Responses from the second phase student interviews

During the second phase interviews, some students did not perceive a change in their understanding of critical thinking from the previous year (2013) but agreed that it had been easier to speak about critical thinking in their second year of training as compared to when they were in their first year of study.

Six out of thirteen students attributed their understanding of critical thinking to analysis and evaluation of information, similar to the interview one responses, spoke about problem-solving as a development of their understanding of critical thinking. Two examples are given below:

I think critical thinking is taking a certain problem, breaking it down and finding

the best way to solve whatever the problem is. (Amelia-IV2)

Similarly, Lola (IV2) stated the below:

I realise now that it (critical thinking) is a part of most thought processes, especially in work-related situations when breaking down a problem.

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Apart from analysing the information by ‘breaking it down’ students will reason what is important and what is not. This appraisal of information is equivalent to the evaluation of information. Evaluation of information is a skill of critical thinking. In their responses, students are indicating very clearly their understanding that critical thinking involves analysis and evaluation of information. Both Amelia and Lola attributed their understanding of analysis and evaluation in relation to solving a problem. Lola clarified that she understood critical thinking to be a part of most thought processes used in ‘work-related situations’ when solving a problem. ‘Work-related situations’ is akin to clinical radiographic examinations which require a critical thought process to solve a problem. In the literature, critical thinking skills are used synonymously with clinical decision-making and problem-solving (Jeong, 2015). It is no surprise therefore that students linked their developing understanding of the meaning of critical thinking with problem-solving, particularly in a clinical context.

Another change in perception of critical thinking was offered by Olivia (IV2) who perceived her critical thinking to have changed in the sense that she “was less judgmental”, and now questioned how her actions might affect others. When asked about what factors influenced the change she said the following:

…it will be through placement because you have more eyes on you and you are interacting more with the public who have not known you beforehand and you start to see how things you do are perceived differently by different people.

‘The public’ here refers to patients with whom students interacted with within a clinical environment. Patient perception of them was deemed to be important, and Olivia became aware that her actions were being perceived, as she said, ‘differently by different people.’

Ten out of thirteen students felt they were able to take in and weigh more information as compared with their first year of study. Students recognised that there was more to the meaning of critical thinking than they understood in the previous year (year1). They thus perceived their understanding to have changed as articulated by Thomas and Isla, for example:

My mind has been opened to a lot more possibilities...actually one could argue that my views have changed because I am able to now think in a broader context. (Thomas-IV2)

Everything needs to have a balanced argument…I think with a much more open mind now. (Isla-IV2)

In these students’ first year of study, their scope of learning involved routine examinations and practice on ambulant patients, where they were not required to consider options in imaging or adaptations of radiographic technique. An ambulant patient refers to a patient who, despite

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their injury, is able to walk and move with relative ease, in comparison to a patient who is lying on a trolley or bed. In their second year of study, however, their scope of learning involved dealing with more complex imaging examinations on less ambulant patients which required the consideration of likely options in imaging. This could be a plausible reason for their change in understanding of the meaning of critical thinking and is another sign of students’ development of critical thinking from their first to the second year of study.

However, there was a tendency to regard all thinking as critical thinking as expressed by Charlie (IV2) below:

I can’t really envisage thinking without critical thinking – for me, they’re one and the same.

This is an unusual view from Charlie in comparison to the other students, for example, Isla (IV1) and Isabella (IV1) who made the distinction between thinking and critical thinking. This again presents a disconfirming view which conflicts with other views. In comparison to Charlie’s view above, Isla (IV2) offers the following:

No there are definitely times when you don’t have to think, for example, what to eat. Critical thinking takes longer than normal spontaneous thinking…there is a difference between thinking and critical thinking.

Charlie’s view that thinking and critical thinking are ‘one and the same’ can be considered as not knowing the difference between thinking and critical thinking and appears to be an over- simplification of critical thinking. Charlie therefore wrongly assumes that all thinking is critical thinking, however, what is unclear is whether he was thinking about critical thinking within a radiology context in this statement. In contrast, Isla clearly states that thinking and critical thinking are not the same. Isla demonstrates further development in her understanding of critical thinking from the previous year, where she stated that critical thinking was thinking about a subject ‘in-depth’. Here she has built on her understanding of the meaning of critical thinking by clearly stating that a difference exists between critical and non-critical thinking, demonstrating growth from her first to the second year of study.

Furthermore, in relation to radiography practice, below is what Olivia (IV2) stated:

As we progress all the stuff we learn has generally become mechanical –we don’t really think about it. Even now I can honestly say that I could automatically do a chest X-ray without thinking about it critically.

Here she rightly makes the distinction between mechanical thinking and critical thinking by referring to the performance of routine examinations as not requiring critical thought. She suggests that routine actions occur mechanically rather than through the application of critical thinking. Olivia clearly gained experience in clinical placement in carrying out routine chest X- ray examinations by stating that she did not need to think critically about performing the

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examination. This is due to her experience gained during her first year of training: conducting chest radiographic examinations competently, formed an outcome of their assessment. Olivia feels that performing a routine chest X-ray for an ambulant patient over time became a familiar procedure because over time she used little thinking due to the habitual nature of a patient presentation and the examination. There is, therefore, a level of comfort with performing routine chest examinations. However, if she was faced with a request for a chest X-ray on a patient who presented in a wheelchair or a trolley, then she would have to think of alternate ways of performing the examination. In this case, she would need to use her cognitive and affective skills which are skills of critical thinking. Similarly, if students at Level five were asked to perform a CT scan of the chest, then the thinking process required would need to change to engage their critical thought process. Thinking through the details when undertaking complex examinations and procedures and being able to justify the need for the examination as well as think through the best way to perform the examination when the routine option is not available, is of central importance in radiography specific critical thinking. Olivia, therefore, understands that different thinking skills may be used in different situations and that thinking can be critical and non-critical. This shows similarity with the comment from Isla above and is an indication of her (Olivia’s) developing understanding of the meaning of critical thinking at this stage in the programme.