Preparing Our Future Helping Professionals to Become Critical Thinkers: A Tutorial Critical thinking is increasingly recognized as an essential knowledge and skill for the helping professions. Yet, our pedagogical literature has provided infrequent guidance on how instructors can help students to understand what “critical thinking” means or how it might contribute to their professional lives. Therefore, the purpose of this tutorial ... Article
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Article  |   December 09, 2016
Preparing Our Future Helping Professionals to Become Critical Thinkers: A Tutorial
Author Affiliations & Notes
  • Patrick Finn
    Department of Communication Sciences and Special Education, University of Georgia, Athens, GA
  • Shelley B. Brundage
    Department of Speech and Hearing Science, George Washington University, Washington, D.C.
  • Anthony DiLollo
    Department of Communication Sciences and Disorders, Wichita State University, Wichita, KS
  • Disclosures
    Disclosures ×
  • Financial: Patrick Finn, Shelley B. Brundage, and Anthony DiLollo have no relevant financial interests to disclose.
    Financial: Patrick Finn, Shelley B. Brundage, and Anthony DiLollo have no relevant financial interests to disclose.×
  • Nonfinancial: Shelley B. Brundage and Anthony DiLollo have no relevant nonfinancial interests to disclose. Patrick Finn is an editor for Perspectives.
    Nonfinancial: Shelley B. Brundage and Anthony DiLollo have no relevant nonfinancial interests to disclose. Patrick Finn is an editor for Perspectives.×
Article Information
Professional Issues & Training / Attention, Memory & Executive Functions / Part 2
Article   |   December 09, 2016
Preparing Our Future Helping Professionals to Become Critical Thinkers: A Tutorial
Perspectives of the ASHA Special Interest Groups, December 2016, Vol. 1, 43-68. doi:10.1044/persp1.SIG10.43
History: Received July 2, 2016 , Revised September 11, 2016 , Accepted September 14, 2016
Perspectives of the ASHA Special Interest Groups, December 2016, Vol. 1, 43-68. doi:10.1044/persp1.SIG10.43
History: Received July 2, 2016; Revised September 11, 2016; Accepted September 14, 2016

Critical thinking is increasingly recognized as an essential knowledge and skill for the helping professions. Yet, our pedagogical literature has provided infrequent guidance on how instructors can help students to understand what “critical thinking” means or how it might contribute to their professional lives. Therefore, the purpose of this tutorial is to provide guidelines on how instructors might teach future practitioners to become critical thinkers. The main topics address an instructional definition of critical thinking, the basic knowledge and skills that comprise critical thinking, a broad view of instructional approaches, and a summary of developmental milestones of adult critical thinkers. Specific teaching strategies from instructors who have hands-on experience with guiding their students to become critical thinkers are included.

It's not just what people think that matters, but how they think

- Cook & Lewandowsky (2011, p. 1, emphasis added) 
Part One
Introduction
Critical thinking is increasingly recognized as a relevant knowledge and skill for the helping professions for several reasons. First, it is widely recognized that the quality of clinicians' decision making skills is the foundation for integrating best evidence, clinician expertise, and client preference especially in the context of evidence-based practice and person-centered care. Critical thinking has been identified as the relevant knowledge and skill for helping to ensure quality decision making (DiLollo, 2010; Finn, 2011a; Gambrill, 2012; Gupta, 2011; Huang, Newman, & Schwartzstein, 2014; Jenicek, 2006; Kamhi, 2011; Rousseau & Gunia, 2016). Second, interprofessional education and practice have been promoted as an important feature in the future of health professional education (Frenk et al., 2010), and it has also been recognized as a priority by the American Speech-Language-Hearing Association (ASHA, 2015a) . Critical thinking has been identified as a core competency for implementing interprofessional education and practice (Interprofessional Education Collaborative Expert Panel, 2011). Third, critical thinking has been highlighted as an essential knowledge and skill in several policy documents related to education in our professions, including the clinical doctorate in audiology (Accreditation Commission for Audiology Education, 2016), the guidelines for the clinical doctorate in speech-language pathology (ASHA, 2015b), Academic Affairs Board report on the role of the undergraduate curriculum in communication sciences and disorders (ASHA, 2015c) and in the implementation language of the revised version of the 2014 standards for the Certificate of Clinical Competence in Speech-Language Pathology (ASHA, 2016).
Given the obvious importance of critical thinking as a foundational knowledge and skill in the preparation of future practitioners, it is surprising our pedagogical literature has not provided more information about this higher order thinking skill or provided suggestions on how to help students understand what it means and how it might contribute to the quality of their clinical decision making. It may be that educators continue to embrace the long-held belief that critical thinking will emerge naturally from simply receiving a higher education and, therefore, does not need to be taught directly. This belief, however, appears to be based more on wishful thinking than actual evidence (Arum & Roksa, 2011). Rather, research suggests students are more likely to learn how to think critically when it is taught directly as a set of skills and practiced within a specific knowledge area (Abrami et al., 2008, 2015).
In view of the increasing recognition of the need for critical thinking, it would seem prudent for our preparation programs to begin providing students with the knowledge and skills to become critical thinkers. Therefore, the purpose of this tutorial is to provide instructors with guidelines on how they might prepare future practitioners to become critical thinkers in the context of evidence-based practice. The topics will include: (1) an instructional definition of critical thinking, (2) a description of the knowledge and skills that comprise critical thinking with examples of strategies for helping students to learn these skills, (3) an overview of different instructional approaches for teaching critical thinking with examples of how some of these approaches might be implemented, and (4) a brief look at descriptive profiles of different levels of developing critical thinkers that instructors might use for understanding and assessing student progress.
An Instructional Definition of Critical Thinking
The concept of critical thinking has been developed primarily across three disciplines: philosophy, education, and psychology (Sternberg, 1986). It is often mentioned that there is no agreed-upon definition of critical thinking across these disciplines (e.g., Mulnix, 2012; Tucker, 1996). Though it would be ideal if such a definition could be identified, it is nonetheless reasonably clear that most definitions of critical thinking reported across the literature still share a compelling “family resemblance” (Byrnes & Dunbar, 2014; Gupta & Upshur, 2012; Moore, 2011). Further, Davies (2015)  has argued that it is probably unrealistic to expect a widely agreed-upon, cross-disciplinary definition that is both comprehensive and practical, given differences in disciplinary focus and theoretical orientation.
In the context of teaching critical thinking, however, an instructional definition of critical thinking is necessary to ensure instructors and students share the same view and to minimize the possible negative connotations or misunderstandings that the term “critical thinking” can evoke (Halpern, 2014). The minimal characteristics that such a definition should include are: (1) it is appropriate to the needs of the context, situation, or activity; (2) it is reasonably consistent with an accepted authoritative source, such as the dictionary; (3) it has “local” relevance in that it is applicable to the discipline in which it is being applied; (4) it does not include features that most authorities would recognize as inconsistent with the concept; and (5) like all definitions based on human constructs, it is modifiable if a more accurate definition should emerge (cf. Bloodstein, 1990).
Finn (2011a)  suggested that the following definition provided by Wade, Tavris, and Garry (2014)  could satisfy these characteristics and prove useful as an instructional definition:

Critical thinking is the ability and willingness to assess claims and make objective judgments on the basis of well-supported reasons and evidence rather than emotion and anecdote [emphasis added]. Critical thinkers are able to look for flaws in arguments and to resist claims that have no support. They realize that criticizing an argument is not the same as criticizing the person making it. Critical thinking, however, is not merely negative thinking. It includes the ability to be creative and constructive—the ability to come up with alternative explanations for events, think of implications of research findings, and apply new knowledge to social and personal problems. (pp. 6-7)

