Skip to main content
Top
Published in: Perspectives on Medical Education 5/2019

Open Access 01-10-2019 | Original article

Clear skies ahead: optimizing the learning environment for critical thinking from a qualitative analysis of interviews with expert teachers

Authors: Lynn E. Jaffe, Deborah Lindell, Amy M. Sullivan, Grace C. Huang

Published in: Perspectives on Medical Education | Issue 5/2019

Login to get access

Abstract

Introduction

The learning environment refers to the physical, pedagogical, and psychosocial contexts in which learning occurs and critically influences the educational experience of trainees in the health professions. However, the manner in which individual faculty explicitly organize the educational setting to facilitate learning of essential competencies such as critical thinking deserves more examination; lack of attention to this component can undermine the formal curriculum. The purpose of our study was to examine how faculty shape the learning environment to advance their learners’ development of critical thinking.

Methods

We took a constructivist grounded theory approach using the framework method for qualitative content analysis. Data were derived from interviews conducted with 44 faculty identified as skilled teachers of critical thinking at eight academic health professions institutions.

Results

Three major themes emerged regarding participants’ descriptions of their experiences of how they optimized the learning environment to support critical thinking: 1) Setting the atmosphere (establishing ground rules, focusing on process rather than answers, and building trust), 2) Maintaining the climate (gently pushing learners, tolerating discomfort, and adjusting to learner level), and 3) Weathering the storm (responses to challenges to learning critical thinking, including time and effort, negative evaluations, and resistance to effortful learning).

