Critical thinking for transformation: An extension to the 5-steps of evidence-based practice incorporating ways of thinking and practising.
Creators: name: Thompson, Rachel
Publisher: name: UNSW Sydney
Year: 2019

description: Background Over the years since the Sicily Statement was published (Dawes et al, 2005) teachers of evidence-based practice (EBP) have discussed, published and battled with the knowledge that their students find learning this practice difficult. Over nearly the same period of time, the explanatory Threshold Concept Framework (TCF), first proposed by Meyer and Land in 2003, has demonstrated that transformative conceptual learning is key to gaining disciplinary knowledge and expertise but can be troublesome for students. This framework has successfully improved student outcomes by identifying and targeting these troublesome transformative concepts with pedagogical support. Recent TCF research has focused on the ‘liminal space’, the time-space where students struggle to grasp transformative concepts. However, no research has fully mapped this learning journey to transformation considering the contribution of critical thinking to this cognitive process. In addition, the threshold concepts of EBP, biostatistics and research skills have not been fully elucidated separately or in combination. Aims This doctoral research took a qualitative approach to investigate how critical thinking acts within the liminal space during conceptual learning of evidence-based practice and biostatistics in an Australian undergraduate medicine program. Its first aim was to identify the troublesome and transformational conceptual development domains for EBP and biostatistics, and from this it explored how students use critical thinking to transform to be evidence-based clinical practitioners. Methods Local experts and medical students at an Australian university medical school were interviewed about their experiences of threshold concepts in learning and teaching evidence-based practice and biostatistics. This led to a year-long case-study series of students from across the medicine program. Participants were invited to keep a reflective journal of the critical thinking employed at troublesome conceptual learning moments. Journal and interview data were analysed using an abductive analysis method that applied a combined theoretical framework of the TCF, Vygotskian educational development theory and relevant theoretical learning models.   Results Iterative abductive analysis revealed that students experience challenging learning thresholds where individualised conceptual systematisation creates distinct disciplinary conceptual elements. These were identified and clarified for EBP, biostatistics and research skills. Importantly, the research showed that assimilation of key overarching concepts initiates a core transformation of knowledge and disciplinary perspectives, leading to new ways of thinking and practising with augmented clinical expertise. Language and critical thinking both assist in this; language acts as the central cognitive bridge that initiates and enables critical thinking within the liminal space. Dialogue with experts and peers was important for student learning, but self-teaching, as inner speech, was significant in exploiting crucial critical thinking steps that unlock transformation. It is proposed that specific critical thinking steps can be harnessed to ensure that students reach their full potential in learning these threshold concepts for application as clinical practitioners. A revised model of the 5-steps of EBP was developed from these findings that incorporates the main threshold concepts identified by this research, and emphasises the transformed ways of thinking and practising that our students should aspire to. Limits This was a sole-researcher, qualitative study of participants at one university medical school using a relatively novel methodology, so its limitations are acknowledged. However, evaluation showed that the process undertaken was rigorous and the results are considered valid and transferable. This research offers fresh avenues of research for EBP teachers, a new theoretical framework for qualitative research of threshold concepts, and an extension of the knowledge and ways of teaching EBP for healthcare professionals. Conclusions Language and critical thinking work together as ‘bridges’ for transformative learning of EBP and biostatistical concepts. Recommendations are made to emphasise and nurture this intrinsic language-critical thinking integrator system to enhance student conceptual transformative learning. It is proposed that specific critical thinking steps can be harnessed to ensure that students reach their full potential in learning these threshold concepts. The desired metamorphosis from novice to competent, and then expert clinical practitioner can be assisted by emphasising the ways of thinking and practising represented in this extended model of the 5-steps of EBP.
description: Evidence-based Health Care (EBHC) 2019: The Ecosystem of Evidence.; Taormina, Sicily; 2019-11-06 - 2019-11-09