Efficacy of teaching methods used to develop critical thinking in nursing and midwifery undergraduate students: A systematic review of the literature

doi:10.1016/j.nedt.2016.03.010

Nurse Education Today

Volume 40, May 2016, Pages 209-218

https://doi.org/10.1016/j.nedt.2016.03.010 Get rights and content

Highlights

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Evidence-based teaching methods are needed to develop critical thinking skills.
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Evaluation of teaching methods and effect on critical thinking is inconsistent.
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Problem-based learning methods are commonly used to develop critical thinking.
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Standardised, discipline specific tools are required to measure critical thinking in practise.
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Active constructivist-based learning strategies are vital in educating nurses.

Abstract

Background

The value and importance of incorporating strategies that promote critical thinking in nursing and midwifery undergraduate programmes are well documented. However, relatively little is known about the effectiveness of teaching strategies in promoting CT. Evaluating effectiveness is important to promote ‘best practise’ in teaching.

Objective

To evaluate the efficacy of teaching methods used to develop critical thinking skills in nursing and midwifery undergraduate students.

Data Sources

The following six databases; CINAHL, Ovid Medline, ERIC, Informit, PsycINFO and Scopus were searched and resulted in the retrieval of 1315 papers.

Review Methods

After screening for inclusion, each paper was evaluated using the Critical Appraisal Skills Programme tool. Twenty-eight studies met the inclusion criteria and quality appraisal.

Results

Twelve different teaching interventions were tested in 8 countries. Results varied, with little consistency across studies using the same type of intervention or outcome tool. Sixteen tools were used to measure the efficacy of teaching in developing critical thinking. Seventeen studies identified a significant increase in critical thinking, while nine studies found no increases, and two found unexplained decreases in CT when using a similar educational intervention.

Conclusions

Whilst this review aimed to identify effective teaching strategies that promote and develop critical thinking, flaws in methodology and outcome measures contributed to inconsistent findings. The continued use of generalised CT tools is unlikely to help identify appropriate teaching methods that will improve CT abilities of midwifery and nursing students and prepare them for practise. The review was limited to empirical studies published in English that used measures of critical thinking with midwifery and nursing students. Discipline specific strategies and tools that measure students' abilities to apply CT in practise are needed.

Introduction

Critical thinking (CT) involves making judicious purposeful judgements as a result of engaging in a process of analysis, interpretation evaluation, inference, explanation, and reflection (Facione, 1990). According to Castledine (2010), critical thinking requires clinicians to carefully define and analyse problems, with a sense of inquisitiveness and questioning of information and decisions. This sense of inquiry is crucial for nurses and midwives working in complex and demanding environments with increased accountability, autonomy and collaboration with other disciplines (Muoni, 2012, Pucer et al., 2014, Castledine, 2010). Therefore, an important aim of nursing and midwifery undergraduate education is to develop students' critical thinking abilities in preparation for practise.

Although there is agreement about the value and importance of incorporating strategies that promote critical thinking in nursing and midwifery undergraduate programmes there is little understanding regarding the best approaches to develop these skills (Tiwari et al., 2006). The inadequacy of the traditional lecture format to promote critical thinking is well documented (Banfield et al., 2012, Popil, 2011). However, relatively little is known about the effectiveness of active learning strategies in promoting critical thinking.

A qualitative systematic review of critical thinking development in nursing explored participant's perspectives, as well as facilitators and barriers (Chan, 2013). Analysis of the 17 studies illustrated that the definition and concept of critical thinking changed from time to time, and identified the need to clarify educators' perspectives towards critical thinking. This review did not include any quantitative studies and tools used to measure the impact of teaching strategies on critical thinking development were not reported. Accordingly, Chan (2013) recommended an evaluation of teaching strategies designed to develop critical thinking skills be undertaken.

Evaluating the effectiveness of teaching strategies and their impact on critical thinking is important to promote ‘best practise’. The purpose of the current systematic review was to determine the efficacy of teaching methods used to develop critical thinking in nursing and midwifery undergraduate students.

Section snippets

Search Strategies Utilised

A search of major databases CINAHL, Ovid Medline, ERIC, Informit, PsycINFO and Scopus, was conducted in October 2015. The search criteria were limited to articles published in English and within peer reviewed journals for the period 2001–2015. This timeframe was identified to build on from the publication by Scheffer and Rubenfeld (2000) who used a Delphi study to develop a consensus definition of CT in nursing. It was considered that scholarly research in this area would have occurred

Results

All 28 included studies involved the measurement of critical thinking skill development or change following completion of a specific educational intervention. The most common educational interventions were problem-based learning (PBL) (7 studies), simulation (6 studies), concept mapping (4 studies), and a combination of PBL and concept mapping (2 studies). The remaining 9 studies examined a diverse range of teaching interventions.

A variety of tools (n = 16) were used to measure critical thinking

Problem Based Learning

Seven studies measured the effects of problem based learning (PBL) on the development of critical thinking (Choi et al., 2014, Tiwari et al., 2006, Jones, 2008, Jun et al., 2013, Yu et al., 2012, Yuan et al., 2008, Dehkordi and Heydarnejad, 2008). Two studies measured the effect of both PBL and concept mapping on critical thinking (Tseng et al., 2011, Orique and McCarthy, 2015). All but one study (Choi et al., 2014) found PBL to have a positive effect with an increase in critical thinking

Discussion

This review included 28 studies from 8 different countries testing 12 different teaching interventions to promote the development of critical thinking. None of the included studies involved midwifery students and highlights a significant gap in midwifery education literature. The findings of the review also need to be considered in light of limitations associated with methodological rigour, cultural influences, appropriateness of the measurement tool, duration of intervention, timing of pre-

Conclusion

Common educational interventions used to promote critical thinking development were PBL, simulation, and concept mapping. There were methodological concerns about most studies such as small sample size and a lack of quality assurance on the delivery of an intervention. The short duration of interventions did not allow sufficient time for students to develop critical thinking skills. Variability in the timing between pre- and post-tests was evident, with the majority of studies repeating the

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ReviewEfficacy of teaching methods used to develop critical thinking in nursing and midwifery undergraduate students: A systematic review of the literature

Highlights

Abstract

Background

Objective

Data Sources

Review Methods

Results

Conclusions

Introduction

Section snippets

Search Strategies Utilised

Results

Problem Based Learning

Discussion

Conclusion

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Newborn Infant Nurs. Rev.

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J. Prof. Nurs.

Int. J. Nurs. Stud.

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J. Nurs. Educ.

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J. Clin. Nurs.

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Review
Efficacy of teaching methods used to develop critical thinking in nursing and midwifery undergraduate students: A systematic review of the literature