The core of Wade et al.'s definition is italicized, but the statements that follow it are useful because they highlight several significant features of critical thinking including: (1) the inclination to engage in critical thinking, (2) the need for skills to perform this process, (3) the goal of determining if a claim is acceptable or should be enacted in some form, (4) the importance of an evaluation that is based on justifiable statements and supportive information instead of affective states or secondhand narrative, (5) the act of critical thinking should not be misunderstood as negative thinking nor is it an attack on the person making the argument, and (6) critical thinking is a forward-looking process that can be used for promoting human advancement. It is also consistent with an authoritative source, such as the Merriam-Webster Dictionary that defines critical thinking as “exercising or involving careful judgment or judicious evaluation” (“Critical Thinking,” n.d.).
Emotion, a key term included in this definition, should be clarified because it can be misconstrued as suggesting that critical thinking is “bloodless, solemn, and dispassionate” (Wade, 1995, p. 27). On the contrary, critical thinking does not require setting aside one's emotions because, in fact, emotion and decision making go hand-in-hand (Keltner & Lerner, 2010). Critical thinking involves emotion because thinking is done with a purpose and its related goals, desires, or needs always have feelings attached to them (Baron, 2008). For example, feelings of compassion and the desire to help others are emotions that typically underlie most students' reasons for choosing the helping professions as a career. This compassion and desire to help others, coupled with their need to make the optimum decisions for their clients, is the attendant emotion that can facilitate their critical thinking in the clinic. Finally, given that helping relationships rarely occur in emotionally neutral situations, it would be useful for students to explore how their emotions may play a role in their ability to interpret, evaluate, and make decisions (LeBlanc, McConnell, & Monteiro, 2015).
At the same time, students must understand that emotions are not reasons (Wade et al., 2014). Feeling passionate or emotional about a belief or claiming the intensity of one's commitment to a belief, when provided as justification, are not the same as objective evidence (Wade, 1995). In other words, Wade et al. are cautioning students to avoid emotional reasoning as a basis for their claims. They also want students to be aware that others may try to persuade them to believe their claims by skillfully appealing to their emotions. In sum, students need to appreciate that their emotions are motivation or guideposts for critical thinking; but they are not substitutes for thinking.
Essential Components of Critical Thinking
Three components are generally recognized as composing the core knowledge and skills for critical thinking (Finn, 2011a): (a) critical thinking skills based on argument analysis (Browne & Keeley, 2015); (b) thinking dispositions consisting of various attitudes towards forming and modifying beliefs and making decisions (Stanovich, 2009), and (c) knowledge of cognitive biases, which consist of well-documented thinking errors (Kahneman, 2011).
Critical thinking skills
Critical thinking skills can be conceptualized as argument analysis that is based on informal logic. Informal logic is reasoning that uses everyday language (Groarke, 2015) and it is more practical for the kinds of complex and often uncertain decisions that are faced in clinical situations.
For the purposes of analysis, an argument can be framed as an issue, conclusion, and reasons (Browne & Keeley, 2015). In an evidence-based context, for example, an issue could be a specific question about the best approach for managing a communication disorder. The conclusion might consist of a recommended treatment approach. And the reasons would include various sources of evidence that support that treatment approach.
Argument analysis consists of three interactive stages (Fischer & Spiker, 2004): Interpretation, evaluation, and metacognition (see Figure 1).
Figure 1.

Three Interactive Stages That Form the Basis of Critical Thinking Skills.

 Three Interactive Stages That Form the Basis of Critical Thinking Skills.
Figure 1.

Three Interactive Stages That Form the Basis of Critical Thinking Skills.

