Thinking About Thinking: Developing a Formal Curriculum on Critical Thinking for Pediatric Residents

Abstract

Introduction: Critical thinking is a fundamental skill for a pediatrician and deficiencies in critical thinking can have a negative impact on patient care. Until recently, critical thinking was presumed to be learned indirectly throughout clinical training. Reduced duty hours and increased standardization of care have threatened the development of critical thinking skills. Research and consensus guidelines now recommend formal critical thinking training. A gap in the literature exists with respect to how to incorporate critical thinking education in a pediatric training environment. Objectives: This study was a targeted needs assessment for developing a formal curriculum on critical thinking for pediatric residents. The objectives of this study include: 1) to explore physicians’ experiences developing critical thinking skills as both learners and educators during post-graduate training; 2) to explore physicians’ attitudes towards developing a critical thinking curriculum; and 3) to explore physicians’ proposed strategies for content, delivery, and evaluation of a formal curriculum in critical thinking skills for pediatric residents. Methods: A qualitative approach, using a semi-structured interview guide, was used to explore the research objectives. A total of 14 faculty physicians, across five different pediatric subspecialties, were interviewed. A conventional content analysis approach was used for data analysis. Results: The key factors in developing critical thinking for pediatric residents that were identified include clinical experience, the preceptor-learner relationship, psychological safety, probing, the role of emotion, and seeing oneself as a lifelong learner. Threats to the development of critical thinking were identified both in general training environments and within pediatrics. Distinct challenges associated with the use of critical thinking skills in a community pediatric setting were identified. There was a positive attitude towards the development of a formal curriculum, particularly the potential positive impact on patient care. Participants suggested educational strategies, including content and delivery methods, identifying both in-person and multimedia modalities. Potential barriers to implementing the curriculum were explored. The challenges in assessing critical thinking skills and broader benefits were acknowledged, and strategies for evaluation at the individual and program level were recommended. Conclusions: The results of the targeted needs assessment will inform the development of a pilot curriculum on critical thinking for pediatric residents. Further work is needed regarding evaluation methods and the broader implementation of a critical thinking curriculum.