1. HMS Academy HMS Academy Medical Education Day Critical Thinking October 2011

2. HMS Academy Disclosures I have no financial relationships with commercial entities.

3. HMS Academy Why Critical Thinking? Error Reduction Growth of Med Content nlm.nih.gov Number of citations – Index Medicus

4. 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)

5. HMS Academy Critical Thinking – Components Millennium Conference 2011 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.

6. HMS Academy Critical Thinking…also includes Metacognition Self-reflection and appraisal Personal “predispositions” or intellectual traits –Curiosity –Perseverance –Open-mindedness

7. HMS Academy Task Force on Classroom Learning Overarching Goals Focus on means to foster long-term learning Analytical and reasoning abilities Problem solving

8. HMS Academy Task Force on Classroom Learning Themes 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

9. HMS Academy How we think…Dual Processing Conscious thought Unconscious thought –Cognitive Biases

10. HMS Academy Conscious Thought You are aware of the thinking Analytical “Like a general atop a platform…sees the world from a distance and analyzes things linearly…”

11. HMS Academy Subconscious Thought 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.”

12. HMS Academy The Subconscious Mind is a Wonderful Thing flickr.com

13. HMS Academy An Experiment Take out a piece of paper….

14. HMS Academy Who is this?

15. HMS Academy WRITE DOWN YOUR ANSWER

16. HMS Academy Who is this?

17. HMS Academy WRITE DOWN YOUR ANSWER

18. HMS Academy The Limits of Patterns

19. HMS Academy How do we teach and learn? Modified from Harasym 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 without reflection 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

20. HMS Academy Routine vs. Adaptive Expert Mylopoulos 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

21. 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

22. 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

23. 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