Thinking about thinking (metacognition)
In discussing analytical thinking, two particular types are relevant to healthcare, and these are critical thinking and statistical thinking. We will explore each of these in further detail.
Sharples and colleagues, in their paper titled Critical Thinking in Healthcare and Education, described critical thinking as ‘the ability to think clearly and rationally about what to do or what to believe‘, and they portrayed it as a skill that ‘is essential for the practice of medicine’. Asserting that ‘it is important for clinicians and patients to learn to think critically’, they argued that ‘the teaching and learning of these skills should be considered explicitly’. On their part, Croskerry and Nimmo, in a paper titled Better clinical decision making and reducing diagnostic error, describe six stages in the evolution of critical thinking; at the bottom is the unreflective thinker who doesn’t self-monitor his or her thoughts, and whose thinking is undermined by prejudices and misconceptions. The hierarchy then progresses through the stages of the challenged, the beginning, the practicing, and the advanced critical thinker. At the top of the pyramid is the accomplished thinker who ‘systematically takes charge of thinking and strives for improvement‘, and who is able to assess thinking for such features as its clarity, accuracy, precision, relevance, and logic. The authors further characterised the accomplished thinker as having a ‘high degree of intellectual humility, integrity, perseverance, courage, empathy, autonomy, responsibility and fair-mindedness‘.
Statistical thinking is perhaps the most challenging form of thinking for most people, and it is a cause of serious errors in the clinical judgment of doctors. Writing on this theme in the book Better doctors, better patients, better decisions. Envisioning health care 2020, Wolfgang Gaissmaier and Gerd Gigerenzer particularly noted that doctors struggle to understand such fundamental statistical concepts as base rates, risk, risk reduction, sensitivity, and specificity. They further argued quite strongly that the inability to think statistically is responsible for many healthcare errors such as the tendency to overestimate the benefits of screening interventions. Writing in the same book, Gigerenzer and Wegwarth illustrated the scale of ‘statistical illiteracy‘ when they cited studies which show that ‘most doctors have problems in understanding health statistics, including those from their own area of speciality‘.
Thinking is therefore quite a challenging task, but in the next blog post we will explore the 4 strategies that promise to make us all better thinkers.