Participant responses revealed that although teaching and learning activities, which are perceived to develop critical thinking skills in students, are offered on the programme, these are occurring implicitly rather than explicitly. There is, therefore, scope to consider a greater dimension of opportunities for development of this skill within teaching and learning practice. Participants felt that scenario-based case studies, involving discussion with fellow students, would help more in the development of critical thinking skills. They also felt that tutor feedback was a valuable learning tool. Acting on feedback following conversations with tutors would thus help to develop critical thinking skills. Although learning through university feedback was perceived by the participants as being helpful in generating more thinking and discussion, clinical placement was acknowledged as having provided the most scope for learning and developing critical thinking skills. Furthermore, student participants said that “more opportunity
for debates and getting involved in ‘sticky’ discussions” would help. ‘Sticky’ here implies
debates on topics that would generate good quality discussion with diverse opinions: for example, scenarios that involved ethical dilemmas and moral issues where each student is certain to have their own viewpoint and where a number of patient and clinical factors need to be taken into account.
Teaching methods that can be used to develop critical thinking abilities, offered by Sommers (2013) and Chan (2013), include role-play scenarios, simulation activities, case studies and reflection activities that have been used in nurse education. Simulation activities provide particularly valuable insight by transferring textbook knowledge to typical real-life situations that students are likely to encounter within the clinical setting (Chan, 2013). In addition, Fesler- Birch (2005) posits that concept analysis, problem-based learning tasks, the Socratic questioning method, thinking instruction, and contextually specific metacognition instruction, are useful techniques to understand critical thinking and how it is to be used and developed. Socratic questioning and dialogical discussion have been published as a helpful pedagogical means of engaging students in the subject matter so that learning occurs as a consequence of questioning and finding solutions, alternatives, examining inferences and so on (Paul, 1990). Students also learn about intellectual discipline and thoroughness in pursuing a line of questioning in their search for the right solution, and over time, learn the power of logical
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thinking and reasoning (Paul, 1990). From my experience as a radiography tutor, most students feel uncomfortable with asking and answering questions in a large class environment.
Fesler-Birch (2005) suggests open-ended Socratic questioning to facilitate students’ reflection about the decisions they make so that those are based on reliable evidence. The method that Socrates used to question his subjects could be perceived as having injected an element of criticality into their thought process (Benson, 2006) in order to answer the question: a learning point that cements much of what we are expected to do today as autonomous radiographers. In addition, Paul (1990) asserts that pedagogically, Socratic questioning is a powerful method of promoting critical thinking through rational questioning and dialogue between teacher and students. This implies that students’ critical thinking skills can be developed through skilled questioning by teachers. Teachers though, have to be trained to ask appropriate questions that direct students’ thought process in order to raise their standard of thinking (Sahamid, 2016). One wonders as to what advice Socrates would have given to radiography lecturers wishing to extend their skills in questioning. In clinical radiographic practice, however, due to the nature of the clinical scenarios where there is often more than one option, there is unlikely to be a single response answer to questions. Students, therefore, have to be trained to consider multiple options in relation to how they would apply their knowledge depending on the situation (Kost & Chen, 2015). Socratic questioning methods, therefore, appear to be an instrumental strategy to aid critical thinking and questioning.
As tutors, we can teach the skills of critical thinking but, according to McPeck (1981), critical thinking per se cannot be taught. I agree with McPeck since critical thinking is a deep thinking process thus cannot be taught. The component skills of critical thinking, such as questioning skills, however, can be and should be taught just as other skills are. By developing these skills students will be able to refine their thinking process thus enabling the development of critical thought. However, Paul (1990) postulates that students’ skills of questioning, arguing, analysing, and having open discussions on other people’s points of views, are underdeveloped. This thus restricts their motivation and ability to mature intellectually and morally in a democratic world. Students need to be taught about asking specific, prudent questions and when to ask a question. It should not be a case of teaching about questioning for the sake of questioning. This is of particular importance as Edwards (2003) argues that dealing with complex patient cases, involving ethical and moral dilemmas, requires engagement in high-level questioning. In order to ask critical and facilitative questions, one needs to develop the skill of reflection in order to apply “reflective scepticism” (McPeck, 1981: 7). It is therefore important that students’ reflective abilities be developed to a high standard, in order to develop their critical thinking skills (McPeck, 1981). Paul (1990) advises tutors, in
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general, to consider more realistic and suitable approaches in their teaching practice to enable students to question ambiguity and complexity in order to develop high-level questioning skills. Teaching and learning exercises that foster critical thinking development were not explored as part of this study. However, from participant responses it is clear that the current teaching and learning activities do not explicitly address the requirement of the development of this key skills-set, hence the reason for including examples of what to consider in terms of teaching and learning instruction.
