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  • What Is Critical Thinking? | Definition & Examples

What Is Critical Thinking? | Definition & Examples

Published on May 30, 2022 by Eoghan Ryan . Revised on May 31, 2023.

Critical thinking is the ability to effectively analyze information and form a judgment .

To think critically, you must be aware of your own biases and assumptions when encountering information, and apply consistent standards when evaluating sources .

Critical thinking skills help you to:

  • Identify credible sources
  • Evaluate and respond to arguments
  • Assess alternative viewpoints
  • Test hypotheses against relevant criteria

Table of contents

Why is critical thinking important, critical thinking examples, how to think critically, other interesting articles, frequently asked questions about critical thinking.

Critical thinking is important for making judgments about sources of information and forming your own arguments. It emphasizes a rational, objective, and self-aware approach that can help you to identify credible sources and strengthen your conclusions.

Critical thinking is important in all disciplines and throughout all stages of the research process . The types of evidence used in the sciences and in the humanities may differ, but critical thinking skills are relevant to both.

In academic writing , critical thinking can help you to determine whether a source:

  • Is free from research bias
  • Provides evidence to support its research findings
  • Considers alternative viewpoints

Outside of academia, critical thinking goes hand in hand with information literacy to help you form opinions rationally and engage independently and critically with popular media.

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critical thinking skills research

Critical thinking can help you to identify reliable sources of information that you can cite in your research paper . It can also guide your own research methods and inform your own arguments.

Outside of academia, critical thinking can help you to be aware of both your own and others’ biases and assumptions.

Academic examples

However, when you compare the findings of the study with other current research, you determine that the results seem improbable. You analyze the paper again, consulting the sources it cites.

You notice that the research was funded by the pharmaceutical company that created the treatment. Because of this, you view its results skeptically and determine that more independent research is necessary to confirm or refute them. Example: Poor critical thinking in an academic context You’re researching a paper on the impact wireless technology has had on developing countries that previously did not have large-scale communications infrastructure. You read an article that seems to confirm your hypothesis: the impact is mainly positive. Rather than evaluating the research methodology, you accept the findings uncritically.

Nonacademic examples

However, you decide to compare this review article with consumer reviews on a different site. You find that these reviews are not as positive. Some customers have had problems installing the alarm, and some have noted that it activates for no apparent reason.

You revisit the original review article. You notice that the words “sponsored content” appear in small print under the article title. Based on this, you conclude that the review is advertising and is therefore not an unbiased source. Example: Poor critical thinking in a nonacademic context You support a candidate in an upcoming election. You visit an online news site affiliated with their political party and read an article that criticizes their opponent. The article claims that the opponent is inexperienced in politics. You accept this without evidence, because it fits your preconceptions about the opponent.

There is no single way to think critically. How you engage with information will depend on the type of source you’re using and the information you need.

However, you can engage with sources in a systematic and critical way by asking certain questions when you encounter information. Like the CRAAP test , these questions focus on the currency , relevance , authority , accuracy , and purpose of a source of information.

When encountering information, ask:

  • Who is the author? Are they an expert in their field?
  • What do they say? Is their argument clear? Can you summarize it?
  • When did they say this? Is the source current?
  • Where is the information published? Is it an academic article? Is it peer-reviewed ?
  • Why did the author publish it? What is their motivation?
  • How do they make their argument? Is it backed up by evidence? Does it rely on opinion, speculation, or appeals to emotion ? Do they address alternative arguments?

Critical thinking also involves being aware of your own biases, not only those of others. When you make an argument or draw your own conclusions, you can ask similar questions about your own writing:

  • Am I only considering evidence that supports my preconceptions?
  • Is my argument expressed clearly and backed up with credible sources?
  • Would I be convinced by this argument coming from someone else?

If you want to know more about ChatGPT, AI tools , citation , and plagiarism , make sure to check out some of our other articles with explanations and examples.

  • ChatGPT vs human editor
  • ChatGPT citations
  • Is ChatGPT trustworthy?
  • Using ChatGPT for your studies
  • What is ChatGPT?
  • Chicago style
  • Paraphrasing


  • Types of plagiarism
  • Self-plagiarism
  • Avoiding plagiarism
  • Academic integrity
  • Consequences of plagiarism
  • Common knowledge

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Critical thinking refers to the ability to evaluate information and to be aware of biases or assumptions, including your own.

Like information literacy , it involves evaluating arguments, identifying and solving problems in an objective and systematic way, and clearly communicating your ideas.

Critical thinking skills include the ability to:

You can assess information and arguments critically by asking certain questions about the source. You can use the CRAAP test , focusing on the currency , relevance , authority , accuracy , and purpose of a source of information.

Ask questions such as:

  • Who is the author? Are they an expert?
  • How do they make their argument? Is it backed up by evidence?

A credible source should pass the CRAAP test  and follow these guidelines:

  • The information should be up to date and current.
  • The author and publication should be a trusted authority on the subject you are researching.
  • The sources the author cited should be easy to find, clear, and unbiased.
  • For a web source, the URL and layout should signify that it is trustworthy.

Information literacy refers to a broad range of skills, including the ability to find, evaluate, and use sources of information effectively.

Being information literate means that you:

  • Know how to find credible sources
  • Use relevant sources to inform your research
  • Understand what constitutes plagiarism
  • Know how to cite your sources correctly

Confirmation bias is the tendency to search, interpret, and recall information in a way that aligns with our pre-existing values, opinions, or beliefs. It refers to the ability to recollect information best when it amplifies what we already believe. Relatedly, we tend to forget information that contradicts our opinions.

Although selective recall is a component of confirmation bias, it should not be confused with recall bias.

On the other hand, recall bias refers to the differences in the ability between study participants to recall past events when self-reporting is used. This difference in accuracy or completeness of recollection is not related to beliefs or opinions. Rather, recall bias relates to other factors, such as the length of the recall period, age, and the characteristics of the disease under investigation.

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Critical Thinking in Academic Research - Second Edition

(4 reviews)

critical thinking skills research

Cindy Gruwell, University of West Florida

Robin Ewing, St. Cloud State University

Copyright Year: 2022

Last Update: 2023

Publisher: Minnesota State Colleges and Universities

Language: English

Formats Available

Conditions of use.


Learn more about reviews.

Reviewed by Julie Jaszkowiak, Community Faculty, Metropolitan State University on 12/22/23

Organized in 11 parts, this his textbook includes introductory information about critical thinking and details about the academic research process. The basics of critical thinking related to doing academic research in Parts I and II. Parts III –... read more

Comprehensiveness rating: 5 see less

Organized in 11 parts, this his textbook includes introductory information about critical thinking and details about the academic research process. The basics of critical thinking related to doing academic research in Parts I and II. Parts III – XI provide specifics on various steps in doing academic research including details on finding and citing source material. There is a linked table of contents so the reader is able to jump to a specific section as needed. There is also a works cited page with information and links to works used for this textbook.

Content Accuracy rating: 5

The content of this textbook is accurate and error free. It contains examples that demonstrate concepts from a variety of disciplines such as “hard science” or “popular culture” that assist in eliminating bias. The authors are librarians so it is clear that their experience as such leads to clear and unbiased content.

Relevance/Longevity rating: 5

General concepts about critical thinking and academic research methodology is well defined and should not become obsolete. Specific content regarding use of citation tools and attribution structure may change but the links to various research sites allow for simple updates.

Clarity rating: 5

This textbook is written in a conversational manner that allows for a more personal interaction with the textbook. It is like the reader is having a conversation with a librarian. Each part has an introduction section that fully defines concepts and terms used for that part.

Consistency rating: 5

In addition to the written content, this textbook contains links to short quizzes at the end of each section. This is consistent throughout each part. Embedded links to additional information are included as necessary.

Modularity rating: 4

This textbook is arranged in 11 modular parts with each part having multiple sections. All of these are linked so a reader can go to a distinct part or section to find specific information. There are some links that refer back to previous sections in the document. It can be challenging to return to where you were once you have jumped to a different section.

Organization/Structure/Flow rating: 5

There is clear definition as to what information is contained within each of the parts and subsequent sections. The textbook follows the logical flow of the process of researching and writing a research paper.

Interface rating: 4

The pictures have alternative text that appears when you hover over the text. There is one picture on page 102 that is a link to where the downloaded picture is from. The pictures are clear and supportive of the text for a visual learner. All the links work and go to either the correct area of the textbook or to a valid website. If you are going to use the embedded links to go to other sections of the textbook you need to keep track of where you are as it can sometimes get confusing as to where you went based on clicking links.

Grammatical Errors rating: 4

This is not really a grammatical error but I did notice on some of the quizzes if you misspelled a work for fill in the blank it was incorrect. It was also sometimes challenging to come up with the correct word for the fill in the blanks.

Cultural Relevance rating: 5

There are no examples or text that are culturally insensitive or offensive. The examples are general and would be applicable to a variety of students study many different academic subjects. There are references and information to many research tools from traditional such as checking out books and articles from the library to more current such as blogs and other electronic sources. This information appeals to a wide expanse of student populations.

I really enjoyed the quizzes at the end of each section. It is very beneficial to test your knowledge and comprehension of what you just read. Often I had to return and reread the content more critically based on my quiz results! They are just the right length to not disrupt the overall reading of the textbook and cover the important content and learning objectives.

Reviewed by Sara Stigberg, Adjunct Reference Librarian, Truman College, City Colleges of Chicago on 3/15/23

Critical Thinking in Academic Research thoroughly covers the basics of academic research for undergraduates, including well-guided deeper dives into relevant areas. The authors root their introduction to academic research principles and practices... read more

Critical Thinking in Academic Research thoroughly covers the basics of academic research for undergraduates, including well-guided deeper dives into relevant areas. The authors root their introduction to academic research principles and practices in the Western philosophical tradition, focused on developing students' critical thinking skills and habits around inquiry, rationales, and frameworks for research.

This text conforms to the principles and frames of the Framework for Information Literacy for Higher Education, published by the Association of College and Research Libraries. It includes excellent, clear, step-by-step guides to help students understand rationales and techniques for academic research.

Essential for our current information climate, the authors present relevant information for students who may be new to academic research, in ways and with content that is not too broad or too narrow, or likely to change drastically in the near future.

The authors use clear and well-considered language and explanations of ideas and terms, contextualizing the scholarly research process and tools in a relatable manner. As mentioned earlier, this text includes excellent step-by-step guides, as well as illustrations, visualizations, and videos to instruct students in conducting academic research.

