The relationship between critical thinking and clinical reasoning

Critical thinking and clinical reasoning have similar dimensions, contexts, metaskills, and purposes

Clinical reasoning has been described as extending critical thinking into practice (Mitchell and Batorski 2009). Indeed, many similarities can be drawn between the dimensions, contexts, metaskills, and purposes of critical thinking and clinical reasoning (table 27.1). Health practitioners use metaskills like knowledge generation and reflexivity (Christensen, Jones, Higgs, and Edwards 2008), applied in the contexts of clinical practice (e.g., practice knowledge and models, the workplace, the patient's context, and the practitioner's unique frames of reference). When health practitioners gather data about patients, analyze it, and develop working diagnoses, they draw on a range of strategies to deal with problems that they encounter in their daily practices. Some problems require a technical-rational decision while others, the "messy confusing problems which deny technical solutions" (Schon 1987, 3), require "a rich blend of biomedical, psychosocial, professional craft and personal knowledge together with diagnostic, teaching, negotiating, listening and counselling skills" (Jones and Rivett 2004, 3).

Critical thinking and clinical reasoning are distinguished by the context of clinical practice

Practitioners use metaskills like knowledge generation and reflexivity and may draw on emotional capability and practice model authenticity more than critical thinkers in nonclinical contexts. Smith et al. (2008), recognizing the decision-making capabilities of physiotherapists in acute care settings, included emotional capabilities like awareness of the impact emotions have on decisionmaking and the capacity to deal with problematic emotions when making the difficult decisions required for patient management, as a core component of clinical reasoning. The overarching remit of clinical practice is caring—doing what is within the scope of practice to care for patients; respecting their illness

Table 27.1 Comparison between critical thinking and clinical reasoning

Critical thinking

Clinical reasoning

Dimensions

Acquire a deep understanding of and commitment to the tacit norms of a discipline, learn the challenges of contemporary work Gain an immediate sense of what citizenship might mean

Develop the powers of self-critique

Acquire a deep understanding of and commitment to the tacit norms of a health discipline, learn the challenges of contemporary work

Gain an immediate sense of what being a health practitioner might mean (e.g., having social and moral awareness of issues affecting the profession, the health care system, and broader social issues like chronic diseases, healthy aging, environment)

Develop the powers of self-critique

Context

A set of problem spaces:

i) Knowledge

ii) World

iii) Self

A set of problem spaces:

i) Practice knowledge Domain-specific conceptual knowledge Domain-specific procedural knowledge Dispositional knowledge

ii) Workplace context, practice models, patient's contexts

iii) The practitioner's

unique frames of reference

Metaskills

Including:

Critical inquiry and reflection

Knowledge generation

Reflexivity

Metacognition

Including:

Critical inquiry and reflection

Knowledge generation (including

hypothesis generation/working diagnoses)

Reflexivity

Metacognition

Emotional capability

Practice model authenticity

Purpose

Wise action: Critically engage with the world and with oneself and with knowledge

Wise practice action: Critically engage with the patient's context, onself, and with practice knowledge to make decisions, individually and collaboratively constructed, that guide practice actions

experiences and treatment preferences; and dealing with their family and friends, other members of the health care team, and the organization. Health practitioners are indeed interactional—interactional "with their work environments, key players, situational elements pertinent to the patient" (Higgs and Hunt 1999), but more than that, they are interacting in a potentially emotionally charged environment. Practitioners not only manage their own emotional reactions to their patients' pain and suffering, but are also well aware that the outcomes of their critical thinking can directly affect their patients' safety and well-being.

 
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