Kowalczyk et al. (2012) state that diagnostic radiography lags behind other professions, such as nursing and medicine, in adopting critical thinking approaches to teaching. This could be due to the large amount of content that needs to be taught hence less emphasis on analysis, synthesis, and application of knowledge. In addition, they report that tutors find it difficult to develop teaching methods that cultivate critical thinking skills in students and are somewhat resistant to change their teaching style. This is interesting empirical evidence from their study conducted on deans and directors of nursing programmes. Tutors’ teaching styles were however, not explored in my study. Castle (2006) advises that tutors should carefully consider their teaching philosophy in order to positively influence students. In so doing, as tutors, we will be shifting the focus from tutor–centred to student-centred teaching, as discussed above. Tyler (1949, in Biggs, 2003: 25) assures tutors that “learning takes place through the active behaviour of the student: it is what he does that he learns, not what the teacher does”, where ‘he’ is the student. This structured set of skills can be added to complete critical thinking tasks to make learning objectives more specific and focussed on guiding the development of critical thinking skills in students.
Another challenge emerging in relation to learning and teaching activities is the implicit link between learning and teaching activities and the skills they are designed to develop. Although the findings indicate that there are learning and teaching activities, which do engender critical thinking skills development, there is evidence to suggest that we, as tutors, do not make the link with critical thinking skills explicit within those activities. Making this explicit will foster a deeper engagement with knowledge and understanding in students’ decision-making process and may help with the development of metacognition (Fesler-Birch, 2005; Panettieri, 2015). This is clearly an area that needs addressing in terms of curriculum design. Tutor participants agreed that teaching methods should be focussed on developing critical thinking skills and the fact that this requirement is so implicit rather than explicit within the curriculum means that it could get lost. They stated that in a large class of diverse learners, the multiplicity of learning styles means that ‘good’ students will take the initiative and get on with their learning regardless of whether it is in the curriculum or not, while others will need more encouragement.
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In terms of good practice and inclusion we need to consider the remaining students who are not considered as ‘good students.’ What should be done to address this? Is it sufficient that we accept that critical thinking is implicit within the curriculum whilst we explicitly assess it? Students’ performance, according to pre-defined competency criteria, is explicitly assessed during formal assessments. If students are developing the skills sufficiently without the overt teaching of those skills and considering that radiography students struggle to develop and apply the skills for higher order thinking, there therefore needs to be more “explicit constructive alignment of the curriculum and more transparent links between learning and assessment” to improve students’ development of these skills (Castle, 2006: 89). Although critical thinking is not an outcome at Level four of the degree programme, students have demonstrated that they developed this skill at a low level in their assessment involving the justification of X-ray examination requests. Tutors need to ensure, therefore, that the curriculum at Level four prepares students for this expectation by offering appropriate teaching and learning exercises that develop the component skills of critical thinking at this level.
Furthermore, guidance given to students has in the past comprised of only the cognitive skills of critical thinking, for example, the skills of analysis and evaluation. From the findings, it is evident that critical thinking involves more than just the cognitive domains of thought: it involves the affective domain as well. This is essential to the safe and caring practice of diagnostic radiography. Guidance on critical analysis given to students, therefore, must include both the cognitive skills and affective dispositions of critical thinking (Panettieri, 2015), in relation to diagnostic radiography.