which teachers treat students. (2) Education has the task of preparing children to be successful adults, a task that requires development of their self-sufficiency. (3) Education should initiate children into the rational traditions in such fields as history, science and mathematics. (4) Education should prepare children to become democratic citizens, which requires reasoned procedures and critical talents and attitudes. To supplement these considerations, Siegel (1988: 62–90) responds to two objections: the ideology objection that adoption of any educational ideal requires a prior ideological commitment and the indoctrination objection that cultivation of critical thinking cannot escape being a form of indoctrination.

Despite the diversity of our 11 examples, one can recognize a common pattern. Dewey analyzed it as consisting of five phases:

  • suggestions , in which the mind leaps forward to a possible solution;
  • an intellectualization of the difficulty or perplexity into a problem to be solved, a question for which the answer must be sought;
  • the use of one suggestion after another as a leading idea, or hypothesis , to initiate and guide observation and other operations in collection of factual material;
  • the mental elaboration of the idea or supposition as an idea or supposition ( reasoning , in the sense on which reasoning is a part, not the whole, of inference); and
  • testing the hypothesis by overt or imaginative action. (Dewey 1933: 106–107; italics in original)

The process of reflective thinking consisting of these phases would be preceded by a perplexed, troubled or confused situation and followed by a cleared-up, unified, resolved situation (Dewey 1933: 106). The term ‘phases’ replaced the term ‘steps’ (Dewey 1910: 72), thus removing the earlier suggestion of an invariant sequence. Variants of the above analysis appeared in (Dewey 1916: 177) and (Dewey 1938: 101–119).

The variant formulations indicate the difficulty of giving a single logical analysis of such a varied process. The process of critical thinking may have a spiral pattern, with the problem being redefined in the light of obstacles to solving it as originally formulated. For example, the person in Transit might have concluded that getting to the appointment at the scheduled time was impossible and have reformulated the problem as that of rescheduling the appointment for a mutually convenient time. Further, defining a problem does not always follow after or lead immediately to an idea of a suggested solution. Nor should it do so, as Dewey himself recognized in describing the physician in Typhoid as avoiding any strong preference for this or that conclusion before getting further information (Dewey 1910: 85; 1933: 170). People with a hypothesis in mind, even one to which they have a very weak commitment, have a so-called “confirmation bias” (Nickerson 1998): they are likely to pay attention to evidence that confirms the hypothesis and to ignore evidence that counts against it or for some competing hypothesis. Detectives, intelligence agencies, and investigators of airplane accidents are well advised to gather relevant evidence systematically and to postpone even tentative adoption of an explanatory hypothesis until the collected evidence rules out with the appropriate degree of certainty all but one explanation. Dewey’s analysis of the critical thinking process can be faulted as well for requiring acceptance or rejection of a possible solution to a defined problem, with no allowance for deciding in the light of the available evidence to suspend judgment. Further, given the great variety of kinds of problems for which reflection is appropriate, there is likely to be variation in its component events. Perhaps the best way to conceptualize the critical thinking process is as a checklist whose component events can occur in a variety of orders, selectively, and more than once. These component events might include (1) noticing a difficulty, (2) defining the problem, (3) dividing the problem into manageable sub-problems, (4) formulating a variety of possible solutions to the problem or sub-problem, (5) determining what evidence is relevant to deciding among possible solutions to the problem or sub-problem, (6) devising a plan of systematic observation or experiment that will uncover the relevant evidence, (7) carrying out the plan of systematic observation or experimentation, (8) noting the results of the systematic observation or experiment, (9) gathering relevant testimony and information from others, (10) judging the credibility of testimony and information gathered from others, (11) drawing conclusions from gathered evidence and accepted testimony, and (12) accepting a solution that the evidence adequately supports (cf. Hitchcock 2017: 485).

Checklist conceptions of the process of critical thinking are open to the objection that they are too mechanical and procedural to fit the multi-dimensional and emotionally charged issues for which critical thinking is urgently needed (Paul 1984). For such issues, a more dialectical process is advocated, in which competing relevant world views are identified, their implications explored, and some sort of creative synthesis attempted.

If one considers the critical thinking process illustrated by the 11 examples, one can identify distinct kinds of mental acts and mental states that form part of it. To distinguish, label and briefly characterize these components is a useful preliminary to identifying abilities, skills, dispositions, attitudes, habits and the like that contribute causally to thinking critically. Identifying such abilities and habits is in turn a useful preliminary to setting educational goals. Setting the goals is in its turn a useful preliminary to designing strategies for helping learners to achieve the goals and to designing ways of measuring the extent to which learners have done so. Such measures provide both feedback to learners on their achievement and a basis for experimental research on the effectiveness of various strategies for educating people to think critically. Let us begin, then, by distinguishing the kinds of mental acts and mental events that can occur in a critical thinking process.

  • Observing : One notices something in one’s immediate environment (sudden cooling of temperature in Weather , bubbles forming outside a glass and then going inside in Bubbles , a moving blur in the distance in Blur , a rash in Rash ). Or one notes the results of an experiment or systematic observation (valuables missing in Disorder , no suction without air pressure in Suction pump )
  • Feeling : One feels puzzled or uncertain about something (how to get to an appointment on time in Transit , why the diamonds vary in frequency in Diamond ). One wants to resolve this perplexity. One feels satisfaction once one has worked out an answer (to take the subway express in Transit , diamonds closer when needed as a warning in Diamond ).
  • Wondering : One formulates a question to be addressed (why bubbles form outside a tumbler taken from hot water in Bubbles , how suction pumps work in Suction pump , what caused the rash in Rash ).
  • Imagining : One thinks of possible answers (bus or subway or elevated in Transit , flagpole or ornament or wireless communication aid or direction indicator in Ferryboat , allergic reaction or heat rash in Rash ).
  • Inferring : One works out what would be the case if a possible answer were assumed (valuables missing if there has been a burglary in Disorder , earlier start to the rash if it is an allergic reaction to a sulfa drug in Rash ). Or one draws a conclusion once sufficient relevant evidence is gathered (take the subway in Transit , burglary in Disorder , discontinue blood pressure medication and new cream in Rash ).
  • Knowledge : One uses stored knowledge of the subject-matter to generate possible answers or to infer what would be expected on the assumption of a particular answer (knowledge of a city’s public transit system in Transit , of the requirements for a flagpole in Ferryboat , of Boyle’s law in Bubbles , of allergic reactions in Rash ).
  • Experimenting : One designs and carries out an experiment or a systematic observation to find out whether the results deduced from a possible answer will occur (looking at the location of the flagpole in relation to the pilot’s position in Ferryboat , putting an ice cube on top of a tumbler taken from hot water in Bubbles , measuring the height to which a suction pump will draw water at different elevations in Suction pump , noticing the frequency of diamonds when movement to or from a diamond lane is allowed in Diamond ).
  • Consulting : One finds a source of information, gets the information from the source, and makes a judgment on whether to accept it. None of our 11 examples include searching for sources of information. In this respect they are unrepresentative, since most people nowadays have almost instant access to information relevant to answering any question, including many of those illustrated by the examples. However, Candidate includes the activities of extracting information from sources and evaluating its credibility.
  • Identifying and analyzing arguments : One notices an argument and works out its structure and content as a preliminary to evaluating its strength. This activity is central to Candidate . It is an important part of a critical thinking process in which one surveys arguments for various positions on an issue.
  • Judging : One makes a judgment on the basis of accumulated evidence and reasoning, such as the judgment in Ferryboat that the purpose of the pole is to provide direction to the pilot.
  • Deciding : One makes a decision on what to do or on what policy to adopt, as in the decision in Transit to take the subway.

By definition, a person who does something voluntarily is both willing and able to do that thing at that time. Both the willingness and the ability contribute causally to the person’s action, in the sense that the voluntary action would not occur if either (or both) of these were lacking. For example, suppose that one is standing with one’s arms at one’s sides and one voluntarily lifts one’s right arm to an extended horizontal position. One would not do so if one were unable to lift one’s arm, if for example one’s right side was paralyzed as the result of a stroke. Nor would one do so if one were unwilling to lift one’s arm, if for example one were participating in a street demonstration at which a white supremacist was urging the crowd to lift their right arm in a Nazi salute and one were unwilling to express support in this way for the racist Nazi ideology. The same analysis applies to a voluntary mental process of thinking critically. It requires both willingness and ability to think critically, including willingness and ability to perform each of the mental acts that compose the process and to coordinate those acts in a sequence that is directed at resolving the initiating perplexity.

