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Improving Students’ Patient Care Management Using the Thinker’s Guide to Clinical Reasoning

Course Number: 551


Dental and dental hygiene students need clinical reasoning skills to plan and individualize patient care and communicate effectively with their patients. As health professionals, we have the responsibility to apply problem-solving processes in decision-making and to evaluate these processes.1,2 Often, educators are not sure of how to help students improve their clinical reasoning and problem-solving skills. The Paul-Elder Critical Thinking Framework is a helpful model educators can use to guide students through an analysis and evaluation of their thinking and reasoning processes. Applying intellectual standards to the elements of reasoning from the framework allows students to think through the data acquired from clinical assessments and correctly diagnose the patient’s unmet needs and subsequently plan the patient’s care. When using these components of the model, students begin to develop stronger critical thinking and make reasonable decisions.2-7

Image showing a person in a white coat assists a person in scrubs with a dental patient

Some believe critical thinking is inherent in healthcare, and healthcare professionals already do this on a daily basis. Others have questioned the purpose behind the need for detail in modeling and teaching critical thinking to students. The notion that students have “it” or they don’t as it pertains to critical thinking is false; it does not come naturally for anyone. Faculty members can be role models to students.8-9 If students see educators engaging in the critical thinking process, then they are more likely to perceive its value, practice and develop their skills.8-9 It is important to emphasize to students that developing and continually enhancing critical thinking abilities will help them in all aspects of life, such as in interactions with future dental patients and dental colleagues. Helping students practice these critical thinking skills is an expectation for all courses and is an essential tool to use to help students become exceptional healthcare providers.2-11

Dental professionals see numerous patients each day and every patient has a different clinical presentation. A patient’s health, including dental health, is generally never a black and white situation. Students must learn to identify important aspects of the patient’s health and combine them with concepts learned from didactic classes. To do this, students must evaluate all clinical assessments to determine the most beneficial care plans. Sometimes in healthcare, this process could result in the life or death of a patient. Hawkins, Paul and Elder state, “It isn’t enough to have a strong background in the biomedical sciences or to possess excellent clinical knowledge, nor to know how to conduct a history and physical exam on a patient or even to know how to formulate a differential diagnosis given the signs, symptoms, and test results of a patient. There is still a need to think critically about all the important information pertaining to a particular case and to formulate or synthesize a rational plan of action. Clinical reasoning requires critical thinking skills, abilities and traits which are often not taught in schools and colleges for the health professions.”2 Based on these ideas, the Paul-Elder framework was developed.

Dentistry provides a unifying and unique “language” shared by providers. Using the Paul-Elder critical thinking framework can lend additional terminology to use with common dental terminology and language to enhance critical thinking for students. This specifically designed course introduces or re-familiarizes educators to the Paul-Elder Critical Thinking framework language as well as gives them a few practical teaching strategies that foster critical thinking for students. This course provides a way to incorporate the Paul-Elder framework into didactic and clinical courses to produce the best future dental professionals.