Predictive Validity of Critical Thinking Skills and Disposition for the National Board Dental Hygiene Examination: A Preliminary Investigation

Evaluating the use of HEIghten critical thinking assessment to monitor critical thinking in dental students

PURPOSE/OBJECTIVES

Critical thinking and evidence-based dentistry are skills that dental students are required to demonstrate, but monitoring and quantifying progress can be challenging. This study is investigating whether the HEIghten critical thinking assessment (HCTA) could be used as a potential tool, both for use prior to admitting students, and to monitor whether the students' skills improve over their time at dental school.

METHODS

Freshman dental students (n = 92) were given the HCTA during their first semester of dental school. Statistical analyses were then performed to examine the association of Dental Admission Test (DAT) scores (overall, perceptual ability, and total science) and Grade Point Average (GPA) (overall and science) on critical thinking scores (total, analytic, and synthetic).

RESULTS

There was a significant positive association between GPA, DAT scores and critical thinking scores.

CONCLUSIONS

Our results indicate that the HCTA may be a useful tool to enable monitoring of students analytical and synthetic skills throughout their time at dental school.

Psychometric Characteristics of Oral Pathology Test Items in the Dental Hygiene Curriculum-A Longitudinal Analysis

As the landscape of oral healthcare and the delivery of services continue to undergo change, the dental hygienist plays an increasing role in assisting dentists with oral diagnosis and preventive strategies. Hence, the dental hygiene curriculum standards require biomedical science instructions, including general and oral pathology. Student learning and cognitive competencies are often measured using multiple-choice questions (MCQs). The objectives of this study were to perform a longitudinal analysis of test items and to evaluate their relation to the absolute grades of the oral pathology course in the dental hygiene curriculum. A total of 1033 MCQs covering different concepts of oral pathology administered from 2015 through 2019 were analyzed for difficulty and discriminatory indices, and the differences between the years were determined by one-way ANOVA. Test reliability as determined by the average KR-20 value was 0.7 or higher for each exam. The mean difficulty index for all exams was 0.73 +/− 0.05, and that of the discriminatory index was 0.33 +/− 0.05. Wide variations were observed in the discriminatory indices of test items with approximately the same difficulty index, as well as in the grade distribution in each cohort. Furthermore, longitudinal data analyses identified low achieving cohorts amongst the groups evaluated for the same knowledge domain, taught with the same instruction, and using similar test tools. This suggest that comparative analyses of tests could offer feedback not only on student learning attributes, but also potentially on the admission processes to the dental hygiene program.

A Systematic Review of Critical Thinking Instruments for Use in Dental Education

Critical thinking is widely recognized as an essential competency in dental education, but there is little agreement on how it should be assessed. The aim of this systematic review was to determine the availability of instruments that could be used to measure critical thinking in dental students and to evaluate psychometric evidence to support their use. In January 2017, an electronic search of both the medical and education literature was performed on nine databases. The search included both keyword and Medical Subject Heading terms for critical thinking, higher education/health sciences education, measurement/assessment, and reproducibility of results. The grey literature was included in the search. The search produced 2,977 unique records. From the title and abstract review, 183 articles were selected for further review, which resulted in 36 articles for data extraction. Ten of these studies sought to evaluate psychometric properties of the instruments used and were subjected to quality assessment. Seven assessment instruments were identified. Of these, three instruments that have not been widely used nor tested in health professions students showed evidence of psychometric strength and appeared to have potential for use in dental education. Further research should focus on the three critical thinking instruments with strong psychometric evidence, with the aim of establishing validity and reliability in the context of dental education.

Association Between Critical Thinking and Academic Performance in Dental Hygiene Students

Critical thinking is a key element of complex problem-solving that facilitates health professionals' clinical practice and professional behavior. Despite the importance of critical thinking, the measurement of critical thinking skills and its associations with academic performance remains a challenge. The aim of this study was to determine the associations between critical thinking and academic performance among undergraduate dental hygiene students. All 63 third- and fourth-year baccalaureate degree dental hygiene students (Class of 2018 and Class of 2017, respectively) in The Ohio State University Dental Hygiene Program were invited to participate in this quantitative, cross-sectional research study. Critical thinking was measured with the California Critical Thinking Disposition Inventory (CCTDI) and the Health Sciences Reasoning Test with Numeracy (HSRT-N). A total of 45 students completed the two tests, for an overall response rate of 71.4%. For the Class of 2018, the response rate was 90.6% (n=29), and for the Class of 2017, the response rate was 51.6% (n=16). The results showed the CCTDI and HSRT-N scores were higher for the Class of 2017 than the Class of 2018, suggesting that critical thinking skills were being developed across the course of the curriculum. The CCTDI was not significantly correlated with or a predictor of academic performance. The HSRT-N was more correlated with clinical performance than was the CCTDI, and HSRT-N components were found to be predictors of clinical performance. Continued attention is needed in the development and measurement of critical thinking skills to improve the academic and clinical performance of undergraduate dental hygiene students.

