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Predicting everyday critical thinking: a review of critical thinking assessments.

1. Introduction

2. how critical thinking impacts everyday life, 3. critical thinking: skills and dispositions.

“the use of those cognitive skills and abilities that increase the probability of a desirable outcome. It is used to describe thinking that is purposeful, reasoned, and goal directed—the kind of thinking involved in solving problems, formulating inferences, calculating likelihoods, and making decisions” ( Halpern 2014, p. 8 ).

4. Measuring Critical Thinking

4.1. practical challenges, 4.2. critical thinking assessments, 4.2.1. california critical thinking dispositions inventory (cctdi; insight assessment, inc. n.d. ), 4.2.2. california critical thinking skills test (cctst; insight assessment, inc. n.d. ), 4.2.3. cornell critical thinking test (cctt; the critical thinking company n.d. ), 4.2.4. california measure of mental motivation (cm3; insight assessment, inc. n.d. ), 4.2.5. ennis–weir critical thinking essay test ( ennis and weir 2005 ), 4.2.6. halpern critical thinking assessment (hcta; halpern 2012 ), 4.2.7. test of everyday reasoning (ter; insight assessment, inc. n.d. ), 4.2.8. watson–glaser tm ii critical thinking appraisal (w-gii; ncs pearson, inc. 2009 ).

“Virtual employees, or employees who work from home via a computer, are an increasing trend. In the US, the number of virtual employees has increased by 39% in the last two years and 74% in the last five years. Employing virtual workers reduces costs and makes it possible to use talented workers no matter where they are located globally. Yet, running a workplace with virtual employees might entail miscommunication and less camaraderie and can be more time-consuming than face-to-face interaction”.

5. Conclusions

Institutional review board statement, informed consent statement, data availability statement, conflicts of interest.

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Share and Cite

Butler, H.A. Predicting Everyday Critical Thinking: A Review of Critical Thinking Assessments. J. Intell. 2024 , 12 , 16. https://doi.org/10.3390/jintelligence12020016

Butler HA. Predicting Everyday Critical Thinking: A Review of Critical Thinking Assessments. Journal of Intelligence . 2024; 12(2):16. https://doi.org/10.3390/jintelligence12020016

Butler, Heather A. 2024. "Predicting Everyday Critical Thinking: A Review of Critical Thinking Assessments" Journal of Intelligence 12, no. 2: 16. https://doi.org/10.3390/jintelligence12020016

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Promoting critical thinking through an evidence-based skills fair intervention

Journal of Research in Innovative Teaching & Learning

ISSN : 2397-7604

Article publication date: 23 November 2020

Issue publication date: 1 April 2022

The lack of critical thinking in new graduates has been a concern to the nursing profession. The purpose of this study was to investigate the effects of an innovative, evidence-based skills fair intervention on nursing students' achievements and perceptions of critical thinking skills development.

Design/methodology/approach

The explanatory sequential mixed-methods design was employed for this study.

The findings indicated participants perceived the intervention as a strategy for developing critical thinking.

Originality/value

The study provides educators helpful information in planning their own teaching practice in educating students.

Critical thinking

Evidence-based practice, skills fair intervention.

Gonzalez, H.C. , Hsiao, E.-L. , Dees, D.C. , Noviello, S.R. and Gerber, B.L. (2022), "Promoting critical thinking through an evidence-based skills fair intervention", Journal of Research in Innovative Teaching & Learning , Vol. 15 No. 1, pp. 41-54. https://doi.org/10.1108/JRIT-08-2020-0041

Emerald Publishing Limited

Copyright © 2020, Heidi C. Gonzalez, E-Ling Hsiao, Dianne C. Dees, Sherri R. Noviello and Brian L. Gerber

Published in Journal of Research in Innovative Teaching & Learning . Published by Emerald Publishing Limited. This article is published under the Creative Commons Attribution (CC BY 4.0) licence. Anyone may reproduce, distribute, translate and create derivative works of this article (for both commercial and non-commercial purposes), subject to full attribution to the original publication and authors. The full terms of this licence may be seen at http://creativecommons.org/licences/by/4.0/legalcode

Introduction

Critical thinking (CT) was defined as “cognitive skills of analyzing, applying standards, discriminating, information seeking, logical reasoning, predicting, and transforming knowledge” ( Scheffer and Rubenfeld, 2000 , p. 357). Critical thinking is the basis for all professional decision-making ( Moore, 2007 ). The lack of critical thinking in student nurses and new graduates has been a concern to the nursing profession. It would negatively affect the quality of service and directly relate to the high error rates in novice nurses that influence patient safety ( Arli et al. , 2017 ; Saintsing et al. , 2011 ). It was reported that as many as 88% of novice nurses commit medication errors with 30% of these errors due to a lack of critical thinking ( Ebright et al. , 2004 ). Failure to rescue is another type of error common for novice nurses, reported as high as 37% ( Saintsing et al. , 2011 ). The failure to recognize trends or complications promptly or take action to stabilize the patient occurs when health-care providers do not recognize signs and symptoms of the early warnings of distress ( Garvey and CNE series, 2015 ). Internationally, this lack of preparedness and critical thinking attributes to the reported 35–60% attrition rate of new graduate nurses in their first two years of practice ( Goodare, 2015 ). The high attrition rate of new nurses has expensive professional and economic costs of $82,000 or more per nurse and negatively affects patient care ( Twibell et al. , 2012 ). Facione and Facione (2013) reported the failure to utilize critical thinking skills not only interferes with learning but also results in poor decision-making and unclear communication between health-care professionals, which ultimately leads to patient deaths.

Due to the importance of critical thinking, many nursing programs strive to infuse critical thinking into their curriculum to better prepare graduates for the realities of clinical practice that involves ever-changing, complex clinical situations and bridge the gap between education and practice in nursing ( Benner et al. , 2010 ; Kim et al. , 2019 ; Park et al. , 2016 ; Newton and Moore, 2013 ; Nibert, 2011 ). To help develop students' critical thinking skills, nurse educators must change the way they teach nursing, so they can prepare future nurses to be effective communicators, critical thinkers and creative problem solvers ( Rieger et al. , 2015 ). Nursing leaders also need to redefine teaching practice and educational guidelines that drive innovation in undergraduate nursing programs.

Evidence-based practice has been advocated to promote critical thinking and help reduce the research-practice gap ( Profetto-McGrath, 2005 ; Stanley and Dougherty, 2010 ). Evidence-based practice was defined as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of the individual patient” ( Sackett et al. , 1996 , p. 71). Skills fair intervention, one type of evidence-based practice, can be used to engage students, promote active learning and develop critical thinking ( McCausland and Meyers, 2013 ; Roberts et al. , 2009 ). Skills fair intervention helps promote a consistent teaching practice of the psychomotor skills to the novice nurse that decreased anxiety, gave clarity of expectations to the students in the clinical setting and increased students' critical thinking skills ( Roberts et al. , 2009 ). The researchers of this study had an opportunity to create an active, innovative skills fair intervention for a baccalaureate nursing program in one southeastern state. This intervention incorporated evidence-based practice rationale with critical thinking prompts using Socratic questioning, evidence-based practice videos to the psychomotor skill rubrics, group work, guided discussions, expert demonstration followed by guided practice and blended learning in an attempt to promote and develop critical thinking in nursing students ( Hsu and Hsieh, 2013 ; Oermann et al. , 2011 ; Roberts et al. , 2009 ). The effects of an innovative skills fair intervention on senior baccalaureate nursing students' achievements and their perceptions of critical thinking development were examined in the study.

