Development of higher-order thinking in health profession education: A comprehensive toolkit for medical educators

BACKGROUND

Higher-order thinking (HOT) is widely recognized as an essential objective of health profession education (HPE). Based on Lipman's three-dimensional model of thinking, we investigated strategies for the development of HOT including critical thinking (CT), creative thinking, and caring thinking in HPE in three consecutive studies. Fostering students' CT is regarded as an outcome of HPE. However, there is the limited level of consensus on educational interventions for CT development. In view of some of the controversies surrounding the development of CT skills and dispositions in HPE, the aim of this study was to determine educational interventions affecting CT development in HPE.

MATERIALS AND METHOD

This study employed the best-fit framework synthesis design. The frameworks recommended by Abrami et al. were used as a basis for the synthesis. The priori themes were extracted from the selected best-fit frameworks. Then, Google Scholar, PubMed, SID, and ProQuest databases were searched for the literature related to the development of CT skills and dispositions in HPE students. Derived data from the HPE literature were coded against the priori themes, extracted from the best-fit frameworks. Interpretation and restructuring of the new themes derived from HPE literature, and the preexisting priori themes resulted in the final framework of the interventions affecting CT development in HPE students.

RESULTS

The themes extracted from the HPE studies (including reflection, discussion, simulation, role-playing, questioning, and explicit expression of CT goals in curriculum) were similar to the a priori themes derived from the studies by Abrami et al. The new themes of experiential learning, art-based learning, argument mapping, concept mapping, and creating appropriate educational atmosphere were obtained by constant comparison of the data among the studies.

CONCLUSION

The comprehensive framework of CT development methods provides a toolkit for medical educators. According to the results of the current study, the mixed approach, where CT is taught as an independent track, along with the discipline-specific CT development, seems to be more effective, compared to the immersion approach. Creating learning moments in the context of practice through experiential learning is noteworthy in the development of CT skills and dispositions. Further research is needed to evaluate the efficacy of the newly developed strategies, such as art-based learning and concept mapping.

Teaching Strategies for Developing Clinical Reasoning Skills in Nursing Students: A Systematic Review of Randomised Controlled Trials

BACKGROUND

Clinical reasoning (CR) is a holistic and recursive cognitive process. It allows nursing students to accurately perceive patients' situations and choose the best course of action among the available alternatives. This study aimed to identify the randomised controlled trials studies in the literature that concern clinical reasoning in the context of nursing students.

METHODS

A comprehensive search of PubMed, Scopus, Embase, and the Cochrane Controlled Register of Trials (CENTRAL) was performed to identify relevant studies published up to October 2023. The following inclusion criteria were examined: (a) clinical reasoning, clinical judgment, and critical thinking in nursing students as a primary study aim; (b) articles published for the last eleven years; (c) research conducted between January 2012 and September 2023; (d) articles published only in English and Spanish; and (e) Randomised Clinical Trials. The Critical Appraisal Skills Programme tool was utilised to appraise all included studies.

RESULTS

Fifteen papers were analysed. Based on the teaching strategies used in the articles, two groups have been identified: simulation methods and learning programs. The studies focus on comparing different teaching methodologies.

CONCLUSIONS

This systematic review has detected different approaches to help nursing students improve their reasoning and decision-making skills. The use of mobile apps, digital simulations, and learning games has a positive impact on the clinical reasoning abilities of nursing students and their motivation. Incorporating new technologies into problem-solving-based learning and decision-making can also enhance nursing students' reasoning skills. Nursing schools should evaluate their current methods and consider integrating or modifying new technologies and methodologies that can help enhance students' learning and improve their clinical reasoning and cognitive skills.

Analysing Complex Problem-Solving Strategies from a Cognitive Perspective: The Role of Thinking Skills

Complex problem solving (CPS) is considered to be one of the most important skills for successful learning. In an effort to explore the nature of CPS, this study aims to investigate the role of inductive reasoning (IR) and combinatorial reasoning (CR) in the problem-solving process of students using statistically distinguishable exploration strategies in the CPS environment. The sample was drawn from a group of university students (N = 1343). The tests were delivered via the eDia online assessment platform. Latent class analyses were employed to seek students whose problem-solving strategies showed similar patterns. Four qualitatively different class profiles were identified: (1) 84.3% of the students were proficient strategy users, (2) 6.2% were rapid learners, (3) 3.1% were non-persistent explorers, and (4) 6.5% were non-performing explorers. Better exploration strategy users showed greater development in thinking skills, and the roles of IR and CR in the CPS process were varied for each type of strategy user. To sum up, the analysis identified students’ problem-solving behaviours in respect of exploration strategy in the CPS environment and detected a number of remarkable differences in terms of the use of thinking skills between students with different exploration strategies.

English Teachers' Conceptualizations of Key Competencies in English Language Teaching and Challenges to Their Implementation

Limited empirical research on the key competencies of front-line English teachers, particularly primary and middle school English teachers in rural regions, exists in the current literature. This research focuses on front-line instructors and examines their mastery of the key competencies in English language teaching. Through in-depth interviews, this paper examined eight rural junior middle school English teachers on their understanding of developing students’ key competencies in English language teaching, as well as the obstacles and challenges they experienced in curriculum implementation. The study found that although front-line teachers have a positive attitude toward the key competencies, there is still a certain gap between their comprehension of key competencies and policy requirements and practical demands. In order to implement core qualities and effectively promote curriculum reform, we need to strengthen teacher development training for front-line English teachers, especially for primary and secondary school English teachers in rural areas, to improve their understanding and professionalization of the new round of curriculum reform.

