By Kerri Arruda, RDH
As dental hygienists we have the opportunity to provide deliberate, well thought out treatment. In general, we seldom face the duress of a trauma center or emergency room. We are afforded time to review medical histories with our patients and discuss their present concerns. We have time to plan, review, and reflect. We have time to think. But are we thinking critically?
What is critical thinking and why is it important? Developing Minds: A Resource Bookfor Teaching Thinking defines critical thinking as, “Reasonable and reflective thinking focused on deciding what to believe or do (Costa, 2001).” This manner of thinking will help us discern between fact and fiction. As dental hygienists, we warn our patients of the erosion of enamel due to soft drinks and acidic juices based on studies that provide empirical evidence. Empirical evidence, produced by scientifically performed studies, attempts to reveal objective and unbiased facts. Shouldn’t we aim to think in the same manner? Our thinking impacts our actions, our beliefs, what we say, and who we are. Don’t we want to be unbiased, intelligent thinkers? Am I? Are you?
Suppose you sell a new dental whitening system to a patient for $500. You promise the patient that they will notice several shades of whitening within the first week as is reflected in the product’s claims. The patient leaves the office feeling grateful to you and excited about the purchase. Two weeks later the same patient returns. This time the patient is not excited; this time the patient is angry. The product did not work and there will be no refund. This patient has lost faith in you. You may have lost a little faith in yourself as well. Maybe the dental whitening company did not have empirical evidence to support its claims and maybe you did not do your research. Maybe you were not thinking critically.
A cognitive time out
Critical thinking can be learned, although it requires “Practice, concentration, reflection and coaching (Costa, 2001).” There are several skills that you can apply to become a more effective thinker. You might unknowingly use these skills, but learning the skills will offer you a cognitive tool kit to draw from in challenging situations. Critical thinking skills are best applied to challenging situations, since it is not often that we have to cognitively struggle with simple tasks such as how to make a peanut butter and jelly sandwich. In fact, the stress and anxiety presented by a situation ought to be recognized as a trigger to initiate your critical thinking skills; let’s call it a cognitive “time out.”
Are you thinking about your thinking right now, wondering if you actually are a critical thinker? If so, you are using metacognition. Metacognition is your knowledge, awareness, and control of your cognitive processes (Matlin, 175). This includes strategies for learning, and adapting and changing in order to improve your cognitive skills. When you had to study anatomy for local anesthesia, did you apply a learning style different from the style you used to study basic terminology? Making changes to facilitate cognitive skills is an example of metacognition.
It is crucial that health-care providers continue to grow cognitively. Our profession has seen change over the last two decades. Dental hygienists can now provide local anesthesia, and we are on the forefront of the emergence of the advanced dental hygiene practitioner. Health-care providers must evolve with the rapidly advancing world of medicine. Thinking critically will help us adapt to changes and to remain professional in an advancing field.
Outside of your perspective
Thinking critically requires that we are aware of our own frame of reference and that we recognize, and correct, for our bias. Professor David Takacs states, “Few things are more difficult than to see outside the bounds of your own perspective — to be able to identify assumptions that you take as universal truths but which, instead, have been crafted by your own unique identity and experiences in the world (Takacs, 2003).”
Our thinking can be flawed by our established background as well as by accepting an assumption as truth. By making an assumption, we draw our own conclusions that might be inaccurate. If we build on inaccurate assumptions, we encourage further flawed thinking. Inaccurate assumptions can lead to unwanted consequences. A conscious effort must be made to ensure our thought processes are objective and unbiased.
We all have one of those patients who arrive late for every dental appointment. Maybe we assume that they do not care about their teeth and have no respect for our schedule. Maybe we consider this behavior rude, since we are always encouraged to be timely. This might result in tension between patients and dental professionals. If we look closely at our assumptions, we might be overlooking, for example, that this patient does not drive, and his only means of transportation is to rely on his tardy friend. When he arrives, he is embarrassed by his late arrival. His quiet demeanor might be perceived as indifference.
By looking into our assumptions and recognizing our own frames of reference, we might be able to understand this patient’s possible circumstances. We would then better be able to consider solutions to potential problems. We might ask if we could schedule a better time for him, or pair him up with a mutual patient that drives but is lonely and would enjoy the company of another patient in need of transportation.
When we develop our critical thinking skills, we must ensure that we are fair-minded. Dr. Linda Elder warns that “It is possible to develop as a thinker and yet not develop as a fair-minded thinker (Elder, 2012).”
