Thinking Critically About the Quality of Critical Thinking Definitions and Measures

Abstract

Leading policy and professional organizations are in agreement that critical thinking is a key competency for health professionals to function in our complex health care environment. There is far less clarity in professions education literature about what it really means or how to best measure it in providers and students. Therefore, in order to clarify terminology and describe the context, definitions, and measures in critical thinking research, a systematic review using the keywords “critical thinking” or the associated term “clinical reasoning,” cross keywords nurse and physician, resulting in 43 studies is presented in this chapter. Results indicated that an explicit definition was not provided in 43 % of the studies, 70 % ascribed equivalency to the terms critical thinking, clinical reasoning, clinical judgment, problem-solving, or decision-making, and 40 % used researcher-made study-specific measures. Full alignment of definition and measure was found in 47 % of studies, 42 % of studies reported validity for obtained scores, and reliability was documented in 54 % of studies. Keyword analysis identified six common constructs in nursing studies of critical thinking in nursing: individual interest, knowledge, relational reasoning, prioritization, inference, and evaluation, along with three contextual factors: patient assessment, caring, and environmental resource assessment. Recommendations for future research include increased use of purposeful samples spanning multiple levels of provider experience; documentation of effect sizes, means, SD, and n; adherence to official standards for reliability and validity requiring documentation of both previous and current datasets as appropriate; and greater use of factor analysis to validate scales or regression to test models. Finally, critical thinking research needs to use explicit definitions that are part and parcel of the measures that operationalize the construct, and alternative measures need to be developed that line up the attributes of the definition with the attributes measured in the instrument. Once we can accurately describe and measure critical thinking, we can better ensure that rising members of the professions can apply this vital competency to patient care.