Consider willingness first. We can identify causal contributors to willingness to think critically by considering factors that would cause a person who was able to think critically about an issue nevertheless not to do so (Hamby 2014). For each factor, the opposite condition thus contributes causally to willingness to think critically on a particular occasion. For example, people who habitually jump to conclusions without considering alternatives will not think critically about issues that arise, even if they have the required abilities. The contrary condition of willingness to suspend judgment is thus a causal contributor to thinking critically.

Now consider ability. In contrast to the ability to move one’s arm, which can be completely absent because a stroke has left the arm paralyzed, the ability to think critically is a developed ability, whose absence is not a complete absence of ability to think but absence of ability to think well. We can identify the ability to think well directly, in terms of the norms and standards for good thinking. In general, to be able do well the thinking activities that can be components of a critical thinking process, one needs to know the concepts and principles that characterize their good performance, to recognize in particular cases that the concepts and principles apply, and to apply them. The knowledge, recognition and application may be procedural rather than declarative. It may be domain-specific rather than widely applicable, and in either case may need subject-matter knowledge, sometimes of a deep kind.

Reflections of the sort illustrated by the previous two paragraphs have led scholars to identify the knowledge, abilities and dispositions of a “critical thinker”, i.e., someone who thinks critically whenever it is appropriate to do so. We turn now to these three types of causal contributors to thinking critically. We start with dispositions, since arguably these are the most powerful contributors to being a critical thinker, can be fostered at an early stage of a child’s development, and are susceptible to general improvement (Glaser 1941: 175)

8. Critical Thinking Dispositions

Educational researchers use the term ‘dispositions’ broadly for the habits of mind and attitudes that contribute causally to being a critical thinker. Some writers (e.g., Paul & Elder 2006; Hamby 2014; Bailin & Battersby 2016) propose to use the term ‘virtues’ for this dimension of a critical thinker. The virtues in question, although they are virtues of character, concern the person’s ways of thinking rather than the person’s ways of behaving towards others. They are not moral virtues but intellectual virtues, of the sort articulated by Zagzebski (1996) and discussed by Turri, Alfano, and Greco (2017).

On a realistic conception, thinking dispositions or intellectual virtues are real properties of thinkers. They are general tendencies, propensities, or inclinations to think in particular ways in particular circumstances, and can be genuinely explanatory (Siegel 1999). Sceptics argue that there is no evidence for a specific mental basis for the habits of mind that contribute to thinking critically, and that it is pedagogically misleading to posit such a basis (Bailin et al. 1999a). Whatever their status, critical thinking dispositions need motivation for their initial formation in a child—motivation that may be external or internal. As children develop, the force of habit will gradually become important in sustaining the disposition (Nieto & Valenzuela 2012). Mere force of habit, however, is unlikely to sustain critical thinking dispositions. Critical thinkers must value and enjoy using their knowledge and abilities to think things through for themselves. They must be committed to, and lovers of, inquiry.

A person may have a critical thinking disposition with respect to only some kinds of issues. For example, one could be open-minded about scientific issues but not about religious issues. Similarly, one could be confident in one’s ability to reason about the theological implications of the existence of evil in the world but not in one’s ability to reason about the best design for a guided ballistic missile.

Critical thinking dispositions can usefully be divided into initiating dispositions (those that contribute causally to starting to think critically about an issue) and internal dispositions (those that contribute causally to doing a good job of thinking critically once one has started) (Facione 1990a: 25). The two categories are not mutually exclusive. For example, open-mindedness, in the sense of willingness to consider alternative points of view to one’s own, is both an initiating and an internal disposition.

Using the strategy of considering factors that would block people with the ability to think critically from doing so, we can identify as initiating dispositions for thinking critically attentiveness, a habit of inquiry, self-confidence, courage, open-mindedness, willingness to suspend judgment, trust in reason, wanting evidence for one’s beliefs, and seeking the truth. We consider briefly what each of these dispositions amounts to, in each case citing sources that acknowledge them.

  • Attentiveness : One will not think critically if one fails to recognize an issue that needs to be thought through. For example, the pedestrian in Weather would not have looked up if he had not noticed that the air was suddenly cooler. To be a critical thinker, then, one needs to be habitually attentive to one’s surroundings, noticing not only what one senses but also sources of perplexity in messages received and in one’s own beliefs and attitudes (Facione 1990a: 25; Facione, Facione, & Giancarlo 2001).
  • Habit of inquiry : Inquiry is effortful, and one needs an internal push to engage in it. For example, the student in Bubbles could easily have stopped at idle wondering about the cause of the bubbles rather than reasoning to a hypothesis, then designing and executing an experiment to test it. Thus willingness to think critically needs mental energy and initiative. What can supply that energy? Love of inquiry, or perhaps just a habit of inquiry. Hamby (2015) has argued that willingness to inquire is the central critical thinking virtue, one that encompasses all the others. It is recognized as a critical thinking disposition by Dewey (1910: 29; 1933: 35), Glaser (1941: 5), Ennis (1987: 12; 1991: 8), Facione (1990a: 25), Bailin et al. (1999b: 294), Halpern (1998: 452), and Facione, Facione, & Giancarlo (2001).
  • Self-confidence : Lack of confidence in one’s abilities can block critical thinking. For example, if the woman in Rash lacked confidence in her ability to figure things out for herself, she might just have assumed that the rash on her chest was the allergic reaction to her medication against which the pharmacist had warned her. Thus willingness to think critically requires confidence in one’s ability to inquire (Facione 1990a: 25; Facione, Facione, & Giancarlo 2001).
  • Courage : Fear of thinking for oneself can stop one from doing it. Thus willingness to think critically requires intellectual courage (Paul & Elder 2006: 16).
  • Open-mindedness : A dogmatic attitude will impede thinking critically. For example, a person who adheres rigidly to a “pro-choice” position on the issue of the legal status of induced abortion is likely to be unwilling to consider seriously the issue of when in its development an unborn child acquires a moral right to life. Thus willingness to think critically requires open-mindedness, in the sense of a willingness to examine questions to which one already accepts an answer but which further evidence or reasoning might cause one to answer differently (Dewey 1933; Facione 1990a; Ennis 1991; Bailin et al. 1999b; Halpern 1998, Facione, Facione, & Giancarlo 2001). Paul (1981) emphasizes open-mindedness about alternative world-views, and recommends a dialectical approach to integrating such views as central to what he calls “strong sense” critical thinking.
  • Willingness to suspend judgment : Premature closure on an initial solution will block critical thinking. Thus willingness to think critically requires a willingness to suspend judgment while alternatives are explored (Facione 1990a; Ennis 1991; Halpern 1998).
  • Trust in reason : Since distrust in the processes of reasoned inquiry will dissuade one from engaging in it, trust in them is an initiating critical thinking disposition (Facione 1990a, 25; Bailin et al. 1999b: 294; Facione, Facione, & Giancarlo 2001; Paul & Elder 2006). In reaction to an allegedly exclusive emphasis on reason in critical thinking theory and pedagogy, Thayer-Bacon (2000) argues that intuition, imagination, and emotion have important roles to play in an adequate conception of critical thinking that she calls “constructive thinking”. From her point of view, critical thinking requires trust not only in reason but also in intuition, imagination, and emotion.
  • Seeking the truth : If one does not care about the truth but is content to stick with one’s initial bias on an issue, then one will not think critically about it. Seeking the truth is thus an initiating critical thinking disposition (Bailin et al. 1999b: 294; Facione, Facione, & Giancarlo 2001). A disposition to seek the truth is implicit in more specific critical thinking dispositions, such as trying to be well-informed, considering seriously points of view other than one’s own, looking for alternatives, suspending judgment when the evidence is insufficient, and adopting a position when the evidence supporting it is sufficient.

Some of the initiating dispositions, such as open-mindedness and willingness to suspend judgment, are also internal critical thinking dispositions, in the sense of mental habits or attitudes that contribute causally to doing a good job of critical thinking once one starts the process. But there are many other internal critical thinking dispositions. Some of them are parasitic on one’s conception of good thinking. For example, it is constitutive of good thinking about an issue to formulate the issue clearly and to maintain focus on it. For this purpose, one needs not only the corresponding ability but also the corresponding disposition. Ennis (1991: 8) describes it as the disposition “to determine and maintain focus on the conclusion or question”, Facione (1990a: 25) as “clarity in stating the question or concern”. Other internal dispositions are motivators to continue or adjust the critical thinking process, such as willingness to persist in a complex task and willingness to abandon nonproductive strategies in an attempt to self-correct (Halpern 1998: 452). For a list of identified internal critical thinking dispositions, see the Supplement on Internal Critical Thinking Dispositions .

