Clinical reasoning

Docentes da Universidade Estadual de Londrina criam Blog de Raciocínio Clínico

Por iniciativa de docentes do Curso de Medicina da Universidade Estadual de Londrina, foi criado recentemente o Blog 'Raciocínio Clínico', dedicado ao estudo e discussão de aspectos relacionados ao tema e visando a melhoria das competências diagnósticas e consequente melhoria das condições de saúde da população.

Os responsáveis pelo blog são os Professores Pedro Gordan, Leandro Diehl e Fabrizio Prado. 

Link:  http://raciocinioclinico.com.br/

Ethics

Navigating Ethical Waters in the College Classroom

By Donna M. Qualters, PhD Should teachers strike?   How should government balance privacy rights with national security? Should companies value their shareholders over the environment?   How quickly should a software company fix a known bug? Regardless of discipline, faculty are faced with ethical issues in our classes around a variety of sensitive topics, and students will question the ethics of certain practices or topics in our field. As trained academics, we are not always comfortable having discussions where there is no clear right or wrong answer or talking about ethical areas in which we do not feel we are experts. So, how do you respond to students who really want to know “the answer” to these types of questions? Many disciplines respond by requiring ethics courses in the major. While these courses are valuable, the issues covered often do not transfer when students are faced with real issues in the real world. Talking about the ethics of stem cells and being in a lab that uses stem cells are two entirely different contexts. The current “wanted and watched” generation has a learned reliance on adult authority and direction to help them solve their problems. While we can debate the role of ethics in our classes and discuss whether it’s even our responsibility to teach ethics, the reality is we are asked to do that every semester. We would better serve our students to engage in these challenging discussions during the “teachable” moment than ignore them. ne way to help students wrestle with these ethical dilemmas, without declaring what we would do, is to teach them ethical inquiry when you come across a discipline issue that raises ethical questions. If our goal is to help students respond in a compassionate, sensitive way to important issues, we need to show them how to think through questions where there are no clear-cut answers. There are many forms of ethical inquiry we can use to guide students, but they all have common components. Awareness – The first step is being aware of what is an ethical issue. Knowing that you shouldn’t cheat on a test is easy, but deciding whether to turn in a classmate is not easy. Ethical issues are the ones that make us stay up at night. Helping students clearly articulate the ethical issues in your discipline is important. During a discussion in my education class on whether or not teachers should strike, the class realized that the ethical issue was fairness and equity, both for the teachers and their students. This framed the discussion that followed. Identifying the Stakeholders – An important and often-overlooked step to an ethics discussion is having students map out who will be affected by their decision. Again, in our discussion on teacher strikes, the students ended up creating an elaborate stakeholder map that illustrated how the issue went beyond just the students and teachers to also affect the administration, community, and families of everyone involved. It was quite an eye-opening exercise for them! Resources – Students are often unaware that many professions have their own are codes of conduct. They are so busy learning the content that thinking about the ethical issues of the discipline is just not on their minds. Encourage students to investigate the ethical standards and guidelines that may govern their future profession, and then use those resources to help inform their decision-making process. Identifying Multiple Solutions – Students tend to think there is just one right answer to an ethical dilemma, but there is usually more than one solution. Students started calling this the third option. They would ask each other “what’s your third option” in each case that arose. Reflection – Perhaps the most important part of ethical inquiry is reflection. Reflection on their own value system and understanding where it came from, reflection on the process of ethical inquiry, and reflection on identifying their biases and uncovering and/or validating their assumptions. Deciding the Course of Action – Having students review the pros and cons of each of the possible solutions and then choose the one that most closely matches their belief system can help them learn to make choices that are right for them rather than spend their efforts trying to figure out what they think the teacher wants. In our teacher strike scenario, some students chose to strike and others did not, but ALL were comfortable with their choice and understood why they made it and the consequences of taking the action they chose. Giving students the gift of ethical inquiry allows us to do the work we signed up for—helping students grow, mature, and use critical thinking and evidence to make decisions and function in the world. Resources:   Cohen, P.S., M. McDaniels & D.M. Qualters (2005). Air Model: A Tool for Cultivating Reflective Ethical Inquiry, College Teaching (53) 3. 120-127. Ethics Resource Center: http://www.ethics.org Landrum, R.E. & M.A. McCarthy (2012) Teaching Ethically: Challenges and Opportunities. Washington, D.C.: American Psychological Association. Strike, K. & J. Soltis (2004) The Ethics of Teaching. NY, NY: Teachers College Press. Dr. Donna M. Qualters is the director of the Center for the Enhancement of Learning and Teaching at Tufts University.

