CRITICAL THINKING, CLINICAL REASONING SKILLS AND COGNITIVE ABILITIES OF DENTAL STUDENTS

https://doi.org/10.22146/jpki.72915

Bernadetta Esti Chrismawaty(1), Ova Emilia(2), Gandes Retno Rahayu(3*), Ika Dewi Ana(4)

(1) Department of Oral Medicine Faculty of Dentistry University of Gadjah Mada Yogyakarta
(2) Faculty of Medicine, Public Health, Nursing, University of Gadjah Mada, Yogyakarta,
(3) Faculty of Medicine, Public Health, Nursing, University of Gadjah Mada, Yogyakarta,
(4) Department of Biomedical Faculty of Dentistry University of Gadjah Mada Yogyakarta
(*) Corresponding Author

Abstract


Background: Critical thinking (CT) and clinical reasoning (CR), along with adequate clinical knowledge, are crucial components of thinking in clinical practice. This study aimed to assess, compare and analyze the relationship between CT skills, CR skills, and cognitive abilities in undergraduate (UDS) and clinical dental students (CDS).

Methods: This natural experimental study was conducted using the quantitative descriptive-analytic methods with a cross-sectional design. Thirty UDS and sixty-one CDS were selected purposively. Demographic and academic data were obtained through questionnaires. The Critical Thinking Tool (CriTT) was used to measure CT skills, and CR skills were measured by the Diagnostic Thinking Inventory (DTI). Knowledge acquisition was measured through the Cognitive Ability Test (CAT), which is a set of multiple-choice questions specifically developed and validated for this study. The statistical differences between them were analyzed by one-way ANOVA, and their relationship was tested by correlation matrix analyses.

Results: There were no differences in CriTT measurements between groups. The overall DTI score and subscale 2 (Structure of memory) showed significant differences between groups, as did the overall CAT score and all clinical science subscales. Correlation matrix analyses revealed CR skills were related to CT skills, while the cognitive abilities or knowledge acquisition were related to CR skills.

Conclusion: Results showed the CR skills and cognitive abilities of clinical dental students are superior to undergraduate dental students. Generally, the results indicated the more skilled students are in critical thinking, the better are their clinical reasoning skills. Better cognitive abilities tended to improve clinical reasoning skills.

 


Keywords


Dental student, critical thinking skills, Critical Thinking Tool, clinical reasoning skills, Diagnostic Thinking Inventory, cognitive abilities.

Full Text:

PDF


References

  1. Watt RG, Daly B, Allison P, Macpherson LMD, Venturelli R, Listl S, et al. Ending the neglect of global oral health: time for radical action. Lancet [Internet]. 2019 Jul 20;394(10194):261–72. Available from: http://dx.doi.org/10.1016/S0140-6736(19)31133-X
  2. Lamster IB, Myers-Wright N. Oral health care in the future: expansion of the scope of dental practice to improve health. J Dent Educ [Internet]. 2017 Sep;81(9):eS83–90. Available from: http://doi.wiley.com/10.21815/JDE.017.038
  3. Tubert-Jeannin S, Jourdan D. Renovating dental education: a public health issue. Eur J Dent Educ [Internet]. 2018 Aug;22(3):e644–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29582568
  4. Kassebaum NJ, Smith AGC, Bernabé E, Fleming TD, Reynolds AE, Vos T, et al. Global, regional, and national prevalence, incidence, and disability-adjusted life years for oral conditions for 195 countries, 1990–2015: a systematic analysis for the global burden of diseases, injuries, and risk factors. J Dent Res [Internet]. 2017 Apr 1;96(4):380–7. Available from: http://journals.sagepub.com/doi/10.1177/0022034517693566
  5. Glick M, Carrasco-Labra A. Raison d’être for clinical reasoning. J Am Dent Assoc [Internet]. 2019 Dec;150(12):987–90. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0002817719307366
  6. Faucher C. Differentiating the elements of clinical thinking. Optom Educ [Internet]. 2011;36(3). Available from: https://journal.opted.org/articles/Volume_36_Number_3_CriticalThinking.pdf
  7. Fish, Della and Higgs J. The context for clinical decision making in the 21st century. In: Higgs J, Jones MA, Loftus S, Christensen N, editors. Clinical Reasoning in the Health Professions. 3rd ed. Elsevier (Butterworth Heinemann); 2008. p. 19–30.
  8. Sharples JM, Oxman AD, Mahtani KR, Chalmers I, Oliver S, Collins K, et al. Critical thinking in healthcare and education. BMJ [Internet]. 2017 May 16;357:j2234. Available from: http://www.bmj.com/lookup/doi/10.1136/bmj.j2234
  9. Behar-Horenstein LS, Schneider-Mitchell G, Graff R. Promoting the teaching of critical thinking skills through faculty development. J Dent Educ [Internet]. 2009 Jun;73(6):665–75. Available from: https://onlinelibrary.wiley.com/doi/10.1002/j.0022-0337.2009.73.6.tb04746.x
  10. Gruppen L. Clinical reasoning: defining it, teaching it, assessing it, studying it. West J Emerg Med [Internet]. 2017 Jan 19;18(1):4–7. Available from: http://escholarship.org/uc/item/8249101m
  11. Young M, Thomas A, Gordon D, Gruppen L, Lubarsky S, Rencic J, et al. The terminology of clinical reasoning in health professions education: implications and considerations. Med Teach [Internet]. 2019 Nov 2;41(11):1277–84. Available from: https://www.tandfonline.com/doi/full/10.1080/0142159X.2019.1635686
  12. Higgs J, Jones MA. Clinical decision making and multiple problem spaces. In: Higgs J, Jones MA, Loftus S, Christensesn N, editors. Clinical Reasoning in the Health Professions. 3rd ed. Elsevier (Butterworth Heinemann); 2008. p. 3–18.
  13. Khatami S, MacEntee MI. Evolution of clinical reasoning in dental education. J Dent Educ [Internet]. 2011 Mar;75(3):321–8. Available from: http://doi.wiley.com/10.1002/j.0022-0337.2011.75.3.tb05045.x
  14. Fejerskov O, Uribe S, Mariño RJ. Dentistry in a historical perspective and a likely future of the profession. In: Mariño RJ, Morgan M V., Walmsley AD, editors. Career Paths in Oral Health [Internet]. Cham: Springer International Publishing; 2018. p. 3–19. Available from: http://link.springer.com/10.1007/978-3-319-89731-8
  15. Bestall S, Flynn R, Charleson G, Abbott P V. Assessment of Australian dentists’ treatment planning decisions based on diagnosis. J Endod [Internet]. 2020;46(4):483–9. Available from: https://doi.org/10.1016/j.joen.2020.01.004
  16. Baelum V. Dentistry and population approaches for preventing dental diseases. J Dent [Internet]. 2011 Dec;39(SUPPL. 2):S9–19. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0300571211002636
  17. Best L, Walton JN, Walker J, von Bergmann H. Reaching consensus on essential biomedical science learning objectives in a dental curriculum. J Dent Educ [Internet]. 2016 Apr;80(4):422–9. Available from: http://doi.wiley.com/10.1002/j.0022-0337.2016.80.4.tb06100.x
  18. Spielman A. The future of oral medicine. Oral Dis [Internet]. 2018 Mar;24(1–2):285–8. Available from: https://onlinelibrary.wiley.com/doi/10.1111/odi.12739
  19. Bennett JH, Beeley JA, Anderson P, Belfield L, Brand HS, Didilescu AC, et al. A core curriculum in the biological and biomedical sciences for dentistry. Eur J Dent Educ [Internet]. 2020 Aug 19;24(3):433–41. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/eje.12518