×
Interpretation
The goal of interpretation is to determine how much one understands about the argument that will be the focus of one's thinking. The objectives are to identify, understand, and clarify the specific issue, the possible conclusion, and the reasons that support that conclusion (Browne & Keeley, 2015). For example, if a colleague recommended a treatment approach as the “best available,” an evidence-based practitioner would want to understand the reasons for her colleague's recommendation.
Evaluation
The goal of evaluation is to determine how acceptable the conclusion is in view of the reasons provided (Browne & Keeley, 2015) and it consists of three interrelated steps. The first is to examine the relevancy and plausibility of reasons for supporting the credibility of the conclusion. For example, if a colleague recommends a treatment approach because several other clinicians she knows use this approach, then the evidence-based practitioner would want to determine if this is a good reason or if it is an irrelevant reason because it may be an appeal to popularity, which may not be related to the treatment's applicability to her client.
The second step is to determine the kind, quantity, and quality of evidence that supports the conclusion. For example, the colleague's reasons for recommending a treatment approach might be based on personal experience or from research findings read in a journal. The evidence-based practitioner would appreciate that personal experience as evidence of a treatment effect may be more biased or limited than evidence obtained from a clinical trial, and she would weigh this evidence accordingly.
The final step is to make a judgment of the likely acceptability of the argument in light of the evaluation. For example, the evidence-based practitioner's evaluation of the research that her colleague claimed supported her recommendation might reveal that the quality of the evidence is sufficient to support her claim, but it is accurate only for a narrow age range.
Metacognition
The goal of metacognition is to monitor and evaluate the quality of one's own thinking during the argument analysis; there are three possible objectives. The first is to monitor the level of one's understanding of the argument during the stages of interpretation and evaluation. For example, the evidence-based practitioner might ask her colleague what she means when she describes her recommendation as the “best available” rather than assuming they both share the same meaning. The second is to be aware of one's own biases, assumptions, and values relative to the argument. For example, the evidence-based practitioner might disagree with the theoretical perspective supporting her colleague's recommendation and, thus, she would need to be aware that this view might unfairly influence her evaluation of the argument. The final objective is the deliberate application and monitoring of different thinking strategies to provide the most effective evaluation of the argument. For example, the evidence-based practitioner might actively apply open-mindedness, signaling her willingness to consider that she might be wrong in rejecting her colleague's theoretical perspective without first fairly evaluating the evidence for or against that perspective.
Asking the right questions
Asking the right questions is an approach to teaching argument analysis based on informal logic. Various textbooks are available for teaching argument analysis to students (e.g., Moore & Parker, 2014; Morrow & Weston, 2015; Paul & Elder, 2012). Most of them are suitable for students taking a philosophy course, but they are not readily adaptable for students in communication sciences and disorders. However, a textbook co-authored by Browne and Keeley (2015)  will be the focus of this tutorial because it has been adapted successfully for teaching critical thinking skills to students at the undergraduate and graduate levels in communication sciences and disorders.
Browne and Keeley (2015)  have operationalized informal logic in a straightforward, easy-to-apply approach that is presented in their text, Asking the Right Questions: A Guide to Critical Thinking. Their approach is especially applicable to the interpretation and evaluation stages of argument analysis and, as the title suggests, it is based on asking a series of 10 questions (see Table 1). The first four questions in Table 1 help to meet the goal of interpretation. The remaining six questions help to meet the goal of evaluation.
Table 1. Critical Thinking Questions Developed by Browne and Keeley (2015) .
Critical Thinking Questions Developed by Browne and Keeley (2015) .×
Interpretation
What are the issue and conclusion?
What are the reasons?
What words or phrases are ambiguous?
What are the assumptions?
Evaluation:
Are there fallacies in the reasoning?
How good is the evidence?
Are there rival causes?
Are the statistics deceptive?
What significant information is missing?
What reasonable conclusions are possible?
Table 1. Critical Thinking Questions Developed by Browne and Keeley (2015) .
Critical Thinking Questions Developed by Browne and Keeley (2015) .×
Interpretation
What are the issue and conclusion?
What are the reasons?
What words or phrases are ambiguous?
What are the assumptions?
Evaluation:
Are there fallacies in the reasoning?
How good is the evidence?
Are there rival causes?
Are the statistics deceptive?
What significant information is missing?
What reasonable conclusions are possible?
×
Browne and Keeley (2015)  do not address the metacognitive stage of argument analysis in the same direct way that they do for interpretation and evaluation. They do, however, provide many suggestions and recommendations throughout their textbook that are consistent with the objectives of metacognition, but never identify them as such. They also encourage students to self-evaluate their own arguments by directing the questions listed in Table 1 inwards on themselves. For example, when evaluating an argument students are encouraged to ask, “What are my assumptions about the credibility of this treatment claim?,” or “Are there fallacies in my reasoning?,” or “Can I see rival causes for my preferred explanation of this event?”
Browne and Keeley (2015)  wrote their textbook for use in a university-level course without a specific discipline in mind. Their examples of how to understand and use the questions for argument analysis would be familiar to most college students because they are usually relatable to their everyday lives. Thus, their approach is easy for most students to understand and apply. However, Browne and Keeley also wanted their approach to be sufficiently straightforward and practical that instructors could readily adapt it to other situations or disciplines. The following examples provide a sketch of how this textbook was adapted, first, for a required undergraduate course on critical thinking (see Finn, 2011a) and, second, across a graduate curriculum in speech-language pathology (DiLollo, Scherz, Strattman, & Parham, 2016).
Example 1: From an undergraduate course on critical thinking
Finn (2011a)  has provided an overview of a required undergraduate course he designed and teaches for students who major in communication sciences and disorders at the University of Georgia. This course has been offered every year since 2008. Browne and Keeley's (2015)  book in its various editions has served as the primary textbook. During the course, students are provided with a set of questions to guide their reading and understanding for each chapter. In addition, they are asked to consider how the critical thinking questions described in the book (see Table 1) might apply to their own lives as well as to their roles as future helping professionals. The students' answers to the questions are discussed in class and applied to brief clinical scenarios so that they can begin to appreciate the application of critical thinking to speech-language pathology and audiology. The brief clinical scenarios are adapted from journal articles or actual clinical cases (without client or clinician identities). As the semester progresses, the students begin to apply their emerging skills to various discussion topics and journal articles from the helping professions.
The readings are selected because they have the potential to provide students with a deeper appreciation of how to apply their critical thinking skills for understanding treatment claims and how, as future evidence-based practitioners, they can develop their own informed understanding of the issues. For example, a series of articles related to facilitated communication were included in a recent class discussion.
Facilitated communication—or “supported typing”—is a method claimed to help nonverbal clients with autism or other developmental disabilities to communicate. It is based on the hypothesis that facilitated communication can assist individuals in overcoming their neuromotor difficulties for making their selection of typed letters or other targets for communication by receiving physical support by a trained facilitator. An important premise of this method is that the facilitators do not assist the communicators in making their actual selections for communication. They only stabilize the communicator's hand, wrist, or arm during typing and pull it back after the selection is made (Biklen, 1992; Crossley, 1992).
Not long after it appeared, facilitated communication received considerable positive media attention when it was claimed that this method allowed many clients to reveal remarkable cognitive and communication abilities that had not been previously identified or uncovered (e.g., Crossley, 1992). However, this method subsequently fell out of favor during the 1990s when research strongly suggested that the facilitated messages were being produced unwittingly by the facilitators and not the clients (Mostert, 2001). As a result, several professional associations, including ASHA (1995), wrote policy statements discouraging the use of this method.
In recent years, however, there has been an alarming resurgence in the use of facilitated communication, especially with persons across the autism spectrum (Lilienfeld, Marshall, Todd, & Shane, 2014), despite the absence of any compelling new evidence to support its efficacy (Schlosser et al., 2014).
To help students gain some insight into this controversy, they were presented with a homework assignment that asked them to apply their critical thinking skills to a study by Shane and Kearns (1994)  that provided a convincing demonstration that the facilitator, not the client, was the source of typed responses to questions. The students also read a New York Times Magazine account of a Rutgers University professor, Anna Stubblefield, who became a facilitator for a young man (D.J.) that resulted in disastrous consequences for Stubblefield and D.J.'s family that stemmed from Stubblefield's unshakeable belief that facilitated communication was a reliable and valid approach (Engber, 2015, 2016).
The class discussion began with the students identifying any personal assumptions or biases that they might have had about facilitated communication prior to reading the articles. This was followed by their interpretation and evaluation of the Shane and Kearns (1994)  study, based on the argument analysis approach described by Browne and Keeley (2015) . Then, the discussion turned to trying to understand how the Shane and Kearns study might provide some insight or understanding of Anna Stubblefield's values, beliefs, and decisions related to implementing facilitated communication. The instructor guided the student discussion, provided clarification, and offered his views as well. The class discussion, and the learning journal that followed, provided students with an opportunity to develop their own critical perspective of a questionable treatment approach for communication disorders, and to understand the potential concerns that can arise when a person in a helping relationship fails to adequately evaluate the foundations for her treatment approach or to objectively examine the contrary evidence that might question or challenge that approach.
Example 2: From a graduate curriculum in speech-language pathology
DiLollo and colleagues (DiLollo, Scherz, & Strattman, 2015; DiLollo et al., 2016; Scherz, DiLollo, & Strattman, 2015) have described a series of three critical thinking courses developed for the graduate speech-language pathology program at Wichita State University (for more details on the approach taken at Wichita State, see section below titled, “Instructional approaches to teaching critical thinking”). Browne and Keeley's (2015)  book is used as the required textbook for the first course in this series. Students who take this required course are in their first semester of the Master of Science, Speech-Language Pathology program.
The focus of the first course is to review and learn about critical thinking, initially independent of specific clinical content, and, later, with some application to emerging clinical experiences. In this respect, the course addresses Halpern's (2014)  model for teaching critical thinking, specifically the “explicit critical thinking skills instruction” and “encouraging students' disposition or attitude toward effortful thinking and learning” aspects (see Table 2). Interestingly, feedback from students following completion of this first course on critical thinking is frequently characterized by comments such as, “I thought that I already used critical thinking, but after reading the book and discussing it in classes, I realized that I really didn't use it as much as I thought!”
Table 2. Four-Part Model for Teaching Critical Thinking (Halpern, 2014).
Four-Part Model for Teaching Critical Thinking (Halpern, 2014).×
1. Explicit critical thinking skills instruction
2. Encouraging students' disposition or attitude toward effortful thinking and learning
3. Directing learning activities in ways that increase the probability of trans-contextual transfer
4. Making metacognitive monitoring explicit and overt
Table 2. Four-Part Model for Teaching Critical Thinking (Halpern, 2014).
Four-Part Model for Teaching Critical Thinking (Halpern, 2014).×
1. Explicit critical thinking skills instruction
2. Encouraging students' disposition or attitude toward effortful thinking and learning
3. Directing learning activities in ways that increase the probability of trans-contextual transfer
4. Making metacognitive monitoring explicit and overt
×
Students are assigned readings from the book to complete prior to each class session—usually 2–3 chapters per week, as chapters are short and easily read. They work through the entire book in sequence over the first 9 weeks of the semester (a few other readings and activities are included as part of those 9 weeks). As a part of their reading, students must complete a “Reading Notes” worksheet (see Figure 2) that has been specifically designed to facilitate students' reflection and integration of the material in the chapters. For example, when reading Chapter 3, a chapter that guides students in examining the issue and conclusion in an argument, students are asked to “Use the ‘clues to discovery: How to find the conclusion’ (pp. 27–28) to examine 2 appropriate social media posts. Identify the issue and conclusion.” Similarly, when reading Chapter 4, a chapter that focuses on reasons and the questioning process, students are asked to “Describe a time when YOU have ‘created reasons only to defend a previously held opinion’ (p. 38).” A further example from Chapter 6, a chapter that examines values and assumptions, shows how the question might link to students' clinical experiences. In this example, students are asked, “What value conflicts might your client have faced in therapy sessions this semester?” There are usually 6–8 such questions that students must respond to each week in their preparation for class.
Figure 2.

