4.4. Critical thinking as reflection and metacognition
4.4.4. Summary of findings in relation to the sub-theme, ‘critical thinking as reflection
therefore similar to Jacob (IV3) where he (Jacob) asserted that critical thinking and reflection were ‘parallels in thinking.’ It appears possible that both thought processes could take place simultaneously.
4.4.4. Summary of findings in relation to the sub-theme, ‘critical thinking as reflection and
metacognition’
There were no comments relating to reflection in the students’ first year of study. During the second and third year, students expressed a perceived link between critical thinking and reflection. Reflection has been described as past tense critical thinking, which involved the higher order skills of thinking, and was thought to occur in the latter portion of a typical
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reflective cycle. Both thought processes were described as parallels in thinking where they appear to be inter-dependent.
Participants also suggested that reflection is always critical thinking. This reflective, critical thought process can take place during imaging examinations and can be called thinking-in- action or reflecting-in-action. It can also take place after the examination and can be called thinking-on-action or reflection-on-action. Students spoke of deliberating over their thoughts and actions long after the event, thus learning through self-awareness and reflexivity. Developing their self-awareness is indicative of their development of metacognition. Tutors, like students, spoke about the process of reflecting on thinking, as part of the critical thinking process. Reflection on thinking during thinking is metacognition.
Overall, responses from the second and third phase student interviews and the tutor interviews indicate that reflection often led to an outcome, which determined what action could be taken that may be different to the one taken before. They articulated that this could happen during the action (in action) and after the action (post action), sometimes long after the decision was made. Thinking about their thinking is metacognition and is an act of reflection. According to the participants, the process of reflection involved analysis and evaluation; these are the cognitive skills of critical thinking. Critical thinking was therefore seen as integral to reflection and metacognition.
4.5. Chapter summary
This chapter has addressed key findings in relation to my first research question: what is radiography students’ and tutors’ understanding of what is meant by the term ‘critical thinking?’
During the first phase interviews, students attributed meaning to simple situations that required seemingly straightforward thinking processes. Their experience of university learning and clinical placement resulted in the development of their understanding of the meaning of critical thinking as they progressed through the programme. They learned to rationally and logically consider their inferences even though most of them had not developed the confidence or assertiveness to argue their inferences to the full extent in clinical practice.
During the second phase interviews students built on their understanding of the meaning of critical thinking from the evaluation of information, in decision-making, to problem-solving. They perceived the thinking process to involve breaking down of a problem with the evaluation of the component parts to help them solve a problem. They spoke about complex situations
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where the decision-making process is not considered a straightforward situation. They linked examples to how they would think in various clinical situations. They indicated that they would weigh up their argument by careful consideration of criteria and felt better informed about the consequences of decisions made. They stated that they reflected on their decisions long after the decisions were made and used the outcome of their reflective thought processes to inform future decisions and actions. In building on their responses, following their first interview, therefore, students now understand that critical thinking is more than the analysis of information. It involves evaluation seen in solving a problem. The comparison of their responses (above) in relation to the analysis of information in the first year, to the evaluation of information in relation to problem-solving in their second year, indicates a growth in understanding of critical thinking from the first year to the second year.
During the third phase interviews, students indicated their development through being less inclined to be judgmental and more open to considering alternative options. They felt that their decision-making abilities were strongly influenced by empathy developed from working with patients in a clinical practice environment, as well as ethical and moral considerations in making the right choices for patients. Students demonstrated awareness of themselves through metacognition and self-regulation in relation to consequences of their thought process and subsequent decisions they made. There were no new themes emerging from the third year interviews revealing that the themes had consolidated. The third-year interviews, therefore, served to validate the findings in relation to participants’ understanding of the meaning of critical thinking.
The study has evidenced that students were able to describe their understanding of critical thinking using words and explanations cited in published definitions from key authors in the field. However, contrary to the literature, the findings indicate that students do have some understanding of the meaning of critical thinking; this was evident from their interview responses. Over the course of the three interview phases, student participants grew in confidence and developed a broader sense of thinking. They also demonstrated an understanding of the consequences of their thought processes and decisions regarding the welfare of patients. Their responses informed me that they developed as student radiographers and their thinking skills had developed too.