  20. Anders PL, Stellrecht EM, Davis EL, McCall WD. A systematic review of critical thinking instruments for use in dental education. J Dent Educ [Internet]. 2019 Apr;83(4):381–97. Available from: http://doi.wiley.com/10.21815/JDE.019.043
  21. Pardamean B. Measuring change in critical thinking skills of dental students educated in a PBL curriculum. J Dent Educ [Internet]. 2012 Apr;76(4):443–53. Available from: https://onlinelibrary.wiley.com/doi/10.1002/j.0022-0337.2012.76.4.tb05276.x
  22. Hanlon JP, Prihoda TJ, Verrett RG, Jones JD, Haney SJ, Hendricson WD. Critical thinking in dental students and experienced practitioners assessed by the Health Sciences Reasoning Test. J Dent Educ [Internet]. 2018 Sep;82(9):916–20. Available from: http://doi.wiley.com/10.21815/JDE.018.089
  23. Stupple EJN, Maratos FA, Elander J, Hunt TE, Cheung KYF, Aubeeluck A V. Development of the Critical Thinking Toolkit (CriTT): a measure of student attitudes and beliefs about critical thinking. Think Ski Creat [Internet]. 2017;23:91–100. Available from: http://dx.doi.org/10.1016/j.tsc.2016.11.007
  24. Chan ZCY. A systematic review on critical thinking in medical education. Int J Adolesc Med Health [Internet]. 2018 Feb 23;30(1). Available from: https://www.degruyter.com/document/doi/10.1515/ijamh-2015-0117/html
  25. Whitney EM, Aleksejuniene J, Walton JN. Critical thinking disposition and skills in dental students: development and relationship to academic outcomes. J Dent Educ [Internet]. 2016 Aug;80(8):948–58. Available from: https://onlinelibrary.wiley.com/doi/10.1002/j.0022-0337.2016.80.8.tb06175.x
  26. Escudier MP, Woolford MJ, Tricio JA. Assessing the application of knowledge in clinical problem-solving: the structured professional reasoning exercise. Eur J Dent Educ [Internet]. 2018 May;22(2):e269–77. Available from: http://doi.wiley.com/10.1111/eje.12286
  27. Keshmiri F, Owlia F, Kazemipoor M, Meybodi FR. Assessment of clinical reasoning and diagnostic thinking among dental students. 2021;1–14. Available from: https://doi.org/10.21203/rs.3.rs-792901/v1
  28. Modi JN, Anshu, Gupta P, Singh T. Teaching and assessing clinical reasoning skills. Indian Pediatr [Internet]. 2015 Sep 20;52(9):787–94. Available from: https://link.springer.com/content/pdf/10.1007/s13312-015-0718-7.pdf
  29. Groves M, Scott I, Alexander H. Assessing clinical reasoning: a method to monitor its development in a PBL curriculum. Med Teach [Internet]. 2002 Jan 3;24(5):507–15. Available from: http://www.tandfonline.com/doi/full/10.1080/01421590220145743
  30. Khatami S, MacEntee MI, Pratt DD, Collins JB. Clinical reasoning in dentistry: a conceptual framework for dental education. J Dent Educ [Internet]. 2012 Sep;76(9):1116–28. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22942407
  31. Maupomé G, Schrader S, Mannan S, Garetto L, Eggertsson H. Diagnostic thinking and information used in clinical decision-making: a qualitative study of expert and student dental clinicians. BMC Oral Health [Internet]. 2010 May 13;10(1):11. Available from: https://bmcoralhealth.biomedcentral.com/articles/10.1186/1472-6831-10-11
  32. Rahayu GR, McAleer S. Clinical reasoning of Indonesian medical students as measured by diagnostic thinking inventory. South East Asian J Med Educ [Internet]. 2008;2(1):5. Available from: http://www.md.chula.ac.th/jmet/articleVol2No1/OR4_Gandes Retno Rahayu.pdf
  33. Azer SA, Guerrero APS, Walsh A. Enhancing learning approaches: practical tips for students and teachers. Med Teach [Internet]. 2013 Jun 15;35(6):433–43. Available from: http://www.tandfonline.com/doi/full/10.3109/0142159X.2013.775413
  34. Haladyna TM, Rodriguez MC, Stevens C. Are multiple-choice items too fat? Appl Meas Educ [Internet]. 2019;32(4):350–64. Available from: https://doi.org/10.1080/08957347.2019.1660348
  35. Bordage G, Grant J, Marsden P. Quantitative assessment of diagnostic ability. Med Educ [Internet]. 1990 Sep;24(5):413–25. Available from: http://doi.wiley.com/10.1111/j.1365-2923.1990.tb02650.x
  36. Konsil Kedokteran Indonesia. Standar Kompetensi Dokter Gigi Indonesia. Jakarta: KONSIL KEDOKTERAN INDONESIA; 2015. 1–90 p.
  37. Krathwohl DR. A revision of Bloom’s taxonomy: an overview. Theory Pract [Internet]. 2002 Nov 1;41(4):212–8. Available from: http://www.tandfonline.com/doi/abs/10.1207/s15430421tip4104_2
  38. Malau-Aduli BS, Zimitat C. Peer review improves the quality of MCQ examinations. Assess Eval High Educ [Internet]. 2012 Dec 6;37(8):919–31. Available from: https://www.tandfonline.com/doi/full/10.1080/02602938.2011.58699
  39. McKay JC, Quiñonez CR. The feminization of dentistry: implications for the profession. J Can Dent Assoc [Internet]. 2012;78(c1). Available from: http://www.ncbi.nlm.nih.gov/pubmed/22322017
