Critical-thinking skills of undergraduate allied health professions students in the clinical rotation years at the University of the Free State
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Date
2020-01
Authors
Louw, M.
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Publisher
University of the Free State
Abstract
In the health professional’s world, decisions have to be made in an instant, and because these decisions influence the lives of the patients that health care professionals treat – wrong decisions can be fatal. These decisions need to be based on solid knowledge and have to be adapted to the patients or the situations and, in order to make unique, knowledge-based decisions, the health care professional must apply critical reasoning. Decision-making is dependent on inductive and deductive reasoning processes, and critical thinking (CT) has been found to be one part of the clinical reasoning process (Vendrely 2005:55). Watson and Glaser (2011:3) define CT as “the ability to identify and analyse problems, as well as seek and evaluate relevant information in order to reach the appropriate conclusion”. By entrusting allied health professions (AHP) students with higher-order thinking skills and the ability to make sound clinical decisions, students are provided with the tools they need to be successful in their careers. CT forms part of the exit-level requirements for AHP, for example, physiotherapists need to work autonomously and in interdisciplinary teams, and have to demonstrate accountability. In turn, occupational therapists should be able to use basic science, social science and arts, as well as information technology, effectively and critically (Velde, Wittman & Vos 2006:49). A curriculum usually combines didactic learning and clinical placements, to ensure a competent practitioner that applies CT skills (Reed 2014:1). However, no CT skills tests are currently administered at the University of the Free State (UFS) to test the actual level of critical thinking of undergraduate AHP students. Worldwide, a few tests exist that test CT skills at different levels of education, from school to postgraduate level. The only research articles that could be found in relation to testing CT skills in AHP used the California Critical-thinking skills Test (CCTST), the California Critical Thinking Disposition Inventory (CCTDI), the Health Sciences Reasoning Test (HSRT) and the Watson-Glaser™ Critical Thinking Appraisal (W-GCTA). Most of these tests only test the CT skills of Master’s and PhD-level students, with a select few including undergraduate students. The research that was found did not indicate that one test was superior, but suggests that a test of which the questions could be adjusted to a particular health profession would give a better indication of CT skills (Ennis 1996:174; Velde et al. 2006:58). These CT skills tests are all quite costly to apply, and this led the researcher to search for alternative CT tests, and to investigate whether any other universities, in South Africa and beyond, use CT skills tests. The University of Cambridge developed the Thinking Skills Assessment (TSA) test for admission testing of CT and problem-solving skills, to assess the applicants’ suitability for their chosen course (Admission Testing Services 2016:2). Other universities that use the same test for admission are Oxford University and University College London. A free online TSA specimen test is available, for applicants to complete to prepare for the TSA test. The TSA tests the following abilities: Summarising the main conclusion, drawing a conclusion, identifying an assumption, assessing the impact of additional evidence, detecting reasoning errors, matching arguments and applying principles. The aim of this study was to determine the CT skills that undergraduate AHP students at the UFS, possess in their clinical rotation years, and to determine if these skills change over a period of one clinical rotation year of study. Secondly, the type of activities that lecturers in the different departments in the School for Allied Health Professions (SAHP), excluding the Department of Exercise and Sport Science, use to develop CT skills in their undergraduate students was investigated in this study. This study was conducted in the field of health professions education. The study is interdisciplinary, as it forms a bridge between health professions education and allied health education. This study consisted of two parts. Part 1 was a quantitative research study that was experimental in nature, with a one-group pretest-posttest design. A literature study was done to conceptualise and contextualise CT skills and determine the CT skills in undergraduate AHP students. A CT skills test (TSA-Modified) was used to test the CT skills of undergraduate AHP students who were at the point of completing their third and fourth years of study in 2018. The TSA-Modified was completed at the beginning and end of one year, to determine if changes had taken place in CT skills over this period. Part 2 was a descriptive study, using a self-constructed questionnaire to investigate the types of teaching activities lecturers in the different departments of the SAHP employed to develop CT skills in their students. The data gathered in this study can be used for further research by the researcher to determine the need for and feasibility of a CT skills test for undergraduate AHP students at the UFS. Part 1 included a target population of 227 undergraduate allied health professions students at the University of the Free State, of whom 136 completed the pretest, but only 106 completed the pretest and posttest, and who were consequently included in the study (55,5% and 43,3% response rates respectively). This study found no statistically significant development ofoverall CT skills over the study period. Interestingly, occupational therapy students showed a statistically significant difference in median test scores compared to the other groups, though this finding needs further investigation. This study highlights the need for more extensive research on the CT skills of different health care professionals, to build a stronger foundation regarding thinking, and to improve clinical reasoning skills, which could lead to better patient care Part 2 of this study include lecturers in four of the departments (Physiotherapy, Occupational Therapy, Nutrition and Dietetics, and Optometry) of the SAHP at the UFS completed a self-designed questionnaire, to determine which strategies they used to develop students’ CT skills. A response rate of 60% of the target population was achieved. Lecturers indicated problem-based learning and experiential learning as the teaching strategies applied most often to develop CT skills. This study identified how these strategies were scaffolded in 2018 in the four curricula of the different allied health professions disciplines to develop well-rounded graduates who engage in CT. This research study will provide feedback to the SAHP about the CT skills of its undergraduate AHP students in their clinical rotation years, and make recommendations, if necessary, about incorporating CT skills in the different departments’ teaching methods, to improve the level of CT skills in undergraduate students. This dissertation contains information about the research study, including the research design and methodology.
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Keywords
Dissertation (M.HPE. (Health Professions Education))--University of the Free State, 2020, Critical-thinking skills, Thinking Skills Assessment (TSA), Undergraduate allied health professions students, Graduate attributes