Some theorists postulate skills, i.e., acquired abilities, as operative in critical thinking. It is not obvious, however, that a good mental act is the exercise of a generic acquired skill. Inferring an expected time of arrival, as in Transit , has some generic components but also uses non-generic subject-matter knowledge. Bailin et al. (1999a) argue against viewing critical thinking skills as generic and discrete, on the ground that skilled performance at a critical thinking task cannot be separated from knowledge of concepts and from domain-specific principles of good thinking. Talk of skills, they concede, is unproblematic if it means merely that a person with critical thinking skills is capable of intelligent performance.

Despite such scepticism, theorists of critical thinking have listed as general contributors to critical thinking what they variously call abilities (Glaser 1941; Ennis 1962, 1991), skills (Facione 1990a; Halpern 1998) or competencies (Fisher & Scriven 1997). Amalgamating these lists would produce a confusing and chaotic cornucopia of more than 50 possible educational objectives, with only partial overlap among them. It makes sense instead to try to understand the reasons for the multiplicity and diversity, and to make a selection according to one’s own reasons for singling out abilities to be developed in a critical thinking curriculum. Two reasons for diversity among lists of critical thinking abilities are the underlying conception of critical thinking and the envisaged educational level. Appraisal-only conceptions, for example, involve a different suite of abilities than constructive-only conceptions. Some lists, such as those in (Glaser 1941), are put forward as educational objectives for secondary school students, whereas others are proposed as objectives for college students (e.g., Facione 1990a).

The abilities described in the remaining paragraphs of this section emerge from reflection on the general abilities needed to do well the thinking activities identified in section 6 as components of the critical thinking process described in section 5 . The derivation of each collection of abilities is accompanied by citation of sources that list such abilities and of standardized tests that claim to test them.

Observational abilities : Careful and accurate observation sometimes requires specialist expertise and practice, as in the case of observing birds and observing accident scenes. However, there are general abilities of noticing what one’s senses are picking up from one’s environment and of being able to articulate clearly and accurately to oneself and others what one has observed. It helps in exercising them to be able to recognize and take into account factors that make one’s observation less trustworthy, such as prior framing of the situation, inadequate time, deficient senses, poor observation conditions, and the like. It helps as well to be skilled at taking steps to make one’s observation more trustworthy, such as moving closer to get a better look, measuring something three times and taking the average, and checking what one thinks one is observing with someone else who is in a good position to observe it. It also helps to be skilled at recognizing respects in which one’s report of one’s observation involves inference rather than direct observation, so that one can then consider whether the inference is justified. These abilities come into play as well when one thinks about whether and with what degree of confidence to accept an observation report, for example in the study of history or in a criminal investigation or in assessing news reports. Observational abilities show up in some lists of critical thinking abilities (Ennis 1962: 90; Facione 1990a: 16; Ennis 1991: 9). There are items testing a person’s ability to judge the credibility of observation reports in the Cornell Critical Thinking Tests, Levels X and Z (Ennis & Millman 1971; Ennis, Millman, & Tomko 1985, 2005). Norris and King (1983, 1985, 1990a, 1990b) is a test of ability to appraise observation reports.

Emotional abilities : The emotions that drive a critical thinking process are perplexity or puzzlement, a wish to resolve it, and satisfaction at achieving the desired resolution. Children experience these emotions at an early age, without being trained to do so. Education that takes critical thinking as a goal needs only to channel these emotions and to make sure not to stifle them. Collaborative critical thinking benefits from ability to recognize one’s own and others’ emotional commitments and reactions.

Questioning abilities : A critical thinking process needs transformation of an inchoate sense of perplexity into a clear question. Formulating a question well requires not building in questionable assumptions, not prejudging the issue, and using language that in context is unambiguous and precise enough (Ennis 1962: 97; 1991: 9).

Imaginative abilities : Thinking directed at finding the correct causal explanation of a general phenomenon or particular event requires an ability to imagine possible explanations. Thinking about what policy or plan of action to adopt requires generation of options and consideration of possible consequences of each option. Domain knowledge is required for such creative activity, but a general ability to imagine alternatives is helpful and can be nurtured so as to become easier, quicker, more extensive, and deeper (Dewey 1910: 34–39; 1933: 40–47). Facione (1990a) and Halpern (1998) include the ability to imagine alternatives as a critical thinking ability.

Inferential abilities : The ability to draw conclusions from given information, and to recognize with what degree of certainty one’s own or others’ conclusions follow, is universally recognized as a general critical thinking ability. All 11 examples in section 2 of this article include inferences, some from hypotheses or options (as in Transit , Ferryboat and Disorder ), others from something observed (as in Weather and Rash ). None of these inferences is formally valid. Rather, they are licensed by general, sometimes qualified substantive rules of inference (Toulmin 1958) that rest on domain knowledge—that a bus trip takes about the same time in each direction, that the terminal of a wireless telegraph would be located on the highest possible place, that sudden cooling is often followed by rain, that an allergic reaction to a sulfa drug generally shows up soon after one starts taking it. It is a matter of controversy to what extent the specialized ability to deduce conclusions from premisses using formal rules of inference is needed for critical thinking. Dewey (1933) locates logical forms in setting out the products of reflection rather than in the process of reflection. Ennis (1981a), on the other hand, maintains that a liberally-educated person should have the following abilities: to translate natural-language statements into statements using the standard logical operators, to use appropriately the language of necessary and sufficient conditions, to deal with argument forms and arguments containing symbols, to determine whether in virtue of an argument’s form its conclusion follows necessarily from its premisses, to reason with logically complex propositions, and to apply the rules and procedures of deductive logic. Inferential abilities are recognized as critical thinking abilities by Glaser (1941: 6), Facione (1990a: 9), Ennis (1991: 9), Fisher & Scriven (1997: 99, 111), and Halpern (1998: 452). Items testing inferential abilities constitute two of the five subtests of the Watson Glaser Critical Thinking Appraisal (Watson & Glaser 1980a, 1980b, 1994), two of the four sections in the Cornell Critical Thinking Test Level X (Ennis & Millman 1971; Ennis, Millman, & Tomko 1985, 2005), three of the seven sections in the Cornell Critical Thinking Test Level Z (Ennis & Millman 1971; Ennis, Millman, & Tomko 1985, 2005), 11 of the 34 items on Forms A and B of the California Critical Thinking Skills Test (Facione 1990b, 1992), and a high but variable proportion of the 25 selected-response questions in the Collegiate Learning Assessment (Council for Aid to Education 2017).

Experimenting abilities : Knowing how to design and execute an experiment is important not just in scientific research but also in everyday life, as in Rash . Dewey devoted a whole chapter of his How We Think (1910: 145–156; 1933: 190–202) to the superiority of experimentation over observation in advancing knowledge. Experimenting abilities come into play at one remove in appraising reports of scientific studies. Skill in designing and executing experiments includes the acknowledged abilities to appraise evidence (Glaser 1941: 6), to carry out experiments and to apply appropriate statistical inference techniques (Facione 1990a: 9), to judge inductions to an explanatory hypothesis (Ennis 1991: 9), and to recognize the need for an adequately large sample size (Halpern 1998). The Cornell Critical Thinking Test Level Z (Ennis & Millman 1971; Ennis, Millman, & Tomko 1985, 2005) includes four items (out of 52) on experimental design. The Collegiate Learning Assessment (Council for Aid to Education 2017) makes room for appraisal of study design in both its performance task and its selected-response questions.

Consulting abilities : Skill at consulting sources of information comes into play when one seeks information to help resolve a problem, as in Candidate . Ability to find and appraise information includes ability to gather and marshal pertinent information (Glaser 1941: 6), to judge whether a statement made by an alleged authority is acceptable (Ennis 1962: 84), to plan a search for desired information (Facione 1990a: 9), and to judge the credibility of a source (Ennis 1991: 9). Ability to judge the credibility of statements is tested by 24 items (out of 76) in the Cornell Critical Thinking Test Level X (Ennis & Millman 1971; Ennis, Millman, & Tomko 1985, 2005) and by four items (out of 52) in the Cornell Critical Thinking Test Level Z (Ennis & Millman 1971; Ennis, Millman, & Tomko 1985, 2005). The College Learning Assessment’s performance task requires evaluation of whether information in documents is credible or unreliable (Council for Aid to Education 2017).

Argument analysis abilities : The ability to identify and analyze arguments contributes to the process of surveying arguments on an issue in order to form one’s own reasoned judgment, as in Candidate . The ability to detect and analyze arguments is recognized as a critical thinking skill by Facione (1990a: 7–8), Ennis (1991: 9) and Halpern (1998). Five items (out of 34) on the California Critical Thinking Skills Test (Facione 1990b, 1992) test skill at argument analysis. The College Learning Assessment (Council for Aid to Education 2017) incorporates argument analysis in its selected-response tests of critical reading and evaluation and of critiquing an argument.

Judging skills and deciding skills : Skill at judging and deciding is skill at recognizing what judgment or decision the available evidence and argument supports, and with what degree of confidence. It is thus a component of the inferential skills already discussed.