Development of critical thinking in health professions education: A meta-analysis of longitudinal studies

INTRODUCTION

While reports of critical thinking exist in the health professions literature, development of critical thinking across a broad range of health-professions students has not been systematically reviewed.

METHODS

In this meta-analysis, multiple databases and journals were searched through February 2016 to identify longitudinal studies using standardized tests of critical thinking [California Critical Thinking Skills Test (CCTST), Health Science Reasoning Test (HSRT), and Defining Issues Test (DIT)] in any language. Two reviewers extracted information and collected information regarding primary author, publishing journal, health profession, critical thinking test, and time1/time2 means and standard deviations. Standardized mean differences (SMD) with 95% confidence intervals (CI) were reported using a random-effects model.

RESULTS

Four hundred sixty-two studies were screened, and 79 studies (representing 6884 students) were included. Studies contained 37 CCTST, 22 DIT, and 20 HSRT. Health professions comprised nursing, pharmacy, physical therapy, occupational therapy, dentistry, medicine, veterinary medicine, dental hygiene, clinical laboratory sciences, and allied health. Cohen's kappa was strong (0.82) for inter-reviewer agreement. Both the CCTST (SMD = 0.37, 95% CI = 0.23-0.52) and DIT (SMD = 0.28, 95%CI = 0.18-0.39) demonstrated significant increases in total scores, but the HSRT (SMD = 0.03, 95%CI = -0.05-0.12) did not show improvement.

DISCUSSION/CONCLUSIONS

In this meta-analysis, students from the majority of health professions consistently showed improvement in development of critical thinking. In this diverse population, only the CCTST and DIT appeared responsive to change.

Collaborative Concept Mapping and Critical Thinking in Fourth-Year Medical Students

OBJECTIVE

To test the hypothesis that small group concept mapping of 4 core neonatal topics as part of a fourth-year allopathic medical student elective would improve critical thinking (CT) as measured by the California Critical Thinking Skills Test (CCTST). To describe any correlations between scores on the CCTST and the step 1 and step 2 Clinical Knowledge parts of the United States Medical Licensing Exam.

METHODS

Twenty-seven students participated in this pilot study during a 1-month elective. A pretest CCTST, California Critical Thinking Disposition Inventory (CCTDI), and multiple choice knowledge test (MCKT) were completed immediately before the elective began. Four weekly group sessions were held with assigned reading on each of the 4 neonatal topics. Concept mapping was performed in small groups of 4 to 6 students with a group concept map collected at the end of the exercise. A posttest CCTST and MCKT was completed after the 4 group sessions.

RESULTS

Pre-CCTST overall score was 83.9 ± 6, and post-CCTST overall score was 85.6 ± 6.9 (P = .57). Pearson correlation of USMLE step 1 and pre-CCTST showed r(25) = .276, P = .164. Pearson correlation of USMLE step 2 CK and pre-CCTST revealed r(25) = .214, P = .482. The precourse MCKT average was 35%, and the postcourse average 50% (P ≤ .001).

CONCLUSIONS

A recent meta-analysis confirms this is the first report of a comparison between the increasingly common CCTST and the USMLE. We confirmed that concept mapping is a valid mechanism to teach content knowledge. Although the difference in the CCTST scores was not significant, this study could serve as an important start toward development of a curriculum devoted to teaching content and improving CT. The small number of students may have prevented us from defining a significant impact.

Do scores on three commonly used measures of critical thinking correlate with academic success of health professions trainees? A systematic review and meta-analysis

PURPOSE

To determine whether the three commonly used measures of critical thinking correlate with academic success of medical professionals in training.

METHOD

The search for English-language articles (from 1980 to 2011) used Medline, Embase, Scopus, Cochrane Library on Ovid, Proquest Dissertations, Health and Psychosocial Instruments, PsychINFO, and references of included articles. Studies comparing critical thinking with academic success among medical professionals were included. Two authors performed study selection independently, with disagreement resolved by consensus. Two authors independently abstracted data on study characteristics, quality, and outcomes, with disagreement resolved by a third author. Critical thinking tests studied were the California Critical Thinking Skills Test (CCTST), California Critical Thinking Disposition Inventory (CCTDI), and Watson-Glaser Critical Thinking Appraisal. Correlation coefficients were pooled in meta-analysis.

RESULTS

The search identified 557 studies: 52 met inclusion for systematic review, 41 of which were meta-analyzed. Critical thinking was positively correlated with academic success, r=0.31 (95% confidence intervals [CI] 0.26, 0.35), with a moderate statistical heterogeneity (I=67%). In subgroup analysis, only student type had statistical significance for correlation, although bias was likely due to low numbers for some student types. In direct comparison, using studies that employed two critical thinking tests, the CCTDI (r=0.23, 95% CI 0.15, 0.30) was significantly inferior (P<.001) to the CCTST (r=0.39, 95% CI 0.33, 0.45).

CONCLUSIONS

Critical thinking was moderately correlated with academic success of medical professionals in training. The CCTDI was inferior to the CCTST in correlating with academic success.