Discussion

An optimal learning environment for critical thinking was actively created by faculty to establish a safe environment and shared understanding of expectations. Understanding how to produce a conducive learning climate is paramount in teaching essential topics such as critical thinking. These findings have potential utility for faculty development initiatives to optimize the learning environment.
Appendix
Available only for authorised users
Literature
1.
go back to reference Shochet RB, Colbert-Getz JM, Levine RB, Wright SM. Gauging events that influence students’ perceptions of the medical school learning environment: findings from one institution. Acad Med. 2013;88:246–52.CrossRef Shochet RB, Colbert-Getz JM, Levine RB, Wright SM. Gauging events that influence students’ perceptions of the medical school learning environment: findings from one institution. Acad Med. 2013;88:246–52.CrossRef
2.
go back to reference Maudsley RF. Role models and the learning environment: essential elements in effective medical education. Acad Med. 2001;76:432–4.CrossRef Maudsley RF. Role models and the learning environment: essential elements in effective medical education. Acad Med. 2001;76:432–4.CrossRef
3.
go back to reference Moutier C, Wingard D, Gudea M, Jeste D, Goodman S, Reznik V. The Culture of Academic Medicine: Faculty Behaviors Impacting the Learning Environment. Acad Psychiatry. 2016;40:912–8.CrossRef Moutier C, Wingard D, Gudea M, Jeste D, Goodman S, Reznik V. The Culture of Academic Medicine: Faculty Behaviors Impacting the Learning Environment. Acad Psychiatry. 2016;40:912–8.CrossRef
4.
go back to reference Bakhshialiabad H, Bakhshi M, Hassanshahi G. Students’ perceptions of the academic learning environment in seven medical sciences courses based on DREEM. Adv Med Educ Pract. 2015;6:195–203.CrossRef Bakhshialiabad H, Bakhshi M, Hassanshahi G. Students’ perceptions of the academic learning environment in seven medical sciences courses based on DREEM. Adv Med Educ Pract. 2015;6:195–203.CrossRef
5.
go back to reference Hafler JP, Ownby AR, Thompson BM, et al. Decoding the learning environment of medical education: a hidden curriculum perspective for faculty development. Acad Med. 2011;86:440–4.CrossRef Hafler JP, Ownby AR, Thompson BM, et al. Decoding the learning environment of medical education: a hidden curriculum perspective for faculty development. Acad Med. 2011;86:440–4.CrossRef
6.
go back to reference Swing SR. The ACGME outcome project: Retrospective and prospective. Med Teach. 2007;29:648–54.CrossRef Swing SR. The ACGME outcome project: Retrospective and prospective. Med Teach. 2007;29:648–54.CrossRef
7.
go back to reference Greiner AC, Knebel E. Health Professions Education: A Bridge to Quality. US: National Academies Press; 2003. Greiner AC, Knebel E. Health Professions Education: A Bridge to Quality. US: National Academies Press; 2003.
8.
go back to reference O’Sullivan PS, Blevins-Stephens WL, Smith FM, Vaughan-Wrobel B. Addressing the National League for Nursing critical-thinking outcome. Nurse Educ. 1997;22:23–9.CrossRef O’Sullivan PS, Blevins-Stephens WL, Smith FM, Vaughan-Wrobel B. Addressing the National League for Nursing critical-thinking outcome. Nurse Educ. 1997;22:23–9.CrossRef
9.
go back to reference Huang GC, Newman LR, Schwartzstein RM. Critical Thinking in Health Professions Education: Summary and Consensus Statements of the Millennium Conference. Teach Learn Med. 2011;2014(26):95–102. Huang GC, Newman LR, Schwartzstein RM. Critical Thinking in Health Professions Education: Summary and Consensus Statements of the Millennium Conference. Teach Learn Med. 2011;2014(26):95–102.
10.
go back to reference Huang GC, Lindell D, Jaffe LE, Sullivan AM. A multi-site study of strategies to teach critical thinking: ‘why do you think that? Med Educ. 2016;50:236–49.CrossRef Huang GC, Lindell D, Jaffe LE, Sullivan AM. A multi-site study of strategies to teach critical thinking: ‘why do you think that? Med Educ. 2016;50:236–49.CrossRef
11.
go back to reference Mills J, Bonner A, Francis K. Adopting a constructivist approach to grounded theory: Implications for research design. Int J Nurs Pract. 2006;12:8–13.CrossRef Mills J, Bonner A, Francis K. Adopting a constructivist approach to grounded theory: Implications for research design. Int J Nurs Pract. 2006;12:8–13.CrossRef
12.
go back to reference Charmaz K. Constructionism and the Grounded Theory Method. In: Holst J, Gubrium J, editors. Handb Constr Res. NY City NY: Guilford; 2008. P. 397–412. ISBN 978-1593853051. Charmaz K. Constructionism and the Grounded Theory Method. In: Holst J, Gubrium J, editors. Handb Constr Res. NY City NY: Guilford; 2008. P. 397–412. ISBN 978-1593853051.
13.
go back to reference Christensen M, Welch A, Barr J. Husserlian Descriptive Phenomenology: A review of intentionality, reduction and the natural attitude. J Nurs Educ Pract. 2017;7:113.CrossRef Christensen M, Welch A, Barr J. Husserlian Descriptive Phenomenology: A review of intentionality, reduction and the natural attitude. J Nurs Educ Pract. 2017;7:113.CrossRef
14.
go back to reference Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol. 2013;13:117.CrossRef Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol. 2013;13:117.CrossRef
15.
go back to reference Ritchie J, Lewis J. Qualitative Research Practice. Thousand Oaks, CA: Publications, Sage; 2003. Ritchie J, Lewis J. Qualitative Research Practice. Thousand Oaks, CA: Publications, Sage; 2003.
16.
go back to reference Ritchie J, Spencer E, O’Connor W. Carrying out Qualitative Analysis. In: Lincoln YSGE, editor. ed. Establishing Trustworthiness in Naturalistic Inquiry. Beverly Hills, CA: SAGE; 1985. Ritchie J, Spencer E, O’Connor W. Carrying out Qualitative Analysis. In: Lincoln YSGE, editor. ed. Establishing Trustworthiness in Naturalistic Inquiry. Beverly Hills, CA: SAGE; 1985.
17.
go back to reference Norris TE, Schaad DC, DeWitt D, et al. Longitudinal integrated clerkships for medical students: An innovation adopted by medical schools in Australia, Canada, South Africa, and the United States. Acad Med. 2009;84:902–7.CrossRef Norris TE, Schaad DC, DeWitt D, et al. Longitudinal integrated clerkships for medical students: An innovation adopted by medical schools in Australia, Canada, South Africa, and the United States. Acad Med. 2009;84:902–7.CrossRef