Lists and tests of critical thinking abilities often include two more abilities: identifying assumptions and constructing and evaluating definitions.

In addition to dispositions and abilities, critical thinking needs knowledge: of critical thinking concepts, of critical thinking principles, and of the subject-matter of the thinking.

We can derive a short list of concepts whose understanding contributes to critical thinking from the critical thinking abilities described in the preceding section. Observational abilities require an understanding of the difference between observation and inference. Questioning abilities require an understanding of the concepts of ambiguity and vagueness. Inferential abilities require an understanding of the difference between conclusive and defeasible inference (traditionally, between deduction and induction), as well as of the difference between necessary and sufficient conditions. Experimenting abilities require an understanding of the concepts of hypothesis, null hypothesis, assumption and prediction, as well as of the concept of statistical significance and of its difference from importance. They also require an understanding of the difference between an experiment and an observational study, and in particular of the difference between a randomized controlled trial, a prospective correlational study and a retrospective (case-control) study. Argument analysis abilities require an understanding of the concepts of argument, premiss, assumption, conclusion and counter-consideration. Additional critical thinking concepts are proposed by Bailin et al. (1999b: 293), Fisher & Scriven (1997: 105–106), and Black (2012).

According to Glaser (1941: 25), ability to think critically requires knowledge of the methods of logical inquiry and reasoning. If we review the list of abilities in the preceding section, however, we can see that some of them can be acquired and exercised merely through practice, possibly guided in an educational setting, followed by feedback. Searching intelligently for a causal explanation of some phenomenon or event requires that one consider a full range of possible causal contributors, but it seems more important that one implements this principle in one’s practice than that one is able to articulate it. What is important is “operational knowledge” of the standards and principles of good thinking (Bailin et al. 1999b: 291–293). But the development of such critical thinking abilities as designing an experiment or constructing an operational definition can benefit from learning their underlying theory. Further, explicit knowledge of quirks of human thinking seems useful as a cautionary guide. Human memory is not just fallible about details, as people learn from their own experiences of misremembering, but is so malleable that a detailed, clear and vivid recollection of an event can be a total fabrication (Loftus 2017). People seek or interpret evidence in ways that are partial to their existing beliefs and expectations, often unconscious of their “confirmation bias” (Nickerson 1998). Not only are people subject to this and other cognitive biases (Kahneman 2011), of which they are typically unaware, but it may be counter-productive for one to make oneself aware of them and try consciously to counteract them or to counteract social biases such as racial or sexual stereotypes (Kenyon & Beaulac 2014). It is helpful to be aware of these facts and of the superior effectiveness of blocking the operation of biases—for example, by making an immediate record of one’s observations, refraining from forming a preliminary explanatory hypothesis, blind refereeing, double-blind randomized trials, and blind grading of students’ work.

Critical thinking about an issue requires substantive knowledge of the domain to which the issue belongs. Critical thinking abilities are not a magic elixir that can be applied to any issue whatever by somebody who has no knowledge of the facts relevant to exploring that issue. For example, the student in Bubbles needed to know that gases do not penetrate solid objects like a glass, that air expands when heated, that the volume of an enclosed gas varies directly with its temperature and inversely with its pressure, and that hot objects will spontaneously cool down to the ambient temperature of their surroundings unless kept hot by insulation or a source of heat. Critical thinkers thus need a rich fund of subject-matter knowledge relevant to the variety of situations they encounter. This fact is recognized in the inclusion among critical thinking dispositions of a concern to become and remain generally well informed.

Experimental educational interventions, with control groups, have shown that education can improve critical thinking skills and dispositions, as measured by standardized tests. For information about these tests, see the Supplement on Assessment .

What educational methods are most effective at developing the dispositions, abilities and knowledge of a critical thinker? Abrami et al. (2015) found that in the experimental and quasi-experimental studies that they analyzed dialogue, anchored instruction, and mentoring each increased the effectiveness of the educational intervention, and that they were most effective when combined. They also found that in these studies a combination of separate instruction in critical thinking with subject-matter instruction in which students are encouraged to think critically was more effective than either by itself. However, the difference was not statistically significant; that is, it might have arisen by chance.

Most of these studies lack the longitudinal follow-up required to determine whether the observed differential improvements in critical thinking abilities or dispositions continue over time, for example until high school or college graduation. For details on studies of methods of developing critical thinking skills and dispositions, see the Supplement on Educational Methods .

12. Controversies

Scholars have denied the generalizability of critical thinking abilities across subject domains, have alleged bias in critical thinking theory and pedagogy, and have investigated the relationship of critical thinking to other kinds of thinking.

McPeck (1981) attacked the thinking skills movement of the 1970s, including the critical thinking movement. He argued that there are no general thinking skills, since thinking is always thinking about some subject-matter. It is futile, he claimed, for schools and colleges to teach thinking as if it were a separate subject. Rather, teachers should lead their pupils to become autonomous thinkers by teaching school subjects in a way that brings out their cognitive structure and that encourages and rewards discussion and argument. As some of his critics (e.g., Paul 1985; Siegel 1985) pointed out, McPeck’s central argument needs elaboration, since it has obvious counter-examples in writing and speaking, for which (up to a certain level of complexity) there are teachable general abilities even though they are always about some subject-matter. To make his argument convincing, McPeck needs to explain how thinking differs from writing and speaking in a way that does not permit useful abstraction of its components from the subject-matters with which it deals. He has not done so. Nevertheless, his position that the dispositions and abilities of a critical thinker are best developed in the context of subject-matter instruction is shared by many theorists of critical thinking, including Dewey (1910, 1933), Glaser (1941), Passmore (1980), Weinstein (1990), and Bailin et al. (1999b).

McPeck’s challenge prompted reflection on the extent to which critical thinking is subject-specific. McPeck argued for a strong subject-specificity thesis, according to which it is a conceptual truth that all critical thinking abilities are specific to a subject. (He did not however extend his subject-specificity thesis to critical thinking dispositions. In particular, he took the disposition to suspend judgment in situations of cognitive dissonance to be a general disposition.) Conceptual subject-specificity is subject to obvious counter-examples, such as the general ability to recognize confusion of necessary and sufficient conditions. A more modest thesis, also endorsed by McPeck, is epistemological subject-specificity, according to which the norms of good thinking vary from one field to another. Epistemological subject-specificity clearly holds to a certain extent; for example, the principles in accordance with which one solves a differential equation are quite different from the principles in accordance with which one determines whether a painting is a genuine Picasso. But the thesis suffers, as Ennis (1989) points out, from vagueness of the concept of a field or subject and from the obvious existence of inter-field principles, however broadly the concept of a field is construed. For example, the principles of hypothetico-deductive reasoning hold for all the varied fields in which such reasoning occurs. A third kind of subject-specificity is empirical subject-specificity, according to which as a matter of empirically observable fact a person with the abilities and dispositions of a critical thinker in one area of investigation will not necessarily have them in another area of investigation.

The thesis of empirical subject-specificity raises the general problem of transfer. If critical thinking abilities and dispositions have to be developed independently in each school subject, how are they of any use in dealing with the problems of everyday life and the political and social issues of contemporary society, most of which do not fit into the framework of a traditional school subject? Proponents of empirical subject-specificity tend to argue that transfer is more likely to occur if there is critical thinking instruction in a variety of domains, with explicit attention to dispositions and abilities that cut across domains. But evidence for this claim is scanty. There is a need for well-designed empirical studies that investigate the conditions that make transfer more likely.

It is common ground in debates about the generality or subject-specificity of critical thinking dispositions and abilities that critical thinking about any topic requires background knowledge about the topic. For example, the most sophisticated understanding of the principles of hypothetico-deductive reasoning is of no help unless accompanied by some knowledge of what might be plausible explanations of some phenomenon under investigation.

