The need to teach dental students how to develop and use critical thinking skills (CTS) has been a dominant theme in dental education for more than a decade. However, an understanding of how faculty teach these skills as well as how well students demonstrate these skills in didactic basic science courses and the predoctoral dental learning environment is less widespread. The quality of teaching in dental classrooms and clinics has been infrequently studied. Examination of how faculty develop opportunities for students to demonstrate critical thinking suggests that dental educators and researchers have a unique opportunity to change the course of academic history.
Teaching students critical thinking skills also has implications for patient care. As students take ownership of diagnosis and treatment planning and articulate the thinking that supports their decisionmaking, they are poised to become better teachers. That is, they will be able to teach patients about diseases, self-care, what symptoms to look for, and the role of compliance in promoting self-care. Patients who take primary roles in self-care are likely to have fewer dental and other health care visits. Aside from helping students transform learning so they can become competent practitioners, teaching students critical thinking skills has implications for the quality of oral health care, costs, and well being.
Those who believe critical thinking skills are already taught and are skeptical of the need to strengthen CTS may wish to consider the following questions.
Table 1. Checklist for Teaching Basic Critical Thinking Skills
1. What percentage of the time do I encourage students to explain or demonstrate what they know?
2. What percentage of the time do I dominate teaching in the classroom or clinic with teacher-talk?
3. What percentage of the time do I include teacher-student discussion in the classroom or clinic?
4. What percentage of the time do I devote teaching time in the classroom or clinic to having students provide rationale for “what” they think and to explain “how” and “why” they know?
5. What percentage of the time do I use questions to check for student understanding?
6. What percentage of the time do I ask students to identify the cues that indicate or contraindicate treatment and to explain why these cues are relevant to prospective treatment outcomes?
7. What percentage of the time do I ask students to describe how their understanding of body systems, like the cardiovascular system and related diseases, impact oral health?
8. What percentage of the time do I ask students to rephrase what I have just told them?
9. What percentage of the time do I ask students questions in order to identify why a patient is not responding to treatment as he or she should?
10. What percentage of the time do I explicitly explain to students how they will be evaluated on their clinical skills?
11. What percentage of the time do I ask students to explain to me the differences between a poor and an excellent tooth preparation?
If, in response to questions 1-11, you find that you are talking for 50% or more of your instructional time, then you are likely to benefit from this toolkit.
Distler has observed that patients are now being treated by a multitude of highly specialized health care professionals1. A recent Institute of Medicine report emphasizes interprofessional collaboration2. If dental professionals become more involved in systemic health and cooperating with other health care professionals, the problems dentists face are likely to become more complicated and ambiguous. Because of these changes, dental educators are likely to see more
patients who are acutely ill and it is more likely they will need to coordinate care with other health care providers.
The information explosion is yet another reason why it is important that dental students utilize critical thinking skills3. Technology is becoming more sophisticated, and methods of diagnosis and treatment continue to expand. The sheer amount of readily available information challenges faculty to teach students how to decide what information is credible and what to do with the deluge of data.
Recognizing the need to make substantial changes in the dental education curriculum, the American Dental Educational Association (2004) established the ADEA Commission on Change and Innovation (CCI). This group serves as a focal point where dental educators and administrators, along with representatives from dental organizations, the dental licensure community, the Commission on Dental Accreditation, the ADA Council on Dental Education and Licensure, and the Joint Commission on National Dental
Examinations, coordinate efforts to improve dental education and the oral health of the nation.
To assist dental educators across the United States and Canada in making necessary curricular changes, ADEA and the Academy for Academic Leadership agreed to jointly sponsor the creation of a critical thinking skills toolkit.
Dental education has a longstanding history of telling and showing students what they need to know. Today's students may not receive the type of instruction that allows them to transform learning and make it their own4. Learning how to teach
students to use critical thinking skills will require fundamental shifts in beliefs about and planning for teaching. Some dental educators ask, "What does critical thinking look like in the clinic? In the classroom? How do I successfully teach students to use critical thinking skills when they don't read before class or attend class regularly?"
An overview of the dental education literature shows how dental hygienists have effectively used instructional strategies to promote critical thinking skills5. Moore used a mnemonic (a memory aid denoting a series of steps) to help lower students'
initial cognitive load and better remember how to transfer the steps to new problem-solving settings. The mnemonic, INFORMED, was:
|| Issues and Information Known
|| Need to Know
|| Find Information
|| Teach and Learn From Others
|| Recycle, Reflect, and Identify Real Problems
|| Make a List of Solutions
|| Evaluate Solutions
|| Decide, Deliver, and Debrief
However, because this study occurred in a highly structured, contextualized program, it is difficult to determine whether the results can be attributed to problem-based learning (PBL), teacher expertise, group dynamics, student expertise, or prior experience.
Thamasitboon et al. found that there was a significant difference between students who engaged in problem-based learning experiences and those who had traditional learning experiences in their development of several skill sets, including critical thinking skills6. While these and other studies hold promise for enculturating the teaching of critical thinking into dental school curriculum, they are limited by small sample sizes and the use of single outcome measures. In addition, Thamasitboon et al.'s study
was limited by a low response rate and the disadvantages inherent to using a questionnaire with a rating scale.
There is little practice-based evidence suggesting how to implement critical thinking changes in dental education. Some studies with small samples of undergraduate students have shown that a moderate infusion of critical thinking instruction can enhance critical
thinking skills without the instructor making considerable changes to the course. (See Teaching Students to Use CTS during Instruction). Similar studies have not yet been conducted in dental education. Perhaps without social demand and funding opportunities
faculty are reluctant to take on these types of studies. Nonetheless, the importance of teaching dental students to develop and use critical thinking skills is not a question; it is necessary.
The shift to teaching critical thinking will require an organizational commitment to understanding what critical thinking is, identifying what strategies can be used to effectively teach critical thinking, testing changes in students' critical thinking skills, and providing continuous faculty development opportunities and places to discuss, implement, and examine the scholarship of teaching. As Hansten and Washurn point out, an educational organization can support and foster critical thinking, or hinder it by creating faculty who are apathetic and feel powerless to make the changes that will be needed7. Behar-Horenstein et al. describe how faculty development initiatives brought about changes in instructional practices8. Behar-Horenstein et al. (2005) and Behar-Horenstein et al. (2000) also describe the role of assessment in studying how teaching critical thinking skills affects student thinking and practice in the classroom and predoctoral clinical learning environments9,10. As dental educators seek to transform the nature of teaching from telling and showing to holding students accountable for explaining their understanding and thinking, dental educators will need to develop more robust research studies to build an evidence-based collective of studies that reflect how efforts directed at teaching critical thinking skills matter to the new dental professional, the dental school, and society.