Critical Thinking or the Facts?

The purpose of this exercise is to present some arguments and examples which might encourage you to look at your teaching in a different way.

Which Should I Teach: Critical Thinking or the Facts? Can I do Both?

A Practical Course in Critical Thinking



Marilyn A. Cairns, ScD
Associate Professor, Cardiopulmonary Science Department
Northeastern University, Boston MA

Creation Date:

9 November 1996


Education, Teaching, Critical Thinking


The purpose of this exercise is to present some arguments and examples which might encourage you to look at your teaching in a different way such that the outcome for the students will include not only the acquisition of facts but the ability to think about, integrate, and use these facts in a more productive way. At the end of this exercise, you should be better able to define critical thinking and apply some of the principles to a curriculum in athletic training or other clinical profession.


Upon completion of this material, the user will be able to:

  1. Define critical thinking.
  2. Identify the Elements of Reasoning.
  3. Describe how to develop critical thinking skills.
  4. Present critical thinking activities in the course syllabus.
  5. Develop strategies to implement critical thinking strategies in the classroom.


Much of the information to be presented here is based upon a personal reflection and revision of my own teaching in the area of anatomy and physiology. For many years, I considered myself to be an excellent teacher; my student evaluations were excellent, and I received a university award for teaching excellence. I had developed better course outlines; I had added technology to my classroom; I had prepared note packets to guide students through my courses... I was working to improve my teaching, but I had failed to reflect on what my students were actually learning.

In conversation with several students one day, I was shocked to learn that the more work I was doing to provide information to my students, the less work the students were doing to prepare for class. One student boldly stated that my outline notes were all he needed; there was no reason to purchase the text. My students were concentrating on learning isolated facts to pass factual objective exams. I came to realize that many of them could communicate only in "fill in the blank" or "sound bite" responses and were not able to answer questions through sentences or paragraphs. They were not able to effectively use and apply their anatomical and physiological knowledge in other classes or in the clinic.

It was this frustration and concern that led me on a quest to find a way to return the responsibility for learning to the students and regain my enthusiasm for teaching. The material which follows will focus on teaching content as a mode of thinking, designing ways to facilitate critical thinking skills, and designing tactics to improve the effectiveness of instruction.


Critical thinking is a popular concept in American education today. Many universities offer general critical thinking courses while many professions, such as nursing, have adopted critical thinking as an important professional outcome of clinical course work. The word "critical", meaning to question, make sense of, or analyze, is often used in a negative context. Thinking critically in a learning context, however, connotes a positive process to challenge your thinking or the thinking of others. There have been many "definitions" of critical thinking proposed in the literature. Chaffee defines critical thinking as "an active , purposeful, organized, cognitive process we use to carefully examine our thinking and the thinking of others, in order to clarify and improve our understanding." (1) Critical thinking involves a set of thinking abilities and attitudes coupled with the Elements of Reasoning (Table 1) and also includes the ability to assess your own reasoning.



Table 1--Elements of Reasoning


All reasoning has a purpose

  • Is the purpose clear?
  • Is the purpose achievable?




All reasoning is an attempt to settle some question, solve some problem

  • Is the question clear?
  • Is the question significant or trivial?
  • Is the question relevant?
  • Is the question answerable




All reasoning is done from some frame of reference or point of view

  • What is the frame of reference?
  • Are there different points of view?
  • Is the point of view appropriately broad?




All reasoning is based on data, information, evidence

  • Is the evidence clear, precise, and accurate?
  • Is the evidence relevant?
  • Has adequate evidence been provided and was it applied with consistency?




All reasoning is shaped by concepts and theories

  • Are the key theories or concepts clear?
  • What are the implications of these concepts?




All reasoning is based upon some assumptions

  • Are the assumptions clear, justifiable, and consistent?



and Consequences

All reasoning leads somewhere... to implications and consequences

  • Are there significant implications?
  • Are the implications clear and realistic?
  • Are there positive as well as negative implications?
  • Are there any other unexpected consequences?



and Conclusions

All reasoning contains inferences by which we draw conclusions and give meaning to the data

  • Are the inferences clear?
  • Can the inferences be justified with evidence?
  • Are the conclusions profound?
  • Are the conclusions reasonable and consistent with each other?

