Critical thinking and critical appraisal: the chicken and the egg?

From the 1Department of Epidemiology and Public Health, Queens University, Belfast, and 2Royal Victoria Hospital, Belfast, UK Having attended the first National Workshop on Teaching Evidence-Based Medicine (Oxford, 1995), one of us actually has the T-shirt declaring his critical appraisal credentials. But although trained in clinical epidemiology, both before and since the workshop, the same person continues daily to doubt his critical thinking skills. The profusion of mini-guides and short courses in Critical Appraisal and Evidence-Based Practice has enriched our curricula for over a decade,1 but perhaps basic skills of critical thought should take precedence in developing our day-to-day practice, which is rather less informed by the published evidence than we would care to admit. Although the term critical thinking was used in the General Medical Council's 1993 edition of Tomorrow's Doctors, it has now been dropped in favour of phrases such as: an ability ‘to gain, assess, apply and integrate new knowledge … ‘; or an ability ‘to integrate and critically evaluate evidence … ’.2 While a shift towards problem-based learning has occurred in some UK medical schools, the proof that such curricula can enhance critical thinking may be elusive.3 However, many of the contributions to the teaching of critical thinking have not come from medical schools, but rather from philosophy and psychology departments, and there are now regular International Conferences on Critical Thinking.4 Perhaps it is time to learn some lessons from the ‘professionals’. Below we describe a few local initiatives to promote critical thinking at an undergraduate and post-graduate level. We give a brief overview of some material covered in a one semester course (for third-year medical students), and briefly describe a few take-home messages that postgraduates have also found helpful. Space permits description of only a small selection of this material.