We can use our critical thinking skills in a self-centered manner where we recognize the flaws in other’s thinking, but not in our own. This is referred as weak-sense critical thinking. Elder states that weak-sense critical thinking may be, “Working well for the thinker in some respects, but it is missing certain important, higher-level skills and values in critical thinking.” Part of critical thinking requires that we are fair. We know that even a child will scold another child for “Not playing fair!” As health-care professionals, we must ensure our thinking is fair; we do not want to become a skilled thinker for the wrong purposes.
Fair-mindedness is defined by Elder as entailing “The predisposition to consider all relative viewpoints equally, without reference to one’s own feelings or selfish interests, or the feelings or selfish interests of one’s friends, community, or nation (Elder, 2012).” As dental hygienists, it is our duty to be fair-minded. We are providing care to patients who expect that their needs are our greatest concern. We can provide quality care for our patients by trying to truly understanding them. In order to do this effectively, we must set our perspectives aside and listen to what our patients express to us.
Sometimes we encounter others that we cannot seem to understand. In this case, there is a handy skill that can help bridge the gap between opposing views. Professor Peter Elbow names this skill The Believing Game, also known as methodological belief and methodological doubt. He explains methodological doubt as, “The disciplined practice of trying to be as skeptical and analytic as possible with every idea we encounter (Elbow, 2009).”
Elbow states that methodological doubt is done to, “Discover hidden contradictions, bad reasoning, or other weaknesses — especially in the case of ideas that seem true or attractive (Elbow, 2009).” He contrasts this with methodological belief, which he explains as, “Trying to be as welcoming or accepting as possible to every idea we encounter; we use belief to scrutinize unfashionable or even repellent ideas for hidden virtues (Elbow, 2009).”
As a dental hygienist I can use methodological belief to understand the private practice dentist — employers to many of us. As hygienists, we consider our profession as designed to provide oral health care to our patients. We discuss medical conditions, such as diabetes, that have an oral-systemic connection. We educate patients and treat periodontal disease. Many private practice dentists see the hygienist as a profit builder for the practice. Such dentists have us monitor our production and urge us to sell dental products, such as rotary toothbrushes and whitening systems. There is a discrepancy between our desired image as a health-care provider and the image of the aggressive dentist’s funds-producing salesperson.
Let’s apply methodological belief. We can apply the five-minute rule where we force ourselves to honestly argue in favor of the dentist for five full minutes. Though the end result may not be complete persuasion, we might find a better understanding of a previously unwelcomed viewpoint.
My result? Arguing in favor of the dentist, an activity of which I would rather not take part, I discover some understanding. The dentist feels that a businessman’s urgency for production will keep the practice running so it can continue to provide quality medical care. The dentist feels that hygienists are a great source of production because they can perform their duties with little oversight. The dentist feels that a little motivation may push the hygienist to be at the top of their game. It is the confidence that the dentist has in us that projects urgency in our known abilities.
I almost convinced myself! Still, I do not agree completely with the private practice dentist, but I can understand the motivation for certain actions. Taking time to stop and apply critical thinking skills requires what I previously termed as a “cognitive time out.” A dental hygienists, and as people, we need to take notice of our thoughts and emotions. We need to recognize anxiety, frustration, and stress. Stress management is not a critical thinking skill, but it is recognized that management of stress facilitates our ability to think critically. If we can all pause when we notice a heightened emotional state, we can force ourselves to take the cognitive time out. We can force ourselves to pause and consider a different approach to current bothersome situation. Application of a critical thinking skill from our cognitive toolbox might help us to put a situation into a more manageable package.
Sharpening the tools
We have briefly discussed metacognition, assumptions, frame of reference, fair-mindedness, and methodological belief. We have discussed the importance of stress management and defined a cognitive time out. There are many other critical thinking skills to become familiar with that you can add to your toolbox. Don’t stop here! Once you are aware of critical thinking skills you will want to practice their application. One way to practice these skills is by using hands-on activities. Hands-on activities are simple exercises that you can use yourself, or present at your office meeting, or introduce to students. Try these activities as examples of the critical thinking skills we have discussed in this article.
Metacognition activity — This activity can be done alone or with others. All you need is a writing tool and index cards. Each index card will present a question that is designed to challenge your thinking. In any given situation you can pull out a card, read it, and then supply an answer.
- Create the index cards with these questions (or try to create some of your own!):
- Can I approach this problem from a different perspective? (Imagine you are a person that you are familiar with; describe how they might approach the problem)
- Is there a part of my information that might be incorrect? (Are you certain that all aspects of your knowledge of your situation accurate? If not, what uncertainties can you identify?)
- What parts of your situation are you familiar with, and what parts are new to you? (Have you experienced part of your situation before but yet other parts are new to you?)
Assumption activity — This activity can be done alone but works best with others. All you need is a writing tool and a piece of paper, or do this via email. Any topic that you want to explore further can be addressed. You or a leader will create questions that are specific to the topic.