Literature review

The ability to use reasoned opinion focusing equally on processes and outcomes over emotions is called critical thinking ( Paul and Elder, 2008 ). Critical thinking skills are desired in almost every discipline and play a major role in decision-making and daily judgments. The roots of critical thinking date back to Socrates 2,500 years ago and can be traced to the ancient philosopher Aristotle ( Paul and Elder, 2012 ). Socrates challenged others by asking inquisitive questions in an attempt to challenge their knowledge. In the 1980s, critical thinking gained nationwide recognition as a behavioral science concept in the educational system ( Robert and Petersen, 2013 ). Many researchers in both education and nursing have attempted to define, measure and teach critical thinking for decades. However, a theoretical definition has yet to be accepted and established by the nursing profession ( Romeo, 2010 ). The terms critical literacy, CT, reflective thinking, systems thinking, clinical judgment and clinical reasoning are used synonymously in the reviewed literature ( Clarke and Whitney, 2009 ; Dykstra, 2008 ; Jones, 2010 ; Swing, 2014 ; Turner, 2005 ).

Watson and Glaser (1980) viewed critical thinking not only as cognitive skills but also as a combination of skills, knowledge and attitudes. Paul (1993) , the founder of the Foundation for Critical Thinking, offered several definitions of critical thinking and identified three essential components of critical thinking: elements of thought, intellectual standards and affective traits. Brunt (2005) stated critical thinking is a process of being practical and considered it to be “the process of purposeful thinking and reflective reasoning where practitioners examine ideas, assumptions, principles, conclusions, beliefs, and actions in the contexts of nursing practice” (p. 61). In an updated definition, Ennis (2011) described critical thinking as, “reasonable reflective thinking focused on deciding what to believe or do” (para. 1).

The most comprehensive attempt to define critical thinking was under the direction of Facione and sponsored by the American Philosophical Association ( Scheffer and Rubenfeld, 2000 ). Facione (1990) surveyed 53 experts from the arts and sciences using the Delphi method to define critical thinking as a “purposeful, self-regulatory judgment which results in interpretation, analysis, evaluation, and inference, as well as an explanation of the evidential, conceptual, methodological, criteriological, or contextual considerations upon which judgment, is based” (p. 2).

To come to a consensus definition for critical thinking, Scheffer and Rubenfeld (2000) also conducted a Delphi study. Their study consisted of an international panel of nurses who completed five rounds of sequenced questions to arrive at a consensus definition. Critical thinking was defined as “habits of mind” and “cognitive skills.” The elements of habits of mind included “confidence, contextual perspective, creativity, flexibility, inquisitiveness, intellectual integrity, intuition, open-mindedness, perseverance, and reflection” ( Scheffer and Rubenfeld, 2000 , p. 352). The elements of cognitive skills were recognized as “analyzing, applying standards, discriminating, information seeking, logical reasoning, predicting, and transforming knowledge” ( Scheffer and Rubenfeld, 2000 , p. 352). In addition, Ignatavicius (2001) defined the development of critical thinking as a long-term process that must be practiced, nurtured and reinforced over time. Ignatavicius believed that a critical thinker required six cognitive skills: interpretation, analysis, evaluation, inference, explanation and self-regulation ( Chun-Chih et al. , 2015 ). According to Ignatavicius (2001) , the development of critical thinking is difficult to measure or describe because it is a formative rather than summative process.

Fero et al. (2009) noted that patient safety might be compromised if a nurse cannot provide clinically competent care due to a lack of critical thinking. The Institute of Medicine (2001) recommended five health care competencies: patient-centered care, interdisciplinary team care, evidence-based practice, informatics and quality improvement. Understanding the development and attainment of critical thinking is the key for gaining these future competencies ( Scheffer and Rubenfeld, 2000 ). The development of a strong scientific foundation for nursing practice depends on habits such as contextual perspective, inquisitiveness, creativity, analysis and reasoning skills. Therefore, the need to better understand how these critical thinking habits are developed in nursing students needs to be explored through additional research ( Fero et al. , 2009 ). Despite critical thinking being listed since the 1980s as an accreditation outcome criteria for baccalaureate programs by the National League for Nursing, very little improvement has been observed in practice ( McMullen and McMullen, 2009 ). James (2013) reported the number of patient harm incidents associated with hospital care is much higher than previously thought. James' study indicated that between 210,000 and 440,000 patients each year go to the hospital for care and end up suffering some preventable harm that contributes to their death. James' study of preventable errors is attributed to other sources besides nursing care, but having a nurse in place who can advocate and critically think for patients will make a positive impact on improving patient safety ( James, 2013 ; Robert and Peterson, 2013 ).

Adopting teaching practice to promote CT is a crucial component of nursing education. Research by Nadelson and Nadelson (2014) suggested evidence-based practice is best learned when integrated into multiple areas of the curriculum. Evidence-based practice developed its roots through evidence-based medicine, and the philosophical origins extend back to the mid-19th century ( Longton, 2014 ). Florence Nightingale, the pioneer of modern nursing, used evidence-based practice during the Crimean War when she recognized a connection between poor sanitary conditions and rising mortality rates of wounded soldiers ( Rahman and Applebaum, 2011 ). In professional nursing practice today, a commonly used definition of evidence-based practice is derived from Dr. David Sackett: the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient ( Sackett et al. , 1996 , p. 71). As professional nurses, it is imperative for patient safety to remain inquisitive and ask if the care provided is based on available evidence. One of the core beliefs of the American Nephrology Nurses' Association's (2019) 2019–2020 Strategic Plan is “Anna must support research to develop evidence-based practice, as well as to advance nursing science, and that as individual members, we must support, participate in, and apply evidence-based research that advances our own skills, as well as nursing science” (p. 1). Longton (2014) reported the lack of evidence-based practice in nursing resulted in negative outcomes for patients. In fact, when evidence-based practice was implemented, changes in policies and procedures occurred that resulted in decreased reports of patient harm and associated health-care costs. The Institute of Medicine (2011) recommendations included nurses being leaders in the transformation of the health-care system and achieving higher levels of education that will provide the ability to critically analyze data to improve the quality of care for patients. Student nurses must be taught to connect and integrate CT and evidence-based practice throughout their program of study and continue that practice throughout their careers.

One type of evidence-based practice that can be used to engage students, promote active learning and develop critical thinking is skills fair intervention ( McCausland and Meyers, 2013 ; Roberts et al. , 2009 ). Skills fair intervention promoted a consistent teaching approach of the psychomotor skills to the novice nurse that decreased anxiety, gave clarity of expectations to the students in the clinical setting and increased students' critical thinking skills ( Roberts et al. , 2009 ). The skills fair intervention used in this study is a teaching strategy that incorporated CT prompts, Socratic questioning, group work, guided discussions, return demonstrations and blended learning in an attempt to develop CT in nursing students ( Hsu and Hsieh, 2013 ; Roberts et al. , 2009 ). It melded evidence-based practice with simulated CT opportunities while students practiced essential psychomotor skills.

Research methodology

Context – skills fair intervention.

