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Creating a Culture of Inquiry to Promote Critical Thinking

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By Dr. David C. Johnsen, Dean, University of Iowa College of Dentistry

Critical thinking is considered by many to be the vortex of learning in higher education. This exhilarating activity can serve as the hub for just about everything we do in dentistry. Whether it is the way we take in and organize our knowledge, the way we picture the outcome of a technical procedure, or the way we analyze an ethical dilemma, thinking and judgment pervade our every decision.

My interest in critical thinking goes back to an unexpected phone call in 1987. Our Associate Provost asked if I would chair a university committee on educational outcomes assessment. I told her I was not sure what that was. She replied that probably not many other faculty members were sure either.

The committee she put together consisted of the chairs and former chairs of physics, mechanical engineering, history, sociology, psychology, organizational behavior, and so forth. At the first meeting, after admitting to each other that none of us really knew what educational outcomes assessment meant, we went around the table asking, "What is the most important thing a student should get from our programs?" To a person, every committee member said some variation of "the ability to think critically and analytically."

Of course, everyone was secretly hoping that the committee would come up with a formula, a simple test that could assess this complex behavior. After all, the educational literature argues for-not just against-the idea that multiple-choice high-stakes exams can provide an in-depth assessment. But one member of our committee soon dispensed with any lingering hopes for an easy solution. An organizational behavior scholar with expertise in performance measurement, he insisted that critical thinking was very difficult to measure beyond a general performance level.

Measuring a change for that ability during the course of a student's education to show the value added, my colleague believed, was probably beyond the means of most academic units. His views helped shape the committee's ideas, and soon a consensus emerged. Since measurement would likely be imperfect, we should: (1) spend our energy creating a culture of inquiry and (2) build in some kind of assessment, as imperfect as it might be.

As a result, many programs at our school have cultivated a culture of inquiry during the past two decades, and while we still haven't found a magic assessment bullet, we are measuring student progress. Many of our efforts to address critical thinking cross disciplines and curricular years, strive to demonstrate the progression from novice to expert, and include some form of assessment.

Several of our efforts are quite creative, designed from the "bottom up," and they incorporate a variety of assessments. (I can take no credit for the design of any.) Unfortunately, when accreditation comes along, this variety can be dicey. At some point, we will need a "shoelace" to pull these assessments together, but for now-and until some definitive form of assessment comes along-I think our approach works well, if imperfectly.

Concrete Steps

I urge others who are ready to tackle critical thinking to begin by agreeing on a definition. Agreement will require a discussion, but faculty should resist the temptation to spend two years wordsmithing the definition to death. The ADEA Competencies for the New General Dentist and the ADEA Commission on Change and Innovation in Dental Education (CCI) white paper on critical thinking offer excellent places to start.

The next step should be to take a look at the work of our colleagues in education. There is no "quick fix" formula for developing and assessing critical thinking in our students, but the education literature is rich with ideas on complex thought processes. Several of the ideas have potential for application to dental education. A number of well designed programs in dental education already apply some of these concepts without referencing them. These include:

  • Define critical thinking. Agree on an institutional definition and one or more desired outcomes.
  • Offer multiple critical-thinking exercises. Educational psychologist Dr. David F. Lohman asserts that the whole of cognitive, moral, and emotional development can be summarized by the breadth of the perspectives a person can take in. This assertion reminds us that critical thinking doesn't fit well into silos and compels us to integrate it across disciplines and curriculum years.
  • Emulate the activity being assessed. To be valid, each exercise should translate an activity's thought processes into concrete steps that guide learning and assess performance. (The art of emulation requires replicating the essential elements of the activity in order to guide learning without being so prescriptive as to stifle learning. At a recent workshop, I observed just how agonizingly difficult this process can be the first time around.)
  • Agree on content, steps, and the assessment mechanism. To be reliable, exercises must be structured in ways that faculty have agreed upon. Faculty calibration will increase this reliability even further.
  • Use the same instrument to guide learning and assess performance.
  • Expect the students to systematically address alternative solutions, uncover biases in decision-making, and self-assess.

These concepts can be applied to an array of complex activities common in dentistry: searching and critiquing the scientific literature, assessing patients, planning treatment, performing self-assessment, implementing evidence-based practice, making ethical decisions, and integrating technology into practice, to name just a few.

Thinking is an art, both liberating for the mind and elusive to measure. Some assessment of critical thinking will necessarily be subjective as a result. At its core, critical thinking demands that the learner ask questions to reflect, doubt, inquire, challenge, investigate, and create. Assessing (or self-assessing) that process can be done in steps or it can be done holistically. It can be encapsulated in a single question or described in a rubric. Either way, the result should demonstrate whether a student grasps the principles of a particular exercise well enough to be considered competent.

Challenges

Creating a culture of inquiry should come naturally to institutions of learning, but as we all know well, challenges abound. Dental schools share the legacy of a century-old culture dominated by knowledge and technical skills delivered by separate disciplines. These are still important, even essential, but we need to evolve.

Acquiring critical thinking skills differs from acquiring knowledge because thinking starts with doubt and reflection. Developing a culture of inquiry that allows for critical thinking will likely take time. It may also occur in an idiosyncratic way. Because each student learns differently, one system will probably not guide each student's learning well. We will also have to prepare for some leveling between faculty and students because it is difficult to say, "Think critically and analytically and don't ask me why."

Another cultural challenge is the tension between the mission of the predoctoral curriculum to educate all students to emerge with entry-level competency and the pressure to rank students. The types of formative assessments that support the development of critical thinking may not be conducive to ranking students in a meaningful way. Nevertheless, our job as educators is to create a culture of inquiry that teaches our students to adapt to the unexpected in clinical situations and to changing trends in care delivery.

While schools may struggle to figure out how precisely to demonstrate their compliance with the new Commission on Dental Accreditation (CODA) standard related to critical thinking, I hope they will welcome this new requirement. It affirms exciting initiatives already taking place on many of our campuses. It should also stimulate new efforts that will move us all closer to creating a culture of inquiry in dental education.

This commentary represents a synthesis of ideas gleaned during 35 years from various sources and from colleagues at many institutions. The author will discuss this topic further in a forthcoming issue of the Journal of Dental Education.


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