|Year : 2021 | Volume
| Issue : 3 | Page : 280-288
Exploring the critical thinking skills of respiratory care students and faculty
Bshayer Ramadan Alhamad1, Genevieve Pinto Zipp2
1 Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences; King Abdullah International Medical Research Center, Al Ahsa, Saudi Arabia
2 Department of Interprofessional Health Sciences and Health Administration, School of Health and Medical Sciences, Seton Hall University, South Orange, New Jersey, United States
|Date of Submission||06-Jul-2021|
|Date of Decision||19-Jul-2021|
|Date of Acceptance||28-Jul-2021|
|Date of Web Publication||13-Sep-2021|
Dr. Bshayer Ramadan Alhamad
College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, P. O. Box 2477, Al Ahsa 31982
Source of Support: None, Conflict of Interest: None
Background: Critical thinking is an essential skill for respiratory therapists to provide competent patient care. However, limited evidence of respiratory care students' critical thinking levels and no empirical evidence assessing that of respiratory care faculty exists. This study aims to assess the overall critical thinking levels of respiratory care students and faculty, determine whether faculty have stronger overall critical thinking skills than students, and investigate students' and faculty's perceptions regarding what critical thinking is and how it develops. Methods: An E-mail invitation was sent to all accredited US respiratory care education program directors asking for their participation and forwarding the solicitation letter to students and faculty. Participants completed a two-section online survey first requesting demographic information and presenting three open-ended questions and then providing the health sciences reasoning test (HSRT) to assess participants' critical thinking. Quantitative data were analyzed using descriptive statistics and one-tailed independent t-test (P < 0.05); content analysis was used for qualitative data. IRB approval was obtained. Results: Twenty-two students (12 females and in associate degree programs) and 20 faculty (13 females, 9 with a master's) completed the HSRT. Students demonstrated moderate overall critical thinking ability (17.81 ± 4.19), whereas faculty had a statistically stronger level (21.65 ± 5.41) than students (P = 0.007). Qualitative data demonstrated participants' use of themes (e.g., problem-solving) identified in the literature to define critical thinking, reported faculty role (e.g., mentor) in promoting students' critical thinking, and presented educational strategies (e.g., case studies) for fostering students' critical thinking. Conclusions: This study found faculty displayed stronger overall critical thinking skills than students. It is imperative for respiratory care programs and faculty to develop further students' critical thinking levels from moderate to advanced, as recommended for the competencies specified in the American Association for Respiratory Care 2015 and Beyond report.
Keywords: Education, faculty, perception, respiratory therapy, students, thinking
|How to cite this article:|
Alhamad BR, Zipp GP. Exploring the critical thinking skills of respiratory care students and faculty. Indian J Respir Care 2021;10:280-8
|How to cite this URL:|
Alhamad BR, Zipp GP. Exploring the critical thinking skills of respiratory care students and faculty. Indian J Respir Care [serial online] 2021 [cited 2021 Oct 26];10:280-8. Available from: http://www.ijrc.in/text.asp?2021/10/3/280/325892
| Introduction|| |
A key characteristic of a respiratory therapist is the ability to use evidenced-based critical thinking when working in an inter-professional health care team, to meet the needs of patient-centered care models. The American Association for Respiratory Care (AARC) requires that graduate respiratory therapists possess excellent critical thinking skills, and thus has called on respiratory care education programs to employ strategies that promote critical thinking to prepare students for the challenges associated with their responsibilities and expanding role projected by the AARC 2015 and Beyond taskforce.
Conventionally, the first step in fostering the critical thinking skills of students is to assess their current levels and then to advance these accordingly. To date, limited meaningful evidence of the levels of critical thinking skills of health professionals including respiratory care students exists. The few studies that have measured critical thinking have employed generalized critical thinking assessment tools such as the Watson and Glaser Critical Thinking Appraisal and the California Critical Thinking Skills Test (CCTST), which are global critical thinking assessments and not specifically health care related, as in the health sciences reasoning test (HSRT), so their findings may not translate to the clinical situations faced by respiratory therapists.,,,,,
In addition, although the literature identifies that faculty in general, play an integral part as mentors in promoting students' critical thinking skills,,the researcher was unable to locate any studies that specifically measured the critical thinking skills of respiratory care faculty. While it is reasonable to assume that faculty members have stronger critical thinking skills than their students, a lack of evidence to support this assertation exists. Recognizing that this assumption must be explored and supported by evidence. The researcher using Mishoe, critical thinking definition which includes logical reasoning, problem-solving, and reflection as a lens to view, the seven critical thinking skills required in respiratory care practice: Prioritizing, anticipating, troubleshooting, communicating, negotiating, reflecting, and making decisions explored the following quantitative research questions using the HSRT.
- RQ1. What is the level of critical thinking skills of respiratory care students?
- RQ2. What is the level of critical thinking skills of respiratory care faculty?
- RQ3. Do respiratory care faculty members have stronger critical thinking skills than respiratory care students?
In addition, the following qualitative research questions were addressed:
- How would you define “critical thinking”?
- RQ5. What role do you believe faculty play in fostering students' critical thinking?
- RQ6. What class assignments, activities, and experiences do you believe foster students' critical thinking? (Please provide specific examples).
| Methods|| |
Design and participants
This study used a mixed-methods research approach employing a survey to compare the critical thinking skills between respiratory care faculty and students. The qualitative component was embedded within the primary quantitative survey to gain insights that could not be captured by the quantitative data alone.
The study had two participant groups: (1) respiratory care faculty with a minimum of 21 years of age and currently teaching in any accredited respiratory care program in the United States, and (2) respiratory care students who were 18 years of age or older and currently enrolled in any accredited respiratory care program in the United States.
Data collection tool
Participants completed one online survey with two sections: A profile sheet and the HSRT. The HSRT was purchased from Insight Assessment with permission granted for student testing.
Health sciences reasoning test
The HSRT, evolved from the CCTST, is a standardized tool developed by Facione and Facione specifically to assess critical thinking skills for health care students and professionals. It consists of 33 items. Each item begins with a short scenario framed in the health care context followed by a multiple-choice question. Although the scenarios are set in the health care context, no prior knowledge of health care is required because the specialized information required to correctly answer is provided in the question stem itself. The HSRT questions ask test-takers to “draw inferences, to make interpretations, to analyze information, to draw warranted inferences, to identify claims and reasons, and to evaluate the quality of arguments” (para. 4). The HSRT reports six distinct critical thinking scores. Of these scores, five are considered subscales and one is an overall score. The overall score represents the total number of correct answers from the 33 questions and describes the overall strength of an individual's critical thinking skills. The five subscale scores of critical thinking are induction, deduction, analysis, inference, and evaluation; they are meant to identify which particular skill areas are strong and which are weaker and require consideration in subsequent training opportunities.
Each of the six scales scores on a range along with categorical interpretation. The online HSRT is timed to be completed in 50 min, but a test-taker can submit their responses before the end of the period. Once 50 min is reached, test-taker responses are submitted automatically for scoring.
The HSRT is a reliable and valid tool and has a Kuder Richardson-20 internal consistency coefficient of. 81 for the overall score, and ranges from 0.52 to 0.77 for the five subscales. The HSRT content validity is based on the consensus definition of critical thinking identified in the APA Delphi study (p. 2). The construct validity of the HSRT has also been established. Furthermore, its five subscales match the constructs in the Mishoe, definition of critical thinking that guided this study.
The purchased HSRT allows for 10 additional questions to be added to its standard demographic questions. Of the 10 additional questions created by the principal investigator, 7 were demographic in the form of close-ended questions with the purpose of describing the characteristics of the participants and were based on the type of participant. The remaining three questions were embedded in the form of open-ended questions intended to obtain qualitative data.
Following Institutional Review Board approval, the primary investigator sent an E-mail to the directors of all the accredited respiratory care programs in the United States, as identified within the Commission on Accreditation for Respiratory Care website. The E-mail invited the directors to participate in the study since they were faculty and asked them to forward the attached letters of solicitation designed for each group of participants (students and faculty) to their current students and faculty members. The letter of solicitation included all the required National Institutes of Health items and provided a unique login and password for each group along with instructions on how to access and complete the survey. The survey could be accessed via a hyperlink, which directed them to the Insight Assessment online testing interface where the participants could access and complete the two sections of the survey using their login and password. Participation in the study was voluntary and anonymous. Submission of the survey by the participants implied their consent to participate in the study. After the submission of the survey, participant's results automatically appeared on the computer screen which gave them the option to print the results for their personal use. The recruitment period was open for 2 months. Two reminder E-mails were sent in addition to a direct invitation E-mail to faculty members whose E-mails were found on their schools' websites.
After the recruitment period ended, the primary researcher accessed the Researcher Insight Assessment account using a unique login and password and retrieved the HSRT score participant de-identified package.