An Example of the Reading Notes Worksheet for Facilitating Students' Reflection and Integration of Material Read in Chapters 3–5 from Browne and Keeley (2015) .

 An Example of the Reading Notes Worksheet for Facilitating Students' Reflection and Integration of Material Read in Chapters 3–5 from Browne and Keeley (2015).
Figure 2.

An Example of the Reading Notes Worksheet for Facilitating Students' Reflection and Integration of Material Read in Chapters 3–5 from Browne and Keeley (2015) .

×
As a way of organizing their responses, students are given the Reading Notes template (Figure 2) that has been specifically designed for that week's readings. Students write brief notes in the space provided on the Reading Notes template and come to class ready to share their responses with other students. A significant portion of time in the class is devoted to small group discussion of responses to the Reading Notes questions. In the space on the Reading Notes template, students are expected to take notes on additional perspectives that they learn from their fellow students. Instructors (there are usually 3–5 faculty and clinical instructors involved in these courses) move between student groups and join in discussions and pose additional questions. Following small group discussion, a short whole-class debriefing is conducted, where students are encouraged to share what they have learned and what surprised them about their small-group discussions. This debriefing is an important time that facilitates students' reflection on their learning and provides an opportunity for instructors to emphasize any particularly relevant points that emerged from the group discussions.
Thinking dispositions
Thinking dispositions are the second component of critical thinking. Sometimes, they are referred to as “intellectual traits” or “values.” These alternative terms will also be used here to be consistent with the authors that used them.
Thinking dispositions are widely believed to be a necessary complement to the successful implementation of critical thinking skills (Ennis, 1996, Halpern, 2014, Stanovich, 2009). They are hypothesized to play two important roles related to (1) the tendency for a person to act or think in a particular way and (2) the metacognitive skills associated with a particular disposition.
Tendency consists of two reciprocal elements: sensitivity and inclination (Perkins, Jay, & Tishman, 1993). Sensitivity refers to a person's awareness that a specific behavior, such as critical thinking, is appropriate in a given situation. Inclination refers to a person's motivation to actually engage in that behavior. For example, uncertainty in a clinical situation should trigger and motivate clinicians to use their critical thinking skills (Dollaghan, 2007).
Thinking dispositions are also related to metacognitive skills that moderate the quality and direction of one's thinking. For example, open-mindedness, fair-mindedness, and reflectiveness are often cited as thinking dispositions that complement critical thinking and moderate its effectiveness, especially in the context of evidence-based practice (Finn, 2011a). An open-minded practitioner, for example, would be willing to consider alternative treatment approaches for a communication disorder rather than assume her favored approach is necessarily the best available.
Research investigating the role of thinking dispositions has indicated that they are: (a) unique predictors of an individual's ability to evaluate arguments (Stanovich & West, 1997), (b) correlated with critical thinking skills and related to the ability to minimize the influence of cognitive biases (West, Toplak, & Stanovich, 2008), and (c) relevant to the helping professions (Papp et al., 2014) and the education of students in our professions (Ng, Bartlett, & Lucy, 2013).
Teaching thinking dispositions
Browne and Keeley's (2015)  textbook provides some guidance on developing thinking dispositions. They discuss the “values” of a critical thinker or mental attitudes that complement critical thinking. They mention, for example, autonomy, which refers to a critical thinker who makes the effort to develop her own viewpoint while drawing on a wide array of information, both supportive and non-supportive, so that her viewpoint is well-informed and balanced. In addition, the authors continually encourage their readers to consider alternative points of view and to give those views a fair hearing when evaluating an argument.
Another useful resource for teaching thinking dispositions is based on Paul and Elder's (2012)  work. They describe the relevance of dispositions, or “intellectual traits” as they refer to them, for engaging in critical thinking. They contrast eight different intellectual traits that are listed in Table 3. These contrasts are useful for helping students to understand how an intellectual trait has the potential to develop a productive attitude towards evaluating knowledge and developing beliefs and, at the same time, suggest how its opposite might hinder or impede these processes.
Table 3. Intellectual Traits Described by Paul and Elder (2012) .
Intellectual Traits Described by Paul and Elder (2012) .×
Intellectual Humility vs. Intellectual Arrogance
Intellectual Courage vs. Intellectual Cowardice
Intellectual Empathy vs. Intellectual Closemindedness
Intellectual Autonomy vs. Intellectual Conformity
Intellectual Integrity vs. Intellectual Hypocrisy
Intellectual Perseverance vs. Intellectual Laziness
Confidence in Reason vs. Distrust in Reason and Evidence
Fair-mindedness vs. Intellectual Unfairness
Table 3. Intellectual Traits Described by Paul and Elder (2012) .
Intellectual Traits Described by Paul and Elder (2012) .×
Intellectual Humility vs. Intellectual Arrogance
Intellectual Courage vs. Intellectual Cowardice
Intellectual Empathy vs. Intellectual Closemindedness
Intellectual Autonomy vs. Intellectual Conformity
Intellectual Integrity vs. Intellectual Hypocrisy
Intellectual Perseverance vs. Intellectual Laziness
Confidence in Reason vs. Distrust in Reason and Evidence
Fair-mindedness vs. Intellectual Unfairness
×
For example, fair-mindedness refers to a person's willingness to evaluate all viewpoints alike while being aware of how her own biases and assumptions could prejudice her evaluation. When a student or clinician practices fair-mindedness, she is attempting to accurately understand alternative perspectives that she might not otherwise agree with, such as a study that supports a treatment she does not value or a client's cultural perspective that is different from her own. In contrast, a person who might be characterized as intellectually unfair is essentially self-centered and assumes the position that her point of view is correct and the views of others are wrong or negligible.
Instructors and supervisors can model thinking dispositions in class discussions or in the clinic by demonstrating their willingness to be open-minded and fair-minded while engaging in critical evaluation of a problem or dealing with a difficult clinical case. It can also be instructive to discuss with students the kinds of situations when critical thinking would be appropriate, useful, and worth the effort, such as determining the best treatment approach for clients given their preferences.
The assignment of learning journals is also useful for encouraging students to reflect on thinking dispositions. Students can be asked to self-evaluate their strengths and weaknesses on Paul and Elder's (2012)  list of intellectual traits (see Table 3). In addition, they can consider how these traits appear applicable to their future practice as helping professionals.
Another approach for helping students to understand thinking dispositions is to administer the Critical Thinking Disposition Scale (CTDS; Sosu, 2013). The CTDS is a brief 11-item assessment that has two subscales designed to evaluate open-mindedness and reflective skepticism. Respondents indicate on a Likert scale the extent to which various statements are an accurate reflection of themselves. Sample items include “I use more than one source to find information for myself” (e.g., open-mindedness) and “I usually check the credibility of the source of information before making judgments” (e.g., reflective skepticism). The scored results of CTDS subscales also have suggested ranges for identifying low, moderate, and high levels of each disposition (Sosu, 2013). The CTDS has been shown to have sound psychometric characteristics including reasonable internal consistency, discriminant validity (Sosu, 2013), and convergent validity with measures of critical thinking (Yockey, 2016). It is limited, however, by its possible social desirability, which means that some students may rate themselves according to how they wish they were, or how they would like you to believe they are, rather than the way they really think and behave.