(4.75) The terminology and framework of this text are consistent. Early discussions of critical thinking skills are tied in to content in later chapters, with regard to selecting different types of sources and search tools, as well as rationales for choosing various formats of source references. Consciously making the theme of critical thinking as applied to the stages of academic research more explicit and frequent within the text would further strengthen it, however.

Modularity rating: 5

Chapters are divided in a logical, progressive manner throughout the text. The use of embedded links to further readings and some other relevant sections of the text are an excellent way of providing references and further online information, without overwhelming or side-tracking the reader.

Topics in the text are organized in logical, progressive order, transitioning cleanly from one focus to the next. Each chapter begins with a helpful outline of topics that will be covered within it.

There are no technical issues with the interface for this text. Interactive learning tools such as the many self-checks and short quizzes that are included throughout the text are a great bonus for reinforcing student learning, and the easily-accessible table of contents was very helpful. There are some slight inconsistencies across chapters, however, relative to formatting images and text and spacing, and an image was missing in the section on Narrowing a Topic. Justifying copy rather than aligning-left would prevent hyphenation, making the text more streamlined.

Grammatical Errors rating: 5

(4.75) A few minor punctuation errors are present.

The authors of this text use culturally-relevant examples and inclusive language. The chapter on Barriers to Critical Thinking works directly to break down bias and preconceived notions.

Overall, Critical Thinking in Academic Research is an excellent general textbook for teaching the whys and hows of academic research to undergraduates. A discussion of annotated bibliographies would be a great addition for future editions of the text. ---- (As an aside for the authors, I am curious if the anonymous data from the self-checks and quizzes is being collected and analyzed for assessment purposes. I'm sure it would be interesting!)

Reviewed by Ann Bell-Pfeifer, Program Director/ Instructor, Minnesota State Community and Technical College on 2/15/23

The book has in depth coverage of academic research. A formal glossary and index were not included. read more

Comprehensiveness rating: 4 see less

The book has in depth coverage of academic research. A formal glossary and index were not included.

The book appears error free and factual.

The content is current and would support students who are pursuing writing academic research papers.

Excellent explanations for specific terms were included throughout the text.

The text is easy to follow with a standardized format and structure.

The text contains headings and topics in each section.

It is easy to follow the format and review each section.

Interface rating: 5

The associated links were useful and not distracting.

No evidence of grammatical errors were found in the book.

The book is inclusive.

The book was informative, easy to follow, and sequential allowing the reader to digest each section before moving into another.

Reviewed by Jenny Inker, Assistant Professor, Virginia Commonwealth University on 8/23/22

This book provides a comprehensive yet easily comprehensible introduction to critical thinking in academic research. The author lays a foundation with an introduction to the concepts of critical thinking and analyzing and making arguments, and... read more

This book provides a comprehensive yet easily comprehensible introduction to critical thinking in academic research. The author lays a foundation with an introduction to the concepts of critical thinking and analyzing and making arguments, and then moves into the details of developing research questions and identifying and appropriately using research sources. There are many wonderful links to other open access publications for those who wish to read more or go deeper.

The content of the book appears to be accurate and free of bias.

The examples used throughout the book are relevant and up-to-date, making it easy to see how to apply the concepts in real life.

The text is very accessibly written and the content is presented in a simple, yet powerful way that helps the reader grasp the concepts easily. There are many short, interactive exercises scattered throughout each chapter of the book so that the reader can test their own knowledge as they go along. It would be even better if the author had provided some simple feedback explaining why quiz answers are correct or incorrect in order to bolster learning, but this is a very minor point and the interactive exercises still work well without this.

The book appears consistent throughout with regard to use of terminology and tone of writing. The basic concepts introduced in the early chapters are used consistently throughout the later chapters.

This book has been wonderfully designed into bite sized chunks that do not overwhelm the reader. This is perhaps its best feature, as this encourages the reader to take in a bit of information, digest it, check their understanding of it, and then move on to the next concept. I loved this!

The book is organized in a manner that introduces the basic architecture of critical thinking first, and then moves on to apply it to the subject of academic research. While the entire book would be helpful for college students (undergraduates particularly), the earlier chapters on critical thinking and argumentation also stand well on their own and would be of great utility to students in general.

This book was extremely easy to navigate with a clear, drop down list of chapters and subheadings on the left side of the screen. When the reader clicks on links to additional material, these open up in a new tab which keeps things clear and organized. Images and charts were clear and the overall organization is very easy to follow.

I came across no grammatical errors in the text.

Cultural Relevance rating: 4

This is perhaps an area where the book could do a little more. I did not come across anything that seemed culturally insensitive or offensive but on the other hand, the book might have taken more opportunities to represent a greater diversity of races, ethnicities, and backgrounds.

This book seems tailor made for undergraduate college students and I would highly recommend it. I think it has some use for graduate students as well, although some of the examples are perhaps little basic for this purpose. As well as using this book to guide students on doing academic research, I think it could also be used as a very helpful introduction to the concept of critical thinking by focusing solely on chapters 1-4.

Table of Contents

  • Introduction
  • Part I. What is Critical Thinking?
  • Part II. Barriers to Critical Thinking
  • Part III. Analyzing Arguments
  • Part IV. Making an Argument
  • Part V. Research Questions
  • Part VI. Sources and Information Needs
  • Part VII. Types of Sources
  • Part VIII. Precision Searching
  • Part IX. Evaluating Sources
  • Part X. Ethical Use and Citing Sources
  • Part XI. Copyright Basics
  • Works Cited
  • About the Authors

Ancillary Material

About the book.

Critical Thinking in Academic Research - 2nd Edition provides examples and easy-to-understand explanations to equip students with the skills to develop research questions, evaluate and choose the right sources, search for information, and understand arguments. This 2nd Edition includes new content based on student feedback as well as additional interactive elements throughout the text.

About the Contributors

Cindy Gruwell is an Assistant Librarian/Coordinator of Scholarly Communication at the University of West Florida. She is the library liaison to the department of biology and the College of Health which has extensive nursing programs, public health, health administration, movement, and medical laboratory sciences. In addition to supporting health sciences faculty, she oversees the Argo IRCommons (Institutional Repository) and provides scholarly communication services to faculty across campus. Cindy graduated with her BA (history) and MLS from the University of California, Los Angeles and has a Masters in Education from Bemidji State University. Cindy’s research interests include academic research support, publishing, and teaching.

Robin Ewing is a Professor/Collections Librarian at St. Cloud State University. Robin is the liaison to the College of Education and Learning Design. She oversees content selection for the Library’s collections. Robin graduated with her BBA (Management) and MLIS from the University of Oklahoma. She also has a Masters of Arts in Teaching from Bemidji State University. Robin’s research interests include collection analysis, assessment, and online teaching.

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The Importance of Critical Thinking Skills in Research

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Why is Critical Thinking Important: A Disruptive Force

Research anxiety seems to be taking an increasingly dominant role in the world of academic research. The pressure to publish or perish can warp your focus into thinking that the only good research is publishable research!

Today, your role as the researcher appears to take a back seat to the perceived value of the topic and the extent to which the results of the study will be cited around the world. Due to financial pressures and a growing tendency of risk aversion, studies are increasingly going down the path of applied research rather than basic or pure research . The potential for breakthroughs is being deliberately limited to incremental contributions from researchers who are forced to worry more about job security and pleasing their paymasters than about making a significant contribution to their field.

A Slow Decline

So what lead the researchers to their love of science and scientific research in the first place? The answer is critical thinking skills. The more that academic research becomes governed by policies outside of the research process, the less opportunity there will be for researchers to exercise such skills.

True research demands new ideas , perspectives, and arguments based on willingness and confidence to revisit and directly challenge existing schools of thought and established positions on theories and accepted codes of practice. Success comes from a recursive approach to the research question with an iterative refinement based on constant reflection and revision.

The importance of critical thinking skills in research is therefore huge, without which researchers may even lack the confidence to challenge their own assumptions.

A Misunderstood Skill

Critical thinking is widely recognized as a core competency and as a precursor to research. Employers value it as a requirement for every position they post, and every survey of potential employers for graduates in local markets rate the skill as their number one concern.

Related: Do you have questions on research idea or manuscript drafting? Get personalized answers on the FREE Q&A Forum!

When asked to clarify what critical thinking means to them, employers will use such phrases as “the ability to think independently,” or “the ability to think on their feet,” or “to show some initiative and resolve a problem without direct supervision.” These are all valuable skills, but how do you teach them?

For higher education institutions in particular, when you are being assessed against dropout, graduation, and job placement rates, where does a course in critical thinking skills fit into the mix? Student Success courses as a precursor to your first undergraduate course will help students to navigate the campus and whatever online resources are available to them (including the tutoring center), but that doesn’t equate to raising critical thinking competencies.

The Dependent Generation

As education becomes increasingly commoditized and broken-down into components that can be delivered online for maximum productivity and profitability, we run the risk of devaluing academic discourse and independent thought. Larger class sizes preclude substantive debate, and the more that content is broken into sound bites that can be tested in multiple-choice questions, the less requirement there will be for original thought.

Academic journals value citation above all else, and so content is steered towards the type of articles that will achieve high citation volume. As such, students and researchers will perpetuate such misuse by ensuring that their papers include only highly cited works. And the objective of high citation volume is achieved.

We expand the body of knowledge in any field by challenging the status quo. Denying the veracity of commonly accepted “facts” or playing devil’s advocate with established rules supports a necessary insurgency that drives future research. If we do not continue to emphasize the need for critical thinking skills to preserve such rebellion, academic research may begin to slowly fade away.

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Search catalog, critical thinking and academic research: intro.

  • Information
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  • Implications

Critical Thinking and Academic Research

Academic research focuses on the creation of new ideas, perspectives, and arguments. The researcher seeks relevant information in articles, books, and other sources, then develops an informed point of view within this ongoing "conversation" among researchers.

The research process is not simply collecting data, evidence, or "facts," then piecing together this preexisting information into a paper. Instead, the research process is about inquiry—asking questions and developing answers through serious critical thinking and thoughtful reflection.

As a result, the research process is recursive, meaning that the researcher regularly revisits ideas, seeks new information when necessary, and reconsiders and refines the research question, topic, or approach. In other words, research almost always involves constant reflection and revision.

This guide is designed to help you think through various aspects of the research process. The steps are not sequential, nor are they prescriptive about what steps you should take at particular points in the research process. Instead, the guide should help you consider the larger, interrelated elements of thinking involved in research.