The quantitative data were analyzed using SPSS (IBM Corp. Released 2015. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp) version 23. Descriptive statistics were used to describe the demographic characteristics of the participants and their critical thinking scores on the HSRT (mean, median, standard deviation, range, frequency, and percentages). The one-tailed independent t-test was used to determine whether faculty members have stronger overall critical thinking skills than their students. All assumptions for the independent samples t-test were met by this particular study. The normality assumption of overall critical thinking score for both faculty and student groups were met, using the Shapiro–Wilk Test (P = 0.066, P = 0.291, respectively). The homogeneity assumption of variances of overall critical thinking scores between faculty and student group was also met (P = 0.078). Significance for the one-tailed independent t-test was defined as P < 0.05. For the qualitative data obtained from the responses to the three open-ended questions, content analysis was used to interpret the meaning of the content.,
| Results|| |
The Insight Assessment company designates an HSRT assessment as “complete” when at least 60% of the questions were answered and a minimum of 15 min was spent on the assessment. Based on these criteria, data from 22 of the 26 respiratory care students and 20 of the 27 respiratory care faculty member groups who volunteered to participate in this study were utilized in data analysis for quantitative data. The time both respiratory care students and faculty spent in completing the HSRT section without including the time they may have spent completing the profile sheet questions prior to the test itself ranged from 22 to 50 min (mean = 39.77 ± 10.03, mean = 39.70 min ± 10.15, respectively). In terms of the percentage of questions answered, students answered in the range of 61%–100% and faculty members answered in the range of 64%–100%.
Detailed demographic characteristics of the student group are represented in [Table 1]. The overall critical thinking score of the student group ranged from 8 to 24 out of a possible 33. The mean was 17.81 ± 4.19. The median score was 19, and the mode score was 22. Using the recommended cut scores for categorical interpretation of the HSRT overall score provided in [Table 2], a mean overall score of 17.81 represents a moderate range. [Table 3] presents the descriptive statistics of students' HSRT six scales scores. [Figure 1] displays the HSRT six scales score distribution of the respiratory care student group.
|Table 1: Demographic characteristics of the respiratory care student group|
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|Table 2: Health sciences reasoning test scoring schemes and categorical interpretation|
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|Table 3: Descriptive statistics for respiratory care students' six scale scores|
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|Figure 1: Histogram for the health sciences reasoning test six scale's scores of the respiratory care student group|
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In terms of the respiratory care faculty group, their detailed demographic characteristics are represented in [Table 4]. The overall critical thinking score of the respiratory care faculty group ranged from 11 to 28 out of a possible 33. The mean was 21.65 ± 5.41. The median score was 23 and the mode scores were 25, 27, and 28. Using the recommended cut scores for categorical interpretation of the HSRT overall score provided in [Table 2], a mean overall score of 21.65 represents a strong range. [Table 5] presents the descriptive statistics of faculty HSRT six scales scores. [Figure 2] displays the HSRT six scales score distribution of the faculty group.
|Table 4: Demographic characteristics of the respiratory care faculty group|
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|Table 5: Descriptive statistics for respiratory care faculty six scale scores|
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|Figure 2: Histogram for the health sciences reasoning test overall and six scale's scores of the respiratory care faculty group|
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The results of the one-tailed independent sample t-test show a statistically significant difference between the student and faculty groups regarding the overall critical thinking score (P = 0.007). The mean overall score for the faculty sample (21.65) was higher than that for the student sample (17.81).
A post hoc analysis using G*Power software was conducted to determine the efficacy of this test. The result of this analysis showed that the study had a power of 0.81, which exceeds the recommended power level of 0.80 for studies in the health and social sciences., The calculated effect size was. 79, very close to Cohen's d of 0.80; this is considered a large effect size. Given that the effect size has an inverse relationship with sample size, the large effect size in this study only required small sample size to reach the recommended power.
The primary investigator and another researcher coded the responses separately using a list of preestablished codes identified from the literature. If the response did not contain any of the preestablished themes, the primary investigator and another researcher independently read the response and developed new codes.
Twenty-five students and 26 faculty members answered the first open-ended question “How would you define critical thinking?” On reviewing the participants' responses, it was evident that the participants understood the concept of critical thinking. The participants used multiple definitions and most of the descriptive terms they used were found in the preestablished codes from the literature [Table 6].
|Table 6: Codes for the responses to the question, “How would you define critical thinking?”|
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Twenty-five students and 25 faculty members answered the second open-ended question “What role do you believe faculty play in fostering students' critical thinking?” Based on a review of the participants' responses, it was evident that the participants emphasized the important role that faculty play. Participants said that faculty can help students by effectively acting as role models, guides, facilitators, and mentors and by employing active learning strategies such as case studies, simulations, and practicum [Table 7].
|Table 7: Codes for the responses to the question, “What role do you believe faculty play in fostering students' critical thinking?”|
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Twenty-five students and 25 faculty members answered the third open-ended question asked, “What class assignments, activities, or experiences do you believe foster students' critical thinking (please provide specific examples)?” Upon examining the responses, it was evident that the participants were able to identify the educational strategies that can promote students' critical thinking as identified in the literature [Table 8].
|Table 8: Codes for the responses to the question “What class assignment, activities, and experiences, do you believe foster students' critical thinking?”|
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| Discussion|| |
In this study, the student group exhibited moderate levels of critical thinking as measured by the mean overall critical thinking score on the HSRT (mean = 17.81). According to the user manual for the HSRT, a moderate level of overall critical thinking indicates there might be skill-related challenges for people engaged in the problem solving and reflective decision making associated with learning or employee development.
