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Critical thinking for medical assistants.

The importance of critical thinking in medical assisting is an innovative tool to be used, not only for educational programs, but also in learning and developing professional skills. It is a form of deductive reasoning that is a composite of attitudes, knowledge, and skills: (1) attitudes in the way the medical assistant responds to the patient's demand for treatment; (2) basic knowledge of the presenting symptoms of the patient and (3) skills in applying the above attitudes and knowledge. (Watson & Glasser). The Watson-Glaser Critical Thinking Appraisal (WGCTA; e.g., Watson & Glaser, 1980) defines the construct of critical thinking in terms of five domains of cognitive activity: i.e., inferences, deductions, interpretations, recognition of assumptions, and evaluation of treatments.

Critical thinking is the engine that drives the processes of knowledge development and professionalism. Robotic responses to doctor's orders without understanding the reasoning for the order will not enhance the knowledge and skills of the medical assistant. The value of a focused and diligent approach to clinical reasoning requires a tolerance of multiple perspectives when those perspectives can be supported by reason and evidence (Facione & Facione, 1994). Critical thinking opens doors to new perspectives about the world, fosters self-confidence, and encourages lifelong learning (Chafee, 1994).

The ideal critical thinker is a habitually inquisitive person, who is well informed, trustful of reason, open-minded, flexible, fair-minded in evaluation, honest in facing personal biases, prudent in making judgments, willing to reconsider outcomes and clear about certain issues. The critical thinker is orderly in complex matters, diligent in seeking relevant information, reasonable in the selection of criteria, focused in inquiry, and persistent in seeking precise results. (Facione, Facione, & Giancarlo, 1994).

To define critical thinking in classroom and clinical settings, many techniques may be used including teacher and learner-group debates over clinical and ethical scenarios. Cooperative learning techniques include clinical conundrums that encourage questions, analysis, and reflections, and using clinical reports to increase students' recognition for common clinical experiences (Facione & Facione, 1996). Cooperative learning occurs when small groups of trainees work together to maximize their own and each other's learning (Gibson & Campbell, 2000). As a matter of fact, interpersonal relations are at the heart of the interface between individuals and groups (Marotta, Peters, & Paliokas, 2000).

Critical Thinking Questions For A Medical Assisting Class

Example 1: Joanne is a medical assistant in a clinical facility, who re ceives a report that is being faxed. As she walks past the exam rooms on each side, she reads out aloud that Jim Jones has a positive report for HIV.

1) What are the legal implications of her actions?

2) What are the ethical implications of her actions?

3) What problems could Joanne's actions cause for the patient?

Outcome: Joanne is violating HIPPA laws. Patient privacy is paramount and if ignored could mean federal prison. Other patients in the office most likely heard her announcement which could embarrass the patient. Mr. Jones could be fired from his job, his marriage may end up in divorce and he could be asked to leave his church congregation. At the very least, I would expect Joanne to be fired for the violation of the HIPPA law.

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Scenario 2: Josephine sees one of the other medical assistants taking samples of a narcotic pain medication and placing them into her pocket. When Josephine confronts her co-worker, the co-worker states that everyone else takes samples, so why shouldn't she. She needs the medication for her backache.

1) Should Josephine report this to the supervisor?

2) Is this an infraction of the law or ethics?

3) What could the outcome be for the medical assistant who took the samples?

Outcome: The other medical assistant should have cleared it with the doctor. Narcotics are a controlled substance for a reason. Josephine should report this to her immediate supervisor. The other medical assistant could be given a warning or even fired. She might also go to jail.

Scenario 3: Jack is a medical assistant with a Radiology Technician license and was asked by Rita, his co-worker, to have an x-ray of her pelvis as she had slipped the day before on a wet floor at a supermarket and had pain in her right hip. The x-ray did not show any definite fracture but fetal parts suggesting an early pregnancy was noted. Jack had not asked her if she was pregnant as he did not wish to embarrass her.

1) Should Jack take an x-ray without a doctor's prescription order?

2) If Jack was embarrassed to ask if his co-worker was pregnant, should he ask if there is any possibility that she may be pregnant?

3) What would the outcome be for the co-worker and Jack?

Outcome: Jack may be dismissed for acting irresponsibly by taking an x-ray without an order. Rita may have an abortion because of the risk of x-rays to the baby.

Intellectual Standards for Reasoning Involves Eight Elements of Thought

All thinking, if it is purposeful, includes the following elements of thought (Paul, 1990).