Research Anxiety?

Research is not often easy or straightforward, so it's completely normal to feel anxious, frustrated, or confused. In fact, if you feel anxious, it can be a good sign that you're engaging in the type of critical thinking necessary to research and write a high-quality paper.

Think of the research process not as one giant, impossibly complicated task, but as a series of smaller, interconnected steps. These steps can be messy, and there is not one correct sequence of steps that will work for every researcher. However, thinking about research in small steps can help you be more productive and alleviate anxiety.

Paul-Elder Framework

This guide is based on the "Elements of Reasoning" from the Paul-Elder framework for critical thinking. For more information about the Paul-Elder framework, click the link below.

Some of the content in this guide has been adapted from The Aspiring Thinker's Guide to Critical Thinking (2009) by Linda Elder and Richard Paul.

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Research in Critical Thinking

Each year it sponsors an annual International Conference on Critical Thinking and Educational Reform. It has worked with the College Board, the National Education Association, the U.S. Department of Education, as well as numerous colleges, universities, and school districts to facilitate the implementation of critical thinking instruction focused on intellectual standards.

The following three studies demonstrate:

  • the fact that, as a rule, critical thinking is not presently being effectively taught at the high school, college and university level, and yet
  • it is possible to do so.

To assess students' understanding of critical thinking, we recommend use of the International Critical Thinking Test as well as the Critical Thinking Interview Profile for College Students . To assess faculty understanding of critical thinking and its importance to instruction, we recommend the Critical Thinking Interview Profile For Teachers and Faculty . By registering as a member of the community, you will have access to streaming video, which includes a sample student interview with Dr. Richard Paul and Rush Cosgrove.


View Abstract  -  View Full Dissertation (Adobe Acrobat PDF)

  A Critical Analysis of Richard Paul's Substantive Trans-disciplinary Conception of Critical Thinking

by Enoch Hale, Ph.D.

Union Institute & University - Cincinnati, Ohio - October 2008

View Abstract      Dissertation Table of Contents

Effect of a Model for Critical Thinking on Student Achievement in Primary Source Document Analysis and Interpretation, Argumentative Reasoning, Critical Thinking Dispositions and History Content in a Community College History Course Abstract of the Study, conducted by Jenny Reed, in partial fulfillment for her dissertation (October 26, 1998) View Abstract   -   View Full Dissertation (Adobe Acrobat PDF)

The Effect of Richard Paul's Universal Elements and Standards of Reasoning on Twelfth Grade Composition A Research Proposal Presented to the Faculty Of the School of Education Alliant International University In Partial Fulfillment of the Requirements for the Degree of Master of Arts in Education: Teaching Study conducted by J. Stephen Scanlan, San Diego (2006) View Abstract   -    View Full Dissertation (Adobe Acrobat PDF)

Study of 38 Public Universities and 28 Private Universities To Determine Faculty Emphasis on Critical Thinking In Instruction

Principal Researchers: Dr. Richard Paul, Dr. Linda Elder, and Dr. Ted Bartell

View Abstract    -    View the full study

Substantive Critical Thinking as Developed by the Foundation for Critical Thinking Proves Effective in Raising SAT and ACT Test Scores at West Side High School:  Staff Development Program Utilizes Critical Thinking Instruction to Improve Student Performance on ACT and SAT Tests, and in Critical Reading, Writing and Math Dr.   John Crook, West Side High School Principal View the Report

Teaching Critical Thinking Skills to Fourth Grade Students Identified as Gifted and Talented by Debra Connerly Graceland University - Cedar Rapids, Iowa - December 2006 View the Report

The Loss of the Space Shuttle Columbia: Portaging Leadership Lessons with a Critical Thinking Model

by Rob Niewoehner, Ph.D. U.S. Navy Graceland University - Cedar Rapids, Iowa - December 2006 View the Report

critical thinking skills research

Course details

Problem solving and critical thinking.

The ability to problem solve and think critically has never been more important. As the speed of decision making and the accuracy of information vary across both personal and organisational life, having the chance to problem solve is difficult. Thinking critically is hugely important to balance longer term consequences with current day action, avoiding the ramifications of poor decision making in an instant. 

Critical Thinking is therefore a vital skill to learn, practice and refresh.

By following a disciplined process, understanding what critical thinking is and why it can be so difficult, this interactive day event will allow you to raise issues or challenges you currently have and use new tools to think these through from an unbiased perspective.

Please note: this event will close to enrolments at 23:59 UTC on 26 February 2025.

Programme details

10.15am Registration at Rewley House reception

10.30am Problem solving: what is a problem and how to define it?

11.45am Tea/coffee

12.15pm Problem solving: tools and tips

1.30pm Lunch

2.30pm Critical thinking: how we as humans think and process information 

3.45pm Tea/coffee

4.15pm Critical thinking: tools and tips to improve 

5.30pm End of day

Recommended reading

Conn, C., Bulletproof Problem-Solving  (Wiley March, 2019) 

Atkinson, I., The Creative Problem Solver  (Pearson Business, 2014)

Kahneman, D., Thinking, Fast and Slow (Penguin, 2012)

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critical thinking skills research

  • Open access
  • Published: 28 June 2024

Perceived efficacy of case analysis as an assessment method for clinical competencies in nursing education: a mixed methods study

  • Basma Mohammed Al Yazeedi   ORCID: orcid.org/0000-0003-2327-6918 1 ,
  • Lina Mohamed Wali Shakman 1 ,
  • Sheeba Elizabeth John Sunderraj   ORCID: orcid.org/0000-0002-9171-7239 1 ,
  • Harshita Prabhakaran   ORCID: orcid.org/0000-0002-5470-7066 1 ,
  • Judie Arulappan 1 ,
  • Erna Judith Roach   ORCID: orcid.org/0000-0002-5817-8886 1 ,
  • Aysha Al Hashmi 1 , 2 &
  • Zeinab Al Azri   ORCID: orcid.org/0000-0002-3376-9380 1  

BMC Nursing volume  23 , Article number:  441 ( 2024 ) Cite this article

Metrics details

Case analysis is a dynamic and interactive teaching and learning strategy that improves critical thinking and problem-solving skills. However, there is limited evidence about its efficacy as an assessment strategy in nursing education.

This study aimed to explore nursing students’ perceived efficacy of case analysis as an assessment method for clinical competencies in nursing education.

This study used a mixed methods design. Students filled out a 13-item study-advised questionnaire, and qualitative data from the four focus groups was collected. The setting of the study was the College of Nursing at Sultan Qaboos University, Oman. Descriptive and independent t-test analysis was used for the quantitative data, and the framework analysis method was used for the qualitative data.

The descriptive analysis of 67 participants showed that the mean value of the perceived efficacy of case analysis as an assessment method was 3.20 (SD = 0.53), demonstrating an 80% agreement rate. Further analysis indicated that 78.5% of the students concurred with the acceptability of case analysis as an assessment method (mean = 3.14, SD = 0.58), and 80.3% assented its association with clinical competencies as reflected by knowledge and cognitive skills (m = 3.21, SD = 0.60). No significant difference in the perceived efficacy between students with lower and higher GPAs (t [61] = 0.05, p  > 0.05) was identified Three qualitative findings were discerned: case analysis is a preferred assessment method for students when compared to MCQs, case analysis assesses students’ knowledge, and case analysis assesses students’ cognitive skills.


This study adds a potential for the case analysis to be acceptable and relevant to the clinical competencies when used as an assessment method. Future research is needed to validate the effectiveness of case analysis exams in other nursing clinical courses and examine their effects on academic and clinical performance.

Peer Review reports


Nurses play a critical role in preserving human health by upholding core competencies [ 1 ]. Clinical competence in nursing involves a constant process of acquiring knowledge, values, attitudes, and abilities to deliver safe and high-quality care [ 2 , 3 ]. Nurses possessing such competencies can analyze and judge complicated problems, including those involving crucial patient care, ethical decision-making, and nurse-patient disputes, meeting the constantly altering health needs [ 4 , 5 ]. To optimize the readiness of the new graduates for the challenging clinical work environment needs, nurse leaders call for integrating clinical competencies into the nursing curriculum [ 6 , 7 ] In 2021, the American Association of Colleges of Nursing (AACN) released updated core competencies for professional nursing education [ 8 ]. These competencies were classified into ten fundamental essentials, including knowledge of nursing practice and person-centered care (e.g. integrate assessment skills in practice, diagnose actual or potential health problems and needs, develop a plan of care), representing clinical core competencies.

Nursing programs emphasize clinical competencies through innovative and effective teaching strategies, including case-based teaching (CBT) [ 9 ]. CBT is a dynamic teaching method that enhances the focus on learning goals and increases the chances of the instructor and students actively participating in teaching and learning [ 10 , 11 ]. Additionally, it improves the students’ critical thinking and problem-solving skills and enriches their capacity for independent study, cooperation capacity, and communication skills [ 12 , 13 , 14 , 15 ]. It also broadens students’ perspectives and helps develop greater creativity in fusing theory and practice [ 16 , 17 , 18 , 19 , 20 ]. As the learning environment significantly impacts the students’ satisfaction, case analysis fosters a supportive learning atmosphere and encourages active participation in learning, ultimately improving their satisfaction [ 21 , 22 ].

In addition to proper teaching strategies for clinical competencies, programs are anticipated to evaluate the students’ attainment of such competencies through effective evaluation strategies [ 23 ]. However, deploying objective assessment methods for the competencies remains challenging for most educators [ 24 ]. The standard assessment methods used in clinical nursing courses, for instance, include clinical evaluations (direct observation), skills checklists, Objective Structured Clinical Examination (OSCE), and multiple-choice questions (MCQs) written exams [ 25 ]. MCQs tend to test the recall of factual information rather than the application of knowledge and cognitive skills, potentially leading to assessment inaccuracies [ 26 ].

Given the aforementioned outcomes of CBT, the deployment of case analysis as a clinical written exam is more closely aligned with the course’s expected competencies. A mixed methods study was conducted among forty nursing students at the University of Southern Taiwan study concluded that the unfolding case studies create a safe setting where nursing students can learn and apply their knowledge to safe patient care [ 6 ]. In a case analysis, the patient’s sickness emerges in stages including the signs and symptoms of the disease, urgent care to stabilize the patient, and bedside care to enhance recovery. Thus, unfolding the case with several scenarios helps educators track students’ attained competencies [ 27 ]. However, case analysis as an assessment method is sparsely researched [ 28 ]. A literature review over the past five years yielded no studies investigating case analysis as an assessment method, necessitating new evidence. There remains uncertainty regarding its efficacy as an assessment method, particularly from the students’ perspectives [ 29 ]. In this study, we explored the undergraduate nursing students’ perceived efficacy of case analysis as an assessment method for clinical competencies. Results from this study will elucidate the position of case analysis as an assessment method in nursing education. The potential benefits are improved standardization of clinical assessment and the ability to efficiently evaluate a broad range of competencies.