Critics have objected to bias in the theory, pedagogy and practice of critical thinking. Commentators (e.g., Alston 1995; Ennis 1998) have noted that anyone who takes a position has a bias in the neutral sense of being inclined in one direction rather than others. The critics, however, are objecting to bias in the pejorative sense of an unjustified favoring of certain ways of knowing over others, frequently alleging that the unjustly favoured ways are those of a dominant sex or culture (Bailin 1995). These ways favour:

  • reinforcement of egocentric and sociocentric biases over dialectical engagement with opposing world-views (Paul 1981, 1984; Warren 1998)
  • distancing from the object of inquiry over closeness to it (Martin 1992; Thayer-Bacon 1992)
  • indifference to the situation of others over care for them (Martin 1992)
  • orientation to thought over orientation to action (Martin 1992)
  • being reasonable over caring to understand people’s ideas (Thayer-Bacon 1993)
  • being neutral and objective over being embodied and situated (Thayer-Bacon 1995a)
  • doubting over believing (Thayer-Bacon 1995b)
  • reason over emotion, imagination and intuition (Thayer-Bacon 2000)
  • solitary thinking over collaborative thinking (Thayer-Bacon 2000)
  • written and spoken assignments over other forms of expression (Alston 2001)
  • attention to written and spoken communications over attention to human problems (Alston 2001)
  • winning debates in the public sphere over making and understanding meaning (Alston 2001)

A common thread in this smorgasbord of accusations is dissatisfaction with focusing on the logical analysis and evaluation of reasoning and arguments. While these authors acknowledge that such analysis and evaluation is part of critical thinking and should be part of its conceptualization and pedagogy, they insist that it is only a part. Paul (1981), for example, bemoans the tendency of atomistic teaching of methods of analyzing and evaluating arguments to turn students into more able sophists, adept at finding fault with positions and arguments with which they disagree but even more entrenched in the egocentric and sociocentric biases with which they began. Martin (1992) and Thayer-Bacon (1992) cite with approval the self-reported intimacy with their subject-matter of leading researchers in biology and medicine, an intimacy that conflicts with the distancing allegedly recommended in standard conceptions and pedagogy of critical thinking. Thayer-Bacon (2000) contrasts the embodied and socially embedded learning of her elementary school students in a Montessori school, who used their imagination, intuition and emotions as well as their reason, with conceptions of critical thinking as

thinking that is used to critique arguments, offer justifications, and make judgments about what are the good reasons, or the right answers. (Thayer-Bacon 2000: 127–128)

Alston (2001) reports that her students in a women’s studies class were able to see the flaws in the Cinderella myth that pervades much romantic fiction but in their own romantic relationships still acted as if all failures were the woman’s fault and still accepted the notions of love at first sight and living happily ever after. Students, she writes, should

be able to connect their intellectual critique to a more affective, somatic, and ethical account of making risky choices that have sexist, racist, classist, familial, sexual, or other consequences for themselves and those both near and far… critical thinking that reads arguments, texts, or practices merely on the surface without connections to feeling/desiring/doing or action lacks an ethical depth that should infuse the difference between mere cognitive activity and something we want to call critical thinking. (Alston 2001: 34)

Some critics portray such biases as unfair to women. Thayer-Bacon (1992), for example, has charged modern critical thinking theory with being sexist, on the ground that it separates the self from the object and causes one to lose touch with one’s inner voice, and thus stigmatizes women, who (she asserts) link self to object and listen to their inner voice. Her charge does not imply that women as a group are on average less able than men to analyze and evaluate arguments. Facione (1990c) found no difference by sex in performance on his California Critical Thinking Skills Test. Kuhn (1991: 280–281) found no difference by sex in either the disposition or the competence to engage in argumentative thinking.

The critics propose a variety of remedies for the biases that they allege. In general, they do not propose to eliminate or downplay critical thinking as an educational goal. Rather, they propose to conceptualize critical thinking differently and to change its pedagogy accordingly. Their pedagogical proposals arise logically from their objections. They can be summarized as follows:

  • Focus on argument networks with dialectical exchanges reflecting contesting points of view rather than on atomic arguments, so as to develop “strong sense” critical thinking that transcends egocentric and sociocentric biases (Paul 1981, 1984).
  • Foster closeness to the subject-matter and feeling connected to others in order to inform a humane democracy (Martin 1992).
  • Develop “constructive thinking” as a social activity in a community of physically embodied and socially embedded inquirers with personal voices who value not only reason but also imagination, intuition and emotion (Thayer-Bacon 2000).
  • In developing critical thinking in school subjects, treat as important neither skills nor dispositions but opening worlds of meaning (Alston 2001).
  • Attend to the development of critical thinking dispositions as well as skills, and adopt the “critical pedagogy” practised and advocated by Freire (1968 [1970]) and hooks (1994) (Dalgleish, Girard, & Davies 2017).

A common thread in these proposals is treatment of critical thinking as a social, interactive, personally engaged activity like that of a quilting bee or a barn-raising (Thayer-Bacon 2000) rather than as an individual, solitary, distanced activity symbolized by Rodin’s The Thinker . One can get a vivid description of education with the former type of goal from the writings of bell hooks (1994, 2010). Critical thinking for her is open-minded dialectical exchange across opposing standpoints and from multiple perspectives, a conception similar to Paul’s “strong sense” critical thinking (Paul 1981). She abandons the structure of domination in the traditional classroom. In an introductory course on black women writers, for example, she assigns students to write an autobiographical paragraph about an early racial memory, then to read it aloud as the others listen, thus affirming the uniqueness and value of each voice and creating a communal awareness of the diversity of the group’s experiences (hooks 1994: 84). Her “engaged pedagogy” is thus similar to the “freedom under guidance” implemented in John Dewey’s Laboratory School of Chicago in the late 1890s and early 1900s. It incorporates the dialogue, anchored instruction, and mentoring that Abrami (2015) found to be most effective in improving critical thinking skills and dispositions.

What is the relationship of critical thinking to problem solving, decision-making, higher-order thinking, creative thinking, and other recognized types of thinking? One’s answer to this question obviously depends on how one defines the terms used in the question. If critical thinking is conceived broadly to cover any careful thinking about any topic for any purpose, then problem solving and decision making will be kinds of critical thinking, if they are done carefully. Historically, ‘critical thinking’ and ‘problem solving’ were two names for the same thing. If critical thinking is conceived more narrowly as consisting solely of appraisal of intellectual products, then it will be disjoint with problem solving and decision making, which are constructive.

Bloom’s taxonomy of educational objectives used the phrase “intellectual abilities and skills” for what had been labeled “critical thinking” by some, “reflective thinking” by Dewey and others, and “problem solving” by still others (Bloom et al. 1956: 38). Thus, the so-called “higher-order thinking skills” at the taxonomy’s top levels of analysis, synthesis and evaluation are just critical thinking skills, although they do not come with general criteria for their assessment (Ennis 1981b). The revised version of Bloom’s taxonomy (Anderson et al. 2001) likewise treats critical thinking as cutting across those types of cognitive process that involve more than remembering (Anderson et al. 2001: 269–270). For details, see the Supplement on History .

As to creative thinking, it overlaps with critical thinking (Bailin 1987, 1988). Thinking about the explanation of some phenomenon or event, as in Ferryboat , requires creative imagination in constructing plausible explanatory hypotheses. Likewise, thinking about a policy question, as in Candidate , requires creativity in coming up with options. Conversely, creativity in any field needs to be balanced by critical appraisal of the draft painting or novel or mathematical theory.

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Critical thinking, the nursing process, and clinical judgment