The CTDS is also adaptable as an instructional assessment. For example, it provides students with an opportunity to self-evaluate the extent to which these dispositions are consistent with their views of themselves, and whether or not they might need to work on developing these dispositions further. The items on the assessment are also useful for student discussion on the relevance of thinking dispositions for critical thinking. Or, they can be used for considering how these dispositions are compatible with clinical attitudes that are important in evidence-based practice. For example, students are usually able to appreciate how the two CTDS items listed in the previous paragraph are consistent with evidence-based practice, even though Sosu (2013)  did not originally design them with this context in mind.
Cognitive biases
Knowledge of cognitive biases, the third essential component of critical thinking, refers to understanding the influence of various human thinking errors that may play a role in developing false beliefs and making poor decisions. Pohl (2004)  suggests that cognitive biases have three defining characteristics: (1) they may lead to judgments different from the optimal choice, (2) they often happen naturally and automatically without our explicit awareness, and (3) they are difficult to avoid until we know about them.
Cognitive biases have been implicated in various case studies of erroneous beliefs and poor decisions. For example, it has been argued that many economists, bankers, and corporate executives made a variety of short-sighted, often self-serving, financial decisions that were compounded by their erroneous beliefs about the rationality of human economic behavior such that they unwittingly contributed to a global economic crisis in 2007 or, at the very least, were unable to see it coming (Knauff, Budek, Wolf, & Hamburger, 2010; Shiller, 2015). There are also many examples of politicians who have sometimes demonstrated sufficiently poor judgment that they practically derailed their careers (Halpern, 2002; Kipnis, 2010) or they so rigidly held on to ill-informed beliefs that their subsequent decisions led to crippling national policies (Smith, 2016; Stanovich, 2009).
Within the helping professions, cognitive biases have been suggested as the likely source of false beliefs among physicians (Vreeman & Carroll, 2007), medical diagnostic errors (Institute of Medicine, 2015), false beliefs in clinical psychology (Dawes, 1994; Lilienfeld, Fowler, Lohr, & Lynn, 2005) and potentially flawed choices in our professions (Finn, Bothe, & Bramlett, 2005; Lof & Watson, 2008).
Cognitive biases affect all of us, and students should be advised that people just like them, who are reasonably bright and have the best of intentions, are just as susceptible to their influence (Gilovich, Epley, & Hanko, 2005; Stanovich, 2009). For example, Stanovich, West, and Toplak (2013)  demonstrated that students' intellectual abilities, as evidenced by conventional indicators of cognitive ability (i.e., SAT scores), were unable to minimize the likelihood that they would be prone to cognitive biases. Further, studies have shown that when people engage in self-assessment, they are often influenced by illusions of personal strength. For example, they believe that they have the best of intentions to do the right thing; however, they are often insensitive to the possible situational variables that may actually influence what they will do (Gilovich et al., 2005). Most of us can probably find personal examples of when we allowed our good intentions to guide our behavior, only to discover that those intentions alone were not good enough for providing the desired outcome. In sum, students need to appreciate that even though they may believe they are above-average in intelligence or that they may have the best-of-intentions in a helping relationship, these beliefs will be insufficient if they are not willing to also carefully evaluate the basis for their decisions.
For instructional purposes, numerous cognitive biases have been described and demonstrated in the literature (e.g., Kahneman, 2011), including the helping professions (e.g., Croskerry, Singhal, & Mamede, 2013a, b). There are also several websites that provide lists and examples of cognitive biases (“List of cognitive biases,” n.d.).
Browne and Keeley (2015)  do not use the term, “cognitive biases.” Instead, they provide an overview of “speed bumps” that interfere with critical thinking, such as stereotyping, the halo effect, and wishful thinking. Students can usually recognize examples of these biases in their own thinking.
Kida (2006)  provides a list of cognitive biases that he describes as the “six pack of problems,” that has also proved useful as a manageable and practical list for instructional purposes (Finn, 2011a). Their brevity may also increase the likelihood that students will remember them. Kida's list of six biases with a brief description for each follows.
1. We prefer “stories” to “statistics”
We are more likely to be persuaded by personal experience and anecdotes than by objective, statistical evidence (Rodriguez, Rhodes, Miller, & Shah, 2016). When presented as evidence, stories in their various forms (e.g., media accounts, memoirs, personal websites, and testimonials) are vivid, personal, and emotional and, thus, they are easy to relate to personally, making them appear more credible. In contrast, scientific evidence is often impersonal, abstract, dry, and sometimes intimidating, which makes it less accessible, more difficult to process, and thus easier to ignore. Even though in most cases, this kind of evidence is more representative, valid, and accurate (Gilovich, 1991).
Meisel and Karlawish (2011), for example, suggested that stories trumped population-based evidence in the ongoing controversy surrounding the public's resistance to the measles-mumps-rubella vaccine due to spurious concerns about its relationship with autism. Media stories also appear to have been the likely reason that some professionals prematurely adopted a treatment approach for stuttering in the absence of any compelling clinical evidence (Finn et al., 2005).
2. We seek to confirm, not question, our beliefs
This is more commonly known as confirmation bias or myside bias. In other words, we prefer evidence that supports our beliefs and ignore, downplay, or distort evidence that questions them (Nickerson, 1998). On the one hand, it is appropriate and natural to look first for evidence to support an idea or belief. But, once we find it, we have a tendency to stop searching. Further, depending on how firmly we hold to a belief, if we do find evidence that questions it, we sometimes evaluate that contrary evidence using a double standard that makes it easier to dismiss or downplay it. In comparison, when we encounter evidence we prefer to hear, it is usually evaluated using a less rigorous standard. To put it another way, when faced with supportive evidence for our beliefs, we ask, “Can I believe this?” But when faced with disconfirming evidence, we ask the much tougher question, “Must I believe this?” (Risen & Gilovich, 2007).
Research has suggested that helping professionals have a tendency to exhibit confirmation bias in helping relationships, especially when attempting to diagnose their clients' problems (Haverkamp, 1993; Owen, 2008; Strohmer, Shivy, & Chiodo, 1990), and that this strategy is more likely to result in diagnostic error compared to those who conduct a disconfirmatory or more balanced approach (Mendel et al., 2011).
Confirmation bias also reflects a larger concern: we don't like being wrong (Schulz, 2010). Our aversion to wrongness appears to be related to a cultural bias that suggests that being wrong is a sign of stupidity or weakness, and that we only succeed by being right. However, we fail to appreciate that being wrong, or negative evidence, is often as informative as positive evidence, and provides a more balanced or corrected view of a topic or behavior than an approach that always insists on being right.