Research design

Mixed-method research with a convergent parallel design was adopted in the study. This approach intends to converge two data types (quantitative and qualitative) at the interpretation stage to ensure an inclusive research problem analysis [ 30 ]. The quantitative aspect of the study was implemented through a cross-sectional survey. The survey captured the perceived efficacy of using case analysis as an assessment method in clinical nursing education. The qualitative part of the study was carried out through a descriptive qualitative method using focus groups to provide an in-depth understanding of the perceived strengths experienced by the students.

Study setting

Data were collected in the College of Nursing at Sultan Qaboos University (SQU), Oman, during the Spring and Fall semesters of 2023. At the end of each clinical course, the students have a clinical written exam and a clinical practical exam, which constitute their final exam. Most clinical courses use multiple-choice questions (MCQs) in their written exam. However, the child health clinical course team initiated the case analysis as an assessment method in the clinical written exam, replacing the MCQs format.


For this study, the investigators invited undergraduate students enrolled in the child health nursing clinical course in the Spring and Fall semesters of 2023. Currently, the only course that uses case analysis is child health. Other courses use MCQs. A total enumeration sampling technique was adopted. All the students enrolled in child health nursing clinical courses in the Spring and Fall 2023 semesters were invited to participate in the study. In the Spring, 36 students registered for the course, while 55 students were enrolled in the Fall. We included students who completed the case analysis as a final clinical written exam on the scheduled exam time. Students who did not show up for the exam during the scheduled time and students not enrolled in the course during the Spring and Fall of 2023 were excluded. Although different cases were used each semester, both had the same structure and level of complexity. Further, both cases were peer-reviewed.

Case analysis format

The format presents open-ended questions related to a clinical case scenario. It comprises three main sections: Knowledge, Emergency Room, and Ward. The questions in the sections varied in difficulty based on Bloom’s cognitive taxonomy levels, as presented in Table  1 . An answer key was generated to ensure consistency among course team members when correcting the exam. Three experts in child health nursing peer-reviewed both the case analysis exam paper and the answer key paper. The students were allocated two hours to complete the exam.

Study instruments

Quantitative stage.

The researchers developed a study questionnaire to meet the study objectives. It included two parts. The first was about the demographic data, including age, gender, type of residence, year in the program, and cumulative grade point average (GPA). The second part comprised a 13-item questionnaire assessing the perceived efficacy of case analysis as an assessment method. The perceived efficacy was represented by the acceptability of case analysis as an assessment method (Items 1–5 and 13) and the association with clinical competencies (Items 6 to 12). Acceptability involved format organization and clarity, time adequacy, alignment with course objectives, appropriateness to students’ level, and recommendation for implementation in other clinical nursing courses. Clinical competencies-related items were relevant to knowledge (motivation to prepare well for the exam, active learning, interest in topics, collaboration while studying) and cognitive skills (critical thinking, decision-making, and problem-solving skills) (The questionnaire is attached as a supplementary document).

The questionnaire is answered on a 4-point Likert scale: 1 = strongly disagree, 2 = disagree, 3 = agree, 4 = strongly agree. Higher scores indicated better perceived efficacy and vice versa. The tool underwent content validity testing with five experts in nursing clinical education, resulting in an item-content validity index ranging from 0.7 to 1. The Cronbach alpha was 0.83 for acceptability and 0.90 for clinical competencies.

Qualitative stage

For the focus group interviews, the investigators created a semi-structured interview guide to obtain an in-depth understanding of the students’ perceived strengths of case analysis as an assessment method. See Table  2 .

Data collection

Data was collected from the students after they gave their written informed consent. Students were invited to fill out the study questionnaire after they completed the case analysis as a clinical written exam.

All students in the child health course were invited to participate in focus group discussions. Students who approached the PI to participate in the focus group discussion were offered to participate in four different time slots. So, the students chose their time preferences. Four focus groups were conducted in private rooms at the College of Nursing. Two trained and bilingual interviewers attended the focus groups, one as a moderator while the other took notes on the group dynamics and non-verbal communication. The discussion duration ranged between 30 and 60 min. After each discussion, the moderator transcribed the audio recording. The transcriptions were rechecked against the audio recording for accuracy. Later, the transcriptions were translated into English by bilingual researchers fluent in Arabic and English for the analysis.

Rigor and trustworthiness

The rigor and trustworthiness of the qualitative method were enhanced using multiple techniques. Firstly, quantitative data, literature reviews, and focus groups were triangulated. Participants validated the summary after each discussion using member checking to ensure the moderator’s understanding was accurate. Third, the principal investigator (PI) reflected on her assumptions, experiences, expectations, and feelings weekly. In addition, the PI maintained a detailed audit trail of study details and progress. The nursing faculty conducted the study with experience in qualitative research and nursing education. This report was prepared following the Standard for Reporting Qualitative Research (SRQR) protocol [ 31 ].

Data analysis

Quantitative data were entered in SPSS version 24 and analyzed using simple descriptive analysis using means, standard deviations, and percentages. After computing the means of each questionnaire item, an average of the means was calculated to identify the perceived efficacy rate. A similar technique was used to calculate the rate of acceptability and clinical competencies. The percentage was calculated based on the mean: gained score/total score* 100. In addition, the investigators carried out an independent t-test to determine the relationship between the perceived efficacy and students’ GPA.

The qualitative data were analyzed using the framework analysis method. In our analysis, we followed the seven interconnected stages of framework analysis: (1) transcription, (2) familiarization with the interview, (3) coding, (4) developing a working analytical framework, (5) applying the analytical framework, (6) charting data into framework matrix and (7) interpreting the data [ 32 ]. Two members of the team separately analyzed the transcriptions. Then, they discussed the coding, and discrepancies were solved with discussion.

Mixed method integration

In our study, the quantitative and qualitative data were analyzed separately, and integration occurred at the interpretation level by merging the data [ 33 ]. As a measure of integration between qualitative and quantitative data, findings were assessed through confirmation, expansion, and discordance. If both data sets confirmed each other’s findings, it was considered confirmation, and if they expanded each other’s insight, it was considered expansion. Discordance was determined if the findings were contradictory.

Ethical considerations

Ethical approval was obtained from the Research and Ethics Committee of the College of Nursing, SQU (CON/NF/2023/18). Informed consent was collected, and no identifiable information was reported. For the focus group interviews, students were reassured that their grades were finalized, and their participation would not affect their grades. Also, the interviewers were instructed to maintain a non-judgmental and non-biased position during the interview. Data were saved in a locked cabinet inside a locked office room. The electronic data were saved in a password-protected computer.

The results section will present findings from the study’s quantitative and qualitative components. The integration of the two data types is described after each qualitative finding.

Quantitative findings

We analyzed the data of 67 participants, representing a 73.6% response rate. The mean age was 21.0 years old (SD 0.73) and 36.4% were male students. See Table  3 for more details.

The descriptive analysis showed that the mean value of the perceived efficacy of case analysis as an assessment method was 3.20 (SD = 0.53), demonstrating an 80% agreement rate. Further analysis indicated that 78.5% of the students concurred the acceptability of case analysis as an assessment method (mean = 3.14, SD = 0.58) and 80.3% (m = 3.21, SD = 0.60) assented the clinical competencies associated with it.

For the items representing acceptability, 81.8% of the students agreed that the case analysis was written clearly, and 80.3% reported that it was well organized. As per the questions, 81% described they were appropriate to their level, and 79.8% agreed upon their alignment with the course objectives. Moreover, the time allocated was adequate for 74.5% of the students, and 73.5% recommend using case analysis as an evaluation strategy for other clinical written examinations.

Regarding the clinical competencies, 77.3% of students agreed that the case analysis motivated them to prepare well for the exam, 81.3% reported that it encouraged them to be active in learning, and 81.0% indicated that it stimulated their interest in the topics discussed in the course. Additionally, 76.5% of the students agreed that the case analysis encouraged them to collaborate with other students when studying for the exam. Among the students, 82.5% reported that the case analysis as an assessment method enhanced their critical thinking skills, 81.0% agreed that it helped them practice decision-making skills, and 81.8% indicated that it improved their problem-solving abilities. See Table  4 .

The independent t-test analysis revealed no significant difference in the perceived efficacy between students with lower and higher GPAs (t [61] = 0.05, p  > 0.05). Further analysis showed that the means of acceptability and clinical competencies were not significantly different between the lower GPA group and higher GPA group, t [62] = 0.72, p  > 0.05 and t [63] = -0.83, p  > 0.05, respectively (Table  5 ).

Qualitative findings

A total of 22 had participated in four focus groups, each group had 5–6 students. The qualitative framework analysis revealed three main findings; case analysis is a preferred assessment method to students when compared to MCQs, case analysis assesses students’ knowledge, and case analysis assesses students’ cognitive skills.

Qualitative Finding 1: case analysis is a preferred assessment method to students when compared to MCQs

Most of the students’ statements about the case analysis as an assessment method were positive. One student stated, “Previously, we have MCQs in clinical exams, but they look as if they are theory exams. This exam makes me deal with cases like a patient, which is good for clinical courses.” . At the same time, many students conveyed optimism about obtaining better grades with this exam format. A student stated, “Our grades, with case analysis format, will be better, … may be because we can write more in open-ended questions, so we can get some marks, in contrast to MCQs where we may get it right or wrong” . On the other hand, a few students suggested adding multiple-choice questions, deleting the emergency department section, and lessening the number of care plans in the ward section to secure better grades.

Although the case analysis was generally acceptable to students, they have repeatedly expressed a need to allocate more time for this type of exam. A student stated, “The limited time with the type of questions was a problem, …” . When further discussion was prompted to understand this challenge, we figured that students are not used to handwriting, which has caused them to be exhausted during the exam. An example is “writing is time-consuming and energy consuming in contrast to MCQs …” . These statements elucidate that the students don’t necessarily mind writing but recommend more practice as one student stated, “More experience of this type of examination is required, more examples during clinical practice are needed.” Some even recommended adopting this format with other clinical course exams by saying “It’s better to start this method from the first year for the new cohort and to apply it in all other courses.”

