Document Type : Original Article


Water and Electrolytes Resaerch Center, Department of Physiology, Isfahan University of Medical Sciences, Isfahan, Iran


Objectives: Critical thinking is an important outcome criterion of higher education in any
discipline. Medical and paramedical students always encounter with many new problems in
clinical settings and medicinal laboratory, and critical thinking is an essential skill in obtaining a
better approach for problem solving. We performed a pre-and post-test to evaluate the change of
critical thinking skills in medical sciences students who enrolled in Isfahan University of Medical
Sciences in Iran during the academic years 2008-2010.Methods: In a longitudinal design
study, the critical thinking skills were compared in medical sciences students in two sequential
semesters using the California Critical Thinking Skills Test. The test is divided into two parts
(parts 1 and 2), including 17 items in each part. Based on proportional stratified sampling, a
groups of students (group 1, n=159) were selected from the university population, who enrolled
in medicine, pharmacy, nursing, and rehabilitation colleges. The students in group 1 were
asked to complete the part 1 of the test (phase I). After one semester, another group (group 2,
n=138) from the same population was randomly selected, and they were asked to complete
the part two (phase II). The students’ demographic data also were recorded. The California
critical thinking skills test was translated and it validity and reliability were approved before.
Results: No significant difference was observed between the two groups in the demographic
data. The students critical thinking scores in phase II significantly reduced in comparison
with phase 1 (p<0.05). The phase II scores in subdivisions of analysis, inference, inductive
reasoning, and deductive reasoning also failed to demonstrate improvement. Conclusion: It
seems curriculum reform is necessary to improve the students’ critical thinking.