3. We rarely appreciate the role of chance and coincidence in shaping events
We tend to overlook or to ignore the role that chance events play in our everyday lives and, instead, erroneously assign them causal status. This includes our inability to consider how these events may also play a role in helping relationships (Finn, 2004). We forget that chance and coincidence are reasons, too. Improvements observed in the clinic, for example, may be mistakenly attributed to the treatment; when in fact they may be due to coincidental factors such as natural history or regression to the mean (Gruber, Lowery, Seung, & Deal, 2003).
4. We sometimes misperceive the world around us
We believe we see the world as it is, failing to appreciate that our senses can be deceived and that our expectations can shape our perceptions (Jensen, Yao, Street, & Simons, 2011). On the one hand, it is natural to accept as true what we personally see and hear because we hold to the adage that “seeing is believing.” For most of our everyday experiences, that saying holds up well. But, we forget that there are times when we are so focused on one event, or intent to see what we want to see or hear, that we can completely miss noteworthy information that happens at the same time (Chabris & Simons, 2010). This information, had we consciously processed it, might have significantly influenced our understanding of the event. This seems especially important for helping professionals to appreciate, because they sometimes rely on personal observation to complement their assessment and management of communication disorders. Evidence suggests that even expert diagnosticians can unintentionally miss obvious, but unexpected, events (Drew, Võ, & Wolfe, 2013).
5. We tend to oversimplify our thinking
When it comes to thinking, we often behave like cognitive misers (Stanovich, 2009) because we tend to take complex questions and unintentionally reduce them to simpler ones so that they become easier for us to manage and think about (Kahneman, 2011). Sometimes that can become a problem because we arrive at a readily obtained answer, but it's the answer to the wrong question. We also fail to look beyond the obvious, overgeneralize, and engage in either-or thinking, when in reality multiple potential answers are more likely. For example, evidence suggests helping professionals are more likely to make diagnostic errors when they reason from their first impressions, rather than taking the time to consider alternative and more complex possibilities (Mamede et al., 2010).
6. We have faulty memories
Our beliefs and decision making are often influenced by what we know and what we can remember (Halpern, 2014). We often regard our memories as having strong evidentiary status. We act as if what we have experienced is permanently stored in our minds and that when we recall this information we trust that it is as accurate as the day it was formed (Loftus & Loftus, 1980). Unfortunately, this trust may be misplaced because although we may believe our memories are faultless; they are often imperfect (Kida, 2006).
Every time we recall a past event, our brains rebuild that memory, and with each successive reconstruction, our memory's accuracy can get further and further from the original event (Talarico & Rubin, 2003). These distortions in the accuracy of our memories are introduced by several factors, including our current beliefs or expectations, new social contexts or environments, and other people's suggestions or leading questions (Roediger & McDermott, 2000; Schacter, 1999). The additional problem with distortions is that when they occur during the reconstructive process we are completely unaware that they are happening (Schacter & Addis, 2007). Our lack of awareness of this process lulls us into remaining confident in the accuracy of our memories, when in fact, that confidence may be misplaced. This suggests that students should be encouraged not to rely solely on their memories when making important clinical decisions. Research literature, internet searches, and case files with objective evidence are complementary resources for double-checking the integrity of their knowledge or recall of past cases.
Teaching about cognitive biases
Many strategies associated with critical thinking skills have been shown to help minimize cognitive biases. Some strategies include looking at the issue from another person's perspective, considering alternative explanations for a conclusion, invoking an audience to justify the reasons for your conclusion, and practicing open-mindedness and fair-mindedness to counter the possibility that you might be wrong (e.g., Larrick, 2004; Lieberman, Rock, & Cox, 2014; Milkman, Chugh, & Bazerman, 2009; Lerner & Tetlock, 1999; Lilienfeld, Ammirati, & Landfield, 2009; Stanovich, 2009). Most of these strategies are also encouraged by Browne and Keeley (2015)  as part of their approach for helping students to engage in argument analysis.
One of the challenges in teaching cognitive biases to students is that simply making them aware of these biases by describing them or presenting the evidence may not be sufficient to minimize them. This is in part because many of us have a bias blind spot, which means we readily see the existence and operation of cognitive biases in others, but have difficulty recognizing them in ourselves (Ehrlinger, Gilovich, & Ross, 2005). Therefore, a useful starting point for helping students to understand cognitive biases and appreciate their susceptibility to them is to create classroom demonstrations that allow them the opportunity to experience the bias for themselves (e.g., Plous, 1993; Pohl, 2004; Swinkels, 2003). Finn (2011b), for example, demonstrates cognitive biases by reconstructing studies described in the literature and recreating them in the classroom with the students as “participants.” These demonstrations can be equally informative for instructors because it also allows them to see how susceptible we all are to these biases. Two examples of these demonstrations based on Kida's (2006)  list of biases are described here.
Example 1: We seek to confirm, not question, our beliefs
A simple but effective demonstration of confirmation bias is to ask students to think about the following question (Gilovich et al., 2005): “Are you good-hearted?” Provide a moment or two to let them think about it, then ask: “What came to mind first?” Because most of us in the helping professions are inclined to believe that we are good-hearted, students will do what we would probably do, search our memories for examples of when we committed kind and generous acts. We engage in a reflexive search for positive evidence to support our beliefs that we are good-hearted. And once we find that evidence, we stop searching. In contrast, it is highly unlikely that we would search for examples of negative evidence, such as when we might have been inconsiderate and uncharitable. Yet, if we are reasonably self-aware and looked hard enough, we could probably find examples of when we demonstrated these behaviors, too. And if we couldn't find those examples, people who know us well probably could. In effect, the search for negative evidence—even after you may have found positive evidence— requires deliberate effort.
Discussion of this cognitive bias usually helps students to realize that a more balanced view or understanding of themselves and the world will typically include a mix of both confirming and disconfirming evidence, rather than a lopsided representation for one side. Classroom discussion, learning journals, and additional readings can also help them to explore the ways that confirmation bias could become a concern in the clinic and how critical thinking might mitigate that concern.
Example 2: We sometimes misperceive the world around us
In our everyday lives, we rely so heavily on our senses of vision and audition that we often trust them implicitly. Therefore, this bias can present challenges for students because it insists that they re-evaluate this trust. As a result, several demonstrations might be necessary.
There are various ways that instructors can construct class demonstrations for this bias. The following is a quick example of how we often see things because our prior experience has led us to expect them (Kida, 2006). Read the following sentence:

PARIS

IN THE

THE SPRING

Most of us read the phrase as “Paris in the spring.” We fail to notice, however, that the word “the” is repeated twice. We expect to see one, not two of them. This is a simple example, but it illustrates that we can misperceive the world when reality doesn't meet our expectations.
Classroom demonstrations of inattentional blindness are also effective in helping students to understand this bias. Inattentional blindness refers to our failure to notice an unexpected, but fully visible, item when our attention is diverted to other aspects of the event (Jensen et al., 2011). Simons and Chabris (1999)  provided one of the most convincing demonstrations of our susceptibility to this bias. For this demonstration, students are instructed to watch a brief video of two teams of three players each passing basketballs. One team is dressed in white shirts, the other in black. The students are asked to silently count how often the team members in white shirts pass the ball to each other. During the video, a person dressed in a gorilla suit (or a woman carrying an open umbrella) walks unannounced through the middle of the players, turns and waves at the camera, and then walks away. After the video is played, the students are asked to report their counts, then asked if they noticed anything unusual, then asked did you see the gorilla? In this instructor's experience (Finn), the majority of students do not see the gorilla, unless they have seen the video before.
This is a surprising finding because our intuition tells us that, yes of course, we would see the gorilla. In fact, in a separate study reported by Levin and Angelone (2008), 90% of 162 students believed they would see the gorilla, when told about this video situation. However, Simons and Chabris (1999)  found that 46% of 192 participants in their study failed to notice the gorilla or the woman with the umbrella. This finding has been replicated in other studies, including a report by Memmert (2006)  that tracked the participants' eye movements when they viewed the video. He showed that the participants who reported that they did not see the gorilla, still looked at it for a full second, which was no different from the participants who reported that they did see it. The gorilla video and others like it are available on YouTube (e.g., Simons, 2010).
As remarkable as these findings may be, some students may simply dismiss them as a curious event that has few real world implications. “Really? What's the likelihood of a person in a gorilla suit walking through the middle of a clinic room?” However, Chabris and Simons (2010)  provide several examples that suggest inattentional blindness also has real world consequences, such as completely missing salient events when witnessing a crime. Further, Drew et al. (2013)  reported that even expert observers in the helping professions are vulnerable to inattentional blindness. For their study, 24 radiologists were asked to perform a familiar lung-nodule detection task with several computerized tomography (CT) scans. The investigators also tracked the radiologists' eye movements during the task. Eighty-three percent of the radiologists failed to notice the image of a gorilla, 48 times the size of an average nodule, embedded in one of the CT scans, even though the majority of them looked directly at it.
Following these classroom demonstrations, students can discuss the possible implications of this bias for the kinds of observational tasks that they will likely engage in as helping professionals, especially when their attention is focused or their expectations for what they should see or hope to see are biased.
Other ideas or studies for constructing classroom demonstrations for these and other cognitive biases can be found in Pohl (2004), Plous (1993), and on the internet (“Examples of cognitive bias,” n.d.).
Summary
In summary, instructors should consider helping their students to become critical thinkers by helping them to: (1) learn and apply critical thinking skills based on argument analysis, (2) understand and develop their thinking dispositions, such as open-mindedness and fair-mindedness, and (3) obtain knowledge about cognitive biases and how they might influence their thinking in the clinic.
Part Two
Instructional Approaches to Teaching Critical Thinking
There are a variety of ways that instructors or programs might consider incorporating critical thinking into their coursework. Ennis (1989)  has provided a useful description of four instructional approaches that could be implemented for helping students to learn critical thinking, referred to as general, infusion, immersion, and mixed.
General approach
The general approach occurs when critical thinking is taught as an explicit course, but the information is presented separate from any specific subject area. A philosophy course on critical thinking taught independently of any content on communication sciences and disorders would be an example of this approach.
Infusion approach
Infusion occurs when critical thinking is encouraged explicitly within a specific subject area. For example, critical thinking skills could be taught and practiced in the context of a research methods course in communication sciences and disorders. Students would learn to practice critical thinking skills across the various aspects of the scientific foundations of the professions. Further, complete infusion would occur when students learn critical thinking skills and they are explicitly applied across the entire curriculum.
Immersion approach
Immersion occurs when critical thinking skills are not explicitly taught, rather, it is inferred that they will emerge naturally from deep examination of a specific subject area. For example, students would engage deeply, thoughtfully, and actively with a subject matter related to communication sciences and disorders. It would be assumed that this would encourage the implicit development of critical thinking, but without explicit instruction concerning specific critical thinking skills.
Mixed approach
A mixed approach occurs when critical thinking skills are taught explicitly and applied to both non-specific and subject-specific content. For example, students learn to think critically with content that they would be familiar with from their everyday lives and also apply these skills to content related to communication sciences and disorders, either within the same course or separately. Finn's (2011a)  undergraduate course on critical thinking, described in various sections earlier in this tutorial, is an example of a mixed approach.
Abrami and colleagues (2008, 2015)  conducted two separate meta-analyses of these four instructional approaches to critical thinking and reported that all four of them were effective for developing critical thinking skills and dispositions. However, the strongest effects occurred when critical thinking was taught explicitly within content-specific courses, and active learning approaches were used that included class discussion, applied problem solving, and student mentoring (e.g., teacher-student interaction).
The following are two examples of these instructional approaches from two ASHA-accredited graduate programs. The first is a combination of an infusion/immersion approach from George Washington University. The second is an example of complete infusion of critical thinking into a graduate program in speech-language pathology at Wichita State University.
Example 1: An infusion/immersion approach
In the Speech and Hearing Science (SPHR) department at George Washington University an infusion/immersion approach is used when teaching critical thinking to graduate students. One of the key tools is the Graduate Student Development Profile (GSDP; Hancock & Brundage, 2010). The GSDP was developed by SPHR faculty and has two main purposes: (1) to provide formative feedback to students regarding their learning of behaviors critical for a successful career in speech-language pathology, and (2) to document student progress over time throughout the students' graduate school experience. In practice, the GSDP has a third purpose, which is to provide context to conversations between students, academic advisors, and clinical instructors. Students receive specific feedback about skills that they are performing satisfactorily, as well as areas in need of continued attention and learning. This specific feedback has replaced the more general, less actionable feedback that faculty used to give students (e.g., “You could be doing better in clinic.”). Students receive faculty feedback three times during their graduate career, and the performance expectation increases at each rating point. Faculty are required to provide specific suggestions to assist student learning if they rate students below the expected level of performance. Once the faculty ratings are complete (via Qualtrix), academic advisors present the feedback in summary form to each of their advisees.
The GSDP is used to evaluate students in five areas: (1) Taking Responsibility for Learning, (2) Critical Thinking, (3) Cognitive Flexibility, (4) Professionalism, and (5) Communication Skills. Each of these areas has sub-sections that define specific skills within that area. For example, the Critical Thinking area has three subsections: Interpreting Information, Addressing Alternative Possibilities, and Analytical Reasoning. Student performance on each skill is rated on a five-point scale that defines different levels of competency. Figure 3 illustrates the 5-point scales for two subsections of the critical thinking section of the GSDP. Behaviors defined as “5” are those demonstrated by competent professionals. Behaviors defined as “1” or “2” are below expectations and not acceptable behaviors for demonstrating competency as a practicing speech-language pathologist. At the end of their first semester in graduate school, students are expected to demonstrate behaviors at “3” or above; as they near graduation, they should be demonstrating behaviors in the 4–5 range in most, if not all, areas. We included behaviors below “3” in order to be able to document behaviors that are below expectations, particularly for students in their first semester of graduate school.
Figure 3.

Examples From the Critical Thinking Section of the Graduate Student Development Profile (Hancock & Brundage, 2010).

 Examples From the Critical Thinking Section of the Graduate Student Development Profile (Hancock & Brundage, 2010).
Figure 3.

Examples From the Critical Thinking Section of the Graduate Student Development Profile (Hancock & Brundage, 2010).