Mixed Methods Inference 1: Confirmation and Expansion

The abovementioned qualitative impression supports the high acceptability rate in quantitative analysis. In fact, there is a general agreement that the case analysis format surpasses the MCQs when it comes to the proper evaluation strategies for clinical courses. Expressions in the qualitative data revealed more details, such as the limited opportunities to practice handwriting, which negatively impacted the perceived adequacy of exam time.

Qualitative Finding 2: case analysis assesses students’ knowledge

Students conferred that they were reading more about the disease pathophysiology, lab values, and nursing care plans, which they did not usually do with traditional means of examination. Examples of statements include “… before we were not paying attention to the normal lab results but …in this exam, we went back and studied them which was good for our knowledge” and “we cared about the care plan. In previous exams, we were not bothered by these care plans”. Regarding the burden that could be perceived with this type of preparation, the students expressed that this has helped them prepare for the theory course exam; as one student said, “We also focus on theory lectures to prepare for this exam …. this was very helpful to prepare us for the theory final exam as well.” However, others have highlighted the risks of limiting the exam’s content to one case analysis. The argument was that some students may have not studied the case completely or been adequately exposed to the case in the clinical setting. To solve this risk, the students themselves advocated for frequent case group discussions in the clinical setting as stated by one student: “There could be some differences in the cases that we see during our clinical posting, for that I recommend that instructors allocate some time to gather all the students and discuss different cases.” Also, the participants advocated for more paper-based case analysis exercises as it is helpful to prepare them for the exams and enhance their knowledge and skills.

Mixed Methods Inferences 2: Confirmation and Expansion

The qualitative finding supports the quantitative data relevant to items 6, 7, and 8. Students’ expressions revealed more insights, including the acquisition of deeper knowledge, practicing concept mapping, and readiness for other course-related exams. At the same time, students recommended that faculty ensure all students’ exposure to common cases in the clinical setting for fair exam preparation.

Qualitative Finding 3. case analysis assesses students’ cognitive skills

Several statements conveyed how the case analysis format helped the students use their critical thinking and analysis skills. One student stated, “It, the case analysis format, enhanced our critical thinking skills as there is a case with given data and we analyze the case….” . Therefore, the case analysis format as an exam is potentially a valid means to assess the student’s critical thinking skills. Students also conveyed that the case analysis format helped them link theory to practice and provided them with the platform to think like real nurses and be professional. Examples of statements are: “…we connect our knowledge gained from theory with the clinical experience to get the answers…” and “The questions were about managing a case, which is what actual nurses are doing daily.” Another interesting cognitive benefit to case analysis described by the students was holistic thinking. For example, one student said, “Case analysis format helped us to see the case as a whole and not only from one perspective.”

Mixed Methods Inferences 3: Confirmation

The quantitative data indicated mutual agreement among the students that the case analysis enhanced their critical thinking, decision-making, and problem-solving skills. The students’ statements from the interviews, including critical thinking, linking theory to practice, and holistic thinking, further supported these presumptions.

This research presents the findings from a mixed methods study that explored undergraduate nursing students’ perceived efficacy of using case analysis as an assessment method. The perceived efficacy was reflected through acceptability and association with two core competencies: knowledge and cognitive skills. The study findings showed a high rate of perceived efficacy of case analysis as an assessment method among nursing students. Additionally, three findings were extracted from the qualitative data that further confirmed the perceived efficacy: (1) case analysis is a preferred assessment method to students compared to MCQs, (2) case analysis assesses students’ knowledge, and (3) case analysis assesses students’ cognitive skills. Moreover, the qualitative findings revealed details that expanded the understanding of the perceived efficacy among nursing students.

Previous literature reported students’ preference for case analysis as a teaching method. A randomized controlled study investigated student’s satisfaction levels with case-based teaching, in addition to comparing certain outcomes between a traditional teaching group and a case-based teaching group. They reported that most students favored the use of case-based teaching, whom at the same time had significantly better OSCE scores compared to the other group [ 34 ]. As noted, this favorable teaching method ultimately resulted in better learning outcomes and academic performance. Although it may be challenging since no answer options are provided, students appreciate the use of case analysis format in their exams because it aligns better with the course objectives and expected clinical competencies. The reason behind students’ preference for case analysis is that it allows them to interact with the teaching content and visualize the problem, leading to a better understanding. When case analysis is used as an assessment method, students can connect the case scenario presented in the exam to their clinical training, making it more relevant.

In this study, students recognized the incorporation of nursing knowledge in the case analysis exam. They also acknowledged improved knowledge and learning abilities similar to those observed in case-based teaching. Boney et al. (2015) reported that students perceived increased learning gains and a better ability to identify links between different concepts and other aspects of life through case-based teaching [ 35 ]. Additionally, case analysis as an exam promotes students’ in-depth acquirement of knowledge through the type of preparation it entails. Literature suggested that case-based teaching promotes self-directed learning with high autonomous learning ability [ 34 , 36 ]. Thus, better achievement in the case analysis exam could be linked with a higher level of knowledge, making it a suitable assessment method for knowledge integration in nursing care.

The findings of this study suggest that case analysis can be a useful tool for evaluating students’ cognitive skills, such as critical thinking, decision-making, and problem-solving. A randomized controlled study implied better problem-solving abilities among the students in the case-based learning group compared to those in the traditional teaching methods group [ 12 ]. Moreover, students in our study conveyed that case analysis as an exam was an opportunity for them to think like real nurses. Similar to our findings, a qualitative study on undergraduate nutrition students found that case-based learning helped students develop professional competencies for their future practice, in addition to higher-level cognitive skills [ 37 ]. Therefore, testing students through case analysis allows educators to assess the student’s readiness for entry-level professional competencies, including the thinking process. Also, to evaluate students’ high-level cognitive skills according to Bloom’s taxonomy (analysis, synthesis, and evaluation), which educators often find challenging.

Case analysis as an assessment method for clinical courses is partially integrated in case presentation or OSCE evaluation methods. However, the written format is considered to be more beneficial for both assessment and learning processes. A qualitative study was conducted to examine the impact of paper-based case learning versus video-based case learning on clinical decision-making skills among midwifery students. The study revealed that students paid more attention and were able to focus better on the details when the case was presented in a paper format [ 38 ]. Concurrently, the students in our study recommended more paper-based exercises, which they believed would improve their academic performance.

This study has possible limitations. The sample size was small due to the limited experience of case analysis as a clinical written exam in the program. Future studies with larger sample sizes and diverse nursing courses are needed for better generalizability.


Little evidence relates to the efficacy of case analysis as an evaluation method, suggesting the novelty of this study. Despite the scarcity of case-based assessment studies, a reader can speculate from this study’s findings that there is a potential efficacy of case analysis as an assessment method in nursing education. Future research is warranted to validate the effectiveness of case-analysis assessment methods and investigate the effects of case-analysis exams on academic and clinical performance.

Overall, our findings are in accordance with the evidence suggesting students’ perceived efficacy of case analysis as a teaching method. This study adds a potential for the case analysis to be acceptable and relevant to the clinical competencies when used as an assessment method. Future research is needed to validate the effectiveness of case analysis exams in other nursing clinical courses and examine their effects on academic and clinical performance.

Data availability

The datasets used and/or analyzed during the current study are available fromthe Principal Investigator (BAY) upon reasonable request.

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The authors wish to thank the nursing students at SQU who voluntarily participated in this study.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Basma Mohammed Al Yazeedi, Lina Mohamed Wali Shakman, Sheeba Elizabeth John Sunderraj, Harshita Prabhakaran, Judie Arulappan, Erna Judith Roach, Aysha Al Hashmi & Zeinab Al Azri

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Dr. Basma Mohammed Al Yazeedi contributed to conceptualization, methods, data collection, data analysis, writing the draft, and reviewing the final draft. Ms. Lina Mohamed Wali Shakman contributed to conceptualization, data collection, data analysis, writing the draft, and reviewing the final draft. Ms. Sheeba Elizabeth John Sunderraj contributed to conceptualization, methods, data collection, writing the draft, and reviewing the final draft.Ms. Harshita Prabhakaran contributed to conceptualization, data collection, writing the draft, and reviewing the final draft.Dr. Judie Arulappan contributed to conceptualization and reviewing the final draft.Dr. Erna Roach contributed to conceptualization writing the draft and reviewing the final draft.Ms. Aysha Al Hashmi contributed to the conceptualization and reviewing the final draft. Dr. Zeinab Al Azri contributed to data collection, data analysis, writing the draft, and reviewing the final draft.All auhors reviewed and approved the final version of the manuscirpt.

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The study was conducted in accordance with the Declaration of Helsinki. Ethical approval was obtained from the Research and Ethics Committee of the College of Nursing, Sultan Qaboos University SQU (CON/NF/2023/18). All data was held and stored following the SQU data policy retention. Informed consent to participate was obtained from all of the participants in the study.

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Yazeedi, B.M.A., Shakman, L.M.W., Sunderraj, S.E.J. et al. Perceived efficacy of case analysis as an assessment method for clinical competencies in nursing education: a mixed methods study. BMC Nurs 23 , 441 (2024). https://doi.org/10.1186/s12912-024-02102-9

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Investigating the impact of mobile interaction gamification on 4C skills: Perspective from student at vocational higher education in Indonesia

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The realm of education has a highly significant impact on advancing civilization in a country. Various factors have been studied and proven to enhance different skills in the educational sector, including gamification aspects. The popularity of gamification has become a trend as a tool to create an engaging learning environment for students. Students show high interest and engagement when a subject is associated with gamification. While many studies have examined 21st-century skills, precisely the 4C skills of critical thinking, creative thinking, communication, and collaboration, few have yet to explore their connection with gamification, especially in higher education in Indonesia. This study aims to investigate students' opinions about the effects of gamification on 4C skills. The method involved an investigation through questionnaires with 105 students, comprising 25 questions on a 5-point Likert scale, and structured interviews with students meeting specific criteria. The findings indicate that several aspects of the 4C skills strongly relate to students' gaming habits, particularly critical thinking and creative thinking skills. However, gaming habits have a meagre impact on communication and collaboration skills, suggesting that not all components of the 4C skills can be enhanced through gamification. In addition, most of the 4C skills, critical thinking, creative thinking, communication, and collaboration, could see enhanced effectiveness through targeted strategies and practices. Further studies are recommended to explore using practical materials in several courses to test gamification through evaluations or other learning media.

