Evaluation and comparison of critical thinking skills of residents of Tehran Medical College. BMC Medical Education


research design

A cross-sectional study was conducted to evaluate and compare CT skill scores of residents at Tehran Medical University (TUMS). A self-reported questionnaire was used to collect the data. The study included residents in training at his three largest teaching hospitals at TUMS (Imam Khomeini Hospital, Shariati Hospital, and Sina Hospital).


The study group was 284 residents (PGY1, PGY2, PGY3, and PGY4) in training, in three disciplines: internal medicine, surgery, and orthopedics. After obtaining informed consent, we distributed a questionnaire to all residents starting the residency program (N.= 284). Excludes assistants who did not meet inclusion criteria. Inclusion criteria included that residents had: (1) residency period of at least 6 months; (2) willingness to participate and respond to surveys; (see table 1).

Table 1 Distribution and results of trainees in teaching hospitals

Rationale for different groups

In this study, we hypothesized that medical, surgical, and orthopedic groups had different forms of critical thinking in their respective specialties. CT, on the other hand, is a general skill set that spans many disciplines.Moreover, it is a specific skill set that varies from discipline to discipline [40]From Fero and Ozturk’s point of view, level of clinical experience and level of education are among the effective factors in developing and improving a student’s CT skills. [25, 26]Previous studies have shown that more educated students have more significant positive CT skills and are better able to meet their medical needs. [23, 24]Therefore, one of the objectives of the current study was to investigate the state of critical thinking skills based on different age groups of residents.

These specialties were also chosen because of the large number of accepted trainees in the fields (internal medicine and surgery) and the availability of orthopedic trainees due to their compatibility with the project manager’s specialties. is mentioned.

In Iran, applicants for residencies are Doctors of General Medicine (MD) who have participated in the Central Entrance Examination and choose a field according to their scores and interests. Based on healthcare priorities, the annual capacity of the residency program is approximately 4,300 residents at 35 medical colleges in Iran. The length of the training program is similar to other countries, depending on the type of specialization he ranges from 3 to 5 years, more or less similar to most residency programs in the world, but a few There is a difference. [41]All specializations selected for this study were of four years duration.

learning tools

This study uses the California Critical Thinking Skills Test (CCTST) Form B. The questionnaire used consisted of his two sections on the demographic characteristics of the residents and the California Critical Thinking Skills Test (CCTST). A pilot study reviewed the validity and reliability of the test. Therefore, we submitted the tool of interest to 12 medical educators, clinical professors, and interested residents for validation. After receiving their opinions, the experts made the necessary modifications and finally approved to examine the reliability of the test. The questionnaire was piloted to 22 residents from different hospitals and specialties. Her Cronbach’s alpha reliability coefficient for this questionnaire was 0.81. Facione and Facione specified the CCTST’s internal consistency reliability (Kuder Richardson-20) to be r = 0.70. [42].. The validity and reliability of the Persian translation of this questionnaire has been confirmed by previous studies in Iran. [11, 43]Based on the international expert consensus definition of critical thinking skills defined in the APA Delphi Report, the California Critical Thinking Skills Test (CCTST) was designed by Fasion to measure critical thinking skills in college students. [44]The CCTST is a 45-minute standardized test that assesses five domains of critical thinking: analytical (9 items), evaluative (14 items), reasoning (11 items), deductive reasoning (16 items), and inductive reasoning. Contains 34 multiple-choice questions. (14 items) [42]Each item has 4 or 5 choices and 1 correct answer. [44]The CCTST is dichotomous (correct = 1 and incorrect = 0). Therefore, the scores range from 0 to 34. Higher CCTST scores indicate better critical thinking skills.