From listening to tutor participants during the interviews it is clear they understand that different forms of thinking exist and that you would use different levels of thinking depending on what the situation or issue is. All tutors were able to describe what critical thinking meant to them in an eloquent and knowledgeable way. They felt the level of thinking applied to
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situations would affect the quality of the decisions taken. They felt that critical thinking skills were important for practice as this influenced a radiographer’s clinical reasoning abilities. In terms of the application of decision-making to clinical practice, all tutors were able to speak about the impact or consequences for not making the ‘right’ decision, and the need to ensure that ethical and moral considerations inform the decision-making process. Similar to students, the tutors spoke candidly about the serious consequences of decisions and the importance of critical thinking in rigorously evaluating their reasoning and thinking processes when decisions needed to be made.
In their responses, they broadly matched the students regarding the subthemes emerging from all interview phases in relation to this theme. They were able to articulate their understanding in a manner, which convinced me that they did know and understand what critical thinking meant, contrary to the position stated in the extant literature which suggests strongly that students do not know anything about critical thinking, and neither do the tutors. What is a mystery is how that learning is instilled in students by tutors? For example, there is no explicit teaching of critical thinking skills on the programme, so although they can demonstrate knowledge and understanding of the concept, the concept has not been explicitly taught in the university-based part of the radiography training programme.
Having summarised the findings of participants’ understanding of the meaning of critical thinking, a discussion of subthemes in relation to participants’ development of critical thinking is presented in Chapter Five.
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Chapter Five
Findings in relation to participants’ perceptions of how critical thinking
develops over the three-year programme period
5.1. Introduction
In this chapter, the findings in relation to my second research question, “how do radiography students and tutors perceive the development of critical thinking skills,” are presented. First, the data from student interview phases are presented followed by tutor interviews. Participants’ verbatim responses are given in italics. The first interview phase was conducted prior to students’ attendance at clinical placement. It was structured in this way to capture the students’ views before they had experience of placement. In addition to not having attended clinical placement, students had limited experience of teaching and assessment at university. Their responses were, therefore, personal experiences of students who were new to the university.
During the second phase interviews, students’ views on any change in their perception of how critical thinking developed and what factors influenced any change, were explored. Prior to the second phase interviews, students experienced a range of assessment at university and attended their first clinical placement. The responses from this interview set, therefore, deals with students’ developing understanding and awareness of critical thinking, both in the context of their own personal critical thinking development and of their clinical placement experience and learning. Included in this interview schedule was a critical thinking exercise. The purpose of the exercise was to explore students’ ability to use critical thinking skills using structured questions which were based on Halpern’s (1989) and Facione’s (1990) attributes and dispositions of critical thinking skills (See second phase student interview schedule in APPENDIX 12 and case study in Section 5.5, p. 134). They were invited to think of a real, recent scenario which could be related to their home, university or clinical placement experience. All students recalled an incident from clinical placement that involved interactions with patients and radiographers. The responses from this exercise are integrated within this section.
During the third phase interviews, student responses to any change in their perception of how critical thinking developed, and what factors influenced any change, were explored. Prior to the third phase interviews, students had experience of a much broader range of assessment
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methods at university, different patient care case study scenarios, and a more complex radiography curriculum to support their development to a graduate practitioner. In addition, they attended longer clinical placements including elective placements and more advanced, specialist placements, including MRI (See p. x), cardiac and interventional radiography (See Glossary, p. xi). The responses from this interview set, therefore, dealt with their extensive experience of learning from both university and clinical placement.
There were three subthemes which emerged from this theme namely:
• Role of university and placement learning – translating theory to practice
• Development of knowledge and understanding from naïve to complex understanding • Challenges in developing critical thinking skills
Figure 5 presents the relationship between the subthemes.
Figure 5. Visual illustration of the relationship between the subthemes
in relation to the development of critical thinking.
Later, in the discussion chapter, I discuss how these subthemes interrelate and overlap