  40. Gross D, Schäfer G. “Feminization” in German dentistry. Career paths and opportunities: a gender comparison. Womens Stud Int Forum [Internet]. 2011 Mar;34(2):130–9. Available from: http://dx.doi.org/10.1016/j.wsif.2010.12.003
  41. Walsh CM, Hardy RC. Dispositional differences in critical thinking related to gender and academic major. J Nurs Educ [Internet]. 1999;38(4):149–55. Available from: http://textos.pucp.edu.pe/pdf/1111.pdf
  42. Everett AC, Anderson OS, Wright MC, Fontana M. Longitudinal assessment of critical thinking skills across a dental curriculum. J Dent Educ [Internet]. 2018 Sep;82(9):921–8. Available from: http://doi.wiley.com/10.21815/JDE.018.088
  43. van der Zanden PJAC, Denessen E, Cillessen AHN, Meijer PC. Domains and predictors of first-year student success: a systematic review. Educ Res Rev [Internet]. 2018 Feb 1;23:57–77. Available from: https://www.sciencedirect.com/science/article/pii/S1747938X18300174
  44. Straková Z, Cimermanová I. Critical thinking development: a necessary step in higher education transformation towards sustainability. Sustainability [Internet]. 2018 Sep 20;10(10):3366. Available from: http://www.mdpi.com/2071-1050/10/10/3366
  45. Boshuizen HP, Schmidt HG. The development of clinical reasoning expertise. In: Higgs J, Jones MA, Loftus S, Christensesn N, editors. Clinical Reasoning in the Health professions. 3rd ed. Elsevier (Butterworth Heinemann); 2008. p. 113–21.
  46. Harasym PH, Tsai T-C, Hemmati P. Current trends in developing medical students’ critical thinking abilities. Kaohsiung J Med Sci [Internet]. 2008 Jul;24(7):341–55. Available from: http://doi.wiley.com/10.1016/S1607-551X(08)70131-1
  47. Khatami S, MacEntee MI, Loftus S. Clinical reasoning in dentistry. In: Higgs J, Jones MA, Loftus S, Christensesn N, editors. Clinical Reasoning in the Health Professions. 3rd ed. Elsevier (Butterworth Heinemann); 2008. p. 257–64.
  48. Epstein RM. Assessment in medical education. N Engl J Med [Internet]. 2007 Jan 25;356(4):387–96. Available from: http://www.nejm.org/doi/10.1056/NEJMra054784
  49. Bowen JL, ten Cate O. Prerequisites for learning clinical reasoning. In: ten Cate O, Custers EJ, Durning SJ, editors. Principles and Practice of Case-based Clinical Reasoning Education: A Method for Preclinical Students [Internet]. Cham, Switzerland: Springer Nature; 2018. p. 47–63. Available from: https://doi.org/10.1007/978-3-319-64828-6_4
  50. Daniel M, Rencic J, Durning SJ, Holmboe E, Santen SA, Lang V, et al. Clinical reasoning assessment methods. Acad Med [Internet]. 2019 Jun;94(6):902–12. Available from: http://journals.lww.com/00001888-201906000-00052
  51. Rikers RMJP, Loyens S, te Winkel W, Schmidt HG, Sins PHM. The role of biomedical knowledge in clinical reasoning: a lexical decision study. Acad Med [Internet]. 2005 Oct;80(10):945–9. Available from: http://journals.lww.com/00001888-200510000-00015
  52. Yazdani S, Abardeh M. Clinical reasoning in medicine: a concept analysis. J Med Educ [Internet]. 2017;16(3):e105581. Available from: https://www.researchgate.net/publication/323116352_Clinical_Reasoning_in_Medicine_A_Concept_Analysis
  53. Custers EJFM. Thirty years of illness scripts: theoretical origins and practical applications. Med Teach [Internet]. 2015 May 4;37(5):457–62. Available from: http://www.tandfonline.com/doi/full/10.3109/0142159X.2014.956052
  54. Scully D. Constructing multiple-choice items to measure higher-order thinking. Pract Assessment, Res Eval. 2017;22(4):1–13. Available from: https://core.ac.uk/download/pdf/322850346.pdf
  55. Yazdani S, Hoseini Abardeh M. A novel model of clinical reasoning: cognitive zipper model. J Adv Med Educ Prof [Internet]. 2020 Apr;8(2):61–71. Available from: http://www.ncbi.nlm.nih.gov/pubmed/32426390
  56. Facione P a. Critical thinking: what it is and why it counts [Internet]. Insight Assessment. 2011. 1–28 p. Available from: https://www.insightassessment.com/CT-Resources/Teaching-For-and-About-Critical-Thinking/Critical-Thinking-What-It-Is-and-Why-It-Counts/Critical-Thinking-What-It-Is-and-Why-It-Counts-PDF
  57. Konsil Kedokteran Indonesia. Standar Pendidikan Profesi Dokter Indonesia. Kons Kedokt Indones [Internet]. 2019; Available from: http://www.kki.go.id/assets/data/arsip/Final_SPPDI,_21_Maret_20131.pdf
  58. Cohen L, Manion L, Morrison K. Research Methods in Education. London: Taylor Francis. 2017.



DOI: https://doi.org/10.22146/jpki.72915

Article Metrics

Abstract views : 1402 | views : 1350

Refbacks

  • There are currently no refbacks.


Copyright (c) 2022 Bernadetta Esti Chrismawaty, Ova Emilia, Gandes Retno Rahayu, Ika Dewi Ana

Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Jurnal Pendidikan Kedokteran Indonesia (The Indonesian Journal of Medical Education) indexed by:

  
JPKI Stats