Source: Center for Critical Thinking, Sonoma State University, Rohnert Park, CA



Didactic (or fact-focused teaching) is a comfortable form of teaching for most of us. It is the manner in which most of us were taught at the undergraduate level. In didactic teaching, the focus and responsibility is on the teacher. Students are taught content in a form (generally lecture style) that does not require them to think things through. Learning for the moment, or for the test, often occurs from rote memorization. Students are rarely challenged to grasp the logic or theory of the content.

The use of a critical thinking approach to teaching requires a paradigm shift which refocuses on the student. In this form of teaching, content "lives" in the form of thinking. Only those students who are able to "think through the content" will truly be able to take possession of the content and make it theirs. Teaching through critical thinking involves thinking about thinking. Students who think critically will begin to think at a higher level and improve the clarity, accuracy, relevance, depth, breadth, and effectiveness of their thinking.


If teaching content effectively involves teaching it as a mode of thinking, then everything we have learned thus far about critical thinking provides insight into how we should design our instruction. For example:

  • If all thinking or reasoning is thinking for a purpose, then am I designing my instruction so that students have to think through the purpose of what they are doing? How (anatomically) does the Lachman's Test differ from the Anterior Drawer Test? Why (legally, ethically) is the preparticipation physical examination essential?
  • If all thinking requires information or data, am I designing instruction so that students are knowledgeable about accessing the information they need to learn? Am I holding them responsible for prerequisite information? Am I encouraging them to use sources other than the textbook?
  • If all sound thinking requires criteria to assess its soundness, am I designing my instruction so that students learn the criteria they need to assess their own thinking? Do I use the vocabulary of assessment (clarity, accuracy, precision, relevance, depth, breadth) in my assignments? Do I teach students to assess their own thinking and writing? Do I reinforce the need for anatomical accuracy and professional clarity? Do I require that they come to class prepared?
  • If all sound thinking is focused on a question or a problem, am I designing my instruction so that students learn to focus their thinking on well-formulated questions or problems? As students learn common athletic injuries, are they focusing on questions such as the anatomical structure, the relationship between the anatomical insult and the course of rehabilitation, the influence of other factors such as age and gender?


Apply the elements of reasoning to the teaching in your particular area of expertise. Ask yourself or how you might design instruction to include the elements of reasoning.

As you redesign your course to include opportunities for students to learn to think, you will be formulating different or additional course objectives. In redesigning three sequential courses (anatomy and physiology 1, 2 and cardiopulmonary physiology) for students in the clinical professions to more effectively focus on critical thinking, I have integrated the following objectives to the anatomical and physiological objectives across my three course sequence.

The student will:

  • Locate and use the sources of information available
  • Develop strategies to learn anatomical and physiological information
  • Develop clarity and precision in written and oral communication
  • Solve clinical problems by applying information that you know
  • Discuss and exchange ideas with others
  • Develop criteria to assess and improve thinking
  • View clinical learning as a lifelong process


If you are to include critical thinking in your instruction, what new objectives will you include in your course or courses? Keep in mind that teaching critical thinking is a long term process and that it cannot be accomplished in one course


The course outline or syllabus should clearly reflect your intended goals. Below are some sample sections from a course outline from an upper level course in cardiopulmonary physiology. As you will note in the sample sections of the course outline, I have made it clear to the students that "thinking" and "communicating" are as important as the physiological information. I have included a general plan for the class which introduces them to the expectations of preassigned work, in-class group discussions, and the language of assessment. Try rewriting parts of your course outline to reflect a change from didactic teaching to a critical thinking approach.

Course Description:

This course will include in-depth integrated physiology of the cardiovascular and respiratory systems. The physiological dynamics and control mechanisms of the events of circulation and respiration will be a major potion of this course. The prerequisite for this course is satisfactory completion of the science sequence through Quarter 5 which includes Biology, Anatomy and Physiology 1 & 2, Chemistry 1 & 2, and Physics 1.

