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

Course Number: 551

The Elements of Reasoning

The main difference between “thinking” and “critical thinking” is that critical thinking must meet a set of standards or criteria as opposed to random thoughts or “thinking” alone. The first step to critical thinking is to identify the “parts” within thought, which will allow identification of the problems within your thinking process.5 If you can do this, you will be able to solve the problems and progress into higher order thinking, like a critical thinker. This is done by employing the Elements of Reasoning (Table 2).2

Paul-Elder Critical Thinking Model

Table 2. The Essential Dimensions of Critical Thinking.

This interactive tool from the website describes the Elements of Reasoning.6

Elements of Reasoning Interactive Tool

Table 3. Elements of Reasoning.12

The following case provides an example in how educators can use the Elements of Clinical Reasoning to help students analyze their thinking process. Interacting with the Elements of Clinical Reasoning diagram and considering the eight different structures in thinking helps the educator develop questions to ask the student to encourage the student to think through the case and arrive at a reasonable decision regarding a clinical problem. This also promotes effective communication between the educator and student and between the student and the patient.

Case scenario: An educator is frustrated because a student failed to show a patient how to use a floss threader under a fixed bridge. No one had ever shown the patient how to clean under the bridge.

One approach to clinical teaching is for the educator to ask the student to show the patient how to use the floss threader under the bridge. Using the Elements of Reasoning of the Paul-Elder Framework, the educator would determine that the student lacked the clinical information to address the patient’s problem of cleaning the bridge. The educator can encourage a deeper level of thinking by asking the student the following questions from the Elements of Reasoning:

  • What key concepts will help you adequately explain or demonstrate how to take care of a bridge to the patient?

  • What are the implications and consequences of not adequately explaining or demonstrating the concepts of how to take care of a bridge to the patient?

These questions are helpful in getting the student to think critically about all the information pertaining to the case and planning appropriate patient education.