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A long tradition at Minneapolis College is offering transformative research opportunities focusing across disciplines within its STEM programming. Research opportunities not only prepare students for transfer to four-year universities, they support building strong communication, critical thinking, and analytical skills, boosting students’ confidence and awareness through experiential learning, preparing them for future academic work and lifelong careers.

Research opportunities at Minneapolis College start both in and outside of the classroom. Upon completion, student’s share their research at academic conferences and seminars and have their work published. They impact change on multiple levels. 

Some of the research within Minneapolis College is supported by the U.S. National Science Foundation (NSF), Louis Stokes North Star STEM Alliance (LS-NSSA), and the 3M Foundation. The NSF, for example, is an independent federal agency that supports science and engineering in all 50 states and U.S. territories in an effort to spark new ideas and creative approaches that can accelerate discovery and transform knowledge into tangible benefits to society.

A Passion for Microbiology “I’ve been given the opportunity to conduct research in the microbiology department under the great guidance of my advisor and mentor Renu Bhagat Kumar,” said Minneapolis College student Eva Skipwith. “Researching antibiotic resistant bacteria from the aquatic environments of Minnesota, Renu Bhagat Kumar introduced me to my passion for microbiology while also teaching me the foundation and principles of research. These experiences have helped me feel prepared and excited to pursue graduate school in the future. They have even given me extra confidence in my current STEM classes.”

Skipwith shared how being able to conduct research is just one of the many great privileges of being in the NSF program. “With the constant support and encouragement from Dr. Kumar, I was given a chance to build my academic plan for my career as a future scientist in multifaceted ways. One example is having the opportunity to be the first in my family to present research at national conferences such as those in Washington, D.C, while also supporting the work of other scientists. The program and support it provided has given me confidence to know my hard work and academic strengths are noticed, celebrated, encouraged, and are set to finish with upstanding support and success.”

Disability Advocate Creates Accessibility Tool Using USB Technology

After experiencing challenges with his own dexterity and witnessing a neighbor’s daily struggles navigating life from a wheelchair, alum Justin Third, who is known as a disability advocate, became acutely aware of the possibilities of technology to change someone’s life while studying at Minneapolis College. “Many people who navigate life with a disability have challenges that are often invisible to the people around them,” said Justin Third, who aspires to be an advocate for disability rights throughout his lifetime.

And Third’s opportunity to make a larger impact on the lives of people with disabilities arrived when he was chosen by the NSF to receive a grant to support the research, design, and creation of an accessibility tool using USB technology while he was studying at Minneapolis College.

“Minneapolis College not only provided me the platform to pursue my passion in technology, it also challenged me to push my boundaries in academia,” said Third. “Through the unwavering support of ITEC faculty and department chair Brian Huilman, and the backing of the NSF, I delved deep into accessible Bluetooth research, leading to discoveries with the real potential to improve quality of life.”

Justin Third Presenting at the Minnesota State Capitol

The research opportunity empowered Third to present his groundbreaking research at the Minnesota State Capitol and at the inaugural NSF Scholars Meeting in Washington, D.C. More than 1,000 scholars and organizations attended. “I can’t thank NSF enough for their support,” said Third. “I truly am a bigger version of myself for the many opportunities this program gave me.”

 Biol 2205 Genetics - Gene Mapping

 “Having a research opportunity as part of a course makes it easier for all students to build their research skills and do real, interesting science,” said faculty member Maire Sustacek.  “I thoroughly enjoy working with my BIOL 2205 Genetics students, for example, to map insulin signaling genes. We also work with the Genomics Education Partnership to submit students’ work for publication and to-date, we have submitted 19 gene annotation projects for publication with 18 students serving as co-authors.”

One the students, Jesus Romero Lopez, presented his research entitled “DENR: Finding Orthologs in Drosophila Species” which detailed the annotation and phylogenetic analysis of the DENR gene in several Drosophila fruit fly species at St. Catherine University Genomic Research Symposium. DENR is important for insulin signaling in flies, and this work helps build our understanding of how insulin signaling genes evolve over time.   

The National Science Foundation Grants

The NSF awarded Minneapolis College grants to improve Science, Technology, Engineering, and Mathematics (STEM) scholastic and career opportunities for low-income students are under the direction of Kumar.

Still going strong, the project, "Collaborative Research: Partner Relationships to Increase STEM Momentum through Transfer Transition," is a collaboration with other higher institutions led by Augsburg University, with a combined budget of $5 million.

“This project contributes to a national commitment to advance well-educated scientists, mathematicians, engineers, and technicians,” said Kumar. “Undergraduate research and internship experiences provided in transfer pathways support professional development through cross-institutional partnerships and workforce development programs.” 

Kumar, along with Minneapolis team members Carmen Buhler, Dean Ben Weng, and faculty from collaborating institutions like Augsburg University work together to create support structures through mentoring, advising, and improved transfer pathways. High achieving students who have financial need are participating in the initiative to secure opportunities for bachelor’s degrees in biology, chemistry, computer science, engineering, food science, mathematics, and physics.

“Research provides collaborative opportunities for students to be involved in exploring important questions in meaningful and valuable ways advancing knowledge and innovation in all fields,” said Kumar, who recognizes offering research opportunities can improve academic performance, retention, and persistence. “As the world evolves, the need for research grows. Minneapolis College has a long tradition of offering research projects to transform the educational experience for its students and prepare them for their future.”

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Teaching Strategies for Developing Clinical Reasoning Skills in Nursing Students: A Systematic Review of Randomised Controlled Trials

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Background: Clinical reasoning (CR) is a holistic and recursive cognitive process. It allows nursing students to accurately perceive patients’ situations and choose the best course of action among the available alternatives. This study aimed to identify the randomised controlled trials studies in the literature that concern clinical reasoning in the context of nursing students. Methods: A comprehensive search of PubMed, Scopus, Embase, and the Cochrane Controlled Register of Trials (CENTRAL) was performed to identify relevant studies published up to October 2023. The following inclusion criteria were examined: (a) clinical reasoning, clinical judgment, and critical thinking in nursing students as a primary study aim; (b) articles published for the last eleven years; (c) research conducted between January 2012 and September 2023; (d) articles published only in English and Spanish; and (e) Randomised Clinical Trials. The Critical Appraisal Skills Programme tool was utilised to appraise all included studies. Results: Fifteen papers were analysed. Based on the teaching strategies used in the articles, two groups have been identified: simulation methods and learning programs. The studies focus on comparing different teaching methodologies. Conclusions: This systematic review has detected different approaches to help nursing students improve their reasoning and decision-making skills. The use of mobile apps, digital simulations, and learning games has a positive impact on the clinical reasoning abilities of nursing students and their motivation. Incorporating new technologies into problem-solving-based learning and decision-making can also enhance nursing students’ reasoning skills. Nursing schools should evaluate their current methods and consider integrating or modifying new technologies and methodologies that can help enhance students’ learning and improve their clinical reasoning and cognitive skills.

1. Introduction

Clinical reasoning (CR) is a holistic cognitive process. It allows nursing students to accurately perceive patients’ situations and choose the best course of action among the available alternatives. This process is consistent, dynamic, and flexible, and it helps nursing students gain awareness and put their learning into perspective [ 1 ]. CR is an essential competence for nurses’ professional practice. It is considered crucial that its development begin during basic training [ 2 ]. Analysing clinical data, determining priorities, developing plans, and interpreting results are primary skills in clinical reasoning during clinical nursing practise [ 3 ]. To develop these skills, nursing students must participate in caring for patients and working in teams during clinical experiences. Among clinical reasoning skills, we can identify communication skills as necessary for connecting with patients, conducting health interviews, engaging in shared decision-making, eliciting patients’ concerns and expectations, discussing clinical cases with colleagues and supervisors, and explaining one’s reasoning to others [ 4 ].

Educating students in nursing practise to ensure high-quality learning and safe clinical practise is a constant challenge [ 5 ]. Facilitating the development of reasoning is challenging for educators due to its complexity and multifaceted nature [ 6 ], but it is necessary because clinical reasoning must be embedded throughout the nursing curriculum [ 7 ]. Such being the case, the development of clinical reasoning is encouraged, aiming to promote better performance in indispensable skills, decision-making, quality, and safety when assisting patients [ 8 ].

Nursing education is targeted at recognising clinical signs and symptoms, accurately assessing the patient, appropriately intervening, and evaluating the effectiveness of interventions. All these clinical processes require clinical reasoning, and it takes time to develop [ 9 ]. This is a significant goal of nursing education [ 10 ] in contemporary teaching and learning approaches [ 6 ].

Strategies to mitigate errors, promote knowledge acquisition, and develop clinical reasoning should be adopted in the training of health professionals. According to the literature, different methods and teaching strategies can be applied during nursing training, as well as traditional teaching through lectures. However, the literature explains that this type of methodology cannot enhance students’ clinical reasoning alone. Therefore, nursing educators are tasked with looking for other methodologies that improve students’ clinical reasoning [ 11 ], such as clinical simulation. Clinical simulation offers a secure and controlled setting to encounter and contemplate clinical scenarios, establish relationships, gather information, and exercise autonomy in decision-making and problem-solving [ 12 ]. Different teaching strategies have been developed in clinical simulation, like games or case studies. Research indicates a positive correlation between the use of simulation to improve learning outcomes and how it positively influences the development of students’ clinical reasoning skills [ 13 ].

The students of the 21st century utilise information and communication technologies. With their technological skills, organisations can enhance their productivity and achieve their goals more efficiently. Serious games are simulations that use technology to provide nursing students with a safe and realistic environment to practise clinical reasoning and decision-making skills [ 14 ] and can foster the development of clinical reasoning through an engaging and motivating experience [ 15 ].

New graduate nurses must possess the reasoning skills required to handle complex patient situations. Aware that there are different teaching methodologies, with this systematic review we intend to discover which RCTs published focus on CR in nursing students, which interventions have been developed, and their effectiveness, both at the level of knowledge and in increasing clinical reasoning skills. By identifying the different techniques used during the interventions with nursing students in recent years and their effectiveness, it will help universities decide which type of methodology to implement to improve the reasoning skills of nursing students and, therefore, obtain better healthcare results.

This study aims to identify and analyse randomised controlled trials concerning clinical reasoning in nursing students. The following questions guide this literature review:

Which randomised controlled trials have been conducted in the last eleven years regarding nursing students’ clinical reasoning? What are the purposes of the identified RCTs? Which teaching methodologies or strategies were used in the RCTs studies? What were the outcomes of the teaching strategies used in the RCTs?

