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Critical Thinking in Medical Practice
Dr. Z. Zayapragassarazan
Associate Professor
Department of Medical Education
JIPMER
Puducherry
Why this topic?
I think, therefore I am.
- Rene Descartes
Objectives
‐to define ‘Critical Thinking’
‐to describe the importance of critical thinking
‐to explain the attributes of critical thinkers
‐to administer a critical thinking skills test
1
4
3
2
Thinking
The action of using one's mind to 
produce thoughts
Bloom’s Thinking Triangle
Use two squares to put all the cows in separate pens
Critical Thinking
• Critical thinking is reasonable, reflective thinking
that is focused on deciding what to believe or
do.
• Critical thinking is skillful, responsible thinking
that is conducive to good judgment because it is
sensitive to context, relies on criteria, and is self‐
correcting.
• Critical thinking is thinking about your thinking,
while you’re thinking, in order to make your
thinking better.
A purposeful, organized, mental process that 
we use to understand the world and make 
informed decisions. 
Four Men in Hats
• Four men buried up to their necks in the ground. They cannot 
move, so they can only look forward. Between A and B is a brick 
wall which cannot be seen through. 
• They all know that between them they are wearing four hats‐‐two 
black and two white‐‐but they do not know what color they are 
wearing. Each of them know where the other three men are 
buried. 
• In order to avoid being shot, one of them must call out to the 
executioner the color of their hat. If they get it wrong, everyone 
will be shot. They are not allowed to talk to each other and have 
10 minutes to work it out. 
• After one minute, one of them calls out. 
• Question: Which one of them calls out? Why is he 100% certain of 
the color of his hat? 
• This is not a trick question. There are no outside influences nor 
other ways of communicating. They cannot move and are buried 
in a straight line; A & B can only see their respective sides of the 
wall, C can see B, and D can see B & C. 
Four Men in Hats
Answer
• C calls out that he is wearing a black hat. 
• Why is he 100% certain of the color of his hat? After a 
while, C comes to the realization that he must answer. 
• This is because D can't answer, and neither can A or B. 
• D can see C and B, but can't determine his own hat color. 
B can't see anyone and also can't determine his own hat 
color. A is in the same situation as B, where he can't see 
anyone and can't determine his own hat color. 
• Since A, B, and D are silent, that leaves C. C knows he is 
wearing a black hat because if D saw that both B and C 
were wearing white hats, then he would have answered. 
But since D is silent, C knows that he must be wearing a 
black hat as he can see that B is wearing a white hat. 
Aspects of Critical Thinking
• Abstract Thinking:
thinking past what your senses tell you
• Creative Thinking:
thinking “out of the box,” innovating
• Systematic Thinking:
organizing your thoughts into logical steps
• Communicative Thinking:
being precise in giving your ideas to others.
• Divergent Thinking:
One question leads to many answers
• Convergent Thinking:
Many Questions leads to one answer
What is involved in Critical Thinking
Question: what is being asked?
Purpose: why do I want the answer?
Point of View:  where do I stand to look at the 
question?
Information: what data do I have?
Concepts: what ideas are involved?
Assumptions:  what am I taking for granted?
Inferences: what conclusions am I drawing?
Consequences:  what are the implications of my 
question?
Why should we think critically?
• Avoid  medical/clinical errors
• Identify better alternate options
• Increases productivity
• Better clinical decision making
• Avoid poor or delayed decisions
• Save time and energy
• Work in resource limited settings
• Quality thinking and quality work output
• Brings in innovation  (Creativity)
• Avoid litigations
• Reduces fatigue
• Develops confidence
• Helps to climb the leadership ladder
What Critical Thinkers do?
Do more data gathering
Avoid premature conclusions
See inconsistencies in information
Utilize knowledge more extensively and explicitly to 
make decisions
Are aware of limitations and doubts
Monitor and evaluate their own decisions 
Involve patients more fully
Provide patients with options
Fostering Critical Thinking
• Self awareness about our own thinking style
• Learning to critique
• Learning to ask questions 
• Trying to find more alternate solutions
• Reflect on what happened
• Use concept maps and mind mapping
• Read literature
Exercise
Section 1: Inference
Inference 1: There is inadequate data
Inference 2: This is probably true
Inference 3: This is True
Inference 4: This is False
Section 2: Recognition of
assumption
Assumption 1: No
Assumption 2: No
Assumption 3: Yes
Assumption 4: No
Section 3: Deduction
Deduction 1: Yes
Deduction 2: No
Deduction 3: Yes
Section 4: Interpretation
Interpretation 1: Yes
Interpretation 2: No
Interpretation 3: Yes
Section 5: Evaluation of Arguments
Argument 1: Strong
Argument 2: Strong
Argument 3: Weak
Scoring
Overall Score Performance Assessment Description
0-3
Not manifested
This result is consistent with possible
insufficient test-taker effort, cognitive
fatigue, or possible reading or
language comprehension issues.
4-6
Weak
This result is predictive of difficulties
with educational and employment
related demands for reflective problem
solving and reflective decision making.
7-9
Moderate
This result indicates the potential for
skills-related challenges when engaged
in reflective problem-solving and
reflective decision-making associated
with learning or employee
development.
10-12
Strong
This result is consistent with the
potential for academic success and
career development.
13& above
Superior
This result indicates critical thinking
skill that is superior to the vast
majority of test-takers. Skills at the
superior level are consistent with the
potential for more advanced learning
and leadership.
You are rating your disposition toward critical 
thinking over the past two days:
• Give yourself 1 point for every “Yes” on odd 
numbered items and for every “No” on even 
numbered items. 
• 15 & Above ‐ generally positive.
• 10‐14 ‐ mixed overall disposition toward critical 
thinking. 
• Below 10 ‐ averse or hostile toward critical 
thinking. 
• Interpret results on this tool cautiously. At best 
this tool offers only a rough approximation with 
regard to a brief moment in time ie two days. 
Thanks

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