CHAPTER 8 Critical thinking, the nursing process, and clinical judgment Learning outcomes After studying this chapter, students will be able to: •  Define critical thinking. •  Describe the importance of critical thinking in nursing. •  Contrast the characteristics of “novice thinking” with those of “expert thinking.” •  Explain the purpose and phases of the nursing process. •  Differentiate between nursing orders and medical orders. •  Explain the differences between independent, interdependent, and dependent nursing actions. •  Describe evaluation and its importance in the nursing process. •  Define clinical judgment in nursing practice and explain how it is developed. •  Devise a personal plan to use in developing sound clinical judgment. To enhance your understanding of this chapter, try the Student Exercises on the Evolve site at http://evolve.elsevier.com/Black/professional . Almost every encounter a nurse has with a patient is an opportunity for the nurse to assist the patient to a higher level of wellness or comfort. A nurse’s ability to think critically about a patient’s particular needs and how best to meet them will determine the extent to which a patient benefits from the nurse’s care. A nurse’s ability to use a reliable cognitive approach is crucial in determining a patient’s priorities for care and in making sound clinical decisions in addressing those priorities. This chapter explores several important and interdependent aspects of thinking and decision making in nursing: critical thinking, the nursing process, and clinical judgment. Chapter opening photo from istockphoto.com . Defining critical thinking Defining “critical thinking” is a complex task that requires an understanding of how people think through problems. Educators and philosophers struggled with definitions of critical thinking for several decades. Two decades ago, the American Philosophical Association published an expert consensus statement ( Box 8-1 ) describing critical thinking and attributes of the ideal critical thinker. This expert statement, still widely used, was the culmination of 3 years of work by Facione and others who synthesized the work of numerous persons who had defined critical thinking. More recently, Facione (2006) noted that giving a definition of critical thinking that can be memorized by the learner is actually antithetical to critical thinking! This means that the very definition of critical thinking does not lend itself to simplistic thinking and memorization. BOX 8-1     EXPERT CONSENSUS STATEMENT REGARDING CRITICAL THINKING AND THE IDEAL CRITICAL THINKER We understand critical thinking (CT) to be purposeful, self-regulatory judgment that results in interpretation, analysis, evaluation, and inference, as well as explanation of the evidential, conceptual, methodological, criteriological, or contextual considerations upon which that judgment is based. CT is essential as a tool of inquiry. As such, CT is a liberating force in education and a powerful resource in one’s personal and civic life. While not synonymous with good thinking, CT is a pervasive and self-rectifying human phenomenon. The ideal critical thinker is habitually inquisitive, well-informed, trustful of reason, open-minded, flexible, fair-minded in evaluation, honest in facing personal biases, prudent in making judgments, willing to reconsider, clear about issues, orderly in complex matters, diligent in seeking relevant information, reasonable in the selection of criteria, focused in inquiry, and persistent in seeking results that are as precise as the subject and the circumstances of inquiry permit. Thus educating good critical thinkers means working toward this ideal. It combines developing CT skills with nurturing those dispositions that consistently yield useful insights and that are the basis of a rational and democratic society. From American Philosophical Association : Critical Thinking: A Statement of Expert Consensus for Purposes of Educational Assessment and Instruction, The Delphi report: Research findings and recommendations prepared for the committee on pre-college philosophy, 1990, ERIC Document Reproduction Services, pp. 315–423. The Paul-Elder Critical Thinking Framework is grounded in this definition of critical thinking: “Critical thinking is that mode of thinking—about any subject, content, or problem—in which the thinker improves the quality of his or her thinking by skillfully taking charge of the structures inherent in thinking and imposing intellectual standards upon them.” Paul and Elder, 2012 Paul and Elder (2012) go on to describe a “well-cultivated critical thinker” as one who does the following: •  Raises questions and problems and formulates them clearly and precisely •  Gathers and assesses relevant information, using abstract ideas for interpretation •  Arrives at conclusions and solutions that are well-reasoned and tests them against relevant standards •  Is open-minded and recognizes alternative ways of seeing problems, and has the ability to assess the assumptions, implications, and consequences of alternative views of problems •  Communicates effectively with others as solutions to complex problems are formulated We live in a “new knowledge economy” driven by information and technology that changes quickly. Analyzing and integrating information across an increasing number of sources of knowledge requires that you have flexible intellectual skills. Being a good critical thinker makes you more adaptable in this new economy of knowledge ( Lau and Chan, 2012). An excellent website on critical thinking can be found at http://philosophy.hku.hk/think/ (OpenCourseWare on critical thinking, logic, and creativity). So what does this have to do with nursing? The answer is very simple: excellent critical thinking skills are required for you to make good clinical judgments. You will be responsible and accountable for your own decisions as a professional nurse. The development of critical thinking skills is crucial as you provide nursing care for patients with increasingly complex conditions. Critical thinking skills provide you with a powerful means of determining patient needs, interpreting physician orders, and intervening appropriately. Box 8-2 presents an example of the importance of critical thinking in the provision of safe care. BOX 8-2     USING CRITICAL THINKING SKILLS TO IMPROVE A PATIENT’S CARE Ms. George has recently undergone bariatric surgery after many attempts to lose weight over the years have failed. She is to be discharged home on postoperative day 2, as per the usual protocol. Although she describes herself as “not feeling well at all,” the physician writes the order for discharge and you, as the nurse who does postoperative discharge planning for the surgery practice, prepare Ms. George to go home with her new dietary guidelines and encouragement for her successful weight loss. You note that Ms. George does not seem as comfortable or pleased with her surgery as most patients with whom you have worked in the past. Ms. George has to wait 3 hours for her husband to drive her home, and you note that she continues to lie on the bed passively, and her lethargy is increasing. You take her vital signs and note that her temperature is 37.8° C and her pulse is 115. You listen to her chest and note that it is difficult to appreciate breath sounds due to the patient’s body habitus. Ms. George points to an area just below her left breast where she notes pain with inspiration. You call her physician to report your findings; she responds that Ms. George’s pain is “not unusual” with her type of bariatric surgery and that her slightly increased temperature is “most likely” related to her being somewhat dehydrated. She instructs you to have Ms. George force fluids to the extent that she can tolerate it, and to take mild pain medication for postoperative pain. You ask her to consider delaying her discharge home, but she refuses. You give Ms. George acetaminophen as ordered, but her pain on inspiration continues. Her temperature remains at 37.8° C, and her pulse is 120. You measure her O 2 saturation with a pulse oximeter, and it is 91%. Her respirations are 26 and somewhat shallow. Her surgeon does not respond to your page, so you call the nursing supervisor, explaining to him that you are concerned with Ms. George’s impending discharge. Although you are wary of the surgeon’s reaction, you call the hospitalist (a physician who sees inpatients in the absence of their attending physician), who orders a chest x-ray study. Ms. George has evidence of a consolidation in her left lower lobe, which turns out to be a pulmonary abscess. She is treated on intravenous antibiotics for 5 days, and the abscess eventually has to be aspirated and drained. Your critical thinking skills and willingness to advocate for your patient prevented an even worse postoperative course. You recognized that Ms. George’s lethargy was unusual, and the location and timing of her pain was of concern. You also realized that although her temperature appeared to be stable, she had been given a pain medicine (acetaminophen) that also reduces fever, so in fact, a temperature increase may have been masked by the antipyretic properties of the acetaminophen. You demonstrated excellent clinical judgment in measuring her O 2 saturation. Furthermore, you sought support through the nursing “chain of command” when you engaged the nursing supervisor, who supported you in contacting the hospitalist. The specific, detailed information that you were able to provide the hospitalist allowed him to follow a logical diagnostic path, determining that Ms. George did indeed have a significant postoperative complication. Two days later, Ms. George reports that she is “feeling much better” and is walking in the hallways several times a day. Critical thinking in nursing You may be wondering at this point, “How am I ever going to learn how to make connections among all of the data I have about a patient?” This is a common response for a nursing student who is just learning some of the most basic psychomotor skills in preparation for practice. You need to understand that, just like learning to give injections safely and maintaining a sterile field properly, you can learn to think critically. This involves paying attention to how you think and making thinking itself a focus of concern. A nurse who is exercising critical thinking asks the following questions: “What assumptions have I made about this patient?” “How do I know my assumptions are accurate?” “Do I need any additional information?” and “How might I look at this situation differently?” Nurses just beginning to pay attention to their thinking processes may ask these questions after nurse–patient interactions have ended. This is known as reflective thinking. Reflective thinking is an active process valuable in learning and changing behaviors, perspectives, or practices. Nurses can also learn to examine their thinking processes during an interaction as they learn to “think on their feet.” This is a characteristic of expert nurses. As you move from novice to expert, your ability to think critically will improve with practice. In Chapter 6 you read about Dr. Patricia Benner (1984, 1996), who studied the differences in expertise of nurses at different stages in their careers, from novice to expert. So it is with critical thinking: novices think differently from experts. Box 8-3 summarizes the differences in novice and expert thinking. BOX 8-3     NOVICE THINKING COMPARED WITH EXPERT THINKING Novice nurses •  Tend to organize knowledge as separate facts. Must rely heavily on resources (e.g., texts, notes, preceptors). Lack knowledge gained from actually doing (e.g., listening to breath sounds). •  Focus so much on actions that they may not fully assess before acting •  Need and follow clear-cut rules •  Are often hampered by unawareness of resources •  May be hindered by anxiety and lack of self-confidence •  Tend to rely on step-by-step procedures and follow standards and policies rigidly •  Tend to focus more on performing procedures correctly than on the patient’s response to the procedure •  Have limited knowledge of suspected problems; therefore they question and collect data more superficially or in a less focused way than more experienced nurses •  Learn more readily when matched with a supportive, knowledgeable preceptor or mentor Expert nurses •  Tend to store knowledge in a highly organized and structured manner, making recall of information easier. Have a large storehouse of experiential knowledge (e.g., what abnormal breath sounds sound like, what subtle changes look like). •  Assess and consider different options for intervening before acting •  Know which rules are flexible and when it is appropriate to bend the rules •  Are aware of resources and how to use them •  Are usually more self-confident, less anxious, and therefore more focused than less experienced nurses •  Know when it is safe to skip steps or do two steps together. Are able to focus on both the parts (the procedures) and the whole (the patient response). •  Are comfortable with rethinking a procedure if patient needs require modification of the procedure •  Have a better idea of suspected problems, allowing them to question more deeply and collect more relevant and in-depth data •  Analyze standards and policies, looking for ways to improve them •  Are challenged