Course Objectives

This course, CPS 1320 Cardiopulmonary Physiology, is designed to integrate basic and more advanced physiological facts, theories, and principles with normal and abnormal cardiopulmonary function. Specific learning objectives include the ability:

  • To clearly describe the physiology, mechanics, and control mechanisms of normal oxygen and carbon dioxide exchange and transport.
  • To clearly describe the physiology, mechanics, and control mechanisms of normal heart function and blood delivery systems.
  • To integrate the function of the cardiovascular and respiratory systems with each other and with other systems of the body.
  • To predict the cardiovascular and respiratory responses to normal stresses such as exercise.
  • To describe the physiological consequences of clinical disruption to normal mechanics and control of cardiopulmonary function.

Everything we do in this course will focus on improving your ability to think critically about cardiopulmonary physiology and examine the basis of normal function or consequential clinical outcomes. Improving your ability to think and to figure things out based on what you know will enable you to analyze information and make decisions in a clinical setting.

General Plan:

The focus of this class will be on discussion, problem solving, and application. You will practice applying and communicating what you know and figuring out what you do not know. On a typical day, you will be working for part of the class in pairs or in small groups on problems or questions distributed in class or in a previous class. This process will require that each student have a clear understanding of the physiological function or control mechanism under discussion. You are therefore responsible for coming to each class prepared to act as an informed participant. This will require that you are thoroughly familiar with the material assigned for each day, have read the assignment, and have completed in writing appropriate chapter objective questions or other assigned problems. On some days, you will be required to bring the written answer to a question posed at the end of the previous class. Failure to come prepared for class may result in your dismissal from class until you are prepared to act as an informed participant.

A major objective of this class is that you will begin to think, speak, and write clearly and precisely. In order to move on and apply anatomical and physiological concepts in the clinical setting, you cannot be vague, imprecise, or obscure in your definitions and explanations of anatomical structure or physiological functioning.


What are some general tactics and strategies that I can use to promote critical thinking in my courses?

1. Include critical thinking goals and intellectual standards in the syllabus and speak about them in the introductory class.

2. Require reading and writing prior to each class. Hold students responsible for pre-requisite information... do not reteach information from last semester but provide opportunities for students to use that information to solve problems or clinical cases.

3. Assist students with reading the text by providing focus questions. Teach lower level students how to read the text more effectively by modeling how you would read a section, by having them summarize a section, or by having them create possible exam questions from a section. Teach students how to rephrase text headers into discussion questions.

4. Randomly grade pre-class writing assignments or use a one question writing quiz to promote adherence to the reading requirement. Consider dismissing students who have not completed the assigned reading during discussions of the reading... send them into the hall to read.

5. Assist students in developing strategies for learning. Design learning activities which promote learning strategies. Model or suggest good learning strategies other than memorization whenever possible.

6. Use class time to solve clinical problems, apply concepts, and make meaningful connections and application of knowledge. Avoid repeating all of the information in the book. You may need to mini-lecture difficult concepts but try to use class time to apply and integrate knowledge. Question students rather than lecturing... probe their thinking and encourage further questioning which may lead the group or individuals to answers beyond the normal scope of the class. Encourage students to make connections between related concepts and to apply knowledge to their clinical experience.

7. In class, assign problems to pairs or small groups for part of the class time. Summarize the problems or issues by calling on groups to present their answers as well as their thought process. To encourage critical listening, call on other class members to add additional information or to restate parts of the presentation.

8. Model thinking by thinking aloud or having students puzzle aloud through a problem. Apply the intellectual standards to your thinking.

9. Discourage "sound bites". Require complete sentences in spoken as well as written responses. Insist on correct terminology and continually ask students to define or interpret terminology... Show me the acromion process... Define cardiac output in words (not as CO = HR x SV). Encourage students to speak as a professional; to speak as they would to another professional or to a patient.

10. Call on students who do not speak often. Be gentle with them but encourage their participation. Encourage these students to be willing to begin to solve a difficult problem... to contribute one portion, or to suggest the information needed to solve the problem.

11. Ask students to summarize and add to the answer of another student to promote active listening.

12. When asking questions, allow students the opportunity to think. Do not always allow spontaneous answers. Ask how many students agree or disagree with the answer and why?

13. Use diagrams, flow charts, and other graphics as the basis of discussion. Put an overhead up or show a film clip and call on students to summarize the concepts illustrated in the graphic or film.