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The GSDP is a reliable instrument that accurately captures the development of student competency over time in the areas it assesses (Hancock & Brundage, 2010). Student reaction to the formative feedback is typically positive. They like that there are specific suggestions for increasing competency and they appreciate the wide range of skills that are assessed. Faculty can also be far more detailed with their student advisees, pointing out specific areas in which they are performing above expectations and suggesting areas where they might want to focus their learning in the coming semester.
Example 2: A complete infusion approach
A complete infusion approach to teaching critical thinking was taken at Wichita State University (DiLollo et al., 2015; DiLollo et al., 2016; Scherz et al., 2015) in response to a growing awareness that students needed more than the specific content courses that have traditionally made up their curriculum. Over a number of years, faculty in the Department of Communication Sciences and Disorders received feedback from students regarding their difficulty integrating information from various academic courses as well as making academic-to-clinical and clinical-to-academic connections. This feedback matched faculty and clinical instructor observations in both the classroom and clinic. These problems were occurring despite the faculty's attempts at making academic coursework applicable to clinical practice and requiring students in clinic to pursue evidence-based practice in an effort to facilitate connections between coursework and clinic. Following extended discussions among all faculty of the department, it was concluded that they needed to be more overt in their attempts to facilitate the connections between academic courses and between courses and clinical practices, and that such an effort might be framed in terms of enhancing critical thinking.
Accepting this challenge required a new conceptual understanding about the autonomy of individual courses as well as time reallocations for these classes. Through a series of small-group and whole-department meetings and discussions, significant curricular changes were implemented that allowed the development and inclusion of a series of three 4-credit-hour “critical thinking in clinical practice” courses, based on Halpern's (2014)  four-part model for teaching critical thinking, into the graduate speech-language pathology curriculum (see Table 2). These courses meet weekly and are taught collaboratively by faculty and clinical instructors who teach content courses in the specific semester.
Sequence of critical thinking courses
The first year, first semester course (CSD 832A—Critical Thinking in Clinical Practice I) focuses on defining and developing basic critical thinking skills—primarily Halpern's Part 1, explicit critical thinking skills instruction, and Part 2, encouraging critical thinking disposition. This is accomplished by working through Browne and Keeley's (2015)  book, with students assigned weekly readings and responding to questions that prepare them for small-group discussions that occur during classes (See Example 2 in section above that describes how Browne & Keeley's book is used). Students learn about critical thinking independent of course and clinical material, often applying it to everyday issues through the use of social media, news, and current event topics. Typically, classes are discussion-based, rotating between whole-class and small-group discussions. As the semester progresses, some discussions relate critical thinking concepts to the students' interactions with clients and their current experiences in clinic. Instructors facilitate discussions through modeling critical thinking and asking “Socratic” questions that promote students' taking an alternative perspective or looking for alternative explanations (MacKnight, 2000).
The first year, second semester course (CSD 832B—Critical Thinking in Clinical Practice II) focuses on applying and developing critical thinking skills in the context of academic and clinical aspects of speech-language pathology— primarily Halpern's Part 2, encouraging critical thinking disposition, and Part 3, transcontextual transfer (see Table 2). This course features a series of case studies designed to address aspects of the clinical process, and focusing on topics being discussed in the students' content courses that are taught concurrently in the semester (i.e., Language/literacy for school-age and adolescents, Autism spectrum disorders, AAC, and Counseling). Students are typically assigned readings to prepare for each class, some of which require use of the Reading Notes format described earlier, while others involve exploration of aspects of a specific case. As with the first course, classes typically consist of whole class and small group discussions. Instructors frequently model critical thinking and clinical problem solving using a “fishbowl” technique in which instructors “think out loud” in discussions of aspects of the case study materials.
The second year, first semester course (CSD 832C—Critical Thinking in Clinical Practice III) focuses on actively applying critical thinking skills, primarily in the context of students' clinical experiences and their anticipated external practicum experience— primarily Halpern's Part 2, encouraging critical thinking disposition; Part 3, transcontextual transfer; and Part 4, explicit metacognitive monitoring (see Table 2). In this course, students are assigned less readings and other material, as the course serves primarily as a time for them to focus on applying critical thinking to clinical problem-solving, both in relation to their own clinical experiences, as well as in relation to information about clinical practicum sites that they learn about from a series of invited speakers. Following presentation by an invited speaker, students engage in whole-class and small-group discussions of what they learned, how the material was presented, and what questions the information raised for them. Instructors facilitate discussions through the use of Socratic questioning and modeling critical thinking.
Overall, the impact of this series of courses has been viewed as positive by students, faculty, and clinical instructors. Students who went through the first sequence of courses at Wichita State improved their scores on the Critical Thinking Basic Concepts & Understanding Test (Elder, Paul, & Cosgrove, 2007) and provided positive feedback through a focus group that was conducted following CSD 832B. Additional qualitative data from students' reflections indicate positive changes in their attitudes and dispositions toward critical thinking. Students have also demonstrated increasing competence with critical thinking through oral exams (based on case scenarios) administered at the end of the first (CSD 832A) and second (CSD 832B) semesters.
Developmental Milestones of the Adult Critical Thinker
Students should not be expected to become completely proficient as critical thinkers in a short amount of time. Even the most accomplished critical thinkers need to continue to practice and hone their skills. To help appreciate different levels of critical thinkers, Papp and colleagues (2014)  described adult milestones in developing competency in critical thinking for the health professions that are also applicable to students in communication sciences and disorders. These milestones could be used to help instructors gauge where their students are in their development and provide constructive feedback.
The milestones were developed by a task force of physician and nurse educators, representing 18 North American medical training programs that convened at the Millennium 2011 Conference on Critical Thinking to explore approaches to teaching critical thinking and to propose strategies for integrating principles of critical thinking into the health professions curricula. The task force agreed that the milestones were meant as broad benchmarks, and that there would likely be considerable variability across individuals and also within individuals. In addition, an individual's competence could vary according to circumstances such as workload, fatigue, and negative personal issues. They also believed it was important to recognize that levels of competence would not necessarily be gained automatically by advancing to higher levels of education or through accumulated clinical experience (Papp et al., 2014).
Their milestones in critical thinking were described in terms of six stages of adult critical thinkers. Three attributes of a thinker were characterized for each stage: metacognitive abilities, attitudes or dispositions towards critical thinking, and cognitive or critical thinking skills. These stages, described in more detail by Papp et al. (2014), are briefly summarized here:
Stage 1: Unreflective thinker.
Metacognition
She lacks knowledge about cognition and different approaches to thinking and is unable to examine her own or others' thinking processes.
Attitudes
She is completely set on her current beliefs and, as a result, is unable to incorporate or adapt to new knowledge. Information raising doubts about her beliefs is met with indifference.
Skills
She has a single-minded approach to obtaining and processing information that is based on rote scripts.
Stage 2: Beginning critical thinker.
Metacognition
He has an emerging awareness of different approaches to thinking and variations in cognitive processes of others, but he requires external prompts to maintain reflection on his own thought processes.
Attitudes
He is willing to accept feedback about his thinking, but unlikely to actively ask for it.
Skills
He inconsistently uses different approaches to thinking, and when he does apply them they are often limited in their application. As a result, his judgments usually lead to the most obvious explanations only, and sometimes result in wrong conclusions. He understands the conceptual foundations of critical thinking, but rarely applies them.
Stage 3: Practicing critical thinker.
Metacognition
She is familiar with the importance of applying metacognitive strategies and consciously applies them.
Attitudes
She acknowledges limits and uncertainties in her knowledge base. She is open-minded to challenges to her thinking and receptive to new approaches.
Skills
She is equipped with multiple approaches to solving clinical problems and uses well-established principles to interpret observations and guide her decisions.
Stage 4: Advanced critical thinker.
Metacognition
He has a well-established set of thinking strategies and recognizes how his approach differs from others. He purposefully performs critical thinking and finds it rewarding. He looks for and seeks to overcome gaps in his knowledge.
Attitudes
He seeks and accepts feedback and is always curious about alternative ways of thinking.
Skills
He can adjust and appropriately apply his non-analytical and analytical thinking styles, and he is attuned to the possibility of cognitive biases and can avoid them when necessary.
Stage 5: Accomplished critical thinker.
Metacognition
She always takes charge of her own thinking and habitually seeks to improve her thinking strategies.
Attitudes
She recognizes and openly acknowledges her assumptions and biases. She sees uncertainty as an opening to deeper understanding and she is constantly creative and innovative in her approaches to solving clinical problems.
Skills
She models critical thinking for others and can adeptly move between non-analytical and analytical types of thinking. She is able to see complex connections between basic principles and uses them to develop a reasonable case for understanding clinical phenomena. She is able to generate new knowledge or understanding by using her reasoning this way.
The challenged thinker: A devolved state
As a “sixth stage,” the task force recognized that even adept critical thinkers can experience conditions when personal factors can temporarily derail their capabilities to think clearly. These are conditions that can affect all of us from time to time, such as emotionally taxing life events (e.g., family illness), allowing self-interests to take priority over the interests of others (e.g., I need to process “x” number of clients in order to be considered for promotion), or threats to personal sense of self (e.g., experiencing prejudice based on race or gender). This state is not considered the same as a beginning critical thinker because the person already has advanced knowledge and skills, but cannot adequately implement them until the stressors are resolved.
In the appendix of their article, Papp et al. (2014)  provide a helpful illustration of the six milestones by describing hypothetical learners' responses to the same clinical scenario. