Transcript Navigating the Critical Thinking Labyrinth

TBL
CT
David Hawkins, PharmD
Professor and Dean
California Northstate College of Pharmacy
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A soporific practice of showing powerpointless slides
Encourages rote memorization
Impairs critical thinking
Impedes construction of knowledge
Slaughters the mind
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Students learn how to think when they
know what to think
Knowledge can be transmitted directly to
students
Coverage is more important than depth
Students will be awe-struck by your
knowledge, expertise, and ability to
entertain while educating the masses
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My observations of
student laptops
Medical student note-taking service
Asking the same question 2 weeks after
an exam
The Capstone Exam
 Carefully crafted to test basic knowledge
 Administered at the end of 3 didactic years
just prior to starting the 1 year experiential
 Average score 57.69
How do people
learn?
Lecture
(5%)
Reading
(10%)
Audiovisual (20%)
Demonstration (30%)
Discussion Group (50%)
Practice By Doing (75%)
“Why is it, in spite of the fact that
teaching by pouring in, learning by
passive absorption, are universally
condemned, that they are still so
entrenched in practice?”
John Dewey
Democracy in Education
1916, Page 46
Are you teaching your content as a skilled way
of thinking?
Are you teaching your content in a way that
facilitates learning instead of encouraging
memorization?
Are you designing your instruction so that students
learn how to focus on well-formulated questions
or problems?
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Asking questions during the lecture to
probe thinking
Embarrasses or intimidates some
students (the Pluto’s)
Favors a small number of students who
can answer any question(the Plato’s)
After students answer question they tend
to doodle (the Picasso’s)
Lecturing
Active
Learning
Lots of content
Memorization
Passive learning
Lower order thinking
Fundamental concepts
Deep learning
Engaged learning
Higher order thinking
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Involving students in doing things and
thinking about the things they are doing.
Students learn content only by thinking
through content.
Activities that require students to engage
in higher order thinking – analysis,
synthesis, and evaluation
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Powerful influence of educational tradition
Faculty self-perceptions and self-defining
roles
Discomfort and anxiety that change
creates
Difficulty in covering course content
Increase amount of preparation time
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Students must do more than listen to
learn.
Students must read, write, discuss, or be
engaged in problem solving to learn
deeply.
Students must engage in higher order
thinking to learn content.
Learning is not a spectator sport. Students
must participate in the process and think
about what they are doing.
“Learning without thought is
labour lost; thought without
learning is perilous.”
Confucius
c. 500 B.C.
 What are the most fundamental concepts in my
course?
 What do I need to do to help my students think
through the fundamental concepts?
 What application activities do I need to develop so my
students can apply concepts to learn content?
 What do I want my students to be able to do with the
content they learn?
Knowledge - recalling specific facts or general concepts
Comprehension - demonstrating the lowest level of
understanding
3. Application - using abstractions in concrete situations
4. Analysis - breaking down an idea or topic into its
constituent elements
5. Synthesis - putting together elements to form a whole
6. Evaluation - making judgments about the value of
materials and methods for given purposes
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2.
Critical thinking involves application, analysis, synthesis, and evaluation.
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10.
Learn and apply new information and concepts
Separate factual information from inferences
Determine the accuracy, fairness, and relevance of
information
Identify and use criteria to evaluate ideas and
evidence
Draw valid conclusions
Identify inappropriate conclusions
Recognize assumptions, implications, and points of
view
Create new ideas and alternative solutions to
problems.
Formulate good questions
Determine the purpose of things
Analyzing Thinking
Assessing Thinking
Purpose
Clarity
Question
Accuracy
Information
Precision
Concepts
Relevance
Assumptions
Depth
Conclusions
Breadth
Implications
Logicalness
Point of view
Fairness
Richard Paul and Linda Elder, Foundation for Critical Thinking
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Determine the outcomes of CT within the
discipline
Choose a methodology through which students
can sharpen their CT skills
Allow students to process content through
exercises that require analysis, synthesis, and
evaluation
Develop a valid, reproducible method for
assessing CT skills
Train all faculty how to teach for CT and how to
assess CT skills
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A tradition of didactic education based on the
lecture and objective testing
Faculty unfamiliarity with pedagogical concepts
and techniques
Lack of models and examples of success
Too much content to cover
Insufficient time and resources
Requires more preparation and creativity
Difficult to assess
“The mind is not like
a vessel for filling,
but like a fire
for kindling.”
Plutarch
c. 46 - 120 A.D.
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Problem-based learning
Case-based learning
Team-based learning
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PBL is an instructional method that
simultaneously develops both
problem-solving skills and knowledge
base by placing students in the active
role of solving real-world problems.
Identify what is known
 Identify what one needs to know
 Formulate hypotheses
 Identify learning issues
 Research Learning Issues
 Present learning issues
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PROBLEM-BASED LEARNING PATHWAY
Organization of the Visual Thinking
Know
Need to know
Hypotheses
Learning Issues
Increases retention of knowledge
Enhances transfer of concepts to new
problems
 Enhances integration of basic
concepts into problem-solving
 Enhances self-directed learning skills
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In PBL the problem is presented first, before
students have learned basic and
fundamental concepts, not after.
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The learning in PBL is student-directed and
in CBL the learning is faculty-directed.
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In CBL, pertinent questions are usually
formulated by faculty whereas in PBL the
students come up with the questions that
need to be answered to solve the problem.
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The learning is directed by the students
Different groups of students will invariably
come up with different learning issues
Quite often the students fail to identify
important learning issues even after a lot
of probing
PBL requires a lot of resources – a
facilitator for each group
Critical Thinking = Content (Paul and Elder)
Students cannot become critical thinkers without
sufficient knowledge about what they are thinking.
Critical thinking must be learned within contexts and
must entail knowledge of facts, rules, and processes
within those contexts. (John McPeck)
Preparation
Pre-class
Individual
Study
Readiness
Assurance
Individual Test
Team Test
Written Appeals
Instructor
Feedback
Application
of Course
Concepts
Group
Assignments
Michaelsen LK et al. Team-Based Learning for Health Professions Education
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Assigned readings
Pre-recorded mini-lectures
Guided learning techniques
Individual Test – reinforces students’ memory
of what they learned during individual study
 Team Test – Students orally elaborate the
reasons for their answer choices and reach
consensus
 Appeals – Teams challenge the instructor on
quality of question or inadequacies of preclass assignments
 Instructor Feedback – Instructor responds to
appeals and clarifies concepts and ideas
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Groups must be properly formed
Students must be accountable for the
quality of their individual and group work
Students must have frequent and timely
feedback
Team assignments must promote both
learning and team development
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What do I want my students to be able to
do when they finish my course?
What will students need to know in order
to be able to do those things?
While solving problems, what knowledge
will students need in order to make
decisions?
What criteria separate a well-made
decision from a poorly made decision
using this knowledge?
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Significant (to students) Problem
Same Problem
Specific Choice
Simultaneous Reporting
Impact of Make-a-Specific-Choice Assignments
Individual Thinking
Make-a-list"
•requires only low
level cognitive skills
(e.g. discrimination)
•produces low
commitment
to output
•portends low individual
accountability
"Make-a specific choice"
•focuses on "Why?"
•requires high level
cognitive skills*
•produces high
commitment
to output
•portends high individual
accountability
Intra-team Discussion
Inter-team Discussion
"Make-a-list"
•focuses on "What?"
•requires only low
level cognitive skill
•produces low commitment
to output
•portends low group
accountability
"Make-a-list"
•focuses on "What?"
•requires only low
level cognitive skill
•produces low commitment
to output
•produces low group
cohesiveness
"Make-a specific choice"
•focuses on "Why?"
•requires high level
cognitive skills*
•produces high commitment
to output
•portends high group
accountability
"Make-a specific choice"
•focuses on "Why?"
•requires high level
cognitive skills*
•produces high commitment
to output
•produces high group
cohesiveness
Larry Michaelsen et al. Team-Based Learning for Health Professions Education
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Pre-class individual activity: Learn
fundamental concepts from 8 page
handout on pathophysiology, treatment,
and prevention (8 different groups)
Individual Readiness Assurance Test
 Scores: 20-80
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Team Readiness Assurance Test
 Scores: 85-100
1. Prevention of recurrent gouty arthritis in a patient with a 24-hour urinary uric acid
excretion > 1000mg should be accomplished with:
a) colchicine
b) indomethacin
c) allopurinol
d) probenecid
2. What would be the drug of first choice for treating an acute episode of gouty
arthritis in most patients?
a) colchicine
b) indomethacin
c) allopurinol
d) probenecid
Epstein Educational Enterprises
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Review Article on Gout from JAMA
Case Study
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Discusses risk factors for gout including
drugs that may increase serum urate
concentration and therefore the likelihood
of gouty arthritis in patients with a positive
history
53 y/o man c/o severe pain in left big toe for past 2 days. PMH of 2
episodes of acute gouty arthritis in past 3 months, HBP for 10 years, and
cholesterol problems. Currently receiving diuretic, Lipitor, and aspirin to
prevent heart disease. Labs include high serum and urine urate
concentration. BP is 130/80.
Appropriate management of this patient’s condition should include:
I.
II.
III.
IV.
Colchicine followed by probenecid
Indomethacin followed by allopurinol
Discontinue diuretic and start alternative BP medication
Discontinue aspirin therapy
a)
b)
c)
d)
e)
I only
II only
I and III
II and III
II, III, and IV
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Purpose: To treat acute attack and to
prevent recurrent attacks
Questions
1. What is the most effective way to treat this
patient’s acute attack?
2. What is the most effective way to prevent
recurrent attacks in this patient?
3. What adjustments, if any, need to be made
to this patient’s other medications?
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Concepts
 Pathophysiology of gout
 Treatment of acute gouty arthritis
 Prevention of recurrent gouty arthritis
 Risk Factors of Gout
 Aspirin to prevent heart attacks
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Information
1. Either colchicine or indomethacin can be used
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to treat acute attacks.
Colchcine’s effectiveness diminishes 48 hours
after onset of pain.
Either probenecid or allopurinol can be used to
prevent recurrent attacks.
Probencid increases urinary uric acid excretion.
Diuretics and adult doses of aspirin increase
serum urate concentrations.
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Assumptions
 Colchicine will not work in this case
 Patient is at high risk of acute gouty arthritis
 Patient’s BP can be controlled with alternative
antihypertensive therapy
 Baby aspirin will not significantly increase
serum urate concentrations
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The lecture transmits information, not knowledge
Knowledge must be constructed in the minds of students
Knowledge construction requires critical thinking
Active learning strategies promote critical thinking
TBL is an efficient pedagogical frame for engaging students in
critical thinking and active learning