According to Roberts et al. (2009) , psychomotor skills decline over time even among licensed experienced professionals within as little as two weeks and may need to be relearned within two months without performing a skill. When applying this concept to student nurses for whom each skill is new, it is no wonder their competency result is diminished after having a summer break from nursing school. This skills fair intervention is a one-day event to assist baccalaureate students who had taken the summer off from their studies in nursing and all faculty participated in operating the stations. It incorporated evidence-based practice rationale with critical thinking prompts using Socratic questioning, evidence-based practice videos to the psychomotor skill rubrics, group work, guided discussions, expert demonstration followed by guided practice and blended learning in an attempt to promote and develop critical thinking in baccalaureate students.

Students were scheduled and placed randomly into eight teams based on attributes of critical thinking as described by Wittmann-Price (2013) : Team A – Perseverance, Team B – Flexibility, Team C – Confidence, Team D – Creativity, Team E – Inquisitiveness, Team F – Reflection, Team G – Analyzing and Team H – Intuition. The students rotated every 20 minutes through eight stations: Medication Administration: Intramuscular and Subcutaneous Injections, Initiating Intravenous Therapy, ten-minute Focused Physical Assessment, Foley Catheter Insertion, Nasogastric Intubation, Skin Assessment/Braden Score and Restraints, Vital Signs and a Safety Station. When the students completed all eight stations, they went to the “Check-Out” booth to complete a simple evaluation to determine their perceptions of the effectiveness of the innovative intervention. When the evaluations were complete, each of the eight critical thinking attribute teams placed their index cards into a hat, and a student won a small prize. All Junior 2, Senior 1 and Senior 2 students were required to attend the Skills Fair. The Skills Fair Team strove to make the event as festive as possible, engaging nursing students with balloons, candy, tri-boards, signs and fun pre and postactivities. The Skills Fair rubrics, scheduling and instructions were shared electronically with students and faculty before the skills fair intervention to ensure adequate preparation and continuous resource availability as students move forward into their future clinical settings.

Research design

Institutional review board (IRB) approval was obtained from XXX University to conduct this study and protect human subject rights. The explanatory sequential mixed-methods design was employed for this study. The design was chosen to identify what effects a skills fair intervention that had on senior baccalaureate nursing students' achievements on the Kaplan Critical Thinking Integrated Test (KCTIT) and then follow up with individual interviews to explore those test results in more depth. In total, 52 senior nursing students completed the KCTIT; 30 of them participated in the skills fair intervention and 22 of them did not participate. The KCTIT is a computerized 85-item exam in which 85 equates to 100%, making each question worth one point. It has high reliability and validity ( Kaplan Nursing, 2012 ; Swing, 2014 ). The reliability value of the KCTIT ranged from 0.72 to 0.89. A t -test was used to analyze the test results.

A total of 11 participants were purposefully selected based on a range of six high achievers and five low achievers on the KCTIT for open-ended one-on-one interviews. Each interview was conducted individually and lasted for about 60 minutes. An open-ended interview protocol was used to guide the flow of data collection. The interviewees' ages ranged from 21 to 30 years, with an average of 24 years. One of 11 interviewees was male. Among them, seven were White, three were Black and one was Indian American. The data collected were used to answer the following research questions: (1) What was the difference in achievements on the KCTIT among senior baccalaureate nursing students who participated in the skills fair intervention and students who did not participate? (2) What were the senior baccalaureate nursing students' perceptions of internal and external factors impacting the development of critical thinking skills during the skills fair intervention? and (3) What were the senior baccalaureate nursing students' perceptions of the skills fair intervention as a critical thinking developmental strategy?

Inductive content analysis was used to analyze interview data by starting with the close reading of the transcripts and writing memos for initial coding, followed by an analysis of patterns and relationships among the data for focused coding. The intercoder reliability was established for qualitative data analysis with a nursing expert. The lead researcher and the expert read the transcript several times and assigned a code to significant units of text that corresponded with answering the research questions. The codes were compared based on differences and similarities and sorted into subcategories and categories. Then, headings and subheadings were used based on similar comments to develop central themes and patterns. The process of establishing intercoder reliability helped to increase dependability, conformability and credibility of the findings ( Graneheim and Lundman, 2004 ). In addition, methods of credibility, confirmability, dependability and transferability were applied to increase the trustworthiness of this study ( Graneheim and Lundman, 2004 ). First, reflexivity was observed by keeping journals and memos. This practice allowed the lead researcher to reflect on personal views to minimize bias. Data saturation was reached through following the recommended number of participants as well as repeated immersion in the data during analysis until no new data surfaced. Member checking was accomplished through returning the transcript and the interpretation to the participants to check the accuracy and truthfulness of the findings. Finally, proper documentation was conducted to allow accurate crossreferencing throughout the study.

Quantitative results

Results for the quantitative portion showed there was no difference in scores on the KCTIT between senior nursing students who participated in the skills fair intervention and senior nursing students who did not participate, t (50) = −0.174, p  = 0.86 > 0.05. The test scores between the nonparticipant group ( M  = 67.59, SD = 5.81) and the participant group ( M  = 67.88, SD = 5.99) were almost equal.

Qualitative results

Initial coding.

The results from the initial coding and generated themes are listed in Table 1 . First, the participants perceived the skills fair intervention as “promoting experience” and “confidence” by practicing previously learned knowledge and reinforcing it with active learning strategies. Second, the participants perceived the skills fair intervention as a relaxed, nonthreatening learning environment due to the festive atmosphere, especially in comparison to other learning experiences in the nursing program. The nonthreatening environment of the skills fair intervention allowed students to learn without fear. Third, the majority of participants believed their critical thinking was strengthened after participating. Several participants believed their perception of critical thinking was “enhanced” or “reinforced” rather than significantly changed.

Focused coding results

The final themes were derived from the analysis of patterns and relationships among the content of the data using inductive content analysis ( Saldana, 2009 ). The following was examined across the focused coding process: (1) factors impacting critical thinking skills development during skills fair intervention and (2) skills fair intervention a critical thinking skills developmental strategy.

Factors impacting critical thinking skills development . The factors impacting the development of critical thinking during the skills fair intervention were divided into two themes: internal factors and external factors. The internal factors were characteristics innate to the students. The identified internal factors were (1) confidence and anxiety levels, (2) attitude and (3) age. The external factors were the outside influences that affected the students. The external factors were (1) experience and practice, (2) faculty involvement, (3) positive learning environment and (4) faculty prompts.

I think that confidence and anxiety definitely both have a huge impact on your ability to be able to really critically think. If you start getting anxious and panicking you cannot think through the process like you need too. I do not really think gender or age necessarily would have anything to do with critical thinking.

Definitely the confidence level, I think, the more advanced you get in the program, your confidence just keeps on growing. Level of anxiety, definitely… I think the people who were in the Skills Fair for the first time, had more anxiety because they did not really know to think, they did not know how strict it was going to be, or if they really had to know everything by the book. I think the Skills Fair helped everyone's confidence levels, but especially the Jr. 2's.

Attitude was an important factor in the development of critical thinking skills during the skills fair intervention as participants believed possessing a pleasant and positive attitude meant a student was eager to learn, participate, accept responsibility for completing duties and think seriously. Participant 6 believed attitude contributed to performance in the Skills Fair.

I feel like, certain things bring critical thinking out in you. And since I'm a little bit older than some of the other students, I have had more life experiences and am able to figure stuff out better. Older students have had more time to learn by trial and error, and this and that.