by novices’ questions, clarifying their own thinking when teaching novices From Alfaro-LeFevre R: Critical Thinking in Nursing: A Practical Approach, ed. 2, Philadelphia, 1999, Saunders. Reprinted with permission. Critical thinking is a complex, purposeful, disciplined process that has specific characteristics that make it different from run-of-the-mill problem solving. Critical thinking in nursing is undergirded by the standards and ethics of the profession. Consciously developed to improve patient outcomes, critical thinking by the nurse is driven by the needs of the patient and family. Nurses who think critically are engaged in a process of constant evaluation, redirection, improvement, and increased efficiency. Be aware that critical thinking involves far more than stating your opinion. You must be able to describe how you came to a conclusion and support your conclusions with explicit data and rationales. Becoming an excellent critical thinker is significantly related to increased years of work experience and to higher education level; moreover, nurses with critical thinking abilities tend to be more competent in their practice than nurses with less well-developed critical thinking skills ( Chang , Chang, Kuo et al., 2011). Box 8-4 summarizes these characteristics and offers an opportunity for you to evaluate your progress as a critical thinker. BOX 8-4     SELF-ASSESSMENT: CRITICAL THINKING Directions: Listed below are 15 characteristics of critical thinkers. Mark a plus sign (+) next to those you now possess, mark IP (in progress) next to those you have partially mastered, and mark a zero (0) next to those you have not yet mastered. When you are finished, make a plan for developing the areas that need improvement. Share it with at least one person, and report on progress weekly. Characteristics of critical thinkers: How do you measure up? ______ Inquisitive/curious/seeks truth ______ Self-informed/finds own answers ______ Analytic/confident in own reasoning skills ______ Open-minded ______ Flexible ______ Fair-minded ______ Honest about personal biases/self-aware ______ Prudent/exercises sound judgment ______ Willing to revise judgment when new evidence warrants ______ Clear about issues ______ Orderly in complex matters/organized approach to problems ______ Diligent in seeking information ______ Persistent ______ Reasonable ______ Focused on inquiry An excellent continuing education (CE) self-study module designed to improve your ability to think critically can be found online ( www.nurse.com/ce/CE168-60/Improving-Your-Ability-to-Think-Critically ). Continuing one’s education through lifelong learning is an excellent way to maintain and enhance your critical thinking skills. The website www.nurse.com has more than 500 CE opportunities available online and may be helpful to you as you seek to increase your knowledge base and improve your clinical judgment. Being intentional about improving your critical thinking skills ensures that you bring your best effort to the bedside in providing care for your patients. The nursing process: An intellectual standard Critical thinking requires systematic and disciplined use of universal intellectual standards ( Paul and Elder, 2012). In the practice of nursing, the nursing process represents a universal intellectual standard by which problems are addressed and solved. The nursing process is a method of critical thinking focused on solving patient problems in professional practice. The nursing process is “a conceptual framework that enables the student or the practicing nurse to think systematically and process pertinent information about the patient” ( Huckabay , 2009, p. 72). Humans are involved in problem solving on a daily basis. Suppose your favorite band is performing in a nearby city the night before your big exam in pathophysiology. Your exam counts 35% of your final grade. But you have wanted to see this band since you were 15, and you do not know when you will have another chance. You are faced with weighing a number of factors that will influence your decision about whether to go see the band: your grade going into the exam; how late you will be out the night before the exam; how far you will have to drive to see the band; and how much study time you will have to prepare for the exam in advance. You are really conflicted about this, so you decide to let another factor determine what you will do: the cost of the ticket. When you learn that the only seats available are near the back of the venue and cost $105.00 each, you decide to stay home, get a good night’s sleep before the big exam, and make a 98%. You then realize that with such a good grade on this exam, you will have much less pressure when studying for the final exam at the end of the semester. You have identified a problem (not a particularly serious one, but one with personal significance!), considered various factors related to the problem, identified possible actions, selected the best alternative, evaluated the success of the alternative selected, and made adjustments to the solution based on the evaluation. This is the same general process nurses use in solving patient problems through the nursing process. For individuals outside the profession, nursing is commonly and simplistically defined in terms of tasks nurses perform. Many students get frustrated with activities and courses in nursing school that are not focused on these tasks, believing themselves that the tasks of nursing are nursing. Even within the profession, the intellectual basis of nursing practice was not articulated until the 1960s, when nursing educators and leaders began to identify and name the components of nursing’s intellectual processes. This marked the beginning of the nursing process. In the 1970s and 1980s, debate about the use of the term “diagnosis” began. Until then, diagnosis was considered to be within the scope of practice of physicians only. Although nurses were not educated or licensed to diagnose medical conditions in patients, nurses recognized that there were human responses amenable to independent nursing intervention. A nursing diagnosis, then, is “a clinical judgment about individual, family or community responses to actual or potential health problems or life processes which provide the basis for selection of nursing interventions to achieve outcomes for which the nurse has accountability” (NANDA-I, 2012). These responses could be identified (diagnosed) through the careful application of specific defining characteristics. In 1973, the National Group for the Classification of Nursing Diagnosis published its first list of nursing diagnoses. This organization, which recently celebrated its 40th year, is now known as NANDA International (NANDA-I; NANDA is the acronym for North American Nursing Diagnosis Association). Its mission is to “facilitate the development, refinement, dissemination and use of standardized nursing diagnostic terminology” with the goal to “improve the health care of all people” (NANDA-I, 2012). In 2011, NANDA-I published its 2012–2014 edition of Nursing Diagnoses: Definitions and Classifications. Currently, NANDA-I has more than 200 diagnoses approved for clinical testing and has recently added 16 new diagnoses and 8 revised diagnoses. Diagnoses are also retired if it becomes evident that their usefulness is limited or outdated, such as the former diagnosis “disturbed thought processes.” Here is a simple example of how an approved nursing diagnosis may be used: Two days after a surgery for a large but benign abdominal mass, Mr. Stevens has not yet been able to tolerate solid food and has diminished bowel sounds. His abdomen is somewhat distended. Your diagnosis is that Mr. Stevens has dysfunctional gastrointestinal motility. This diagnosis is based on NANDA-I’s taxonomy because you have determined that the risk factors and physical signs and symptoms associated with this diagnosis apply to him. A more detailed discussion of nursing diagnosis is located in the next section of this chapter. The nursing process as a method of clinical problem solving is taught in schools of nursing across the United States, and many states refer to it in their nurse practice acts. The nursing process has sometimes been the subject of criticism among nurses. In recent years, some nursing leaders have questioned the use of the nursing process, describing it as linear, rigid, and mechanistic. They believe that the nursing process contributes to linear thinking and stymies critical thinking. They are concerned that the nursing process format, and rigid faculty adherence to it, encourages students to copy from published sources when writing care plans, thus inhibiting the development of a holistic, creative approach to patient care ( Mueller , Johnston, and Bligh, 2002). Certainly the nursing process can be taught, learned, and used in a rigid, mechanistic, and linear manner. Ideally the nursing process is used as a creative approach to thinking and decision making in nursing. Because the nursing process is an integral aspect of nursing education, practice, standards, and practice acts nationwide, learning to use it as a mechanism for critical thinking and as a dynamic and creative approach to patient care is a worthwhile endeavor. Despite reservations among some nurses about its use, the nursing process remains the cornerstone of nursing standards, legal definitions, and practice and, as such, should be well understood by every nurse. Phases of the nursing process Like many frameworks for thinking through problems, the nursing process is a series of organized steps, the purpose of which is to impose some discipline and critical thinking on the provision of excellent care. Identifying specific steps makes the process clear and concrete but can cause nurses to use them rigidly. Keep in mind that this is a process, that progression through the process may not be linear, and that it is a tool to use, not a road map to follow rigidly. More creative use of the nursing process may occur by expert nurses who have a greater repertoire of interventions from which to select. For example, if a newly hospitalized patient is experiencing a great deal of pain, a novice nurse might proceed by asking family members to leave so that he or she can provide a quiet environment in which the patient may rest. An expert nurse would realize that the family may be a source of distraction from the pain or may be a source of comfort in ways that the nurse may not be able to provide. The expert nurse, in addition to assessing the patient, is willing to consider alternative explanations and interventions, enhancing the possibility that the patient’s pain will be relieved. Phase 1: Assessment Assessment is the initial phase or operation in the nursing process. During this phase, information or data about the individual patient, family, or community are gathered. Data may include physiological, psychological, sociocultural, developmental, spiritual, and environmental information. The patient’s available financial or material resources also need to be assessed and recorded in a standard format; each institution usually has a slightly different method of recording assessment data. Types of data Nurses obtain two types of data about and from patients: subjective and objective. Subjective data are obtained from patients as they describe their needs, feelings, strengths, and perceptions of the problem. Subjective data are often referred to as symptoms. Examples of subjective data are statements such as, “I am in pain” and “I don’t have much energy.” The only source for these data is the patient. Subjective data should include physical, psychosocial, and spiritual information. Subjective data can be very private. Nurses must be sensitive to the patient’s need for confidence in the nurse’s trustworthiness. Objective data are the other types of data that the nurse will collect through observation, examination, or consultation with other health care providers. These data are measurable, such as pulse rate and blood pressure, and include observable patient behaviors. Objective data are often called signs. An example of objective data that a nurse might gather includes the observation that the patient, who is lying in bed, is diaphoretic, pale, and tachypneic, clutching his hands to his chest. Objective data and subjective data usually are congruent; that is, they usually are in agreement. In the situation just mentioned, if the patient told the nurse, “I feel like a rock is crushing my chest,” the subjective data would substantiate the nurse’s observations (objective data) that the patient is having chest pain. Occasionally, subjective and objective data are in conflict. A stark example of incongruent subjective and objective data well-known to labor and delivery nurses is when a pregnant woman in labor describes ongoing fetal activity (subjective data); however, there are no fetal heart tones (objective data), and the infant is stillborn. Incongruent objective and subjective data require further careful assessment to ascertain the patient’s situation more completely and accurately. Sometimes incongruent data reveal something about the patient’s concerns and fears. To get a clearer picture of the patient’s situation, the nurse should use the best communication skills he or she possesses to increase the patient’s trust, which will result in more openness.