2. Materials and Methods

This review follows the PRISMA 2020 model statement for systematic reviews. That comprises three documents: the 27-item checklist, the PRISMA 2020 abstract checklist, and the revised flow diagram [ 16 ].

2.1. Search Strategy

A systematic literature review was conducted on PubMed, Scopus, Embase, and the Cochrane Controlled Register of Trials (CENTRAL) up to 15th October 2023.

The PICOS methodology guided the bibliographic search [ 17 ]: “P” being the population (nursing students), “I” the intervention (clinical reasoning), “C” comparison (traditional teaching), “O” outcome (dimension, context, and attributes of clinical reasoning in the students’ competences and the results of the teaching method on nursing students), and “S” study type (RCTs).

The search strategy used in each database was the following: (“nursing students” OR “nursing students” OR “pupil nurses” OR “undergraduate nursing”) AND (“clinical reasoning” OR “critical thinking” OR “clinical judgment”). The filters applied were full text, randomised controlled trial, English, Spanish, and from 1 January 2012 to 15 October 2023. The search strategy was performed using the same process for each database. APP performed the search, and AZ supervised the process.

During the search, the terms clinical reasoning, critical thinking, and clinical judgement were used interchangeably since clinical judgement is part of clinical reasoning and is defined by the decision to act. It is influenced by an individual’s previous experiences and clinical reasoning skills [ 18 ]. Critical thinking and clinical judgement involve reflective and logical thinking skills and play a vital role in the decision-making and problem-solving processes [ 19 ].

The first search was conducted between March and September 2022, and an additional search was conducted during October 2023, adding the new articles published between September 2022 and September 2023, following the same strategy. The search strategy was developed using words from article titles, abstracts, and index terms. Parallel to this process, the PRISMA protocol was used to systematise the collection of all the information presented in each selected article. This systematic review protocol was registered in the international register PROSPERO: CRD42022372240.

2.2. Eligibility Criteria and Study Selection

The following inclusion criteria were examined: (a) clinical reasoning, clinical judgment, and critical thinking in nursing students as a primary aim; (b) articles published in the last eleven years; (c) research conducted between January 2012 and September 2023; (d) articles published only in English and Spanish; and (e) RCTs. On the other hand, the exclusion criteria were studies conducted with students from other disciplines other than nursing, not random studies or review articles.

2.3. Data Collection and Extraction

After this study selection, the following information was extracted from each article: bibliographic information, study aims, teaching methodology, sample size and characteristics, time of intervention, and conclusions.

2.4. Risk of Bias

The two reviewers, APP and AZ, worked independently to minimise bias and mistakes. The titles and abstracts of all papers were screened for inclusion. All potential articles underwent a two-stage screening process based on the inclusion criteria. All citations were screened based on title, abstract, and text. Reviewers discussed the results to resolve minor discrepancies. All uncertain citations were included for full-text review. The full text of each included citation was obtained. Each study was read thoroughly and assessed for inclusion following the inclusion and exclusion criteria explained in the methodology. The CASP tool was utilised to appraise all included studies. The CASP Randomized Controlled Trial Standard Checklist is an 11-question checklist [ 20 ], and the components assessed included the appropriateness of the objective and aims, methodology, study design, sampling method, data collection, reflexivity of the researchers, ethical considerations, data analysis, rigour of findings, and significance of this research. These items of the studies were then rated (“Yes” = with three points; “Cannot tell” = with two points; “No” = with one point). The possible rates for every article were between 0 and 39 points.

2.5. Ethical Considerations

Since this study was a comprehensive, systematic review of the existing published literature, there was no need for us to seek ethical approval.

3.1. Search Results

The initial search identified 158 articles using the above-mentioned strategy (SCOPUS ® n = 72, PUBMED ® n = 56, CENTRAL ® n = 23, and EMBASE ® n= 7), and the results are presented in Figure 1 . After retrieving the articles and excluding 111, 47 were selected for a full reading. Finally, 17 articles were selected. To comply with the methodology, the independent reviewers analysed all the selected articles one more time after the additional search, and they agreed to eliminate two of them because this study sample included nursing students as well as professional nurses. Therefore, to have a clear outcome focused on nursing students, two articles were removed, and the very final sample size was fifteen articles, following the established selection criteria ( Figure 1 ). The reasons for excluding studies from the systematic review were: nurses as targets; other design types of studies different from RCTs; focusing on other health professionals such as medical students; review studies; and being published in full text in other languages other than Spanish or English.

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Flowchart of screening of clinical reasoning RCTs that underwent review.

3.2. Risk of Bias in CASP Results

All studies included in the review were screened with the CASP tool. Each study was scored out of a maximum of 39 points, showing the high quality of the randomised control trial methodology. The studies included had an average score of 33.1, ranging from 30 to 36 points. In addition, this quantitative rate of the items based on CASP, there were 13 studies that missed an item in relation to assessing/analysing outcome/s ‘blinded or not’ or not, and 11 studies that missed the item whether the benefits of the experimental intervention outweigh the harms and costs.

3.3. Data Extraction

Once the articles had undergone a full reading and the inclusion criteria were applied, data extraction was performed with a data extraction table ( Appendix A ). Their contents were summarised into six different cells: (1) CASP total points result, (2) purpose of this study, (3) teaching strategy, (4) time of intervention, (5) sample size, and (6) author and year of publication. After the review by the article’s readers, fifteen RCTs were selected. Of the fifteen, the continent with the highest number of studies was Asia, with 53.33% of the studies (n = 8) (Korea n = 4, Taiwan n = 2, and China n = 2), followed by Europe with 26.66% (n = 4) (Turkey n = 2, Paris n = 1, and Norway n = 1), and lastly South America with 20% (n = 3), all of them from Brazil.

3.4. Teaching Strategies

Different teaching strategies have been identified in the reviewed studies: simulation methods (seven articles) and learning programmes (eight articles). There are also two studies that focus on comparing different teaching methodologies.

3.4.1. Clinical Simulation

The simulation methods focused on in the studies were virtual simulation (based on mobile applications), simulation games, and high-fidelity clinical simulation. Of the total number of nursing students in the studies referring to clinical simulations, 43.85% were in their second year, while 57.1% were senior-year students. The most used method in the clinical simulation group was virtual simulation, and 57.14% of studies included only one-day teaching interventions.

Virtual simulations were used to increase knowledge about medication administration and nasotracheal suctioning in different scenarios [ 21 ], to evaluate the effect of interactive nursing skills, knowledge, and self-efficacy [ 11 ], and to detect patient deterioration in two different cases [ 22 ]. Simulation game methodology was used to improve nursing students’ cognitive and attention skills, strengthen judgment, time management, and decision-making [ 14 ].

Clinical simulation was used to develop nursing students’ clinical reasoning in evaluating wounds and their treatments [ 12 ], to evaluate and compare the perception of stressors, with the goal of determining whether simulations promote students’ self-evaluation and critical-thinking skills [ 23 ], and also to evaluate the impact of multiple simulations on students’ self-reported clinical decision-making skills and self-confidence [ 24 ].

3.4.2. Learning Programs

Different types of learning programmes have been identified in this systematic review: team-based learning, reflective training programs, person-centred educational programmes, ethical reasoning programmes, case-based learning, mapping, training problem-solving skills, and self-instructional guides. Of the total number of nursing students in the studies referring to learning programs, 57.1% were junior-year students, while 43.85% were in their senior year.

Team-based learning is a learner-centred educational strategy that promotes active learning to improve students’ problem-solving, knowledge, and practise performance. It can be implemented in small or large groups divided into teams with an instructor and reading material based on case scenarios [ 25 ]. Reflective training is based on a new mentoring practise to explore, think about, and solve problems actively during an internship. During the reflective training program, the mentors lead students to uncover clinical nursing problems through conversations with them and discussing feedback for their professional portfolios [ 26 ]. The person-centred educational programme focuses on how nursing students perceive individualised care, using design thinking to improve their perception. The use of design thinking gave the students opportunities to apply their theoretical knowledge of the person-centred program to plan innovative solutions that may effectively resolve real-life situations [ 27 ]. Another educational programme identified is the ethical reasoning program, and the aim of this is to improve nursing students’ handling of ethical decision-making situations [ 28 ], engaging the students in complex ethical clinical situations based on real cases.

Case-based learning was used to explore and demonstrate the feasibility of implementing unfolding cases in lectures to develop students’ critical-thinking abilities [ 29 ]. The web-based concept mapping of nursing students was also investigated to determine its impact on critical-thinking skills [ 30 ]. Training problem-solving skills were used to find out how it affected the rate of self-handicapping among nursing students [ 31 ]. And the last article evaluated the effect of the self-instructional guide to improve clinical reasoning skills on diagnostic accuracy in undergraduate nursing students [ 32 ].

4. Discussion

Although 158 studies were initially identified, only 15 articles were finally included in this review. The excluded articles were mainly from other disciplines other than nursing and used a less rigorous study design than RCT.

The three longest interventions were developed in Asia [ 26 , 28 , 29 ]. The longest was 300 h in duration, through one year [ 30 ]. These interventions were based on learning programs, case-based learning, person-centred care (PCC), and reflective training programs. However, it is important to take into account that Asian nursing curriculum programmes are different from European or United States curriculum because their internship is carried out only during the last academic degree year, while in Europe, following the European directive 2005/36/CE, 2013/55/UE nursing education requirements of 4600 h (2300 h of clinical practice) is carried out along the 3–4 years of the academic degree [ 33 ]. On the other hand, the intervention with the biggest sample was 419 nursing students [ 30 ], 210 in the experimental group, and 209 in the control group, and the one with the lowest sample was 51, with 24 students in the control group and 27 in the intervention group [ 32 ]. Therefore, all the included studies had a good sample size.

This systematic review has detected different methodologies to help nursing students improve their reasoning and decision-making skills. Virtual simulation was the most frequently used teaching method, both as a mobile application and as a serious game. In terms of its effectiveness in a study carried out in Taiwan, the use of a mobile application resulted in significantly higher knowledge scores, better skill performance, and higher satisfaction in students than traditional paper materials [ 21 ]. Virtual simulation [ 11 , 14 , 21 ] has also proven to be an effective tool for enhancing knowledge and confidence in recognising and responding to rapidly deteriorating patients, but studies that combined two educational strategies were more effective [ 29 ], like clinical simulation combined with another teaching strategy such as lectures or videos [ 12 ].