Like when I had clinical with you, you'd always tell us to know our patients' medications. To always know and be prepared to answer questions – because at first as a Junior 1 we did not do that in the clinical setting… and as a Junior 2, I did not really have to know my medications, but with you as a Senior 1, I started to realize that the patients do ask about their meds, so I was making sure that I knew everything before they asked it. And just having more practice with IVs – at first, I was really nervous, but when I got to my preceptorship – I had done so many IVs and with all of the practice, it just built up my confidence with that skill so when I performed that skill during the Fair, I was confident due to my clinical experiences and able to think and perform better.

I think teachers will always affect the ability to critically think just because you want [to] get the right answer because they are there and you want to seem smart to them [Laugh]. Also, if you are leading in the wrong direction of your thinking – they help steer you back to [in] the right direction so I think that was very helpful.

You could tell the faculty really tried to make it more laid back and fun, so everybody would have a good experience. The faculty had a good attitude. I think making it fun and active helped keep people positive. You know if people are negative and not motivated, nothing gets accomplished. The faculty did an amazing job at making the Skills Fair a positive atmosphere.

However, for some of the participants, a positive learning environment depended on their fellow students. The students were randomly assigned alphabetically to groups, and the groups were assigned to starting stations at the Skills Fair. The participants claimed some students did not want to participate and displayed cynicism toward the intervention. The participants believed their cynicism affected the positive learning environment making critical thinking more difficult during the Skills Fair.

Okay, when [instructor name] was demonstrating the Chevron technique right after we inserted the IV catheter and we were trying to secure the catheter, put on the extension set, and flush the line at what seemed to be all at the same time. I forgot about how you do not want to put the tape right over the hub of the catheter because when you go back in and try to assess the IV site – you're trying to assess whether or not it is patent or infiltrated – you have to visualize the insertion site. That was one of the things that I had been doing wrong because I was just so excited that I got the IV in the vein in the first place – that I did not think much about the tape or the tegaderm for sterility. So I think an important part of critical thinking is to be able to recognize when you've made a mistake and stop, stop yourself from doing it in the future (see Table 2 ).

Skills fair intervention as a developmental strategy for critical thinking . The participants identified the skills fair intervention was effective as a developmental strategy for critical thinking, as revealed in two themes: (1) develops alternative thinking and (2) thinking before doing (See Table 3 ).

Develops alternative thinking . The participants perceived the skills fair intervention helped enhance critical thinking and confidence by developing alternative thinking. Alternative thinking was described as quickly thinking of alternative solutions to problems based on the latest evidence and using that information to determine what actions were warranted to prevent complications and prevent injury. It helped make better connections through the learning of rationale between knowledge and skills and then applying that knowledge to prevent complications and errors to ensure the safety of patients. The participants stated the learning of rationale for certain procedures provided during the skills fair intervention such as the evidence and critical thinking prompts included in the rubrics helped reinforce this connection. The participants also shared they developed alternative thinking after participating in the skills fair intervention by noticing trends in data to prevent potential complications from the faculty prompts. Participant 1 stated her instructor prompted her alternative thinking through questioning about noticing trends to prevent potential complications. She said the following:

Another way critical thinking occurred during the skills fair was when [instructor name] was teaching and prompted us about what it would be like to care for a patient with a fractured hip – I think this was at the 10-minute focused assessment station, but I could be wrong. I remember her asking, “What do you need to be on the look-out for? What can go wrong?” I automatically did not think critically very well and was only thinking circulation in the leg, dah, dah, dah. But she was prompting us to think about mobility alterations and its effect on perfusion and oxygenation. She was trying to help us build those connections. And I think that's a lot of the aspects of critical thinking that gets overlooked with the nursing student – trouble making connections between our knowledge and applying it in practice.

Thinking before doing . The participants perceived thinking before doing, included thinking of how and why certain procedures, was necessary through self-examination prior to taking action. The hands-on situational learning allowed the participants in the skills fair intervention to better notice assessment data and think at a higher level as their previous learning of the skills was perceived as memorization of steps. This higher level of learning allowed participants to consider different future outcomes and analyze pertinent data before taking action.

I think what helped me the most is considering outcomes of my actions before I do anything. For instance, if you're thinking, “Okay. Well, I need to check their blood pressure before I administer this blood pressure medication – or the blood pressure could potentially bottom out.” I really do not want my patient to bottom out and get hypotensive because I administered a medication that was ordered, but not safe to give. I could prevent problems from happening if I know what to be on alert for and act accordingly. So ultimately knowing that in the clinical setting, I can prevent complications from happening and I save myself, my license, and promote patient safety. I think knowing that I've seen the importance of critical thinking already in practice has helped me value and understand why I should be critically thinking. Yes, we use the 5-rights of medication safety – but we also have to think. For instance, if I am going to administer insulin – what do I need to know or do to give this safely? What is the current blood sugar? Has the patient been eating? When is the next meal scheduled? Is the patient NPO for a procedure? Those are examples of questions to consider and the level of thinking that needs to take place prior to taking actions in the clinical setting.

Although the results of quantitative data showed no significant difference in scores on the KCTIT between the participant and nonparticipant groups, during the interviews some participants attributed this result to the test not being part of a course grade and believed students “did not try very hard to score well.” However, the participants who attended interviews did identify the skills fair intervention as a developmental strategy for critical thinking by helping them develop alternative thinking and thinking before doing. The findings are supported in the literature as (1) nurses must recognize signs of clinical deterioration and take action promptly to prevent potential complications ( Garvey and CNE series 2015 ) and (2) nurses must analyze pertinent data and consider all possible solutions before deciding on the most appropriate action for each patient ( Papathanasiou et al. , 2014 ).

The skills fair intervention also enhanced the development of self-confidence by participants practicing previously learned skills in a controlled, safe environment. The nonthreatening environment of the skills fair intervention allowed students to learn without fear and the majority of participants believed their critical thinking was strengthened after participating. The interview data also revealed a combination of internal and external factors that influenced the development of critical thinking during the skills fair intervention including confidence and anxiety levels, attitude, age, experience and practice, faculty involvement, positive learning environment and faculty prompts. These factors should be considered when addressing the promotion and development of critical thinking.

Conclusions, limitations and recommendations

A major concern in the nursing profession is the lack of critical thinking in student nurses and new graduates, which influences the decision-making of novice nurses and directly affects patient care and safety ( Saintsing et al. , 2011 ). Nurse educators must use evidence-based practice to prepare students to critically think with the complicated and constantly evolving environment of health care today ( Goodare, 2015 ; Newton and Moore, 2013 ). Evidence-based practice has been advocated to promote critical thinking ( Profetto-McGrath, 2005 ; Stanley and Dougherty, 2010 ). The skills fair intervention can be one type of evidence-based practice used to promote critical thinking ( McCausland and Meyers, 2013 ; Roberts et al. , 2009 ). The Intervention used in this study incorporated evidence-based practice rationale with critical thinking prompts using Socratic questioning, evidence-based practice videos to the psychomotor skill rubrics, group work, guided discussions, expert demonstration followed by guided practice and blended learning in an attempt to promote and develop critical thinking in nursing students.

