Critical Thinking skills

CRITICAL THINKING SKILLS

Opinion Column: My patients are dying. But it's their right to keep going.

By: Isaac Shan

Retrieved from: https://www.washingtonpost.com/opinions/my-patients-are-dying-but-its-their-right-to-keep-fighting/2018/08/24/487c71ba-809a-11e8-b660-4d0f9f0351f1_story.html?noredirect=on&utm_term=.ba13b464e9de

Explanations:

• I am watching a 68-year-old man fall apart. He has been through five different types of chemotherapies, yet his kidney cancer continues to grow and metastasize, spreading to different organs. He now sits hunched in his wheelchair. With his worsening diarrhea, and sores in his mouth, he no longer eats with pleasure. Sleeping a few hours without pain has become a luxury.
• I have been talking to him about palliative care, how focusing on reducing symptoms instead of treating his cancer directly can provide him relief.

Position:

• He believes what will help him live longer is more chemotherapy.

Argument:

• This leaves me in an uncomfortable state: caught between my medical recommendation to pursue less aggressive care and my patient’s primal desire to rid his body of cancer.

Description:

• She is only 34 years old, but after two rounds of chemotherapy, her youth is steadily leaving her. 

Disagreement:

• I have been speaking to her and her husband about palliative care since the diagnosis, but they admit they do not really hear these conversations. All they hear is the loud drumbeat of what the next chemotherapy will be. 

Conclusion:

• These cases are not unique in medicine. The biggest lesson I have learned is that our role is to support our patients so that they can have the dignity to make these difficult choices and feel empowered to make their own paths, no matter how frightening the decision may be.

Reasons given to support the conclusion:

• Aggressive treatments, such as more chemotherapy, are not going to cure these two patients. Therapy aimed at controlling their symptoms will help them live their remaining days more comfortably. Meanwhile, we still struggle with one of the primary challenges of modern medicine: end-of-life communication.
• Many physicians encourage early palliative care for terminally ill patients, to make the process of dying less painful, more cost-effective and patient-focused. But if the patients are not ready, instead of feeling relief, they may experience this advice as abandonment. 

Introduction:

• Isaac Chan is a medical oncology fellow at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins.
  “Dr. Chan, please, please keep me alive a little longer and God will surely bless you.”

Author's consideration of opposite arguments:

• Many physicians encourage early palliative care for terminally ill patients, to make the process of dying less painful, more cost-effective and patient-focused. But if the patients are not ready, instead of feeling relief, they may experience this advice as abandonment. 

Summary:

• As a young oncologist, I confess I am not an expert in balancing aggressive treatment with preserving quality of life. But it is clear to me that end-of-life care is not checklist medicine. It is not just about statistics or studies. Achieving true shared decisions is an interactive process that takes time and engagement, leading to mutual trust. It is about continuously setting honest expectations for what is possible and making sure all parties truly understand what the consequences are likely to be. Sometimes what our patients need most is just more time: time to accept the terminal diagnosis and time to grieve and hopefully to find peace. Part of our guidance involves agreeing on the personalized therapies, be it “aggressive care” or more symptomatic control, that can deliver that meaningful extra month, hour or minute.

LECTURE: CREATIVE AND CRITICAL THINKING BY STEPHEN BROOKFIELD - SUMMARY

CREATIVE AND CRITICAL THINKING

For starting with his lecture, Dr. Stephen Brookfield made a biographical disclosure in which he told his audience about his academic process and how he was not prepared enough for going on to an undergraduate program. 

He believes a good teacher is someone who enters a classroom and sees what is valuable for them, then, adapt it to their own setting. Besides, he considers that who we are as teachers is significantly framed by who we have been as learners, which means that the way we teach is linked to the way we learn. And how we as teachers, that have been in the students' position before, can understand many problems students may be through.

He also points out that the freedom to control the direction and the pace of where we are going is important for the student because it feels as though they are in charge of the learning process and therefore they will do better. At that moment is when he talks about experiential positions for carrying out activities or being in charge of students that have the same problem the teacher had had before since that teacher knows how it feels to be in that situation.

Aside from that, he mentions the trust that is built between instructors and students and the relational dimension of teaching and learning. He explains that this dynamic is important since when a teacher asks their students to do something they are afraid to do, that teacher entails thinking creatively and critically.

Dr. Brookfield believes that...

someone who thinks critically can...

• Identify the assumptions behind thinking and actions.
• Check assumptions for accuracy and validity.
• Tale informed action.

Someone who thinks creatively is able to...

• View ideas and practices from multiple viewpoints, which means that person moves outside of their habitual typical mental framework.
• Generate interpretations, perspectives, and responses different from the usual mode of thought or practice. 
• Communicate through a variety of different ways. 

In this way, on the one hand, he perceives critical thinking as the focus on understanding and checking out assumptions. And on the other hand, creative thinking as the ability to look at things from multiple viewpoints and have multiple responses to familiar ideas or practices.

