EDUCATION IN PRACTICE

Promoting Critical Thinking in Students

Scott Weber, EdD, MSN, RN, FACHE, FHIMSS

The two primary student outcomes from clinicaleducation experiences are to think and act likea practitioner.

Probably, the focus during clinicals should be oncritical thinking (clinical reasoning) first and fore-most. In fact, a student should be a good entry-levelcritical thinker by the end of clinical education, forexample, clear, accurate, precise, and relevant in hisor her approach to practice, and able to link theoryand practice in decision making, intervention plan-ning, and even spontaneous modification of on-going intervention processes.

Paul and Elder (2001) in The Miniature Guidefor Critical Thinking: Concepts and Tools describecritical thinking as a process of continuous improve-ment in one’s quality of thinking about problems. Aclinical student who is striving to become a goodcritical thinker will

1. Raise relevant, precise questions during clini-cal education, demonstrating the use of pastexperience blended with knowledge

2. Analyze and interpret clinical experiencesfrom the assessment of relevant information

3. Provide reasoned conclusions and inter-vention recommendations based on practiceframes of reference and standards for profes-sional performance

4. Modify thinking based on practical implica-tions that demonstrate self-correction of think-ing in atypical or unique situations

5. Communicate effectively with others in nego-tiating complex problems.

A clinical educator cannot make a student think critically unless the stu-dent has the desire to reach for clinical practice excellence, but the educatorcan encourage increasing use and development of critical thinking skillswhen observing the student’s behaviors. Sometimes this encouragement canbe in the form of praise or other positive recognition. However, one of thegreatest ways to recognize such performance is by taking time to discuss itwith the student either during regular supervision or informally, such as overcoffee, walking to a staff meeting, or at lunch. The more the tone is collegial,the better, as the student needs to increase his or her self-direction and relyon internal standards of performance and critical self-analysis.

These collegial moments between clinical student and educator help thestudent learn how to behave as a valued professional. The student replaces‘‘fear of doing things the wrong way’’ with self-confidence. Reliance on self-evaluation is seen as an opportunity, not a challenge. Through these collegialdiscussions, the clinical educator moves from director to facilitator and coachas his or her confidence in the student’s demonstrated abilities grows. Mostimportantly, discussion promotes positive reflection on practice competence,which aids the development of clinical reasoning.

Here are some questions that could be used to stimulate this collegialinteraction and promote professional development in your clinical student:

NOVICE

� How did you decide where nursing care should begin or what to do next?� What happened during intervention that you expected to happen? What

did you not expect? From the unexpected outcomes, what did you learn?� What knowledge or experiences did you draw upon to come to a

conclusion or respond to a question that arose in this situation?� How do you know that the session was meaningful to your client or

patient?

INTERMEDIATE

� What other approaches to the situation did you consider? Why didyou accept or reject each choice?

� How would you support or defend your choice of actions if ques-tioned by someone in authority or in the family? Would yourapproach vary if another professional or the family requested theaction? How would it vary?

� How did you know the individual was benefiting and participatingfully in his or her intervention? What motivated them to participate?What was unmotivating?

AuthorScott Weber, EdD, MSN, RN, FACHE,FHIMSS, is an Assistant Professor of nursingeducation and nursing informatics and Coor-dinator of the Nursing Education GraduateProgram at the University of PittsburghSchool of Nursing, Pittsburgh, Pennsylvania.Contact Dr. Weber by e-mail at webersjm@pitt.edu

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ADVANCED

� Do you recall a time when you were not getting orobserving the response you expected to your intervention?What did you decide to do? ‘‘Stay the course’’ or takea different approach? How did you reach this decision?

� What new questions or thoughts do you have aboutfuture interventions because of this experience?

� How do you know when a client is able to sustain his orher own health or intervention regimen versus needing tobe externally motivated? What contributes to this changeor supports this outcome?

These questions are divided into a hierarchy based on stu-dent development. The first rule of good instruction is to ‘‘startwhere the learner is.’’ The second rule is to ‘‘offer challengesthat entice the next level of learning or critical thinking’’ in the

student. Thus, these questions are ordered in a hierarchy basedon how much accumulated experience the student has beyondthe classroom.

This type of inquiry requires the clinical student to reflecton decisions, actions, and outcomes. As a result, the studentbecomes more flexible with interventions and more confident,gaining a depth and breadth of understanding in complexsituations and the pathways of decision making. The ability ofthe clinical student to discuss these logically with you as clinicaleducator demonstrates acquisition of professional critical think-ing. And you are likely to learn from this dialogue, too.

Some clinical educators might use this list of inquiries witha student as a way to structure supervision sessions. Othersmight use it as a stimulus for conversations. Another applica-tion might be to use these as guiding questions you give to astudent to reflect and record before a supervisory session or tobe able to read and comment about in writing.

206 VOLUME 17, ISSUE 6, JUNE 2005