Critical Thinking and Critical Appraisal

Summary

This chapter will focus on two “skills” which occur frequently in discussions in medical education — critical thinking and critical appraisal. While the terms are often used interchangeably, and share some common characteristics, they have very different lineages. Critical thinking refers to general strategies which might be used in a variety of problem situations to gather and evaluate data, generate hypotheses, assess evidence and arrive at conclusions. By contrast, critical appraisal was coined at McMaster University to describe skills used to evaluate clinical research articles according to principles of clinical epidemiology. Thus, there are published criteria to assess the methodological rigor of a study of a therapeutic intervention or a diagnostic test, and learning critical appraisal skills amounts to learning to apply these criteria.

Despite their different histories, the evidence on the effectiveness of both is similar. First, it emerges that teaching such skills is much more difficult than might be imagined. Typical effects amount to a few percent change. Second, like clinical reasoning skills, the evidence strongly suggests that such “skills ”, once learned, are very content-specific and not at all general.