Interestingly, regardless of program degree type, the findings of this study support those from two prior critical thinking studies specific to respiratory care students (Clark [mean = 17.52 ± 6.14, n = 23], Colletti [mean = 18.1 ± 3.9, n = 24 for treatment group and mean = 17.1 ± 4.7, n = 27 for control group]). The only finding not supported by this work was the level of critical thinking of associate's degree students noted in Clark's study which was in the “not-manifested” level (mean = 13.09 ± 4.0, n = 23) but in the “moderate” level in this study (mean = 17.52 ± 6.14, n = 23). Clark suggested that students scored in the not-manifested level because seven of them were interrupted during the online HSRT test and could not complete it within the specified time. In addition, the small sample size in the current study and that of Clark as well as Colletti may account for differences in the findings and thus support the need for additional research with larger sample size.
To date, this study is the only one found in the literature to assess respiratory care faculty members' critical thinking. Not surprisingly respiratory care faculty exhibited a strong level regarding the mean overall critical thinking score on the HSRT (mean = 21.65). Critical thinking levels of respiratory care faculty are consistent with findings observed in nursing faculty (Blondy [mean = 22.12 ± 3.64, n = 49]; Zygmont and Schaefer [mean = 19.14 ± 6.76, n = 37]), where the CCTST was used in an untimed format.
While one might not be surprised by the findings, it was imperative that we measured the critical thinking levels of respiratory care faculty for several reasons. First, since no study, to our knowledge, has measured their level of critical thinking, it generated new information that could be used in academic institutions. Second, while both nurses and respiratory therapists are health care providers who work together to develop patient-centered plans of care, their scopes of practice are different, and their skill sets and roles on the team are different and potentially require different levels of critical thinking. Mishoe found that “problems in practice that were considered routine and simple by respiratory therapists were more difficult or unresolvable for physicians and nurses, and vice versa.” This is because one must have domain-specific knowledge to solve real problems in practice. Thus, inferring that they would possess the same critical thinking skills would limit our knowledge base.
As this study found that faculty do possess stronger critical thinking skills, researchers can now begin to assess the second assumption– whether faculty can develop critical thinking in their students, specifically in the respiratory care profession.
The results of the qualitative findings revealed that students and faculty preferred multiple descriptions of critical thinking rather than one description. This finding is not surprising when considering that critical thinking is a complex process involving a variety of skills. Furthermore, the discrepancies in defining critical thinking are consistent with the results of other studies in health care that have asked faculty to define critical thinking.,
The results of the qualitative findings also revealed that both respiratory care students and faculty emphasized the important role faculty play in promoting students' critical thinking by acting as facilitators, guides, and role models and by employing active learning strategies such as clinical simulation and case studies. These findings support the expectation in the literature that faculty are responsible for promoting students' critical thinking,,, and also support the findings of Hulse study, which found that expert respiratory care faculty believe that students' critical thinking can be developed by motivating them to learn by doing (i.e. active learning strategies).
Finally, both students and faculty reported various active learning strategies that they think foster students' critical thinking. Most of the reported strategies are found in the published literature, including clinical simulation, case studies, problem-based learning, and reflection.,,,,, The responses of students and faculty members in the present study demonstrated their awareness of how critical thinking can be incorporated and facilitated in the classroom and clinical settings and thus offer insights for educators.
The generalizability of the results is limited due to the small sample size and nonprobability sampling. However, given the post hoc analysis with an alpha of 0.05, n = 22 for students and 20 for faculty, the effect size of 0.79, and a power of 0.81, the authors are confident in the findings.
| Conclusions|| |
This study was the first to support with evidence, the assumption that respiratory care faculty have statistically stronger overall critical thinking skills than students as measured by the HSRT. Based on the findings of this study, the road to developing stronger critical thinking skills in students is partially paved; therefore, it is imperative to investigate how respiratory care programs and faculty can continue to develop the critical thinking of students to an advanced level via different teaching and learning strategies.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]