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Chapter 112. Critical Thinking

Francine L. Jacobson, MD, MPH; Sylvia C. McKean, MD, SFHM, FACP

  1. What are the three domains of outcomes regarding competencies in hospital medicine?

  2. What is meant by “critical thinking” in the ordering of imaging studies?

Competencies in hospital medicine are classified within three domains of outcomes: cognitive (knowledge), psychomotor (skills), and affective (attitudes). Critical thinkers must have a basic knowledge about the methods of logical inquiry and reasoning (cognitive), some skill in applying these methods (psychomotor), and an attitude predisposed to thoughtful consideration of the problems and subjects that come within the range of one's experiences (affective). They must recognize the problems confronting patients; ask the right questions to address those problems; gather pertinent data from many sources; efficiently, logically, and resourcefully sort through complex information; acknowledge personal biases that may hinder analysis; interpret data in the context of each patient before them; and expediently reach trustworthy conclusions that form the basis of therapeutic approaches (Tables 112-1 and 112-2).

Table 112-1 Critical Thinking Sidebar
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Table 112-1 Critical Thinking Sidebar
Critical Thinking Defined by Edward Glaser

In a seminal study on critical thinking and education in 1941, Edward Glaser defined critical thinking as follows: “The ability to think critically, as conceived in this volume, involves three things:

  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. It also generally requires ability to recognize problems, to find workable means for meeting those problems, to gather and marshal pertinent information, to recognize unstated assumptions and values, to comprehend and use language with accuracy, clarity, and discrimination, to interpret data, to appraise evidence and evaluate arguments, to recognize the existence (or nonexistence) of logical relationships between propositions, to draw warranted conclusions and generalizations, to put to test the conclusions and generalizations at which one arrives, to reconstruct one's patterns of beliefs on the basis of wider experience, and to render accurate judgments about specific things and qualities in everyday life.”

Data from Glaser EM. An Experiment in the Development of Critical Thinking. Teacher's College, Columbia University. New York, NY; 1941.

Table 112-2 Clinical Problem Solving
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Table 112-2 Clinical Problem Solving

  1. Frame a question to answer a problem.

  2. Formulate a concise and coherent hypothesis devoid of irrelevant information.

    • Organize thoughts and articulate them concisely and coherently.
    • Strip a verbal argument of irrelevancies and phrase it in its essential terms.

  3. Seek and gather critical data to test and evaluate hypothesis.

    • Use evidence skillfully and impartially.
    • Distinguish between logically valid and invalid inferences.

  4. Draw reliable conclusions from the result.

    • Suspend judgment in the ...

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