Critical Thinking

Defining Critical Thinking

Critical thinking...the awakening of the intellect to the study of itself. Critical thinking is a rich concept that has been developing throughout the past 2500 years.  The term "critical thinking" has its roots in the mid-late 20th century.  We offer here overlapping definitions, together which form a substantive, transdisciplinary conception of critical thinking. Critical Thinking as Defined by the National Council for Excellence in Critical Thinking, 1987 A statement by Michael Scriven & Richard Paul, presented at the 8th Annual International Conference on Critical Thinking and Education Reform, Summer 1987. Critical thinking is the intellectually disciplined process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and/or evaluating information gathered from, or generated by, observation, experience, reflection, reasoning, or communication, as a guide to belief and action. In its exemplary form, it is based on universal intellectual values that transcend subject matter divisions: clarity, accuracy, precision, consistency, relevance, sound evidence, good reasons, depth, breadth, and fairness.
It entails the examination of those structures or elements of thought implicit in all reasoning: purpose, problem, or question-at-issue; assumptions; concepts; empirical grounding; reasoning leading to conclusions; implications and consequences; objections from alternative viewpoints; and frame of reference. Critical thinking — in being responsive to variable subject matter, issues, and purposes — is incorporated in a family of interwoven modes of thinking, among them: scientific thinking, mathematical thinking, historical thinking, anthropological thinking, economic thinking, moral thinking, and philosophical thinking. Critical thinking can be seen as having two components: 1) a set of information and belief generating and processing skills, and 2) the habit, based on intellectual commitment, of using those skills to guide behavior. It is thus to be contrasted with: 1) the mere acquisition and retention of information alone, because it involves a particular way in which information is sought and treated; 2) the mere possession of a set of skills, because it involves the continual use of them; and 3) the mere use of those skills ("as an exercise") without acceptance of their results. Critical thinking varies according to the motivation underlying it. When grounded in selfish motives, it is often manifested in the skillful manipulation of ideas in service of one’s own, or one's groups’, vested interest. As such it is typically intellectually flawed, however pragmatically successful it might be. When grounded in fairmindedness and intellectual integrity, it is typically of a higher order intellectually, though subject to the charge of "idealism" by those habituated to its selfish use. Critical thinking of any kind is never universal in any individual; everyone is subject to episodes of undisciplined or irrational thought. Its quality is therefore typically a matter of degree and dependent on, among other things, the quality and depth of experience in a given domain of thinking or with respect to a particular class of questions. No one is a critical thinker through-and-through, but only to such-and-such a degree, with such-and-such insights and blind spots, subject to such-and-such tendencies towards self-delusion. For this reason, the development of critical thinking skills and dispositions is a life-long endeavor. Another Brief Conceptualization of Critical Thinking Critical thinking is self-guided, self-disciplined thinking which attempts to reason at the highest level of quality in a fair-minded way.   People who think critically consistently attempt to live rationally, reasonably, empathically.    They are keenly aware of the inherently flawed nature of human thinking when left unchecked.   They strive to diminish the power of their egocentric and sociocentric tendencies.   They use the intellectual tools that critical thinking offers – concepts and principles that enable them to analyze, assess, and improve thinking.   They work diligently to develop the intellectual virtues of intellectual integrity, intellectual humility, intellectual civility, intellectual empathy, intellectual sense of justice and confidence in reason.   