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Health Humanities - Critical Thinking

Critical Thinking: A Definition 

"To understand critical thinking skills and how they factor into critical thinking, one first needs a definition of the latter. Critical thinking (CT) is a metacognitive process, consisting of a number of skills and dispositions, that when used through self-regulatory reflective judgment, increases the chances of producing a logical conclusion to an argument or solution to a problem (Dwyer, 2017; Dwyer, Hogan & Stewart, 2014). On the surface, this definition clarifies two issues: first, critical thinking is metacognitive—simply, it requires the individual to think about thinking; second, its main components are reflective judgment, dispositions, and skills...Though debate is ongoing over the definition of CT, one list stands out as a reasonable consensus conceptualization of CT skills."

  • Analysis is a core CT skill used to identify and examine the structure of an argument, the propositions within an argument and the role they play (e.g. the main conclusion, the premises and reasons provided to support the conclusion, objections to the conclusion and inferential relationships among propositions), as well as the sources of the propositions (e.g. personal experience, common belief, and research).
  • Evaluation is a core CT skill that is used in the assessment of propositions and claims (identified through the previous analysis ) with respect to their credibility; relevance; balance, bias (and potential omissions); as well as the logical strength amongst propositions (i.e. the strength of the inferential relationships).
  • Similar to other educational concepts like synthesis, the final core CT skill, inference , involves the “gathering” of credible, relevant and logical evidence based on the previous analysis and evaluation, for the purpose of drawing a reasonable conclusion. Drawing a conclusion always implies some act of synthesis (i.e. the ability to put parts of information together to form a new whole).

(Source: Psychology Today)

Healthcare Culture

I'm Sorry, I don't Speak Doctor

Rosinsky, Carolyn Irene, MD

Op-Med, (Published 22 February 2022)

"When medical jargon is used, patients suspect their doctors are trying to avoid them, confuse them, or exclude them from care. They also perceive those doctors as less empathetic and less professional. Code-switching is imperative in allowing patients to make informed choices about their care, plan for the future, follow up appropriately, and trust their doctors — all of which produce better outcomes."

 

Understanding organisational culture for healthcare quality improvement

Russell Mannion, Huw Davies

BMJ 2018;363:k4907 (Published 28 November 2018)

"Organisational culture represents the shared ways of thinking, feeling, and behaving in healthcare organisations. Healthcare organisations are best viewed as comprising multiple subcultures, which may be driving forces for change or may undermine quality improvement initiatives. A growing body of evidence links cultures and quality, but we need a more nuanced and sophisticated understandings of cultural dynamics. Although culture is often identified as the primary culprit in healthcare scandals, with cultural reform required to remedy failings, such simplistic diagnoses and prescriptions lack depth and specificity."

 

Culture, behavior and health

Margarita Hernandez, James K. Gibb

Evolution, Medicine, and Public Health, Volume 2020, Issue 1, 2020, Pages 12–13

"Cultural behaviors have important implications for human health. Culture, a socially transmitted system of shared knowledge, beliefs and/or practices that varies across groups, and individuals within those groups, has been a critical mode of adaptation throughout the history of our species. Socioeconomic status, gender, religion and moral values all play into how individuals experience, conceptualize and react to their world, and therefore general understandings of cultural groups are insufficient for grasping a patient’s unique experience with health and illnesses."

 

From our subscriptions:

Theater for Vaccine Hesitancy—Setting the Stage for Difficult Conversations

Cullen, J. P. , Russ, S. & Russell, H. A. (2022). Theater for Vaccine Hesitancy—Setting the Stage for Difficult Conversations. JAMA, 328 (11), 1018-1019. doi: 10.1001/jama.2022.14864.

"The program had 2 precedents. One of us (J.P.C.) had previously trained in the methods of Forum Theater, one of the components of “Theater of the Oppressed”—a style of improvisational theater developed in the 1970s by social theorist Augusto Boal to catalyze critical dialogue, explore alternative solutions to challenging social situations, and advance social justice—to teach health care workers appropriate, authentic, and respectful responses to patient expressions of bias in clinical encounters. In 2021 the Centers for Disease Control and Prevention and the University of Rochester funded a 16-month Finger Lakes Rural Immunization Initiative (FLRII) that supported efforts of medical center faculty, health project coordinators, and graduate students to address low vaccination rates in rural areas. With underuse of COVID-19 vaccines a substantial public health problem, we adapted the theater methods we had used in medical education to try to help regional health care staff navigate potentially challenging conversations about vaccination with vaccine-hesitant patients."

rt & Observation: Improving Patient Care Through Medical Humanities

Connecting the Dots

Why STEM Students Need Humanities Courses

John Horgan. Scientific American. 

"If I do my job, by the end of this course you'll question all authorities, including me. You'll question what you've been told about the nature of reality, about the purpose of life, about what it means to be a good person. Because that, for me, is the point of the humanities: they keep us from being trapped by our own desire for certainty."