The explanatory sequential mixed-methods design was employed to investigate the effects of the innovative skills fair intervention on senior baccalaureate nursing students' achievements and their perceptions of critical thinking skills development. Although the quantitative results showed no significant difference in scores on the KCTIT between students who participated in the skills fair intervention and those who did not, those who attended the interviews perceived their critical thinking was reinforced after the skills fair intervention and believed it was an effective developmental strategy for critical thinking, as it developed alternative thinking and thinking before doing. This information is useful for nurse educators who plan their own teaching practice to promote critical thinking and improve patient outcomes. The findings also provide schools and educators information that helps review their current approach in educating nursing students. As evidenced in the findings, the importance of developing critical thinking skills is crucial for becoming a safe, professional nurse. Internal and external factors impacting the development of critical thinking during the skills fair intervention were identified including confidence and anxiety levels, attitude, age, experience and practice, faculty involvement, positive learning environment and faculty prompts. These factors should be considered when addressing the promotion and development of critical thinking.

There were several limitations to this study. One of the major limitations of the study was the limited exposure of students' time of access to the skills fair intervention, as it was a one-day learning intervention. Another limitation was the sample selection and size. The skills fair intervention was limited to only one baccalaureate nursing program in one southeastern state. As such, the findings of the study cannot be generalized as it may not be representative of baccalaureate nursing programs in general. In addition, this study did not consider students' critical thinking achievements prior to the skills fair intervention. Therefore, no baseline measurement of critical thinking was available for a before and after comparison. Other factors in the nursing program could have affected the students' scores on the KCTIT, such as anxiety or motivation that was not taken into account in this study.

The recommendations for future research are to expand the topic by including other regions, larger samples and other baccalaureate nursing programs. In addition, future research should consider other participant perceptions, such as nurse educators, to better understand the development and growth of critical thinking skills among nursing students. Finally, based on participant perceptions, future research should include a more rigorous skills fair intervention to develop critical thinking and explore the link between confidence and critical thinking in nursing students.

Initial coding results

Factors impacting critical thinking skill development during skills fair intervention

Skills fair intervention as a developmental strategy for critical thinking

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The role of critical thinking skills and learning styles of university students in their academic performance

Zohre ghazivakili.

1 Emergency medical services department, Paramedical school, Alborz University of Medical Sciences, Karaj, Iran;

ROOHANGIZ NOROUZI NIA

2 Educational Development Center, Alborz University of Medical Sciences, Karaj, Iran;

FARIDE PANAHI

3 Nursing and midwifery school, Shahid Beheshti University of Medical Sciences, Tehran, Iran;

MEHRDAD KARIMI

4 Department of Epidemiology and Biostatistics, Public Health School, Tehran, Iran;

HAYEDE GHOLSORKHI

5 Medical school, Alborz University of Medical Sciences, Karaj, Iran;

ZARRIN AHMADI

6 Amirkabir University of Technology(Polytechnic), Tehran, Iran

Introduction: The Current world needs people who have a lot of different abilities such as cognition and application of different ways of thinking, research, problem solving, critical thinking skills and creativity. In addition to critical thinking, learning styles is another key factor which has an essential role in the process of problem solving. This study aimed to determine the relationship between learning styles and critical thinking of students and their academic performance in Alborz University of Medical Science.

Methods: This cross-correlation study was performed in 2012, on 216 students of Alborz University who were selected randomly by the stratified random sampling. The data was obtained via a three-part questionnaire included demographic data, Kolb standardized questionnaire of learning style and California critical thinking standardized questionnaire. The academic performance of the students was extracted by the school records. The validity of the instruments was determined in terms of content validity, and the reliability was gained through internal consistency methods. Cronbach's alpha coefficient was found to be 0.78 for the California critical thinking questionnaire. The Chi Square test, Independent t-test, one way ANOVA and Pearson correlation test were used to determine relationship between variables. The Package SPSS14 statistical software was used to analyze data with a significant level of p<0.05.

Results: Our findings indicated the significant difference of mean score in four learning style, suggesting university students with convergent learning style have better performance than other groups. Also learning style had a relationship with age, gender, field of study, semester and job. The results about the critical thinking of the students showed that the mean of deductive reasoning and evaluation skills were higher than that of other skills and analytical skills had the lowest mean and there was a positive significant relationship between the students’ performance with inferential skill and the total score of critical thinking skills (p<0.05). Furthermore, evaluation skills and deductive reasoning had significant relationship. On the other hand, the mean total score of critical thinking had significant difference between different learning styles.

Conclusion: The results of this study showed that the learning styles, critical thinking and academic performance are significantly associated with one another. Considering the growing importance of critical thinking in enhancing the professional competence of individuals, it's recommended to use teaching methods consistent with the learning style because it would be more effective in this context.

Introduction

The current world needs people with a lot of capabilities such as understanding and using different ways of thinking, research, problem solving, critical thinking and creativity. Critical thinking is one of the aspects of thinking that has been accepted as a way to overcome the difficulties and to facilitate the access to information in life ( 1 ).

To Watson and Glizer, critical thinking is a combination of knowledge, attitude, and performance of every individual. They also believe that there are some skills of critical thinking such as perception, assumption recognition deduction, interpretation and evaluation of logical reasoning. They argue that the ability of critical thinking, processing and evaluation of previous information with new information result from inductive and deductive reasoning of solving problems. Watson and Glizer definition of critical thinking has been the basis of critical thinking tests that are widely used to measure the critical thinking today ( 2 ).

World Federation for Medical Education has considered critical thinking one of the medical training standards so that in accredited colleges this subject is one of the key points. In fact, one of the criteria for the accreditation of a learning institute is the measurement of critical thinking in its students ( 3 ).

In addition to critical thinking, learning style, i.e. the information processing method, of the learners, is an important key factor that has a major role in problem solving. According to David Kolb’s theory, learning is a four-step process that includes concrete experience, reflective observation, abstract conceptualization and active experimentation. This position represents two dimensions: concrete experience versus abstract thinking, and reflective observation to active experimentation. These dimensions include four learning styles: divergent, convergent, assimilate, and accommodate. According to Kolb and Ferry, the learner needs four different abilities to function efficiently: Learning styles involve several variables such as academic performance of learner, higher education improvement; critical thinking and problem solving ( 4 ).

Due to the importance of learning styles and critical thinking in students' academic performance, a large volume of educational research has been devoted to these issues in different countries. Demirhan, Besoluk and Onder (2011) in their study on critical thinking and students’ academic performance from the first semester to two years later have found that contrary to expectations the students’ critical thinking level reduced but the total mean of students’ scores increased. This is due to the fact that the students are likely to increase adaptive behavior with environment and university and reduce the stress during their education ( 1 ).

In another study over 330 students in Turkey, the students who had divergent learning style, had lower scores in critical thinking in contrast with students who have accommodator learning style ( 5 ).

Also Mahmoud examined the relationship between critical thinking and learning styles of the Bachelor students with their academic performance in 2012. In this study all the nursing students of the university in the semesters four, six and eight were studied. The results did not show any significant relationship between critical thinking and learning styles of nursing students with their academic performance ( 6 ).

Another research by Nasrabadi in 2012 showed a positive relationship between critical thinking attitudes and student's academic achievement. The results showed that there was a significant difference between the levels of critical thinking of assimilating and converge styles. Also converging, diverging, assimilating and accommodating styles had the highest level of critical thinking, respectively ( 4 ). Among other studies we can refer to Sharma’s study in 2011 whose results suggested a relationship between the academic performance and learning styles ( 7 ).

Today university students should not only think but also should think differently and should not only remember the knowledge in their mind but also should research the best learning style among different learning styles. Therefore, the study on the topic of how the students think and how they learn has received great emphasis in recent years. In this regard, with the importance of the subject, researchers attempted to doa research in this area to determine the relationship between critical thinking and learning styles with academic performance of the students at Alborz University of Medical Sciences.