Participants will be required to provide answers to the created questions, but the answers will remain anonymous. After the questions are all answered, the answers will be publicly discussed although the author of the answer will remain anonymous. This will allow an honest discussion about the answers.
Here is an example problem and example questions:
Situation: Refill supplies form the supply room were not available for restocking.
Possible questions: Why did we run out of supplies? Did someone neglect his or her duty? Is this a repeated, recurrent neglect? What impact did this have on you? Can we blame someone, or do we see this as a group failure?
State at least one comment that you feel is relevant to this situation.
Frame of reference activity — This activity can be done alone or with others. All you need is a writing tool and index cards. Each index card will present a question that is designed to highlight your personal frame of reference that might be biasing you thought process. Make certain to identify a situation that you would like to explore further.
Create the index cards with these questions (or try to create some of your own!):
- Name someone who you are familiar with but consider slightly different from you. Describe the situation as if you were them.
- Identify what parts of the situation are emotionally important to you. Describe why this might be.
- Identify situations similar to this one that you have experienced in the past, either experienced yourself, or vicariously but observing or hearing from others. Is this a positive or negative memory?
- Describe how your culture, family, religion, and peers would respond to this situation.
Fair-mindedness activity — This activity can be done alone or with others. All you need is a writing tool and index cards. Each index card will present a question that is designed to question the fairness you present for an identified situation.
Create the index cards with these questions (or try to create some of your own!):
- Who will benefit from the expected outcome of this situation?
- Who might be upset from the expected outcome of this situation?
- Who is this important to, and why?
- Do you, or someone close to you, gain something as a result of the expected income?
- Who is against your situation? Describe why?
- Do you feel any stress or conflict as a result of moving ahead in the attended direction?
- Who could be possible affected by your situation? Consider even the most distant parties.
Methodological belief activity — This activity can be done alone or with others. All you need is a writing tool, a writing surface, and an idea that is in conflict. If there is a topic that you, alone, are conflicted with, you will only need a sheet of paper to record your ideas as you argue as your own adversary in support of this idea.
The goal is to argue in favor of the topic that you are truly not in favor of; do this for five minutes. Do this as fairly as you can; try to convince yourself! Take notes of ideas that arise.
For more than one opponent to an idea, break up into groups. Each group will privately record their reasons for supporting their idea. These will be recorded and later shared. After five minutes, the opponents will switch sides, attempting to fairly argue in support of the opposing view. This is also done for five minutes while answers are recorded privately.
Once arguments are complete and recorded, the recorded results can be revealed and a discussion should ensue.
Considerations to discuss include:
- Did you discover anything that you might not have previously considered?
- Is there anything good in the opposing point of view?
- Are there areas where the supporting and opposing argument overlap or are similar?
- Is there any time, or place, or purpose for the opposing view that might be worthwhile of consideration?
- Did anyone change sides? If so, why?
These activities are a great way to become familiar with some critical thinking skills, as well as share with, and teach others. Although we mentioned stress management is not a critical thinking skill, we recognize that it can facilitate higher thinking. Many studies have been performed that advise us to breathe under duress. Taking 10 deep, slow breaths can exert a physiological effect, aiding in calming.
Now that you are aware of the importance of critical thinking and familiar of some skills, take some time to try the activities. We know that critical thinking skills take practice and if we can reduce the stress enough to stop and take a cognitive time out, we allow ourselves to grow cognitively and professionally. Stop. Take a breath. I will ask you once again; do you want to be an intelligent and unbiased thinker?
Kerri Arruda, RDH, is based in Fall River, Mass., and can be contacted at [email protected].
- Costa, Arthur L., (2001) Developing Minds: A Resource Book for Teaching Thinking (3rd ed.). Publisher: ASCD (Association for Supervision and Curriculum Development). Pages: xvi, 44.
- Elbow, Peter (2009). The Believing Game or Methodological Belief. Retrieved on December 2, 2013 from http://works.bepress.com/cgi/viewcontent.cgi?article=1043&context=peter_elbow
- Elder, Linda (2012). Becoming a Fairminded Thinker, Chapter 1. Retrieved on December 2, 2013 from http://www.pearsonhighered.com/assets/hip/us/hip_us_pearsonhighered/samplechapter/0321857771.pdf
- Matlin, Margaret W. (2003) Cognition, 5th ed. Published by John Wiley & Sons. (p.145)
- Takacs, David (2003). How Does You Positionality Bias Your Epistemology? Retrieved on December 3, 2013 from http://www.nea.org/assets/img/PubThoughtAndAction/TAA_03_04.pdf