“Critical thinking is the identification andevaluation of evidence to guide decisionmaking. A critical thinker uses broadin-depth analysis of evidence to makedecisions and communicate her/his beliefs clearly and accurately.”The CriticalThe CriticalThinking Co.Thinking Co.What Is It?
Hierarchy of Knowledge• Knowledge: What isthe most commoncause of...?• Understand: If yousee this, what mustyou consider…?• Application: In thispatient, what iscausing…?• Analysis, synthesis,evaluation: criticalthinking?Bloom’s Taxonomy, 1956
The KSA Model• Are there specific:– KnowledgeKnowledge/factsfacts– SkillsSkills– Attitudes…that must beacquired, in orderfor the learner tobecome a criticalthinker?
• Content learned in a conceptual framework:– How do the facts fit together?– What are the underlying mechanisms?– What do you do when the patterns break down?• Judge the credibility of the sources:– From primary sources (Google it…)– Primary sources:• Study design• Appropriate population• Statistics• Secondary sources:– Textbooks– Review articles• Evidence-based medicineThe Chazin GroupThe Chazin GroupKnowledge
• Bias and cognitive dispositions torespond:– Availability bias - probability assigned based onease of recall of specific examples; and– Confirmation bias - selectively accepting orignoring data.The Chazin GroupThe Chazin GroupKnowledge
• Formulate hypotheses• Make logical connections between ideas• Utilize of data• Identify assumptionsThe Chazin GroupThe Chazin Group Skills
• Have an open mind - willingness toconsider alternative explanations• Be aware of your own cognitiveprocesses: what type of reasoning was Iusing? (meta-cognition)• Reflection - how did we go wrong? Wheredid we make a mistake?The Chazin GroupThe Chazin Group Attitude
Importance to Medicine““…few physicians spend much time thinkingabout such a fundamental medical activityas thinking. Logic is as important tophysicians as water is to fish. It surroundsus all and we swim in it every day."" Suzanne FletcherProfessor of Ambulatory Care & PreventionHarvard Medical School &Harvard Pilgrim Medical Care
Characteristics of CriticalCharacteristics of CriticalThinkersThinkers
• AnalysisAnalysis: Critical thinking can be defined as anapproach to ideas from the standpoint ofdeliberate consideration. (from VirutalSalt.com)• AttentionAttention: Pay attention to the claims made allaround you.• AwarenessAwareness: have the ability to look aroundand consider all the thoughts provided, ratherthan remaining fixed on your own limitedviews.• Independent JudgmentIndependent Judgment: the ability to formindependent judgments, based on goodevidence.The Chazin GroupThe Chazin GroupWhat Makes a Critical Thinker?
• Critical thinkers are by nature SKEPTICAL.They approach text with the same skepticismand suspicion as spoken comments.• Critical thinkers are ACTIVE, not passive. Theyask questions & analyze. They consciouslyapply tactics and strategies to uncovermeanings and confirm understanding.• Critical thinkers don’t take an egotistical view ofthe world. They’re OPEN to new ideas/perspectives. They’re willing to challenge theirbeliefs and consider competing evidence.The Chazin GroupThe Chazin GroupWhat Makes a Critical Thinker?
• Take a SIMPLISTICSIMPLISTIC view of the world.• They see things in black and white, aseither-or, rather than recognizing avariety of possible understanding.• They see questions as YES/NO with nosubtleties.• They fail to see linkages & complexities.• They fail to recognize related items.The Chazin GroupThe Chazin GroupPassive (Non-Critical) Thinkers
““Shades of grey wherever I go.Shades of grey wherever I go.The more I find out, the lessThe more I find out, the lessThat I know.That I know.Black and white is how itBlack and white is how itshould be.should be.But shades of grey are theBut shades of grey are theColors I see.”Colors I see.”Billy Joel
• Inferences Versus Assumptions:– INFERENCE: A conclusion you come to, basedon something else that is true/you believe to betrue. (Ex. There will be layoffs in my dept.because there were layoffs in another dept.)– ASSUMPTION: Part of your belief system.Something you dont question. Your mind takesfor granted that your assumption is true.(Doctors think they know EVERYTHING.)– Your beliefs (assumptions) cause you to cometo conclusions (inferences). Your inferencesthen cause you to act accordingly.The Chazin GroupThe Chazin GroupFind Assumptions
The Chazin GroupThe Chazin GroupFind Assumptions•Question your assumptions as a path tosubstantiating them.•Most statements or assertions are basedon assumptions.•Sometimes assumptions are implicit, sothey’re much harder to find.