The Insight Rating, which measures thinking worldwide, determined the best college-level CCTST average (M = 17.1) [45]According to this guide, optimal average college-level CCTST total scores ranging from 0 to 7 do not demonstrate evidence of critical thinking. Scores in the range 8-12 are considered weak. Scores in the range 13-18 are considered moderate scores, and scores between 19-23 are considered strong. A score of 24 or higher is considered excellent. An analytical score ranging from 0 to 2 is evidence of critical thinking (not a manifesto). Scores in the range of 3-4 are considered moderate scores, and scores of 5 and above are considered strong. A rating score ranging from 0 to 3 is evidence of critical thinking (not a manifesto). Scores in the range of 4-7 are considered moderate scores, and scores of 8 and above are considered strong. A reasoning score ranging from 0 to 5 is evidence of critical thinking (not a manifesto). Scores in the range of 6-11 are considered moderate scores, and scores of 12 and above are considered strong. A deductive score ranging from 0 to 5 is evidence of critical thinking (not manifest). Scores in the range of 6-11 are considered moderate scores, and scores of 12 and above are considered strong. An induction score ranging from 0 to 5 is evidence of critical thinking (not a manifesto). Scores in the range of 6-11 are considered moderate scores, and scores of 12 and above are considered strong. The table shows the optimal scores for the sum of CT skills and subdomains. 2 [45].

Table 2 Optimal scores for sum of CT skills and subdomains

This means that a score below the cutoff point indicates weak CT skills, and above it indicates high and strong CT skills. [46]Considering the above criteria, this study measured the residents’ CT scores as normal or abnormal.

Why use CCTST

Critical thinking is widely recognized as an essential competency in medical education.Yet there is little agreement on how it should be measured in residency programs [47]Definitions and teaching methods vary, but this is also true of the tools used to measure the performance of critical thinking.There is no gold standard across these studies [48]For objective standardized measures, we used the California Critical Thinking Disposition Inventory (CTDI). [49,50,51]We also use the California Critical Thinking Test (CCTST). Measure critical thinking skills applied to scenarios (e.g. reasoning) [49,50,51]. Razegi et al.Use the Self-Reflection Insight Scale (SRIS) for self-reflection and insight [52]Hong and Yu use the Watson & Glaser CT Appraisal (WGCTA). [51]Singh et al. Using Yoon’s CT Disposition Tool [53]Standardized tests for CT are one of the most common tools used for CT evaluation and are widely used by students of the medical profession. The CCTST is a well-known instrument in the field for measuring cognitive and metacognitive skills associated with CT. [54]. Possibility of use in residency education [10]The CCTST (Form B) predicts the strength of critical thinking skills in real problem situations and success on professional licensure exams. It also provides an objective measure of CT skill.This test is suitable for college-level and post-bachelor student populations [47]With respect to the purpose of this study, it was to assess the CT skills and domains (analysis, evaluation, reasoning, induction, and deduction) of residents. This study intended to assess multiple dimensions of critical thinking. Therefore, we found the CCTST test to be more comprehensive than other tests.

Data collection

All resident names and mobile phone numbers are obtained individually for each hospital. The questionnaire was handed directly to the residents. Participation was voluntary as residents were informed of the purpose of the study and were asked to provide consent to participate at the beginning of the study. A week later, reminders were sent to residents who hadn’t responded for the first time.

data analysis

All collected data were analyzed using the Statistical Package for the Social Sciences (SPSS) Statistics version 16. Descriptive statistics including mean, standard deviation, frequency and percentage were calculated. The Kolmogorov-Smirnov normality test was used to examine the normality of the quantitative data distributions for the various groups. One-way analysis of variance (ANOVA) was used for between-group comparisons and the LSD method was used for post-hoc comparisons when data satisfied a normal distribution and uniform variances in three or more groups. Otherwise, the Kruskal-Wallis test was used. One-sample t-tests were used to compare single-population means with standard values, and independent-sample t-tests were used to compare CT skills and subdomain means by gender. Pearson’s test was performed to explore correlations between several variables.a p– A value of < 0.05 was considered statistically significant.

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