1. Simpson E, Courtney M. Critical thinking in nursing education:
literature review. Int J Nurs Pract 2002;8:89-98.
2. Gul R, Cassum S, Ahmad A, Khan S, Saeed T, Parpio Y.
Enhancement of critical thinking in curriculum design and delivery:
A randomized controlled trial for educators. Procedia-Social and
Behavioral Sciences 2010;2:3219-25.
3. Ku KYL. Assessing students’ critical thinking performance: Urging
for measurements using multi-response format. Thinking Skills and
Creativity 2009;4:70-6.
4. Oja KJ. Using problem-based learning in the clinical setting to
improve nursing students’ critical thinking: an evidence review. J
Nurs Educ 2011;50:145-51.
5. Profetto-McGrath J. Critical thinking and evidence-based practice.
J Prof Nurs 2005;21:364-71.
6. Staib S. Teaching and measuring critical thinking. J Nurs Educ
7. Tsui L. Faculty attitudes and the development of students’ critical
thinking. J General Education 2001;50:1-28.
8. Yuan H, Williams BA, Fan L. A systematic review of selected
evidence on developing nursing students’ critical thinking through
problem-based learning. Nurse Educ Today 2008;28:657-63.
9. Duron R, Limbach B, Waugh W. Critical thinking framework for any
discipline. International Journal of Teaching and Learning in Higher
Education. 2006;17:160-6.
10. Stupnisky RH, Renaud RD, Daniels LM, Haynes TL, Perry RP. The
interrelation of first-year college students’ critical thinking disposition,
perceived academic control, and academic achievement. Research
in Higher Education. 2008;49:513-30.
11. Rimiene V. Assessing and developing students’ critical thinking.
Psychology Learning and Teaching 2002;2:17-22.
12. Hernandez CA. Student articulation of a nursing philosophical
statement: an assignment to enhance critical thinking skills and
promote learning. J Nurs Educ 2009;48:343-9.
13. Carter LM, Rukholm E. A study of critical thinking, teacher-student
interaction, and discipline-specific writing in an online educational
setting for registered nurses. J Contin Educ Nurs 2008;39:133-8.
14. Johnsen DC, Finkelstein MW, Marshall TA, Chalkley YM. A model
for critical thinking measurement of dental student performance. J
Dent Educ 2009;73:177-83.
15. Uys BY, Meyer SM. Critical thinking of student nurses during clinical
accompaniment. Curationis 2005;28:11-9.
16. Van Eerden K. Using critical thinking vignettes to evaluate student
learning. Nurs Health Care Perspect 2001;22:231-4.
17. Vanderburgh PM. Open-book tests and student-authored exam
questions as useful tools to increase critical thinking. Adv Physiol
Educ 2005;29:183-4.
18. Wong MS. A prospective study on the development of critical
thinking skills for student prosthetists and orthotists in Hong Kong.
Prosthet Orthot Int 2007;31:138-46.
19. Brahler CJ, Quitadamo IJ, Johnson EC. Student critical thinking
is enhanced by developing exercise prescriptions using online
learning modules. Adv Physiol Educ 2002;26:210-21.
20. Cascio RS, Campbell D, Sandor MK, Rains AP, Clark MC. Enhancing
critical-thinking skills: faculty-student partnerships in community
health nursing. Nurse Educ 1995;20:38-43.
21. Leppa CJ. Assessing student critical thinking through online
discussions. Nurse Educ 2004;29:156-60.
22. Mogale NM, Botes AC. Problem-based case study to enhance critical
thinking in student nurses. Curationis 2001;24:27-35.
23. Myrick F, Yonge O. Preceptor behaviors integral to the promotion
of student critical thinking. J Nurses Staff Dev 2002;18:127-33; quiz
24. Myrick F, Yonge O. Preceptor questioning and student critical
thinking. J Prof Nurs 2002;18:176-81.
25. Niedringhaus LK. Using student writing assignments to assess
critical thinking skills: a holistic approach. Holist Nurs Pract
26. Rossignol M. Relationship between selected discourse strategies
and student critical thinking. J Nurs Educ 1997;36:467-75.
27. Tschannen D, Aebersold M. Improving student critical thinking skills
through a root cause analysis pilot project. J Nurs Educ 2010;49:475-
28. Facione, PA, Facione NC, and Giancarlo, C. The disposition toward
critical thinking: Its character, measurement, and relationship to
critical thinking skill. Journal of Informal Logic 2000;20: 61-84.
29. Ip WY, Lee DT, Lee IF, Chau JP, Wootton YS, Chang AM. Disposition
towards critical thinking: a study of Chinese undergraduate nursing
students. J Adv Nurs 2000;32:84-90.
30. Baker DD. A longitudinal study of critical thinking skills in
baccalaureate nursing student. Dissertation. Tennessee: The
University of Memphis; 2002.
31. Miller DR. Longitudinal assessment of critical thinking in pharmacy
students. Am Journal of pharmaceutical Education 2003;67: Article
32. Shin K, Jung DY, Shin S, Kim MS. Critical thinking dispositions and
skills of senior nursing students in associate, baccalaureate, and RN-to-BSN programs. J Nurs Educ 2006;45:233-7.
33. Khalili H, Soleimani M. Determination of reliability, validity and norm
of California critical thinking skills test, form B. Journal of Babol
University of Medical Sciences 2003;5 Suppl. 2:84-90.
34. Kawashima A, Petrini MA. Study of critical thinking skills in nursing
students and nurses in Japan. Nurse Educ Today 2004;24:286-92.
35. Shin KR. Critical thinking ability and clinical decision-making skills
among senior nursing students in associate and baccalaureate
programmes in Korea. J Adv Nurs 1998;27:414-8.
36. Brooks KL, Shepherd JM. The relationship between clinical decisionmaking skills in nursing and general critical thinking abilities of senior
nursing students in four types of nursing programs. J Nurs Educ
37. Colucciello ML. Critical thinking skills and dispositions of
baccalaureate nursing students--a conceptual model for evaluation.
J Prof Nurs 1997;13:236-45.
38. McCarthy P, Schuster P, Zehr P, McDougal D. Evaluation of
critical thinking in a baccalaureate nursing program. J Nurs Educ
39. Profetto-McGrath J. The relationship of critical thinking skills and
critical thinking dispositions of baccalaureate nursing students. J
Adv Nurs 2003;43:569-77.
40. Phillips CR, Chesnut RJ, Rospond RM. The California critical thinking
instruments for benchmarking, program assessment and directing
curricular change. Am J Pharm Educ. 2004;68: Article 101.
41. Vaughan-Wrobel BC, O’Sullivan P, Smith L. Evaluating critical
thinking skills of baccalaureate nursing students. J Nurs Educ
42. Ip WY, Lee DT, Lee IF, Chau JP, Wootton YS, Chang AM. Disposition
towards critical thinking: a study of Chinese undergraduate nursing
students. J Adv Nurs 2000;32:84-90.
43. Cisneros RM. Assessment of critical thinking in pharmacy students.
Am J Pharm Educ 2009;73:66.
44. Beckie TM, Lowry LW, Barnett S. Assessing critical thinking in
baccalaureate nursing students: a longitudinal study. Holist Nurs
Pract 2001;15:18-26.