Critical thinking or Common sense?

[tniuqs]

I believe in this so much, I wish there were practical scenarios on the NREMT exam, using critical thinking skills. As well, should be part of the clinical objectives for field, ICU, ER , etc.. clinical sites.

R/r 911

I can't disagree but as you stated the "Grey" areas become very fuzzy at the best of times. Presently in "my hood" the scenario testing has come under serious scrutiny as well.... just how would you propose an evaluation of ones critical thinking skills? OMG....this would open up one serious can of worms, as we all do not think alike. (nor should we)

I will disagree with the theorists that the level of intelligence one is born with can be seriously modified or even think in a different manner, granted "some modification" can be accomplished if there is the desire....as Carl Jung stated (loosely) "one is a product of one's enviroment" you can't easily change the spots on a career truck driver. I have worked with very competent First Aiders but asking them to do multiple triage at a disaster is just not possible..... given the weight of outcomes. I think that's just a fact of life, spending inordinate amounts of effort to do this is a may be lesson absolute futility for some.

Question is: Just when is the end point in an evaluation do you fail someone as not all will pass? Personally through my experience it has been some folks are leaders some are not, is not so much a "tangable value" that can one can put a finger on. Besides the criteria and goals would be extremely difficult to conceive from the get go, I would like to be the fly on the wall in that regard in those meetings :shock: .......but I am open to new ideas.

cheers

[AZCEP]

Getting the student to consider alternatives to the treatments they want to perform is how you can teach this.

When the suggestion of an unsafe treatment is made, and the student can't see the error, gives the evaluator an idea of how the student is integrating information. The difficulty breathing patient that gets treated with albuterol and NTG, the tachycardic patient that is treated with fluids and pressors. There are a number of different scenarios that could be used.

I will commonly use the altered mental status scenario for this purpose. Just because there are so many possibilities, I don't have to have an endpoint set until the student starts giving options for treatment.

[medic_ruth]

Common sense + education + experience + (good observational skills) + situational awareness + Prioritizing = the Critical Thinker

I think you summed it all up right there man.

Right on.

[Michael]

Minus egotism (take my advice, I'm not using it).

[tniuqs]

Minus egotism (take my advice, I'm not using it).

Correction;

Common sense + education + experience + (good observational skills) + situational awareness + Prioritizing - ego = the Critical Thinker

[MedicNorth]

Good post!

I don't think, however, that the ability to think critically separates the medic from the "general population". Skill and knowledge separate the various levels of the EMS system. There are many people, from bystanders to ER Doctors, who are unable to adjust well to an unusual situation, and the opposite is true as well.

Thinking critically means knowing when the rote protocol might not be appropriate, or when the textbook symptoms don't necessarily mean the textbook diagnosis or treatment. It means looking for possible other reasons for a situation, and not always trusting implicitly what is told or observed.

Critical thinking IS a skill that can be taught. It would be great if more schools, from elementary school onwards, would work on this, instead of trying to pour knowledge into empty heads. The world would be a better place for it!

[medicdsm]

Critical thinking is something taken very seriously in my department. Granted am a a Paid on Call with a fire-based EMS service. The paramedics in my service are very willing to teach as well as demanding of the EMT-B's to learn new things. One of the most important things they try and teach us is critical thinking. After every call we run w/ one of the paramedics we are required to do an after action review with the paramedic we went on the call with as well as the Squad Officer. One major key point they hit on is the thinking. During the call if it is a BLS level the paramedic will go from primary to partner(supervisor, and advisor) allowing the basic to gain experience. During the call the paramedics take notes on the basics actions from evaluation to patient care to patient interaction. During the AAR the paramedics enlighten the basics as to any mistakes made as well as questioning the basics on what they could have done differently. The scenario then is re-enacted with station personnel so as to allow the basic to "run" the call as if they were the primary, with no ALS available so as to make the basics think on how to run the call. The basic who was actually on the call is NOT allowed to make comment during the as well as they are not allowed to participate as the BLS provider on the call. To me this is one of the best ways possible to build critical thinking skills.

[Ridryder 911]

Remember, critical thinking can be used for any strategy. This is not always for patient care, as it is highly recommended for administration skills. In fact, many are using and utilizing testing for those that possess such skills for management and leadership capabilities.

Yes, one can "hone" and improve their skills, many never are able to comprehend and obtain it though. That is why there is a difference between "management and leadership".

I do believe this is one of the areas, EMS definitely needs to improve in. By doing so, so much of repetitious training could be removed, as well having protocol manuals several hundred pages in length.

Some have to be led either by others or by a policy and can perform or act within stringent protocols, and step by step procedures. While others can comprehend and understand the "nature" or "intent"of the rule(s).

This is a hot topic, and we have just seen the tip of the ice burg of this discussion and theory.

R/r 911

[tniuqs]

Good post!

I forgot to mention teachers......like again... :oops:

Always wondered how to spell rote... ty

Ok North you have my "somewhat" undivided attention.....Just HOW does one go about this? Frequently the heads are too full on absolute gibberish some folks do get the global picture from the onset were as others get tottally snarled up in the sequenses and or details of a senario or in fact in real life this is quite common. I guess I mean is there a established theory in education to address this as the teacher must be already be a critical thinker themselves....dont take this personal at your old age but so many of the educators focus on the cirriculem content as opposed to the I quote R/r "INTENT".

We see this so much in law, the interpretation of the law can become quite squewred with prescedent being set, I am beginning to believe that emergency medicine somewhat follows this concept sadly. :roll:

Question is: What guidelines as a mentor can be used to teach critical thinking?

I suspect the adage "when your up to your ass in alligators it is difficult to remember the the intent was to drain the swamp".

[Medic2588]

I think I said it before, but Critical Thinking begins with examining WHY we think the way we do. A good mentor will challenge the student to examine the thought process.

Devin