On the Scene

     What makes a good paramedic student into an outstanding practicing paramedic? Obviously, the student should have a solid foundation of knowledge and the ability to perform learned skills, but they should also possess the ability to think critically. Critical thinking is "the process of determining the authenticity, accuracy or value of something; characterized by the ability to seek reasons and alternatives, perceive the total situation and change one's view based on evidence."¹ This ability is not only necessary to diagnose and treat patients, especially those not displaying classic signs and symptoms, but is also necessary for the ambulance crew's safety.

How to Develop Critical Thinking
     So, how does an educator develop students' critical thinking skills? As with any other type of learned skill, it begins with education. Redirecting, reinforcing, asking higher-order questions and lengthening the wait time for a student response all contribute to increasing students' content knowledge and building their critical thinking skills.² Helping them find analogies and other relationships that make connections between disparate bits of information, and establishing alternative ways to solve a problem, as well as promoting interaction among students and asking open-ended questions helps teach them to think analytically.³

Classroom climate has also proven to be a factor in developing these thinking skills. The classroom should be characterized by high expectations, teacher warmth and encouragement, and pleasant physical surroundings.²

Collaboration Vs. Competition
     Collaborative or cooperative learning has been shown to produce students with better critical thinking skills than competitive or individual learning. Researchers showed that students who participated in cooperative learning had a 5- to 7-point increase in average student performance over students who were competitive.⁴

In order for students to learn effectively in a cooperative group setting, the group must have several characteristics: The group size should be of a number that will allow each team member a chance to express his opinions on each topic discussed, usually 4-5 students. Additionally, there should be not only group accountability, but individual accountability for each team member as well. The group has to learn how to resolve conflicts effectively by using a set of operating rules. Most important, the group needs to evaluate their group processes.⁵ All of these characteristics help to develop critical thinking by spawning questions that other group members must analyze and answer.

The Value of Teamwork
     Working in groups is paramount in EMS education, because students must learn how to be an integral part of a team. That's why it's imperative that the educator asks students to evaluate their performance on scenarios acted out in class. This simple task allows students to reflect on their performance individually, as well as on the group's performance. It allows the team to learn how to function more effectively by expressing and finding solutions to weak areas of team performance. Team members have the opportunity to ask why certain procedures were performed and other team members to explain their rationale behind the procedures.

Summary
     In a 1987 practicum report one researcher says, "Teaching children to become effective thinkers is increasingly recognized as an immediate goal of education... If students are to function successfully in a highly technical society, then they must be equipped with the lifelong learning and thinking skills necessary to acquire and process information in an ever-changing world."⁶ There is no doubt that critical thinking skills will help you diagnose what is wrong with your patients and formulate a care plan, keep you and your partner safe, and make you more employable.

References

1. Alvino J. A glossary of thinking-skills terms. Learning 18(6):50, 1990.
2. Cotton K. Classroom questioning: Close-up no. 5. School Improvement Research Series (SIRS). Portland, OR: Northwest Regional Educational Laboratory, May 1988. www.nwrel.org/scpd/sirs/6/cu11.html.
3. Potts B. Strategies for teaching critical thinking. Eric/AE Digest (ED385606). Washington, DC: GWU, School of Education and Human Development, Feb. 1994.
4. Johnson D, Johnson R, Smith K. Cooperative learning: Increasing college faculty instructional productivity. ASHE-ERIC Higher Education Report Number 4. Washington, DC: GWU, School of Education and Human Development, 1991.
5. Gokhale A. Collaborative learning enhances critical thinking. Journal of Technology Education, 7:1, Fall 1995.
6. Robinson IS. A Program to Incorporate High-Order Thinking Skills into Teaching and Learning for Grades K-3 pp. 16, 216. (ED 284 689) Fort Lauderdale, FL: Nova University, 1987. www.nwrel.org/scpd/sirs/6/cu11.html.

Amanda J. Cotter, MS, NREMT-P, has been in EMS since 1994 and involved in EMS education since 2002. She holds an MS degree in microbiology from Clemson University and is currently working as the clinical/internship coordinator for Greenville (SC) Technical College in the Department of Emergency Medical Technology.