This study is a descriptive-analytic, cross sectional study and investigates the relationship between critical thinking and learning styles with students’ academic performance of Alborz University of Medical Science in 2012. After approval and permission from university’s authorities and in coordination with official faculties, the critical thinking and learning styles questionnaire was given to the undergraduate students in associate degree, bachelor, medicine (second semester and after that). The total number of participants in the study was 216 students with different majors such as medical, nursing and midwifery, and health and medical emergency students. The tool to collect the data was a two-part questionnaire of Kolb's learning styles and California's critical thinking skills test (form B). The Kolb's questionnaire has two parts. The first part asks for demographic information and the second part includes 12 multiple choice questions. The participants respond to the questions with regard to how they learn, and the scores of respondents are ranked from 1 to 4 in which 4 is most consistent with the participants’ learning style 3 to some extent, 2 poorly consistent and 1 not consistent To find the participants’ learning styles, the first choice of all 12 questions were added together and this was repeated for other choices. Thus, four total scores for the four learning styles were obtained, the first for concrete experience learning style, the second for reflective observation of learning style, the third for abstract conceptualization learning style and the forth for active experimentation learning style. The highest score determined the learning style of the participant. The California critical thinking skills test (form B) includes 34 multiple choice questions with one correct answer in five different areas of critical thinking skills, including evaluation, inference, analysis, inductive reasoning and deductive reasoning. The answering time was 45 minutes and the final score is 34 and the achieved score in each section of the test varies from 0 to 16. In the evaluation section, the maximum point is 14, in analysis section 9, in inference section 11, in inductive reasoning 16 and in deductive reasoning the maximum point was 14. So there were 6 scores for each participant, which included a critical thinking total score and 5 score for critical thinking skills. Dehghani, Jafari Sani, Pakmehr and Malekzadeh found that the reliability of the questionnaire was 78% in a research. In the study of Khalili et al., the confidence coefficient was 62% and construct validity of all subscales with positive and high correlation were reported between 60%-65%. So this test was reliable for the research. Collecting the information was conducted in two stages. In the first stage, the questionnaires were given to the students and the objectives and importance of the research were mentioned. In the next stage, the students' academic performance was reviewed. After data collection, the data were coded and analyzed, using the SPSS 14 ( SPSS Inc, Chicago, IL, USA) software. To describe the data, descriptive statistics were used such as mean and standard deviation for continues variables and frequency for qualitative variables. Chi Square test, Independent t-test, one way ANOVA and Pearson correlation test were used to determine the relationship between variables at a significant level of p<0.05.

Research hypothesis

• There is a relationship between Alborz University of Medical Sciences students’ learning styles and their demographic information. 
• There is a relationship between Alborz University of Medical Sciences students’ critical thinking and their demographic information. 
• There is a relationship between Alborz University of Medical Sciences students’ academic performance and their demographic information. 
• There is a relationship between Alborz University of Medical Sciences students’ learning styles and their academic performance. 
• There is a relationship between Alborz University of Medical Sciences students’ learning styles and their critical thinking. 

225 questionnaires were distributed of which 216 were completely responded (96%). The age range of the participants was from 16 to 45 with the mean age of (22.44±3.7). 52.8% of participants (n=114) were female, 83.3% (n=180) were single, 30.1% of participants’ (n=65) major was pediatric anesthesiology of OR, 35.2% of participants (n=76) were in fourth semester, 74.5% (n=161) were unemployed and 48.6 % (n=105) had Persian ethnicity.

The range of participants’ average grade points, which were considered as their academic performance, were from 12.51 to 19.07 with a mean of (16.75±1.3). According to Kolbs' pattern, 42.7% (n=85) had the convergent learning style (the maximum percentage) followed by 33.2 % (n= 66) with the assimilating style and only 9.5%, (n= 19) with the accommodating style (the minimum percentage).

Among the 5 critical thinking skills, the maximum mean score belonged to deductive reasoning skill (3.38±1.58) and the minimum mean score belonged to analysis skill (1.67±1.08).

Table 1 shows the frequency distribution and demographic variables and the academic performance of the students. According to the Chi-square (Χ 2 ) p-value, there was a significant relationship between gender and learning style (p=0.032), so that nearly 50 percent of males had the assimilating learning style and nearly 52 percent of the females had the convergent learning style.

The relationship between demographic variable and student’s academic performance with learning styles

The relationship between employment, major and semester of studying with the learning style was significant at a p-value of 0.049, 0.006, 0.009 and 0.001, respectively. The mean and standard deviation of age and students' academic performance in the four learning styles are reported in Table 1 .

Using the one way analysis of variance (One way ANOVA) and comparing the mean age of four groups, we found a significant relation between age and academic performance with learning style (p=0.049).

The students with convergent learning style had a better academic performance than those with other learning styles and in the performance of those with the assimilating learning style the weakest.

Table 2 shows the relationship between the total score of critical thinking skills and each of the demographic variables and academic performance. The results of the t-test and one way ANOVA variance analysis are reported to investigate the relationship between each variable with skills below the mean standard deviation.

Relationships between CCT Skills and demographic variables Using t-test and ANOVA. Pearson Correlation coefficient between age and Student's performance with CCT Skills was reported

* Significant in surface 0.05 

** Significant in surface 0.01

Based on the t-test and ANOVA, p-value of t and F, the mean of total score of critical thinking skills had only significant relationship with students’ major (p=0.020). Also a significant relationship was found between the major of students and gender with inference skill; semester of study with deductive reasoning skill, and ethnicity with 2 skills of inference and deductive reasoning (p<0.05).

Also regarding the relationship between age and the student academic performance with each of the critical thinking skills, the Pearson correlation coefficient results indicated a significant positive relationship but a negative relationship between age and analysis skill, i.e. with the increase of age, the score of analysis skill was reduced (p<0.05). Academic performance of the students had a direct significant relationship with critical thinking total score and inference skill; the more the score, the better the academic performance of students (p<0.05).

Table 3 shows the mean and standard deviation of learning styles score in the 4 groups of learning style. Using ANOVA one way ANOVA, the relationship between learning style and critical thinking skills and the comparison of the mean score for each skill in four styles are reported in the last column of the Table 3 .

The Relationship between critical thinking styles with learning styles

Based on the p-value of ANOVA, the mean of evaluation skill and inductive reasoning skill had a significant difference and the relationship between these two skills with learning style was significant (p<0.05). Also the mean of critical thinking’s total score was significantly different in the four groups and the relationship between total score with learning style was significant, too (p<0.05).

The mean and confidence interval of university students’ performance in four learning  styles

The mean and confidene interval of critical thinking skills

The study findings showed that the popular learning style among the students was the convergent style followed by the assimilating style which is consistent with Kolb's theory stating that medical science students usually have this learning style ( 8 ). This result was consistent with the results of other studies ( 9 , 10 ). In Yenice's study in which the student of training teacher were the target of the project, the most frequent learning styles were divergent and assimilating styles and these differences originate from the different target group of study in 2012 ( 11 ).

This study showed a significant relationship between learning style and gender, age, semester and employment. Meyari et al. did not find any significant relationship between learning style, age and gender of the freshman but for the fifth semester students, a significant relationship with age and gender was found ( 10 ). Also in Yenice's study, no relationship with learning style, gender, semester and age was found.