• There are many different ways to measurevariables, so absolute figures may not be thatrelevant.• In science, it is the EXCEPTION that disprovesthe RULE.• The Scottish philosopher David Hulme noted:"A wise man proportions his belief to theevidence.”The Chazin GroupThe Chazin GroupTrends, Evidence, Exceptions
• Always ask: “Who is funding the project”because EVERONE has an AGENDA.• How are the questions worded/posed?• How are those being questioned selected andthe context in which the questions are put tothem?• How is the statistical analysis carried out andthe statistics interpreted?• How are the findings presented/reported (ormisreported?)The Chazin GroupThe Chazin GroupBe Skeptical of Surveys
• Correlation does not necessarily meancausation .• Because two variables often occur together,doesn’t mean that one actually causes theother.• The concept of causation is extremely complex.The Chazin GroupThe Chazin GroupLook for CAUSE & EFFECT
• Albert Einstein once remarked: "Foolish faithin authority is the worst enemy of truth."• Study the evidence and make an independentjudgment, based on the balance of theavailable evidence.• Confirm the credibility of sources andcredentials of “experts.”The Chazin GroupThe Chazin GroupDON’T Defer to Authority
• The Emperor’s new clothes.• You can be seduced by this esp. if you are amember of a close-knit group of people wherethere is a strong sense of loyalty to the group.• The Independent Evaluation Office of the IMFidentified groupthink as a major factor in itsofficial report on why the IMF did not foreseethe international financial crisis of ‘07-’09.The Chazin GroupThe Chazin GroupBeware of GROUP Think
• Trust your own intuition based on:– your schooling;– on-the-job training;– Past work experience; and– your certifications.The Chazin GroupThe Chazin GroupTrust YOUR Instincts
• A situation occurs in experiments to test theefficacy of drugs or medical treatments knownas the placebo response. A placebo (sugar or atonic containing nothing medicinal) is usedwith a control group of patients to comparewith another group taking the drug ortreatment being tested. Researchers havefound that frequently a placebo has a positiveeffect because the person taking it believes itwill cure them.The Chazin GroupThe Chazin GroupObserving Can Change a Situation
• Often politicians, businessmen, administratorsmake statements which are meaningless:– “I think that if we tried harder we could possibly dosomewhat better."– "Some improvements in performance might beexpected in the fullness of time.”– A much more meaningful sentence would be: "Wewill reduce recorded crimes of violence by 10%before the next election" or "If we increase ourcapital expenditure by 5% annually for the nextthree years, we should achieve a 25% increase inrevenues by the end of the decade".The Chazin GroupThe Chazin GroupFind Meaningful Statements
• In a paper or speech, look at the arguments,the evidence, the structure, and thepresentation.• In a novel, consider the plot, thecharacterization and the language.• In a film, think about the script, the acting, thedirection, the cinematography, and the music.The Chazin GroupThe Chazin GroupDeconstruct Elements
• SWOT analysis is a strategic planning methodused to evaluate the Strengths, Weaknesses,Opportunities, and Threats involved in a projector situation.• Strengths and weaknesses are internal to thehospital.• Opportunities and threats are external.The Chazin GroupThe Chazin GroupUse a SWOT Analysis
• A statistic without any content isMEANINGLESS.• Averages can be misleading.• Medians and modes often work better than themean.• Consider how the data points in a set aredistributed.• The PARETO Principle.The Chazin GroupThe Chazin GroupUse Statistics1, 5, 5, 5, 13, 50, 74, 1001, 5, 5, 5, 13, 50, 74, 100
• When asked to respond to material most peoplelimit their comments to what is requested.• What ISN’T there is just as important. You mightwant to ask: “Why are certain arguments missing?”“Why have certain sources not been used?• What about patient medical histories, priortreatments, allergies, past surgeries?• A clinical trial or hospital annual report will put themost favorable ‘spin on activities and may notmention the financial difficulties or threats.The Chazin GroupThe Chazin GroupWhat’s NOT There?
"Problems cannot be solved bythinking within the framework inwhich they were created.”Think OUTSIDE the Box
• Have someone take a positionon a controversial issue(Euthanasia, evolutionEuthanasia, evolution)• Have someone else ask aquestion to make that personexplain themselves.• Ask a follow up question toexploit a potential weaknessof the answer to the firstquestion.• Keep going to you eitherestablish or disprove theperson’s argument.The Chazin GroupThe Chazin GroupThe Socratic Method