They realize that no matter how skilled they are as thinkers, they can always improve their reasoning abilities and they will at times fall prey to mistakes in reasoning, human irrationality, prejudices, biases, distortions, uncritically accepted social rules and taboos, self-interest, and vested interest.   They strive to improve the world in whatever ways they can and contribute to a more rational, civilized society.    At the same time, they recognize the complexities often inherent in doing so.   They avoid thinking simplistically about complicated issues and strive to appropriately consider the rights and needs of relevant others.   They recognize the complexities in developing as thinkers, and commit themselves to life-long practice toward self-improvement.   They embody the Socratic principle:   The unexamined life is not worth living , because they realize that many unexamined lives together result in an uncritical, unjust, dangerous world.               ~ Linda Elder, September, 2007 Why Critical Thinking? The Problem Everyone thinks; it is our nature to do so. But much of our thinking, left to itself, is biased, distorted, partial, uninformed or down-right prejudiced. Yet the quality of our life and that of what we produce, make, or build depends precisely on the quality of our thought. Shoddy thinking is costly, both in money and in quality of life. Excellence in thought, however, must be systematically cultivated. A Definition Critical thinking is that mode of thinking - about any subject, content, or problem - in which the thinker improves the quality of his or her thinking by skillfully taking charge of the structures inherent in thinking and imposing intellectual standards upon them. The Result A well cultivated critical thinker: raises vital questions and problems, formulating them clearly and precisely; gathers and assesses relevant information, using abstract ideas to interpret it effectively comes to well-reasoned conclusions and solutions, testing them against relevant criteria and standards; thinks openmindedly within alternative systems of thought, recognizing and assessing, as need be, their assumptions, implications, and practical consequences; and communicates effectively with others in figuring out solutions to complex problems. Critical thinking is, in short, self-directed, self-disciplined, self-monitored, and self-corrective thinking. It presupposes assent to rigorous standards of excellence and mindful command of their use. It entails effective communication and problem solving abilities and a commitment to overcome our native egocentrism and sociocentrism.   (Taken from Richard Paul and Linda Elder, The Miniature Guide to Critical Thinking Concepts and Tools, Foundation for Critical Thinking Press, 2008) Critical Thinking Defined by Edward Glaser In a seminal study on critical thinking and education in 1941, Edward Glaser defines critical thinking as follows “The ability to think critically, as conceived in this volume, involves three things: ( 1 ) an attitude of being disposed to consider in a thoughtful way the problems and subjects that come within the range of one's experiences, (2) knowledge of the methods of logical inquiry and reasoning, and (3) some skill in applying those methods. Critical thinking calls for a persistent effort to examine any belief or supposed form of knowledge in the light of the evidence that supports it and the further conclusions to which it tends. It also generally requires ability to recognize problems, to find workable means for meeting those problems, to gather and marshal pertinent information, to recognize unstated assumptions and values, to comprehend and use language with accuracy, clarity, and discrimination, to interpret data, to appraise evidence and evaluate arguments, to recognize the existence (or non-existence) of logical relationships between propositions, to draw warranted conclusions and generalizations, to put to test the conclusions and generalizations at which one arrives, to reconstruct one's patterns of beliefs on the basis of wider experience, and to render accurate judgments about specific things and qualities in everyday life.  (Edward M. Glaser, An Experiment in the Development of Critical Thinking, Teacher’s College, Columbia University, 1941)

"Now you try!"

Teaching Encounter Provides an Up-Close Look at Learning Something New

Maryellen Weimer, PhD

I just taught a dear friend how to knit, and in doing so I revisited how very challenging it is to teach something you can do easily. 