A critically and creative informed action is...

• One based on evidence/experience that can be justified.
• One that has its assumptions known and checked.
• One that stands a chance of achieving its intended consequence.
• One that has been viewed from multiple perspectives.
• One that is enacted via multiple modalities.

Kinds of assumptions

• Causal: this one explains a consequence.
• Prescriptive: this one tells how things should happen.
• Paradigmatic: this one has to do with common sense.

4 key intellectual traditions

• Analytic philosophy: logical fallacies; argument analysis; inductive, deductive, analogical, inferential reasoning.
• Natural science: hypothetical-deductive method, principle of falsifiability.
• Critical theory: uncovering power dynamics and ideological manipulation.
• Pragmatism: experimental and creative pursuit of beautiful consequences.

What most helps your students to think critically and/or creatively?

• Instructors modeling.
• Critical incident questionnaire.
• Assumption inventories.
• Ending presentations, discussions, and exercises with questions.
• Chalk talk - Visual discussion.

Critical Thinking Reflections

Reflection: emotional self-management

For me, the emotions that are most difficult to manage when others disagree with me are: 

Frustration, because I feel as though I am not able to show other people my point of view and make them understand what I am trying to say and defend. It is easy to get frustrated when a person does not agree with you since you start feeling it is pointless trying to make other people see a circumstance or a situation the same way you do, or make them take into account the reasons you have gotten in mind for taking a certain side in an issue.

Impatient. This happens usually when you are trying to convince the other person that they might be wrong and even though you have good arguments to demonstrate it, that person does not understand what you are trying to show them. Additionally, most of the time they think that they are right and you are the one who is wrong and try to convince you about it without taking into account all the evidence that says the opposite. 

Irritated and stressed because it feels as though my arguments are not strong enough to reach the others to see what I mean. This also happens when others start attacking my arguments with weak reasons and keep on doing it until they get away with it.

I deal with this by:

For dealing with frustration, impatience, irritation, and stress; I try to make my point clear at the moment I expose it in order for the others to have a clearer idea of it. I also try to analyze and understand others' perspectives, evaluate how meaningful or strong they are and how they can contribute to the way I see the situation or issue. Additionally, I try to take a deep breath and show others in the calmest possible way why they might be wrong. But if I am not able to do so, I just end the discussion.

Reflection: influences on my thinking

For me, the influences on my own thinking that I need to be most aware of so they do not prejudice my thinking are:

The most powerful influence that affects my thinking is the one that comes from other people. I think that most of the time, I take opinions and comments seriously and I tend to focus on what other people think since I am an indecisive person. For instance, when someone tells you what would be good for you to do and gives you reasons to convince you, in the end, you just do what that person told you or at least you think that is what you have to do. 

I will deal with this by:

I think I have to develop my quality of independence, try to analyze and decide for myself, stick to my beliefs and try to be more critical. All this is necessary for exercising my free will and my rights, for gaining control over my thinking and my decisions.

Reflection: challenging opinions

For me, the things I find most difficult about challenging the opinions of other people are:

I think that one of the most difficult aspects of challenging the opinion of others has to do with their reactions. It is not a secret that the majority of the people do not like others throwing contrastive opinions about what they stand for. Then, what was started as a discussion ends up being an argument. Another aspect has to do with being prepared enough for starting a debate which sooner or later becomes a competition where the one with the best arguments wins.

I deal with this by: 

Trying to expose my perspective in a respectful way so that the other person does not feel as though I am attacking them. Besides, I try to use strong arguments that be able to support my point and make the others reconsider it. Finally, I also try to express my point of view when I do have good arguments and enough knowledge about the topic.

Reflection

Do you recognize anything of yourself in Bodner's description of students? 

Yes, because I think that it is important to go beyond you are expected to do. Then, when I do not understand a topic or certain aspects of a subject I try to ask others or look into it and complement my understanding. Furthermore, as I am a second language learner I think that most of the work must be done by the learner, then, I try to practice the development of my skills every day by doing some activities related to the four main skills.

What effect would the approach he suggests have on your learning and understanding?

I think that it would be great to apply Bodner's approach because it would helps us to develop our learning process in a critical way, as it stands for focusing primarily on being critical and looking for answers to questions that allow us, students, to be rigorous analytics and to be led by the knowledge from our experiences rather than for what is already established on books, which most of the time is ambiguous and hard to understand.

Reflection

Consider what you could do to manage these barriers in the next few months.

I think it is way hard to overcome those barriers since nowadays we, students, are kind of lazy and especially we, Colombian students, tend to carry out our duties in the last minutes. But, I think we could encourage ourselves to be more critical, to ask for reasons as children do mostly, and to participate in the development and experimentation of our own skills rather than just sit and learn theories that we are going to forget some months later. Additionally, it is way important to identify and be aware of the real relevant aspects and pay attention to them.