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  1. PDF Critical Thinking: A Statement of Expert Consensus for Purposes of

    THINKING AND THE IDEAL CRITICAL THINKER We understand critical thinking to be purposeful, self-regulatory judgment which results in interpretation, analysis, evaluation, and inference, as well as explanation of the evidential, conceptual, methodological, criteriological, or contextual considerations upon which that judgment is based.

  2. How Do Critical Thinking Ability and Critical Thinking Disposition

    Introduction. Although there is no consistent definition of critical thinking (CT), it is usually described as "purposeful, self-regulatory judgment that results in interpretation, analysis, evaluation, and inference, as well as explanations of the evidential, conceptual, methodological, criteriological, or contextual considerations that judgment is based upon" (Facione, 1990, p. 2).

  3. PDF CRITICAL THINKING: CONCEPTUAL FRAMEWORK

    Paul in 1988 found that "Critical thinking is the ability to reach sound conclusion based on observation and information" (O' Donnell et al., 2011). Facione in 1990 saw "Critical thinking to be purposeful, self-regulatory judgement, which results in understanding, investigation, evaluation, and inference, as well as an

  4. Critical Thinking

    Critical Thinking. Critical thinking is a widely accepted educational goal. Its definition is contested, but the competing definitions can be understood as differing conceptions of the same basic concept: careful thinking directed to a goal. Conceptions differ with respect to the scope of such thinking, the type of goal, the criteria and norms ...

  5. Overview of Critical Thinking Skills

    Despite differences of opinion, many researchers agree that critical thinking is "Purposeful, self-regulatory judgment which results in interpretation, analysis, evaluation, and inference, as well as explanation of the evidential, conceptual, methodological, criteriological or contextual considerations upon which judgment is based. 11. Critical ...

  6. Introduction to Critical Thinking

    We understand critical thinking to be purposeful, self-regulatory judgment which results in interpretation, analysis, evaluation, and inference, as well as explanation of the evidential, conceptual, methodological, criteriological, or contextual considerations upon which that judgment is based. CT is essential as a tool of inquiry.

  7. Critical Thinking: A Statement of Expert Consensus for Purposes of

    thinking and the ideal critical thinker We understand critical thinking to be purposeful, self-regulatory judgment which results in interpretation, analysis, evaluation, and inference, as we ll as ...

  8. Our Conception of Critical Thinking

    A Definition. Critical thinking is that mode of thinking — about any subject, content, or problem — in which the thinker improves the quality of his or her thinking by skillfully analyzing, assessing, and reconstructing it. Critical thinking is self-directed, self-disciplined, self-monitored, and self-corrective thinking.

  9. Definition and Examples of Critical Thinking

    Critical thinking is the process of independently analyzing, synthesizing, and evaluating information as a guide to behavior and beliefs. The American Philosophical Association has defined critical thinking as "the process of purposeful, self-regulatory judgment. The process gives reasoned consideration to evidence, contexts, conceptualizations ...

  10. Critical Thinking as an Educational Ideal

    Critical thinking arrives at a judgment on a question by looking back in a reasonable way at the relevant evidence; it is "reasonable reflective thinking focused on deciding what to believe or do" (Ennis). ... purposeful, self-regulatory judgment which results in interpretation, analysis, evaluation and inference, as well as explanation of ...

  11. Critical thinking

    Critical thinking is the analysis of available facts, evidence, observations, and arguments in order to form a judgement by the application of rational, skeptical, and unbiased analyses and evaluation. The application of critical thinking includes self-directed, self-disciplined, self-monitored, and self-corrective habits of the mind, thus a critical thinker is a person who practices the ...

  12. What is Critical Thinking?

    "We understand critical thinking to be purposeful, self-regulatory judgment which results in interpretation, analysis, evaluation, and inference, as well as explanation of the evidential, conceptual, methodological, criteriological, or contextual considerations upon which that judgment is based. CT is essential as a tool of inquiry.

  13. [C03] Defining critical thinking

    The Watson-Glaser Critical Thinking Appraisal (1980) is a well-known psychological test of critical thinking ability. The authors of this test define critical thinking as : ... "We understand critical thinking to be purposeful, self-regulatory judgment which results in interpretation, analysis, evaluation, and inference, as well as explanation ...

  14. Externalizing the critical thinking in knowledge development and

    C ritical thinking (CT) is increasingly being recognized as the cognitive engine driving the processes of knowledge development and professional judgment in a wide variety of professional practice fields. In 1990 a consensus definition of CT, the results of a Delphi research project sponsored by the American Philosophical Association (APA), was ...

  15. Critical Thinking and Reflective Judgement

    To apply critical thinking skills, skills to a particular problem implies a reflective sensibility and the capacity for reflective judgment (King & Kitchener, 1994). The simplest description of reflective judgment is that of 'taking a step back.' ( Dwyer, 2017) Reflective judgment is the ability to evaluate and process information in order ...

  16. Thinking Critically About the Quality of Critical Thinking Definitions

    Facione gives one commonly used definition of critical thinking as "purposeful, self-regulatory judgment which results in interpretation, analysis, evaluation, and inference" (p. 2). This present study also examined the term clinical reasoning , defined by Higgs and Jones ( 2000 ) as "the thinking and/or decision-making processes that are ...

  17. Clinical Reasoning, Decisionmaking, and Action: Thinking Critically and

    The American Philosophical Association (APA) defined critical thinking as purposeful, self-regulatory judgment that uses cognitive tools such as interpretation, analysis, evaluation, inference, and explanation of the evidential, conceptual, methodological, criteriological, or contextual considerations on which judgment is based. 2 A more ...

  18. How to Build Your Judgment and Critical Thinking

    You can use the critical thinking-judgment beatitude, "Blessed are the critical thinkers: for they help us understand and find truth" (Niemiec, 2021), to appreciate the depth of this strength of ...

  19. Enhancing Critical Thinking Skills through Decision-Based Learning

    More specifically, the operational definition used in the current study is that critical thinking is a "purposeful, self-regulatory judgment which results in interpretation, analysis, evaluation, and inference, as well as explanation of the evidential, conceptual, methodological, criteriological, or contextual considerations upon which that ...

  20. PDF DOCUMENT RESUME ED 368 311 HE 027 336 AUTHOR Facione, Peter A ...

    "We understand critical thinking to be purposeful, self-regulatory judgment which results in interpretation, analysis, evaluation, and inference, as well. as. ... Thus broadly conceived, CT was characterized as purposeful, self-regulatory judgment, a human. 2. cognitive process. As a result of this non-linear, recursive process a person forms a ...

  21. PDF The Relationship between Leadership Development and Critical Thinking

    thinking, developed the following definition: "We understand critical thinking to be purposeful, self-regulatory judgment, which results in interpretation, analysis, evaluation, and inference, as well as explanation of the evidential, conceptual, methodological, criteriological, or contextual considerations upon which that

  22. Critical Thinking

    Critical Thinking. Critical thinking is a widely accepted educational goal. Its definition is contested, but the competing definitions can be understood as differing conceptions of the same basic concept: careful thinking directed to a goal. Conceptions differ with respect to the scope of such thinking, the type of goal, the criteria and norms ...

  23. Critical thinking, the nursing process, and clinical judgment

    We understand critical thinking (CT) to be purposeful, self-regulatory judgment that results in interpretation, analysis, evaluation, and inference, as well as explanation of the evidential, conceptual, methodological, criteriological, or contextual considerations upon which that judgment is based. CT is essential as a tool of inquiry.