Knitting, like so many of the skills we teach, including concrete skills like running a lathe and abstract ones like critical thinking, cannot be learned in theory. It is learned by doing. “Now you try,” I say after several slow, deliberate demonstrations of the motions. Oh my, such clumsy confusion. “Here, let me show you again.” I slow down even further and talk through the movements needed to make a stitch. Good gracious, I can hardly watch these tortured, truncated movements, so far from the peaceful, rhythmic flow of knitting. As the confusion continues, thoughts start going through my mind. How many times am I going to have to show her? It can’t possibly be this hard? And why am I feeling frustrated?

I worry about order and pacing. Knitting starts (and ends) with two basic stitches, knit and purl. She has those, sort of. Is it time to move on? What’s next? Common combinations of the two basic stitches? Or should I work on her technique? She’s got to stop propping the needles up on her belly. And we need to move on to something other than this scraggly “sampler” (as she calls it). The needle size and yarn weight are creating something less than lovely. It’s not the kind of knitting that inspires continued effort and she still has lots to learn. I search for something that she can do. It needs to offer challenge but also the strong possibility of success.

Then there are the mistakes. I have forgotten how many ways there are to do it wrong. I aspire to learner-centered teaching, which means she needs to take the lead in identifying and fixing her mistakes. Great in theory—hard in practice, I quickly discover. She fixes things slowly, laboriously, and that takes time away from knitting. She focuses with intense ferocity, which is not only tiring, but it seems to lead to even more errors. And some of the mistakes are serious. Whole rows must come out. I step in and make some of the corrections, wondering if that’s a good idea.

My mind whirls. What feedback do I need to provide? How many corrective messages? I think I’m offering too many and they’re worded so negatively. “No, not over the needle, the yarn goes between the two needles.” “No, that’s not a purl bump.” I should be more positive. I should be asking more questions, offering hints, and making helpful suggestions.

She’s trying so hard. Will she notice if I laud the effort and not the knitting? She is improving but more slowly than I expected. I look at her work and know it would be dishonest to call it good. “Look here, see these four stitches? Wow! They are so smooth. That’s exactly what you want. Good job.” She sighs. I sigh. This is hard work.

We have four days together with books to discuss, walks to take, and a friendship to celebrate. Despite working diligently on the knitting, we are running out of time. I’m afraid she isn’t ready to do this on her own. I buy her books and talk about online resources. She will need the help of a couple friends—people she tells me aren’t good teachers. I feel like I’ve failed.

My flight leaves early. I’m getting the coffee on and there on the counter sits her project—or is it her project? Oh my God, she has done 12 error-free rows! I look more closely. Yup, there are no mistakes. She’s beside me now. Joy dances from her face to mine. “I did it!” “Yes, you did and it looks beautiful!” We hug, celebrating the learning and the teaching.

It’s good to have these in-your-face teaching experiences, I decide. With so many students and too much content to teach, it’s easy to miss the struggles of individual learners and not notice how teacher actions aid or confound the process. It’s easy to be perplexed by a learner’s confusion and quickly draw conclusions about ability. Most important, it’s easy to forget that what now seems simple, straightforward, and perfectly obvious is usually not that way when it’s first encountered. Teaching takes a lot of patience; learning takes a lot of persistence.

The Nature of Thinking

Are You Teaching Content Or Teaching Thought?

by Terry Heick

Thinking is troublesome.

For one, it is an intimate act splicing time and space. It is done right here, but it spans moments in the pasts and reaches out uncertainly towards moments in the future. Put another way, you think in a singular, precise space about plural, imprecise times.

It also resists uniformity (and education loves uniformity). Thought hinges on schema (familiar forms and patterns we then impose unfamiliar data to make sense of it), and emotion (in part, our internal response to the former). It is as diverse as character, experience, and affection. It’s like defining art, establishing criteria for beauty, or causing love

And whether it knows it or not, education has a thinking problem.

The Nature Of Thinking

Part of it is due to thinking’s oily skin.

What does it mean to understand, show curiosity, or think? We have tests to try to measure, but the assessment of thought isn’t the priority, but rather grasp of content–and this is another problem.

Priority.