Furthermore, in the first semester divergent style, in the second semester assimilating style and in the third and fourth semester divergent style were accounted for the highest percentage. Also in the group age of 17-20 years the assimilating style and the age of 21-24 years the divergent style were dominant styles ( 11 ).

In the present study, it was found a significant positive relationship between convergent learning style and academic performance. Also in the study of Pooladi et al. the majority of the students had convergent style and they also found a significant relationship between learning style, total mean score and the mean of practical courses ( 12 ). Nasrabadi et al. found that students with the highest achievement were those with convergent style with a significant difference with those with divergent style ( 4 ). But the results are inconsistent to Meyari et al.’s ( 10 ).

In this study, the obtained mean score from the critical thinking questionnaire was (7.15±2.41) that was compared with that in the study of Khalili and Hoseinzadeh which was to validate and make reliable the critical thinking skills questionnaire of California (form B) in the Iranian nursing students; the mean of total score was about the 11th percentile of this study ( 13 ).

In other words, the computed score for critical thinking of the students participating was lower than 11 score that is in the 50th percentile and of course is lower than normal range.

Hariri and Bagherinezhad had shown that the computed score for Bachelor and Master students of Health faculty was also lower than the norm in Iran ( 14 ). Also Mayer and Dayer came to a similar conclusion in critical thinking skill in the Agricultural university of Florida’s students in 2006 ( 15 ).

But in Gharib et al.’s study, the total score of critical thinking test among the freshman and senior of Health-care management was in normal range ( 16 ). Wangensteen et al., found that the critical thinking skills of the newest graduate nursing students were relatively high in Sweden in 2010 ( 17 ).

In this study, students of all levels (Associate, Bachelor and PhD) with various fields of study participated but other studies have been limited to certain graduate courses that may explain the differences in levels of special critical thinking skills score in this study. In this study we found a significant relationship between total score of critical thinking and major of the students. This result is consistent with Serin et al. ( 18 ).

It was found a significant relationship between major of participants, gender and inference skill, semester and deductive reasoning skill, ethnicity and both inference and deductive reasoning skills.

In the Yenice's study significant relationship between critical thinking, group of age, gender and semester was seen ( 11 ). In Wangensteen et al.’s ( 17 ) study in the older age group, the level of critical thinking score increased. In Serin et al.’s ( 18 ) study the level of communication skills in girls was better than that in boys. And also a significant relationship was found between critical thinking and academic semester, but in Mayer and Dayer’s study no significant relationship between critical thinking levels and gender was found ( 4 , 15 ).

The results also showed that the total score of critical thinking and analytical skills of students and their performance had a significant relationship. Nasrabady et al.’s study also showed that there was a positive relationship between critical thinking reflection attitude and academic achievement ( 4 ). This is contradictory with what Demirhan, Bosluk and Ander found ( 6 , 15 ).

The results of the relationship between learning style and critical thinking indicated that the relationship between evaluation and inductive reasoning was significant to learning style (p<0.05). The relationship of critical thinking total score with learning style was also significant (p<0.05). Thus the total score for those with the conforming style of critical skills was more than that with other styles. But in the subgroup of inference skills, those with the convergent style had a higher mean than those with other styles.

Yenice found a negative relationship between critical thinking score and divergent learning style and a positive relation between critical thinking score and accommodating style ( 11 ).

Siriopoulos and Pomonis in their study compared the learning style and critical thinking skills of students in two phases: at the beginning and end of education and came to this conclusion that the learning style of students changed in the second phase.

For example, the divergent, convergent and accommodating styles languished and the assimilating style (combination of abstract thinking and reflective observation) was noticeably strengthened. However, those with converging learning style had higher levels of critical thinking.

The level of students’ critical thinking was lower in all international standards styles. Perhaps it was because of widely used teacher-centered teaching methods (lectures) in that university ( 19 ).

The results in the study of Nasrabady et al. showed that there was a significant difference between the level of learners’ critical thinking and divergent and assimilating styles ( 4 ).

Those with converging, diverging, assimilating and accommodating styles had the highest level of critical thinking, respectively.

Also there was a positive significant relationship between the reflective observation method and critical thinking and also a negative significant relationship between the abstract conceptualization method and critical thinking ( 4 ). But in another study that Mahmud has done in 2012, he did not find any significant relationship between learning style, critical thinking and students’ performance ( 6 ).

The results of this study showed that the students’ critical thinking skills of this university aren't acceptable. Also learning styles, critical thinking and academic performance have significant relationship with each other. Due to the important role of critical thinking in enhancing professional competence, it is recommend using teaching methods which are consistent with the learning styles.

Acknowledgment

This study is based on a research project that was approved in Research Deputy of Alborz University of Medical sciences. We sincerely appreciate all in Research Deputy of Alborz University of Medical sciences who supported us financially and morally and all students and colleagues who participated in this study.

Conflict of Interest: None declared.

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The importance of critical thinking skills in secondary classrooms.

Clinton T. Sterkenburg , Grand Valley State University Follow

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Education-Instruction and Curriculum: Secondary Education (M.Ed.)

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Sherie Klee

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According to research, many students lack effective critical thinking skills. The ability to think critically is crucial for individuals to be successful and responsible. Many students have difficulties understanding this important skill and especially lack the ability to initiate and apply the process. Although a difficult task, educators have the responsibility to teach critical skills to students and to discern when certain instructional methods or activities are not helping students. Each student is different, and their needs must be considered, this correlates with how they learn and process information. Research has shown that traditional teaching methods that require students to regurgitate information do not prove helpful in teaching students to apply and understand the critical thinking process. Therefore, effective teachers expand upon traditional teaching methods and differentiate instructional and activity design for imparting critical thinking skills to students. This project presents some of the possible reasons students have difficulties thinking critically and provides examples of instructional and lesson design methods that are proven to help students understand critical thinking. The goal of this project is to provide a guide for secondary teachers to address the lack of critical thinking skills in many students. The ability to think critically will greatly benefit students and help them become productive members of society.

ScholarWorks Citation

Sterkenburg, Clinton T., "The Importance of Critical Thinking Skills in Secondary Classrooms" (2024). Culminating Experience Projects . 456. https://scholarworks.gvsu.edu/gradprojects/456

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Exploring student perceptions of problem-based learning and clinical field experiences: a phenomenological study.

Ashley Michelle Boles , Liberty University Follow

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Doctor of Philosophy in Education (PhD)

Mary Strickland

problem-based learning, medical education, higher-order thinking and processing, critical thinking, clinical reasoning, problem-solving, clinical field experiences

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Boles, Ashley Michelle, "Exploring Student Perceptions of Problem-Based Learning and Clinical Field Experiences: A Phenomenological Study" (2024). Doctoral Dissertations and Projects . 5866. https://digitalcommons.liberty.edu/doctoral/5866

The purpose of this phenomenological study is to understand the experiences of participating in a physical therapy course primarily taught using problem-based learning teaching methods for Doctor of Physical Therapy students at a university in the mid-western United States. This study aimed to understand student perception of PBL and its effects on clinical field experiences (CFEs), specifically related to higher-order processing skills. The theory guiding this study was the social constructivism theory as it explains how knowledge acquisition and learning occurs through social interactions during problem-based learning activities. The central research question this study attempted to answer was: What were the experiences of DPT students who participate in a PBL education? This study design was a qualitative, hermeneutic phenomenological study. Convenience sampling was done from a pool of DPT students at a university in the midwestern United States. Data collection methods included journal prompts, individual interviews, and focus groups. Data analysis was based on van Manen’s data analysis methods. Findings reveal DPT students preferred PBL over traditional teaching methods and felt the use of PBL improved their higher-order thinking and processing skills. Participants felt that PBL teaching methods were conducive to their learning as the method allowed for real-time feedback and a perception of better content retention. DPT students also felt that using PBL teaching methods improved their ability to prioritize and funnel information to organize information in a way conducive to developing a solution to the problem. Participants felt that the problem-solving, critical thinking, and clinical reasoning they developed during the therapeutic exercise course did carry over into their ability to apply these higher-order thinking and processing skills during CFEs.

