Intro to recall, critical thinking, and clinical reasoning

“The important thing is not to stop questioning. Curiosity has its own reason for existing” -Albert Einstein

When a patient visits a doctor, a diagnosis is rarely immediately obvious, which means that the answer does not simply come from real life interactions with patients. Instead, a diagnosis is reached by combining information from a variety of sources. After recalling what he or she knows about how the body works and recognizing the physiology behind the patient’s condition, the doctor will need to focus on the appropriate organ system based on the patient’s complaints as well as results from lab testing and imaging. Now, the doctor will need to use critical thinking to apply all of the available information to discern what is normal or abnormal, and the reasoning behind any abnormalities. This is why critical thinking is important — critical thinking leads us to approach problems from different angles, and to reach unique solutions that exhibit deeper understanding of a subject. This section will introduce you to strategies to help you think critically as well as define critical thinking.

Getting Started with Critical Thinking

Let us start by asking ourselves — what is critical thinking? Some things that come to mind when you hear critical thinking might be puzzles, analyzing data or written works, or even having a debate or an argument. These activities all share the need for logical reasoning. Critical thinking is a method that requires you to apply prior knowledge from related concepts in order to reach a solution. For example, in order to solve a jigsaw puzzle, you would need to combine what you know about what the finished puzzle looks like together with spatial perception — that is, how the pieces and different portions of images fit together.

The following video attempts to put critical thinking into perspective

Differentiation between Recall and Critical Thinking

Traditional studying such as listening to lectures, taking notes, and revision prompt students to mostly practice recall skills. Recall is simply repeating previously gained knowledge from memory, such as when you match a term to a definition on an exam. Recall questions have one definitive answer, while critical thinking questions may have many possible correct answers and are more open-ended. Critical thinking actually takes place in a different region of the brain than the region used for recall — critical thinking takes place in the prefrontal cortex, while recall takes place in the temporal lobe. Because of this, critical thinking may not come naturally to students who are not accustomed to innervating the neuron pathways in the critical thinking centres of the brain.

Critical thinking may be complex and require outside-the-box thinking. This skill also requires you to be organized in order to combine what you know about a variety of topics to come up with a solution for a problem. As you approach critical thinking questions, highlight important details and ask yourself what else you know regarding the topic, and what other concepts may be related. You will be able to apply your critical thinking abilities for problem-solving in almost any real world scenario, making it a truly invaluable skill.

The following video demonstrates an example of using information from other concepts to work a practice question.

Differentiation between Thinking, Critical Thinking, Clinical Reasoning, and Clinical Judgement

One doesn’t need an introduction to ‘thinking’ as it is a skill we have been doing since birth:  it’s the mental processes needed to gain and recall information and apply it for the appropriate scenario (e.g. recalled skills to drive a car in real life vs a video game).  Critical thinking is thinking with both purpose and control:  one has  a purpose (i.e. a problem) which the thinker controls the logic of what to recall and apply to get the solution needed.  As mentioned earlier, critical thinking is challenging because learners often don’t get much practice with controlling their learning for a specific purpose.

Clinical Reasoning is a process where you apply critical thinking to the purpose of a patient’s current context. Although a patient’s medical history requires recall, the patient’s current context (i.e. their current signs and symptoms) are dynamic which requires both critical thinking (e.g. “Why did the patient’s symptoms change suddenly?”) and forward thinking (e.g. “what else will change for the worse and how can I prevent it?”).  Clinical Reasoning is the logical process needed for actions to take place in the clinical setting (i.e. Clinical Judgement) which outcomes can be measured (e.g. “Did the patient’s vital signs stabilize?”)

To highlight the similarities and differences between Critical Thinking and Clinical reasoning, refer to the Table 1

Table 1 – modified from Figure 1.2 of “Critical Thinking, clinical reasoning, and clinical judgement: A Practical Approach” by R. Alfaro-LeFevre.^[1]

Clinical Reasoning in a Classroom Setting

In a classroom setting, clinical reasoning skills are developed in a safe setting where patient safety isn’t in question.  This can be in the form of a case study, clinical skills simulation, or even a examination question. Generally a clinical reasoning question contains a patient history with or without a story illustrating the patient’s context.  Patient data is included (e.g. labs or physical examination findings) with the expectation of the learner to recognize what is normal and abnormal physiology.  Clinical reasoning still gets the learner to control their logical process of specific recall,  critical thinking with a purpose (ie a solution), but now the patient context now has to be taken into consideration.

Read the next section for demonstrations and strategies on how to apply clinical reasoning skills.