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HMS Academy Medical Education Day. Critical Thinking October 2011. Disclosures. I have no financial relationships with commercial entities. Why Critical Thinking? Error Reduction Growth of Med Content. Number of citations – Index Medicus. nlm.nih.gov. Errors and Patient Harm.
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HMS AcademyMedical Education Day Critical Thinking October 2011 HMS Academy
Disclosures I have no financial relationships with commercial entities. HMS Academy
Why Critical Thinking?Error Reduction Growth of Med Content Number of citations – Index Medicus nlm.nih.gov HMS Academy
Errors and Patient Harm It is estimated that 30% of the errors that occur in the hospital are cognitive or thinking errors What is the source? Medical knowledge Application of knowledge; using knowledge to solve problems (particularly diagnosis) HMS Academy
Critical Thinking – ComponentsMillennium Conference 2011 HMS Academy Critical Thinking – Elements of the definition include: • applying higher cognitive skills (e.g., conceptualization, analysis, evaluation) • analyze information, either gathered from medical history or records or generated by physical exam or laboratory investigation • produce action that is precise, consistent, logical and appropriate.
Critical Thinking…also includes Metacognition Self-reflection and appraisal Personal “predispositions” or intellectual traits Curiosity Perseverance Open-mindedness HMS Academy
Task Force on Classroom LearningOverarching Goals • Focus on means to foster long-term learning • Analytical and reasoning abilities • Problem solving HMS Academy
Task Force on Classroom LearningThemes • Increased active learning • Greater student preparation • Increase frequency and quality of feedback • Enhanced teacher preparation/training • Modify teaching space • Share/explore strategies for interactive teaching that fosters reasoning skills HMS Academy
How we think…Dual Processing • Conscious thought • Unconscious thought • Cognitive Biases HMS Academy
Conscious Thought HMS Academy You are aware of the thinking Analytical “Like a general atop a platform…sees the world from a distance and analyzes things linearly…”
Subconscious Thought HMS Academy You are unaware of the processing “…like a million little scouts. The scouts careen around the landscape, sending back a constant flow of signals and generating instant responses…coat things with emotional significance.”
The Subconscious Mind is a Wonderful Thing flickr.com HMS Academy
An Experiment HMS Academy Take out a piece of paper….
Who is this? HMS Academy
HMS Academy WRITE DOWN YOUR ANSWER
Who is this? HMS Academy
HMS Academy WRITE DOWN YOUR ANSWER
The Limits of Patterns HMS Academy
How do we teach and learn?Modified fromHarasym et al. 2008 Surface Learning -- New info not linked to previous knowledge -- Knowledge abundant but disorganized -- Focus on memorization and recall -- Learns concepts and facts withoutreflection Deep Learning -- Relates new knowledge to previous knowledge -- Content organized into coherent whole -- Focus on problem-solving; synthesis, apply info -- Link concepts/principles to everyday experience HMS Academy
Routine vs. Adaptive ExpertMylopoulos M, Regehr G. Med Ed 2007 Routine Expert Novel problem adapt problem to the solution with which they are comfortable Characterized by speed, accuracy, automaticity Adaptive Expert Use a new problem as a point of departure for exploration; expand knowledge and understanding Characterized by innovation, creativity HMS Academy
Medical School vs. Practice of Medicine “When I was an undergraduate engineering student, all of my exams were open book. In four years of medical school, I never had an open-book exam.” Medical Resident, U of VT, October 2011 Isn’t the practice of medicine one continuous open-book exam? Are we adequately preparing our students for this challenge? HMS Academy
Objectives for Today • Recognize the need to improve teaching of critical thinking skills • Identify theoretical concepts underlying cognitive processes as they relate to medical decision-making and expertise • Identify strategies for teaching to enhance critical thinking in your learners • Reflect on your own teaching re: critical thinking HMS Academy
Keynote Address Mark Quirk, EdD Assistant Dean for Academic Achievement U Mass Medical School Shifting the Medical Education Paradigm from Knowledge to Critical Thinking HMS Academy