An interactive learner-centred nursing education mobile application with systematic contents effectively allowed students to experience positive practical nursing skills [ 11 ]. However, in a study comparing serious game simulation versus traditional teaching methods, no significant difference was found immediately or in the month following the training [ 22 ], but serious games can improve nursing students’ cognitive skills to detect patient deterioration and to make safe decisions about patient care [ 14 ]. Although the innovative teaching method was well received by the students, who expressed higher levels of satisfaction and motivation [ 22 ]. We can affirm that the development of a mobile application and its application can be effectively used by nursing students at all levels [ 11 ]. However, the performance of all these studies was measured on its short-term outcomes, only 40 min [ 21 ], 2 h [ 22 ], and 1 week [ 11 , 14 ] of intervention, and was performed with a mean sample size of 97 nursing students.

The data obtained in a study developed in Brazil [ 12 ] confirm that clinical simulation is effective for the development of nursing students’ clinical reasoning in wound evaluation and treatment and that clinical simulation in conjunction with other educational methods promotes the acquisition of knowledge by facilitating the transition from what the student knows to rational action. Moreover, the high-fidelity simulation strategy increases the perception of stressors related to a lack of competence and interpersonal relationships with patients, multidisciplinary teams, and colleagues compared with the conventional practice class in the skill laboratory. This increase was related to the students’ capacity for self-evaluation and critical reflection, concerning their learning responsibility and the need to acquire the required skills for patient care [ 23 ]. However, in the case of the effect of multiple simulations on students, there are no differences found between the double-versus single-scenario simulations [ 24 ]. The intervention time in these three studies was 30 min [ 23 ], 3.5 h [ 12 ], and 4 days [ 24 ]; then the time used to implement the intervention can determine the results obtained.

The different learning methods have an impact on various learning outcomes and students’ variables. Team-based learning [ 25 ], reflective training [ 26 ], the person-centred education programme [ 27 ], web-based concept mapping [ 30 ], and teaching cognitive-behavioural approaches [ 31 ] have proven to be effective in enhancing problem-solving abilities, knowledge, and reasoning processes and consequently improving the quality of nursing practical education. Team-based learning increased problem-solving ability scores significantly, while those in the control group decreased [ 25 ]. Reflective training, developed in China based on the new mentoring approach, was effective in encouraging nursing students to explore, think about, and solve problems actively during an internship, consequently improving their disposition for critical thinking [ 26 ]. A person-centred education programme using design thinking can effectively improve how nursing students perceive individualised care. Using design thinking allowed the students to apply their theoretical knowledge of the programme to plan innovative solutions that may effectively resolve real health problems [ 27 ]. These programmes were developed in 5 or 6 days [ 27 , 31 ], 1 week or 3 weeks [ 25 , 30 ], and 1 year [ 26 ].

The education programme focused on improving ethical decision-making had statistically significant improvements in nursing students’ self-efficacy in communication confidence, complex ethical decision-making skills, and decreased communication difficulty [ 28 ]. Case-based learning was more effective with lectures than without them in developing students’ critical thinking abilities [ 29 ]. This study was one of the longest developed with 300 h during one school year. This long-term learning intervention could have a positive impact on this study sample. Therefore, the time of the learning intervention could be a limitation in the studied RCTs. The one-time self-instruction guide was ineffective in impacting students’ diagnostic accuracy in solving case studies [ 32 ], and it is possible that only one day of intervention is not enough.

Studies have shown that problem- and team-based learning [ 25 , 31 ] are more beneficial than traditional teaching [ 29 ], as they enhance nursing skills and improve problem-solving abilities, clinical performance, communication competencies, critical thinking, and self-leadership.

Researchers generally agree that clinical reasoning is an important ability and one of the most important competencies for good nursing practise to ensure optimal patient outcomes [ 29 ] and to recognise and address patient deterioration effectively. However, effective communication is crucial in clinical reasoning. It is required to establish a rapport with patients, conduct health evaluations, make collaborative decisions, and discuss clinical cases with colleagues and supervisors. Developing clinical reasoning skills during training is essential to improving nursing professionals’ practice. To enhance clinical reasoning abilities, nursing schools should integrate simulations at every level of education to ultimately improve patient care. Improving nursing students’ preparation will impact the quality of patient care. In addition, new innovative teaching methodologies based on the use of technology could be a motivational driver in nursing clinical reasoning [ 22 ].

5. Limitations

This systematic review did not perform a search on CINAHL. Although most of the journals included in this database are included in MEDLINE, this should be addressed in the future because of the relevance of the database to nursing research. The results of the included studies could have also been influenced by the different times of the interventions and the different contexts. In addition, the reviewers have identified other studies published in languages other than those required by the inclusion criteria. It seems that many articles are published by Asian researchers, but some of them are not in English, so they cannot be analysed.

6. Conclusions

As society progresses, the new generation of nursing students poses a challenge; new technologies are ingrained in their daily lives with access to increasingly advanced technologies like artificial intelligence, and we must adapt training to capture their interest and increase their learning skills. The utilisation of mobile apps, digital simulations, and learning games has a positive impact on the clinical reasoning abilities of nursing students and their motivation. Incorporating new technologies into problem-solving-based learning and decision-making can also enhance nursing students’ reasoning skills. As a result, it is crucial to incorporate these tools into the learning process to maintain students’ interest, motivation, and satisfaction in education. Clinical simulation is particularly important in the training of students in terms of clinical performance. Still, it is necessary to add another teaching method to increase the efficacy of clinical simulations. Therefore, nursing schools should evaluate their current teaching methods and consider integrating or modifying new technologies and methodologies that can help enhance students’ learning, improve their clinical reasoning and cognitive skills, and potentially improve nursing students’ ability to affect patient care positively. By doing so, students will be better equipped to provide high-quality patient care in the future.

Teaching StrategiesPurpose of the RCTsCASP
Maurício et al., 2022 [ ]n = 511 daySelf-Instructional GuideTo evaluate the effect of the Self-Instructional Guide for Clinical Reasoning on the diagnostic accuracy of undergraduate nursing students.36
Calik and Kapucu 2022 [ ]n  =  601 weekSimulation gameEvaluated the efficacy of serious games using pre- and post-tests.36
Zhang et al., 2017 [ ]n = 15712 monthsReflective training programTo evaluate the effects of reflective training for nursing students on their critical thinking disposition.35
Chang et al., 2021 [ ]n = 11040 minMobile applicationTo test the hypothesis that nursing students who used a mobile learning app would have significantly higher levels of knowledge about nasotracheal suctioning and medication administration and a better development of skill performance in medication administration.35
(Virtual simulation)
Blanié et al., 2020 [ ]n= 1462 hGaming and traditional methodsTo compare a traditional teaching method with gaming to improve the clinical reasoning skills necessary to help nursing students detect patient deterioration.35
Bilik et al., 2020 [ ]n = 4191 weekWeb-based concept mapping educationTo investigate the impact of web-based concept mapping education on nursing students’ critical-thinking and concept-mapping skills.34
Zarshenas et al., 2019 [ ]n = 902 h for 6 daysProblem-solvingTo investigate how training problem-solving skills affected the rate of self-handicapping among nursing students.33
Svellingen et al., 2021 [ ]n = 1464 days in 3 yearsClinical simulationTo evaluate the impact of multiple simulations on students’ self-reported clinical decision-making skills and self-confidence.33
Kim and Suh 2018 [ ]n = 721 weekMobile applicationTo determine if a mobile application improved students’ skills and knowledge.33
(virtual simulation)
Park et al., 2021 [ ]n = 1052 h for 5 daysEducation programTo develop a feasibility programme for providing foundational knowledge and skills about patient-centred care to fourth-year undergraduate nursing students using the design-thinking approach.32
Pai et al., 2022 [ ]n = 1018 h for 14 weeksPerson-centred education programTo investigate the impact of an ethical decision-making framework on ethical decision-making and communication self-efficacy in nursing students.32
Silva et al., 2020 [ ]n = 783.5 h for one dayClinical simulationTo analyse the effect of clinical simulation on the development of clinical reasoning and on nursing students’ acquisition of knowledge of wound evaluation and treatment.31
Boostel et al., 2018 [ ]n = 5230 minClinical simulationTo compare and evaluate the perception of stressors by nursing students before and after a high-fidelity conventional laboratory practise class or clinical simulation.30
Hong and Yu, 2017 [ ]n = 122300 hCased-based learningTo compare and explore the effectiveness of two styles of case-based learning methods, unfolding nursing cases and unusual nursing cases, implemented in lectures for developing nursing students’ critical-thinking abilities.30
Kim et al., 2016 [ ]n = 632 h weekly for 3 weeksTeam-based learningTo examine the effects of TBL on learning outcomes and the problem-solving ability (knowledge and clinical performance) of Korean nursing students.30

Funding Statement

This research received external funding from the European programme Eramus +2021-1-BE02-KA220-HED-000023194.

Author Contributions

Conceptualisation, A.P.-P. and A.Z.; methodology, A.P.-P. and A.Z.; formal analysis, A.P.-P.; writing—original draft preparation, A.P.-P.; writing—review and editing, A.Z.; visualisation, A.Z.; supervision, A.Z. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Data availability statement, conflicts of interest.

The authors declare no conflict of interest.

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  27. Investigating the impact of mobile interaction gamification on 4C

    The findings indicate that several aspects of the 4C skills strongly relate to students' gaming habits, particularly critical thinking and creative thinking skills. However, gaming habits have a meagre impact on communication and collaboration skills, suggesting that not all components of the 4C skills can be enhanced through gamification.

  28. Entrepreneurs: Boost Research with Critical Thinking

    Recognizing bias is a critical first step in strengthening your research skills. As an entrepreneur, you must be able to identify potential biases in sources, data, and even your own thinking.

  29. Transformative Research Opportunities

    A long tradition at Minneapolis College is offering transformative research opportunities focusing across disciplines within its STEM programming. Research opportunities not only prepare students for transfer to four-year universities, they support building strong communication, critical thinking, and analytical skills, boosting students' confidence and awareness through experiential ...

  30. Teaching Strategies for Developing Clinical Reasoning Skills in Nursing

    Critical thinking and clinical judgement involve reflective and logical thinking skills and play a vital role in the decision-making and problem-solving processes . The first search was conducted between March and September 2022, and an additional search was conducted during October 2023, adding the new articles published between September 2022 ...