1. The problem, question, concern or issue being discussed or thought about by the thinker. Information gathering is the first step to deductive reasoning.

2. The purpose or goal of the thinking. Why we are attempting to figure something out and to what end. What do we hope to accomplish?

3. The points of view we hold about the issue or problem that the patient presents..

4. The assumptions that we hold to be true about the issue upon which we base our claims or beliefs.

5. The central concepts, ideas, principles and theories that we use in reasoning about the problem.

6. The evidence, data or information provided to support the claims we make about the issue or problem.

7. The interpretations, inferences, reasoning, and lines of formulated thought that lead to our conclusions.

8. The implications and consequences that follow from the positions we hold on the issue or problem.

Intellectual Traits and Habits of Thought

What makes the thinking of a medical assistant different from a doctor, a dentist or a nurse? In most cases, the medical assistant may be the first clinical person the patient encounters on arrival at a clinical facility. The medical assistant should treat the client in a professional manner and respond in a caring manner to the patient's needs.

To become a critical thinker one must be willing to suspend judgment until the other point of view is understood. Nurses come to reasoned judgments so that they can act competently in their clinical practice, so should medical assistants. They should continually monitor their thinking, questioning and reflecting on the quality of their work. Sloppy, superficial thinking leads to poor practice. Critical inquiry is an important quality for safe practice. Medical assistants must understand their role and limitations in the clinical setting practice and must be willing to attempt to seek answers from other professional staff.

Question-posing presupposes intellectual humility and a willingness to admit to one's areas of ignorance and intellectual curiosity. Perseverance, as well as willingness to seek answers, is the basis of an intellectual mind. Critical thinkers demonstrate open-mindedness and tolerance for others' views with constant sensitivity to the possibility of their own bias. This creates self-confidence in their well reasoned thoughts, skills and abilities.

Critical Thinking Skills and Abilities

Critical thinkers are skilful in applying intellectual skills for sound reasoning. These skills have been defined as information gathering, focusing, remembering, organizing, analyzing, generating, integrating and evaluating (Registered Nurse's Association of British Columbia, 1990). As medical assistants encounter increasingly more complex practical situations, they will be required to think through and reason about their role as medical assistants in greater depth and draw on deeper, more sophisticated comprehension of what it means to be a medical assistant in clinical practice.

To accomplish this goal, students are required to reason about medical assisting by reading, writing, listening and speaking critically.

Critical Thinking ... A Holistic Approach

Critical Listening: A mode of monitoring how we are listening so as to maximize our accurate understanding of what another person is saying.

Critical Thinking: 1) Disciplined, self-directed thinking which implies the perfection of thinking appropriate to a particular domain of thinking. 2) Thinking that displays master of intellectual skills and abilities. 3) The art of thinking is to make your thinking better: more clear, more accurate, or more defensible.

Critical Writing: Arrange ideas in some relationship to each other. When accuracy and truth are at issue, then we must understand what our thesis is, how we can support it, how we can elaborate it to make it intelligible to others, what objections can be raised to it from other points of view, what the limitations are to our point of view, and so forth. Disciplined writing requires disciplined thinking; disciplined thinking is achieved through disciplined writing.

Critical Reading: Critical reading is an active, intellectually engaged process in which the reader participates in an inner dialogue with the writer. Most people read uncritically and so miss some part of what is ex pressed while distorting other parts. A critical reader realizes the way in which reading, by its very nature, means entering into a point of view other than our own, the point of view of the writer. A critical reader actively looks for assumptions, key concepts and ideas, reasons and justifications, supporting examples, parallel experiences, implications and consequences, and any other structural features of the written text to interpret and assess it accurately and fairly. ( Paul, 1990, pp 554 & 545)

Critical Speaking: Critical speaking is an active process of expressing verbally a point of view, ideas and thoughts such that others attain an in-depth understanding of the speaker's personal perspective on an issue. Effective communication in the workplace will also enhance learning skills. Monitoring how we express ourselves verbally will ensure that we maximize accurate understanding of what we mean through active dialogue and openness to feedback on our views. (Heaslip, 1993).

Intellectual Standards and Criteria Used in Reviewing a Research Article

The medical assistant should be guided by the following questions in developing his/her assessment of the research article: This will improve the terms of its clarity, accuracy, precision, relevance, depth, breadth, logic, significance, and fairness--or lack thereof.

1. Question: Is the question at issue clear and unbiased?

2. Purpose: Is the purpose well-stated or implied? Is it clear and justifiable?

3. Information: Is relevant evidence, experiences and/or information essential to the issue cited? Is the information accurate?