One common response is to choose a handful of actions that indicate thinking–”power verbs”–that we hang on the wall. We then form short response questions asking students to “Analyze,” and “Evaluate,” and feel bloody well that we’re rigorous.

But in this circumstance is thinking useful, or critical? Think about the fact that we promote “thinking strategies,” which makes as much sense as a five-star restaurant promoting “cooking strategies.”

Shouldn’t a school fail to function without urgent and divergent thinking? Shouldn’t a classroom fall flat on its face when it’s not there? The way education is currently designed, the answer is no. We reteach, intervene, and remediate. Einstein’s definition of insanity seems apt here.

If our job is to teach skills, facts, and concepts–crystallized intelligence–then thinking is simply a tool, and our curriculum is content.

If our job is to teach critical thinking, design, and problem-solving–fluid intelligence–then thinking is our collective circumstance, and our curriculum becomes thought.

So, which is it?

If Curriculum Is Content

As an industry, our collective performance is far too mediocre to dabble here and there. When we 

make content proficiency our goal, all of our resources are applied there. Every unit we plan. Every walkthrough observation. Every PLC meeting we attend. Every PD we have the pleasure of experiencing. Every piece of technology we buy. Every grant we write.

We align everything in pursuit of that goal.

If our curriculum remains content, then we simply need to decide what our terms of success are, and continue to experiment until we turn all the little bar graphs that display all the data from all the assessments from red and yellow to green and blue. Or change our terms for success–new cut scores, softer assessments, etc.

Either way, critical thinking is necessarily secondary–a pathway rather than a destination or playground. And that’s okay as long as we’re on the same page here. As long as that’s what we want.

But if our curriculum is thinking–if our job is to, excuse the convenient phrasing, teach thought–then the classroom floor beneath us tilts right and then left, and our goals as educators change in important ways.

To learn to think, students need powerful and inspiring models that reflect the design, citizenship, creativity, interdependence, affection, and self-awareness we claim to want them to have.

To teach careful, creative, and truly innovative thinking, students need creative spaces and tools, and frameworks to develop their own criteria for quality and success.

They need dynamic literacy skills that they practice and build upon endlessly.

Not projects that have creativity and design thinking added on, but projects that can’t function without them.

And they need control of it all.

Units–if we use them–aren’t planned backwards from standards, but thinking habits, self-direction, and intellectual urgency. If our curriculum is content, these are simply a means to a different end. Not priorities, but feel good phrasing we add to school mission statements and casually drop in parent conferences.

As teachers, we have an intimidating–borderline overwhelming–index of academic standards that every student needs to master. But as both an industry and a culture, we complain that students “can’t think for themselves.”

So which is it–should we teach content, or teach students how to think? This isn’t a false dichotomy; we can teach both thinking and traditional curriculum–teach one through the other–but it just might be that we’re trying to serve two masters and failing both.

Changing Curriculum Forms In Response To Changing Times

How would curriculum change if our priority was on critical, creative, and collaborative thinking?

What role would existing content play?

How would it change the kinds of interactions students have with ideas–and one another?

Would this be easier to assess, or more difficult? Would assessment continue to be central to how we drive learning, or would something else act as the catalyst–collaboration, creativity, ideas, models, etc.?

What does the reality of the modern age of information–this age of Google–suggest that we “teach”?

Do students need teachers less in such a context, or more than ever?

How should curriculum respond to a new world? Can we simply “update” things as we go, or is it time for rethinking of our collective practice?

What would you want for your own children–a curriculum of content, or a curriculum of thought?

And is it up to educators to decide? Where are parents and communities? Do they understand these shifts? Shouldn’t they? What’s at stake if they don’t?

Teachers are forced to squint at 21st century learning frameworks, Ken Robinson videos, Common Core standards, technology initiatives, and dozens of other “pushes” and make sense of it all with students increasingly numb to their efforts.

So let’s be clear once and for all–in a public forum and accessible language that our local communities understand–where our priority lies.

Image attribution flickr user :::m@x:::; Are You Teaching Content, Or Teaching Thought?