18.
go back to reference Leape LL, Shore MF, Dienstag JL, et al. A culture of respect, Part 1: The nature and causes of disrespec tful behavior by physicians. Acad Med. 2012;87:853–8.CrossRef Leape LL, Shore MF, Dienstag JL, et al. A culture of respect, Part 1: The nature and causes of disrespec tful behavior by physicians. Acad Med. 2012;87:853–8.CrossRef
19.
go back to reference Slavin SJ, Chibnall JT. Mistreatment of medical students in the third year may not be the problem. Med Teach. 2017;39:891–3.CrossRef Slavin SJ, Chibnall JT. Mistreatment of medical students in the third year may not be the problem. Med Teach. 2017;39:891–3.CrossRef
21.
go back to reference Genn JM. AMEE Medical Education Guide No. 23 (Part 1): Curriculum, environment, climate, quality and change in medical education—a unifying perspective. Med Teach. 2001;23:337–44.CrossRef Genn JM. AMEE Medical Education Guide No. 23 (Part 1): Curriculum, environment, climate, quality and change in medical education—a unifying perspective. Med Teach. 2001;23:337–44.CrossRef
22.
go back to reference Genn JM. AMEE Medical Education Guide No. 23 (Part 2): Curriculum, environment, climate, quality and change in medical education—a unifying perspective. Med Teach. 2001;23:445–54. Genn JM. AMEE Medical Education Guide No. 23 (Part 2): Curriculum, environment, climate, quality and change in medical education—a unifying perspective. Med Teach. 2001;23:445–54.
23.
go back to reference Guiffrida D. A Constructive Approach to Counseling and Psychotherapy Supervision. J Constr Psychol. 2015;28:40–52. Guiffrida D. A Constructive Approach to Counseling and Psychotherapy Supervision. J Constr Psychol. 2015;28:40–52.
24.
go back to reference Haraldseid C, Friberg F, Aase K. Nursing students’ perceptions of factors influencing their learning environment in a clinical skills laboratory: A qualitative study. Nurse Educ Today. 2015;35:e1–e6.CrossRef Haraldseid C, Friberg F, Aase K. Nursing students’ perceptions of factors influencing their learning environment in a clinical skills laboratory: A qualitative study. Nurse Educ Today. 2015;35:e1–e6.CrossRef
25.
go back to reference Tsui L. Faculty attitudes and the development of students’ critical thinking. J Gen Educ. 2001;50:1–28.CrossRef Tsui L. Faculty attitudes and the development of students’ critical thinking. J Gen Educ. 2001;50:1–28.CrossRef
26.
go back to reference Froneman K, Du Plessis E, Koen MP. Effective educator-student relationships in nursing education to strengthen nursing students’ resilience. Curationis. IEEE Trans Med Imaging. 2016;39:1:9. Froneman K, Du Plessis E, Koen MP. Effective educator-student relationships in nursing education to strengthen nursing students’ resilience. Curationis. IEEE Trans Med Imaging. 2016;39:1:9.
27.
go back to reference McQueen SA, Petrisor B, Bhandari M, Fahim C, McKinnon V, Sonnadara RR. Examining the barriers to meaningful assessment and feedback in medical training. Am J Surg. 2016;211:464–75.CrossRef McQueen SA, Petrisor B, Bhandari M, Fahim C, McKinnon V, Sonnadara RR. Examining the barriers to meaningful assessment and feedback in medical training. Am J Surg. 2016;211:464–75.CrossRef
28.
go back to reference McCarthy CP, McEvoy JW. Pimping in Medical Education. JAMA. 2015;314:2347.CrossRef McCarthy CP, McEvoy JW. Pimping in Medical Education. JAMA. 2015;314:2347.CrossRef
29.
go back to reference Kost A, Chen FM. Socrates was not a pimp: Changing the paradigm of questioning in medical education. Acad Med. 2015;90:20–4.CrossRef Kost A, Chen FM. Socrates was not a pimp: Changing the paradigm of questioning in medical education. Acad Med. 2015;90:20–4.CrossRef
30.
go back to reference Wear D, Kokinova M, Keck-McNulty C, Pimping AJ. Perspectives of 4th year medical students. Teach Learn Med. 2005;17(2):184–91.CrossRef Wear D, Kokinova M, Keck-McNulty C, Pimping AJ. Perspectives of 4th year medical students. Teach Learn Med. 2005;17(2):184–91.CrossRef
31.
go back to reference Zundel S, Wolf I, Christen HJ, Huwendiek S. What supports students’ education in the operating room? A focus group study including students’ and surgeons’ views. Am J Surg. 2015;210:951–9.CrossRef Zundel S, Wolf I, Christen HJ, Huwendiek S. What supports students’ education in the operating room? A focus group study including students’ and surgeons’ views. Am J Surg. 2015;210:951–9.CrossRef
32.
go back to reference Krupat E, Borges NJ, Brower RD, et al. The Educational Climate Inventory: Measuring Students’ Perceptions of the Preclerkship and Clerkship Settings. Acad Med. 2017;92:1757–64.CrossRef Krupat E, Borges NJ, Brower RD, et al. The Educational Climate Inventory: Measuring Students’ Perceptions of the Preclerkship and Clerkship Settings. Acad Med. 2017;92:1757–64.CrossRef
33.
go back to reference Shochet RB, Colbert-Getz JM, Wright SM. The Johns Hopkins Learning Environment Scale. Acad Med. 2015;90:810–8.CrossRef Shochet RB, Colbert-Getz JM, Wright SM. The Johns Hopkins Learning Environment Scale. Acad Med. 2015;90:810–8.CrossRef
34.
go back to reference Schönrock-Adema J, Visscher M, Janet Raat AN, Brand PLP. Development and validation of the scan of postgraduate educational environment domains (SPEED): A brief instrument to assess the educational environment in postgraduate medical education. PLoS One. 2015;10:1–12.CrossRef Schönrock-Adema J, Visscher M, Janet Raat AN, Brand PLP. Development and validation of the scan of postgraduate educational environment domains (SPEED): A brief instrument to assess the educational environment in postgraduate medical education. PLoS One. 2015;10:1–12.CrossRef
Metadata
Title
Clear skies ahead: optimizing the learning environment for critical thinking from a qualitative analysis of interviews with expert teachers
Authors
Lynn E. Jaffe
Deborah Lindell
Amy M. Sullivan
Grace C. Huang
Publication date
01-10-2019
Publisher
Bohn Stafleu van Loghum
Published in
Perspectives on Medical Education / Issue 5/2019
Print ISSN: 2212-2761
Electronic ISSN: 2212-277X
DOI
https://doi.org/10.1007/s40037-019-00536-5

Other articles of this Issue 5/2019

Perspectives on Medical Education 5/2019 Go to the issue