 

The Benefits of an Interdisciplinary Collaborative Learning Experience: The Student Perspective on Outcomes                     

 Wellmon Robert & Gilin, Barbara & Knauss, Linda & Linn, Margaret. (2009). The International Journal of the Interdisciplinary Social Sciences. 4. 15-28. 

"Increasingly, human service professionals require knowledge from other disciplines to develop, and implement comprehensive treatment/intervention plans. Collaborative decision-making and information sharing among the helping professions ensures that consideration is given to all of the factors affecting intervention and outcome and is a skill that is most effectively learned during pre-professional training." 

 

Challenges of integrating evidence into health policy and planning: linking multiple disciplinary approaches

Huckel Schneider C, Blyth F. Public Health Res Pract. 2017;27(2):e2721719

"This article summarises and compares four disciplinary approaches to EIPM with highly contrasting starting points: behavioural science, policy science, critical theory and intervention research. Key insights and theories are highlighted to provide a gateway into each, and to complement what is already known about the evidence needs of policy makers in terms of high-quality, timely and well-communicated research evidence."

 

Integration of the Arts & Humanities To Develop Well-Rounded Physicians: The Roles Of Health Sciences Librarians

Misa Mi, Lin Wu, Yingting Zhang, Wendy Wu. Journal of the Medical Library Association. 110(2) April 2022.

"The Association of the American Medical Colleges (AAMC), recognizing the unique and unrealized role of arts and humanities in preparing and equipping physicians for twenty-first-century challenges, proposed seven recommendations for advancing arts and humanities integration into medical education to improve the education, practice, and well-being of physicians and physician learners across the spectrum of medical education. Institutional initiatives of arts and humanities integration in the medical curriculum in response to the AAMC’s recommendations afford health sciences librarians expansive opportunities and a new landscape of playing an important role in these initiatives."

 

The Powers of a Fish: Clinical Thinking, Humanistic Thinking, and Different Ways of Knowing

"How are ways of knowing similar between clinical reasoning and the humanities, and can the latter be used to elucidate the former? This commentary considers a conceptual model proposed by Prince and colleagues in this issue to explore the different ways of knowing in art and medicine. Their proposed model links 2 approaches to clinical reasoning with an analytic approach said to be characteristic of the humanities—visual thinking strategies (VTS)—to teach skills in clinical reasoning. They suggest that the VTS approach aligns well with the 2 clinical reasoning approaches and use this relationship to argue for the introduction of the humanities into graduate medical education. However, is VTS truly an exemplar of analytic approaches used in the humanities? The approach to clinical decision making is a version of what Donald A. Schön calls technical rationality, but what is the epistemology used in the humanities and art? This commentary explores this question through the perspective of hermeneutics, a branch of philosophy that centers on an interpretive understanding of art, and through art, a way of knowing the self, others, and the world. In contrast to limiting the focus of the humanities in medical education to sharpening the powers of observation and analytical thinking, the author argues that art also offers a way to explore the challenges and triumphs of providing care to those in need and to explore the meanings, feelings, and experiences of living and dying. It offers a way of understanding and expressing the moral dilemmas of our time that aspires toward the aesthetic, philosophical, and existential truths of a life in medicine."

Confronting Bias

Confronting Bias to Advance Science

Joshua Gordon M.D, Ph.D, 

"I’m biased. I know this for several reasons. First, everyone is...Second, I tested positive for bias—yes, there are tests...Third, and perhaps most importantly, I recognize this pattern in myself, perhaps because of my training as a psychiatrist or perhaps because I’ve come of age during a time when we are increasingly recognizing the negative effects of such biases. It is only with such awareness that we can take positive steps as individuals and organizations to challenge assumptions and combat the damaging impact of bias."

 

Conscious & Unconscious Biases in Health Care

Source: National Center for Cultural Competence

An online learning module that informs on the subject of bias in healthcare. "The Institute of Medicine’s (IOM's) landmark study, Unequal Treatment, brought national attention to the critical need to address racial and ethnic health disparities in the U.S. health care system. Numerous public policy initiatives have been launched to address health disparities at the local, state, and national levels...This course focuses on conscious and unconscious biases in health care and their impact on people who are disproportionately affected by disparities in health and health care. It will offer an array of innovative activities, based on current evidence and best practices, that are intended to diminish the negative impact of biases"

 

A Barrier to Science: Language

"Scientists publish some of their studies in national journals in their own native languages. Because these local publications are not accessible to international platforms, there is a risk that valuable results may be overlooked. Meneghini and Packer argue that in the 1930s, German scientists published in the German language that a causal relationship existed between smoking and lung cancer. They reported that up until the 1960s, when British and US scientists rediscovered this connection, the results of the previous studies had been ignored, and for this reason, smoking cessation programs were negatively affected. Here we have the reality of scientific results whose existence is overlooked...In other words, it is only those articles that had the chance to be published and especially those published in English that enter the pyramid of scientific evidence."

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