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How to cite ChatGPT

Use discount code STYLEBLOG15 for 15% off APA Style print products with free shipping in the United States.

We, the APA Style team, are not robots. We can all pass a CAPTCHA test , and we know our roles in a Turing test . And, like so many nonrobot human beings this year, we’ve spent a fair amount of time reading, learning, and thinking about issues related to large language models, artificial intelligence (AI), AI-generated text, and specifically ChatGPT . We’ve also been gathering opinions and feedback about the use and citation of ChatGPT. Thank you to everyone who has contributed and shared ideas, opinions, research, and feedback.

In this post, I discuss situations where students and researchers use ChatGPT to create text and to facilitate their research, not to write the full text of their paper or manuscript. We know instructors have differing opinions about how or even whether students should use ChatGPT, and we’ll be continuing to collect feedback about instructor and student questions. As always, defer to instructor guidelines when writing student papers. For more about guidelines and policies about student and author use of ChatGPT, see the last section of this post.

Quoting or reproducing the text created by ChatGPT in your paper

If you’ve used ChatGPT or other AI tools in your research, describe how you used the tool in your Method section or in a comparable section of your paper. For literature reviews or other types of essays or response or reaction papers, you might describe how you used the tool in your introduction. In your text, provide the prompt you used and then any portion of the relevant text that was generated in response.

Unfortunately, the results of a ChatGPT “chat” are not retrievable by other readers, and although nonretrievable data or quotations in APA Style papers are usually cited as personal communications , with ChatGPT-generated text there is no person communicating. Quoting ChatGPT’s text from a chat session is therefore more like sharing an algorithm’s output; thus, credit the author of the algorithm with a reference list entry and the corresponding in-text citation.

When prompted with “Is the left brain right brain divide real or a metaphor?” the ChatGPT-generated text indicated that although the two brain hemispheres are somewhat specialized, “the notation that people can be characterized as ‘left-brained’ or ‘right-brained’ is considered to be an oversimplification and a popular myth” (OpenAI, 2023).

OpenAI. (2023). ChatGPT (Mar 14 version) [Large language model]. https://chat.openai.com/chat

You may also put the full text of long responses from ChatGPT in an appendix of your paper or in online supplemental materials, so readers have access to the exact text that was generated. It is particularly important to document the exact text created because ChatGPT will generate a unique response in each chat session, even if given the same prompt. If you create appendices or supplemental materials, remember that each should be called out at least once in the body of your APA Style paper.

When given a follow-up prompt of “What is a more accurate representation?” the ChatGPT-generated text indicated that “different brain regions work together to support various cognitive processes” and “the functional specialization of different regions can change in response to experience and environmental factors” (OpenAI, 2023; see Appendix A for the full transcript).

Creating a reference to ChatGPT or other AI models and software

The in-text citations and references above are adapted from the reference template for software in Section 10.10 of the Publication Manual (American Psychological Association, 2020, Chapter 10). Although here we focus on ChatGPT, because these guidelines are based on the software template, they can be adapted to note the use of other large language models (e.g., Bard), algorithms, and similar software.

The reference and in-text citations for ChatGPT are formatted as follows:

• Parenthetical citation: (OpenAI, 2023)
• Narrative citation: OpenAI (2023)

Let’s break that reference down and look at the four elements (author, date, title, and source):

Author: The author of the model is OpenAI.

Date: The date is the year of the version you used. Following the template in Section 10.10, you need to include only the year, not the exact date. The version number provides the specific date information a reader might need.

Title: The name of the model is “ChatGPT,” so that serves as the title and is italicized in your reference, as shown in the template. Although OpenAI labels unique iterations (i.e., ChatGPT-3, ChatGPT-4), they are using “ChatGPT” as the general name of the model, with updates identified with version numbers.

The version number is included after the title in parentheses. The format for the version number in ChatGPT references includes the date because that is how OpenAI is labeling the versions. Different large language models or software might use different version numbering; use the version number in the format the author or publisher provides, which may be a numbering system (e.g., Version 2.0) or other methods.

Bracketed text is used in references for additional descriptions when they are needed to help a reader understand what’s being cited. References for a number of common sources, such as journal articles and books, do not include bracketed descriptions, but things outside of the typical peer-reviewed system often do. In the case of a reference for ChatGPT, provide the descriptor “Large language model” in square brackets. OpenAI describes ChatGPT-4 as a “large multimodal model,” so that description may be provided instead if you are using ChatGPT-4. Later versions and software or models from other companies may need different descriptions, based on how the publishers describe the model. The goal of the bracketed text is to briefly describe the kind of model to your reader.

Source: When the publisher name and the author name are the same, do not repeat the publisher name in the source element of the reference, and move directly to the URL. This is the case for ChatGPT. The URL for ChatGPT is https://chat.openai.com/chat . For other models or products for which you may create a reference, use the URL that links as directly as possible to the source (i.e., the page where you can access the model, not the publisher’s homepage).

Other questions about citing ChatGPT

You may have noticed the confidence with which ChatGPT described the ideas of brain lateralization and how the brain operates, without citing any sources. I asked for a list of sources to support those claims and ChatGPT provided five references—four of which I was able to find online. The fifth does not seem to be a real article; the digital object identifier given for that reference belongs to a different article, and I was not able to find any article with the authors, date, title, and source details that ChatGPT provided. Authors using ChatGPT or similar AI tools for research should consider making this scrutiny of the primary sources a standard process. If the sources are real, accurate, and relevant, it may be better to read those original sources to learn from that research and paraphrase or quote from those articles, as applicable, than to use the model’s interpretation of them.

We’ve also received a number of other questions about ChatGPT. Should students be allowed to use it? What guidelines should instructors create for students using AI? Does using AI-generated text constitute plagiarism? Should authors who use ChatGPT credit ChatGPT or OpenAI in their byline? What are the copyright implications ?

On these questions, researchers, editors, instructors, and others are actively debating and creating parameters and guidelines. Many of you have sent us feedback, and we encourage you to continue to do so in the comments below. We will also study the policies and procedures being established by instructors, publishers, and academic institutions, with a goal of creating guidelines that reflect the many real-world applications of AI-generated text.

For questions about manuscript byline credit, plagiarism, and related ChatGPT and AI topics, the APA Style team is seeking the recommendations of APA Journals editors. APA Style guidelines based on those recommendations will be posted on this blog and on the APA Style site later this year.

Update: APA Journals has published policies on the use of generative AI in scholarly materials .

We, the APA Style team humans, appreciate your patience as we navigate these unique challenges and new ways of thinking about how authors, researchers, and students learn, write, and work with new technologies.

American Psychological Association. (2020). Publication manual of the American Psychological Association (7th ed.). https://doi.org/10.1037/0000165-000

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