Tutor responses in relation to the challenges experienced in developing students’

Similar to the students, tutors acknowledged that teaching and learning activities had not been explicitly linked with skills they were designed to develop. Ruby’s explanation is presented below:

I think we do offer suitable learning activities, but I don’t think we, necessarily, label it as such. And I think if anything, there’s more need at the moment for critical thinking abilities because of the uncertainty of the world we’re in, and the healthcare environments that we’re working within. Because of Google, if you don’t know something you can ‘Google’ it – you don’t actually have to think about it, and you’re probably going to take whatever you find at face value, which I think can be dangerous. I think there’s a need to develop critical thinking abilities so that you can actually assess the information that you’re getting, rather than not thinking about it and taking it at face value… (Ruby)

Ruby agrees that instructional strategies are not linked with the component skills that they are designed to develop, as identified in the previous section. However, she implies that students are impatient and are perceived to want instant gratification. The profession they have entered into requires the engagement of their thinking as a process, which does not always result in a quick decision.

Tutors felt that when students come to university they are not fully prepared for study at university level. Two examples are given below:

… the impression I get from school is that they’re being taught to pass exams, and if you’re being taught to pass exams, you’re being given information and then you’re practicing until you pass, and that doesn’t actually allow people to

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think. So perhaps we need to look at, towards the end of the first year, putting in more thinking exercises, or decision-making exercises, to bridge that gap. What we’re seeing now is that we’ve got an increasingly dependent student culture. (Mia)

... I think in radiography, firstly, what we have to do is we have to get our students to think, when they come through from A-Levels they appear to be spoon-fed. So, I think when they get here they are expecting the same… I don’t think you could teach someone how to think critically. (Sophia)

Both Mia and Sophia feel that there is scope to offer a greater range of critical thinking exercises throughout the programme. Sophia’s comment about not being able to teach someone how to think critically is an interesting one. Some students enter the programme with transferable skills. These are skills that they have already developed from other studies or jobs (as seen in Charlie’s responses from IV2 and IV3), to help them develop further throughout their lives. As tutors, we can use these skills as building blocks to help develop their thinking processes. As Dewey (1933) says, we cannot teach people to think but we can help by giving them the tools needed to think, in a structured way. Regarding feedback comments, Sophia said that increasingly feedback on coursework focuses on the levels of critical analysis:

That is a huge part of the marking criteria especially at Level 6 when we are asking them to critically analyse and evaluate. Often students are very good at describing what they have done or what they have read but then they don't give any interpretation of it at all, e.g. what it may mean? Or what actually was said or what was the quality of the work?

Over the years I would say about 50% of comments on student feedback centered on the level of critical analysis.

This extract demonstrates the expectation of the development of critical thinking skills as a key skill in higher education. Sophia’s comment indicates that feedback comments on the level of critical analysis are still prevalent on written assignments, implying that even at Level six, student writing appears largely descriptive and lacking in critical analysis. This is already a major pedagogical implication for the radiography programme. However, Ruby felt that there are additional implications in terms of how tutors teach and what they consider as a priority for their teaching:

…I think the fact that it’s so implied in the curriculum means that it could get missed. But then the students that are good and aware of critical thinking will be doing so regardless of whether we teach it or not; then I would say that it doesn’t matter that it’s not in the curriculum because the good students will do it.

As tutors, we need to consider all students and not simply those considered as ‘good students.’ It is not good enough that we, as tutors, accept that it is implicit within the curriculum, yet we explicitly assess it.

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Tutors agree that learning and teaching activities that enrich the making and structure of arguments are offered on the programme. It is a challenge to measure the impact of those activities to gauge if critical thinking skills have indeed improved or not. Below are George’s feelings about this:

...that’s where it gets hard. How can you actually measure something like thinking? I know that there are tools out there. But how do you measure something which is so subjective because it is hard to actually quantify it?

Simpson and Courtney (2002) state that the critical thinking test instruments are generic rather than discipline-specific and because the umbrella term of critical thinking encompasses a very broad range of definitions one would choose the test that best matches the definition one believes to be appropriate to the setting. Thus, it would appear that tutors are measuring something different, but they call it critical thinking measurements (Cise et al., 2004). There are critical thinking test tools, but they have proved to be unreliable (Cise et al., 2004). For a result to be considered as valid, the result must be measurable and consistent over time, and applicable to a variety of settings. If the test scores do not satisfy these criteria, then it is considered to be subjective. George’s understanding is therefore justified.

Tutors feel that teaching for critical thinking skills development is challenging. Two examples are given below:

…I think it is difficult to teach critical thinking; it’s really hard, to teach it or to be able to recognise it for what it is…we have to also bear in mind as much as we don’t like to admit it, some staff also struggle with instructions and too much information. As module leader, I have to explain some things in different ways in order for staff to understand. So, if they don’t get it how are they going to explain to students? (George)

… if they (tutors) don't understand it, the students are not going to understand

it. (Sophia)

One of the reasons critical thinking is found to be difficult to develop is because tutors perceive it as being a difficult subject to teach. It is a skill that develops through practice as seen through students’ articulation of their learning experiences. George makes the point that this is a key challenge for tutors. Sophia said that one of the biggest issues experienced was in relation to fellow tutors, for example, where tutors were uncertain regarding their requirements once they were given a set of instructions on marking assessment. This clearly presents a pedagogic implication for the programme.

Some tutors emphasised that there are consequences when action and decisions go wrong hence the need for critical thinking in radiography. This is especially important as practice has

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evolved over time from an instruction led profession to an autonomous one. Mia explained this below:

…the profession has changed so much. There wasn’t much thinking involved, or autonomy or accountability. Now we’ve got an increasingly intelligent public who know their rights, and they wouldn’t think twice about questioning us. So, it is important for us, then, to be thinking critically about what we’re doing. Critical thinking allows for autonomy and not just doing what you have been asked to do. Some radiographers do this very well, but some don’t, and our students see both sides of this kind of practice. Unfortunately, good role modeling is a crucial issue out there. We are not part of their placement learning, but we do not want our students to be radiographers who simply press buttons…they need to be the kind of radiographers that radiologists ask for because they know they will have the answer to their questions…without critical thinking, clinical practice becomes a technical operation…

This will create thoughtful, caring, analytical and reflective students. It will also make them aware of their critical thinking, so it is not muddled daydreaming but purposeful and planned thinking. (Mia)

…They (students) have to know so many more things now and we are expecting this high academic level of discussion coupled with the fact that we constantly have to react to the NSS (National Student Survey) and work our socks off to meet student expectations…they are now autonomous practitioners, who are now part of decision-making teams. We didn't have any autonomy when I was a student, we did as we were told. (Ruby)

Mia’s statement summed up the rapid advances within the professions in the last twenty years. From practitioners who followed didactic instructions without questioning, to the current need for questioning and making decisions autonomously is a big leap for the profession. Developing critical thinking, as part of their learning on an undergraduate programme, is crucial to professional clinical practice. One of the main reasons for this is that the nature of practice within the NHS is changing. Some graduates may go directly into Band Six jobs (See Glossary, p. xi), for example, mammography, where they will be required to make important decisions and to practice at that level of expectation. The NSS is a key consideration at the institution in which I work. As a tutor, it is fair to say that much of our efforts go into providing an equitable student experience rather than a pedagogical focus on developing learners. The overall landscape of education and practice reflects how our profession has changed through evolution, i.e. a theoretical evolution versus vocational evolution. These challenges present pedagogic implications for the radiography programme.