preparing students for critical thinking: accessing and ... · critical thinking i slide 1 critical...

Preparing Students for Critical Thinking: Accessing and Appraising Biomedical Evidence

Larry D. Crouch PhD College of Dentistry

University of Nebraska Medical Center

D1 year Critical Thinking II Critical Thinking III

Fall SummerSpring

Critical Thinking I

UNMC College of Dentistry ADEA CCI Project

“Increasing Critical Thinking Opportunities in the D1 Biomedical Sciences”

Critical Thinking I – tools for critical thinking, accessing and appraising biomedical literature

Critical Thinking II – argument, reasoning, bias, fallacies; concept mapping, decision algorithms

Critical Thinking III – integrated biomedical science PBL course where students work through case-based scenarios

Critical Thinking I

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1. Orientation & expectations2. Conduct and academic integrity3. Review yourself to success4. Medical terminology: Its logic5. Medical terminology: Prefixes6. Medical terminology: Suffixes7. Standards and competencies8. Core concepts in statistics9. The nature of evidence10. The end of know-it-all-ism11. Introduction to PubMed12. Refining a PubMed search I13. Refining a PubMed search II14. Not all studies are equivalent15. Hierarchy of evidence I16. Hierarchy of evidence II17. The power of the placebo18. Not all publications/journals

are equivalent19. Using UNMC / UNL libraries20. Appraising a research article I21. Appraising a research article II22. Formulating a PICO question I23. Formulating a PICO question II24. Finding the evidence I25. Finding the evidence II26. Finding the evidence III27. Finding the evidence IV28. Evidence-based clinical practice

OB 535 CTI LM A(2): 6 slide total

• Accessing and appraising biomedical literature

• 28 learning modules

• Delivered online via Blackboard

• Modules take 15-30 minutes to complete

• PLUS most modules have an active learning component that requires additional time

• Learn it, use it

Critical Thinking I

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1. Orientation and expectations Critical Thinking I




• Several websites contain information regarding the impact of nutritional supplements on health and disease. Antioxidants, in particular, have attracted a great of attention for the past several years. As an example, go to this web site to read what it says about select antioxidants and cardiovascular health: Quantum Health

• Using whatever internet search engine or database you prefer, perform a search regarding antioxidants and cardiovascular health. Quickly look over three of the sources of information that your search identified.

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1Slide

1. Orientation and expectations


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1. Orientation and expectations

% of studentsusing each

search engine

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0 %

50 %

100 %87%

Google

4.3%

Yahoo

2.2%

Foxfire

6.5%

PubMed

• Interestingly, 98% said they knew ofPubMed

• 76% claimed to have used PubMed“extensively”

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1. Orientation and expectations Critical Thinking I



• 48% stated the evidence they found supported the claim• 52% stated the evidence they found did not support the claim

• 98% used Wikipedia as a primary source of information

• Other primary sources were:

HeartMartNutraIngredientsWikiHealthGoogleHealthWebMDCleveland Clinic Newsletter

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9. The nature of evidence

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“Extraordinary claimsrequire extraordinary

proof!”

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10. The end of know-it-all-ism

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11. Introduction to PubMed

To begin learning how to use PubMed for biomedical literature searches, go first to the PubMed homepage and click on the Tutorials hypertext. On the Tutorials page watch the videos “Search PubMed for an Author,” “Searching PubMed by Author and Subject” and “PubMed Simple Subject Search.” To start, click PubMed Home

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12. Refining a PubMed search I

Learner Outcomes:Following this module, the learner will be able to:

• Use the asterisk truncation symbol “ * ” to expand a search• Use the Boolean logic operators AND, OR and NOT to refine the search• Build a Boolean search statement• Use the “Limits” function• Use the “Related Articles” function

Following this module, the learner will be able to construct Boolean search statements that will quickly access very specific information via PubMED. For example:

(periodont* OR gingiv*) AND (allele* OR SNP OR VNTR OR polymorph*)

Critical Thinking I

1. Orientation & expectations2. Conduct and academic integrity3. Review yourself to success4. Medical terminology: Its logic5. Medical terminology: Prefixes6. Medical terminology: Suffixes7. Standards and competencies8. Core concepts in statistics9. The nature of evidence10. The end of know-it-all-ism11. Introduction to PubMed12. Refining a PubMed search I13. Refining a PubMed search II II14. Not all studies are equivalent15. Hierarchy of evidence I16. Hierarchy of evidence II17. The power of the placebo18. Not all publications/journals


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12. Refining a PubMed search I

The best way to become quickly proficient in PubMed searching is to begin performing searches on topics you find interesting or you have just heard about.

“Why do I sneeze when I feel (amorous)?”

sneez* AND (libido OR sexual OR orgasm)

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Prior to PubMed Learning Modules:“On a scale of 1 to 5, with 1 being “Not at all familiar” and 5 being “Very familiar,” how familiar are you regarding how best to perform PubMedliterature searches?” Mean – 3.85

Following PubMed Learning Modules:“On a scale of 1 to 5, with 1 being “Not at all familiar” and 5 being “Very familiar,” how familiar were you regarding how best to perform PubMedsearches PRIOR to these independent study units?” Mean – 2.35

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Number of casesDegree of blindedness

Appropriateness of end pointsParameters of experimental control

(timing, placebo, randomization, etc.)Rigor of peer-review process/editorial boards

Evid

entia

ry v

alue

of

rese

arch

arti

cle

14. Not all studies are equivalentCritical Thinking I



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15. Hierarchy of evidence ICritical Thinking I



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15. Hierarchy of evidence ICritical Thinking I



What level is this, and what is its relative evidentiary value? Explain your reasoning.

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17. The power of the placeboCritical Thinking I



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18. Using UNMC/UNL librariesCritical Thinking I



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20. Appraising a research articleCritical Thinking I



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22. Formulating a PICO questionCritical Thinking I



The PICO question formulation process is a systematic method of constructing focused, high-yield inquiries. The term PICO is the acronym for the four parts of a well-constructed question.

P - Patient, problem or populationI - InterventionC - Comparison O - Outcome

In this learning module, you will utilize a clinical case scenario to construct a PICO question, which will then be used to perform a high quality literature search.

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24. Finding the evidence I-IVCritical Thinking I



- Case report or series- In vitro studies- Animal studies- Retrospective cohort studies- Prospective cohort studies- Randomized controlled trials- Systematic reviews- Meta-analyses

1995 2000 2005 2010

Adapted from John Rugh, ADEA 2008, 2009

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Continuation of student experiences• Transition from knowledge and skills to behaviors• Have students formulate PICO questions and/or perform best-evidence

searches no less than twice each semester

Assessment of outcomesKirkpatrick’s four levels of evaluation

Level one - ReactionLevel two - LearningLevel three - BehaviorLevel four - Results

BarriersBlackboard issuesInstructor time

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