4. Ideas (concepts): Are key ideas clarified when necessary? Are the concepts used justifiably?

5. Assumptions: Is there sensitivity to what is being taken for granted or assumed? Are questionable assumptions being used without addressing problems which might be inherent in those assumptions?

6. Conclusions: Is a line of reasoning well developed explaining the main conclusions? Are alternative conclusions considered?

7. Point of View: Is sensitivity to alternative relevant points of view or lines of reasoning shown? Is consideration given to objections framed from other relevant points of view?

8. Implications: Is sensitivity shown to the implications and consequences of the position taken?

Competency Based Education and Critical Thinking in Medical Assisting Curriculum

Erica S. Walker, Medical Assisting Instructor at Surrey Community College, asked, "How can we deliver the material needed to create quality students and future employees while maintaining an effective learning atmosphere? How can we manage to cover the material and incorporate critical thinking into that material? Medical assisting curriculums are designed to teach students concepts and techniques that will prepare them to pass a national certification examination. The curriculum covers a vast area of instruction including administrative, clinical, and laboratory skills. In each of the areas, students must be prepared to not only pass the examination, but gain employment and function as professionals." This tends to become overwhelming for students and instructors.

"The Commission on Accreditation of Allied Health Education Programs (CAAHEP) requires curriculums to evaluate students by using competency based education". Competency based education (CBE) is instructing students by example, illustration, and active/cooperative techniques. Students are required to complete competencies in the classroom and clinical settings. Students give rationales for why and how the techniques are completed while completing the activity. Some competences include venipuncture, vital signs assessment, accounting procedures and many more. One might wonder what and how critical thinking can be incorporated into skill based competencies. The medical assistant's competency should also begin with the question of why and what is the purpose of learning this skill. Medical assistants should be able to think about the patient's medical condition and the best way to apply their skills. While instructing students in competency based education, the instructor must always ask students "why and what is the purpose." This leads to enhanced critical thinking skills. It is not enough to say "in my experience" without qualifying this statement with proper proof and reasoning.

Instructing students by using illustrations, examples, and realistic case studies are excellent ways to incorporate critical thinking skills into medical assisting courses. Reinforcing material on each test is a great way to help students retain material. As a requirement for students in medical assisting courses, the first question asked at the beginning of any new material is "What is the purpose of this chapter, what do you already know about this topic, and what do you expect to learn from this new material?" This can be used to establish an outline of the material and can help keep students focused on material that is being presented. Assessment techniques are extremely important in competency based education (CBE). The days of multiple choice questions are gone. Some assessment techniques that are helpful are using case studies and requiring students to process the scenario and give explicit directions as to how they would and should handle the scenario and the rationale for their plan. This forces students to think through the problem and form a plan to resolve the problem.

Conclusion

By using the critical thinking approach, the medical assistant learns new skills, which helps him/her not only in their professional career, but in everyday life as well. We are not only preparing students to pass examinations, but we are preparing successful medical assistants to lead meaningful, productive lives. The inquisitive mind will foster higher competency and skills and enhance their career opportunities. ?

References

Watson, G. B., & Glaser, E. M. (1980). WGCTA Watson-Glaser Critical Thinking Appraisal Manual: Forms A and B. San Antonio: The Psychological Corporation.

Facione NC, Facione PA (1996) Externalizing the critical thinking in knowledge development and clinical judgement, Nursing Outlook 44(3):129-36

Chafee, J. Teaching for critical thinking. Educational Vision, 2(1), 24-25. (s)

Chaffee, John : Author of The Thinker's Way: 8 Steps to a Richer Life Gibson DR, Campbell RM. The role of cooperative learning in the training ofjunior hospital doctor. Medical Teacher 2000;3:297-300.

Marotta, S., Peters, B., & Poliokas, K. (2000) Teaching group dynamics: An interdisciplinary model. Journal for Specialists in Group Work, 25(1), 16-28. (s)

Paul R : Critical thinking: How to prepare students for a rapidly changing world (Sonoma, CA : Foundation for Critical Thinking 1995)

Paul, R., & Heaslip, P.(1995). Critical thinking and intuitive nursing practice. Journal of Advanced Nursing Practice, 22, 40-70. (s)

Solomon Goldenberg

RMA, FRCGP(Lon)
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Author:Goldenberg, Solomon
Publication:AMT Events
Geographic Code:1USA
Date:Mar 1, 2011
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