Early cognitive intervention using mediated learning for preschoolers with developmental delay: A randomized controlled trial

Background

The use of mediated learning in cognitive training has been shown to be effective in enhancing students’ cognitive development. Nonetheless, its effects on language development are less explored.

Aims

This study examined the effects of an early cognitive intervention (Think Bright program) in enhancing the cognitive and language development of Hong Kong preschoolers with developmental delay.

Method

Sixty‐eight children (48 boys and 20 girls; mean age = 58 months) with developmental delay were recruited from preschool rehabilitation centres and randomized to two groups (Think Bright training vs. active control). Each child in the Think Bright group received 12 sessions of 1‐hr individual training on thinking skills over 6 months. The control group received the same amount of training based on the regular training regimen adopted at the rehabilitation centres.

Results

After a 6‐month intervention, the Think Bright group significantly outperformed the control group in language, general cognition, analogical thinking, sequential thinking, and logical reasoning. The Think Bright teachers’ mediation skills significantly improved during the course of intervention and correlated moderately with the improvement in students’ language abilities.

Conclusion

This study has shown promising results on the effectiveness of using mediated learning in early cognitive intervention in enhancing both the cognitive and language development of preschoolers with developmental delay.

A Reduction in Pain Intensity Is More Strongly Associated With Improved Physical Functioning in Frustration Tolerant Individuals: A Longitudinal Moderation Study in Chronic Pain Patients

OBJECTIVE

The onset and chronification of pain often has devastating consequences on the physical and mental functioning of individuals. Medical interventions are quite efficacious in reducing pain levels. However, changes in physical and mental health status after medical interventions are not proportional. In the past decades, rational/irrational beliefs, especially catastrophizing, have contributed to a better understanding of the pain experience. This study explores whether pain reduction efforts are more beneficial for individuals scoring high in rational thinking (moderation).

METHODS

The study design was longitudinal. Patients were assessed twice, 2 weeks prior to the start of medical treatment at the pain clinic and 6 months after. A total of 163 patients with heterogeneous pain (mostly low back and neck pain) participated in the study. Their mean age was 58.74 years (SD = 14.28) and 61.3% were female.

RESULTS

Overall, there was a reduction in pain intensity (t = 4.25, p < 0.001, d = 0.32). An improvement in physical functioning (t = 4.02, p < 0.001, d = 0.19), but not mental health (t = -0.66, p = 0.511, d = 0.11) was also observed. In the regression analyses, a decrease in pain intensity was moderately associated with improved physical health (β = 0.87, t = 4.96, p < 0.001, R 2 change = 0.177). This association was found to be moderated by frustration tolerance (β = -0.49, t = -2.80, p = 0.006, R 2 change = 0.039). Specifically, post hoc analyses indicated that changes in pain intensity only correlated with changes in physical health when patients reported high frustration tolerance levels (r = 0.47, p = 0.006, M = 7, n = 32), but not when patients were intolerant to frustration (r = 0.28, p = 0.078, M = 17, n = 41).

CONCLUSION

The results suggest that frustration tolerance may render adaptive by facilitating the positive effect that a reduction in pain intensity has on physical health status. The study findings are discussed in the context of personalized therapy with an emphasis on how to maximize the effectiveness of current interventions for pain.

Impact of sleep deprivation on anaesthesia residents' non-technical skills: a pilot simulation-based prospective randomized trial

Background

Sleep deprivation is common in anaesthesia residents, but its impact on performance remains uncertain. Non-technical skills (team working, situation awareness, decision making, and task management) are key components of quality of care in anaesthesia, particularly in crisis situations occurring in the operating room. The impact of sleep deprivation on non-technical skills is unknown. We tested the hypothesis that in anaesthesia residents sleep deprivation is associated with impaired non-technical skills.

Methods

Twenty anaesthesia residents were randomly allocated to undergo a simulation session after a night shift [sleep-deprived (SLD) group, n =10] or after a night of rest [rested (R) group, n =10] from January to March 2015. The simulated scenario was a situation of crisis management in the operating room. The primary end point was a composite score of anaesthetists' non-technical skills (ANTS) assessed by two blinded evaluators.

Results

Non-technical skills were significantly impaired in the SLD group [ANTS score 12.2 (interquartile range 10.5-13)] compared with the R group [14.5 (14-15), P <0.02]. This difference was mainly accounted for by a difference in the team working item. On the day of simulation, the SLD group showed increased sleepiness and decreased confidence in anaesthesia skills.

Conclusions

In this randomized pilot trial, sleep deprivation was associated with impaired non-technical skills of anaesthesia residents in a simulated anaesthesia intraoperative crisis scenario.

Trial registration

NCT02622217.

Malaysian adolescent students' needs for enhancing thinking skills, counteracting risk factors and demonstrating academic resilience

The adolescence period of life comes along with changes and challenges in terms of physical and cognitive development. In this hectic period, many adolescents may suffer more from various risk factors such as low socioeconomic status, substance abuse, sexual abuse and teenage pregnancy. Findings indicate that such disadvantaged backgrounds of Malaysian adolescent students lead to failure or underachievement in their academic performance. This narrative review scrutinises how some of these students are able to demonstrate academic resilience, which is satisfactory performance in cognitive or academic tasks in spite of their disadvantaged backgrounds. The review stresses the need for developing a caregiving relationship model for at-risk adolescent students in Malaysia. Such a model would allow educators to meet the students' needs for enhancing thinking skills, counteracting risk factors and demonstrating academic resilience.