14. Provide frequent opportunities for students to write and to have writing assessed. Provide examples of good writing... for example, show them a good paper from last year or post some good essay exam answers. Give students the opportunity to write a practice essay answer before the exam... lead a class discussion on the content. Provide students with the assessment tool to be used in grading term papers. Provide students the opportunity to write and document the integration of their academic and clinical knowledge and skills using reflective journals or case studies.

15. Use the 1 minute end-of-class paper or another self-assessment tool at least once a week. You and the students need to be encouraged to assess what they understand and what needs clarification.

16. Be sure that your evaluative mechanisms (quizzes, exams, papers) reflect your critical thinking objectives. Do not profess to encourage critical thinking if your exams consist only of lower order, factual based objective questions.

17. Teaching critical thinking takes time. One hour classes are difficult. If possible, schedule class for a minimum of 90 minutes per session.

18. Use methods of self-assessment, peer assessment, and random grading to reduce the written assignments that you personally evaluate.

19. Design teacher evaluation tools which reflect the focus on student learning. Many teaching evaluations are focused on the delivery of knowledge by the teacher using the lecture method.


Sample assignments and exercises.

Below are three sample assignments and exercises that I have used to promote critical thinking in my classes. Design one assignment to use in your class which will promote one or more of the elements of reasoning.

1. An in-class small group discussion on cardiac function at the end of a week of reading and discussion in a junior level class in Cardiopulmonary Physiology.

Based upon your understanding of normal cardiac function, discuss how the following heart pathologies might affect pressures, blood flow, contractility, stroke volume, cardiac output, or any other cardiac mechanism (45 minutes). Be prepared to present any one of the pathologies to the class during the summary discussion (45 minutes).

  • Ischemic heart disease
  • Atherosclerosis
  • Coronary occlusions
  • Myocardial Infarct
  • Cardiac Failure: left/right
  • Aortic valve disease: regurgitation and stenosis
  • Mitral valve disease: regurgitation and stenosis
  • Patent Ductus Arteriosus
  • Ventricular Septal defect: Left-Right Shunt


2. An in-class writing exercise in Anatomy and Physiology II, the week before the midterm exam.

Without using your notes or books, independently write an answer to the following practice essay question. You will have 10 minutes to prepare your answer. When instructed to do so, you will exchange papers with a partner.

Following the exchange, you will have 10 minutes to read and evaluate your partner's answer. In evaluating your partner's response you may use your notes or text. Feel free to make notes or marks on your partner's paper. Your evaluation should consider clarity, physiological accuracy, precision and detail, relevance of points to the question, depth or completeness, and logical order of thought. The feedback you give to your partner should include constructive suggestions for improvement.

You will then each spend 5 minutes providing feedback to your partner. Before the next class, your assignment is to rewrite the question independently, recalling the points you have learned in this class session.


The question: Following an auto accident, a patient arrives at the emergency room hemorrhaging and has a rapid, thready pulse. Upon arrival, the patient's blood pressure is within normal limits. Describe the compensatory mechanisms which are maintaining blood pressure despite blood loss.

3. An out-of-class writing and self-assessment writing assignment in a junior level class in Cardiopulmonary Physiology.

Higher Order Thinking Question: What are the progressive clinical consequences of an aging cardiovascular system?

Are there smaller questions or problems within that question? Here are some things which you might consider in thinking about that question:

  • How does the process of aging manifest itself structurally in the cardiovascular system?
  • Are there any physiological resolutions to these changes and how do they manifest themselves?
  • Are there any clinical interventions which may also be useful?
  • How are other systems impacted by the aging cardiovascular system?

Are there additional items or issues you would want to include?

Compose a well organized 1-2 page response to the major question. Assess your answer using the following criteria on the sheet provided.

  • Is it clear? Are your points well stated?
  • Are you physiologically accurate?
  • Are you precise? Can you be more detailed?
  • Is the information you include relevant to the question?
  • Does your answer address the complexity of the question?
  • Have you covered the problems within the question?
  • Do you make sense? Do your thoughts flow logically?




1. Chaffe J. Thinking critically, ed 4. Boston, Houghton Mifflin, 1994.

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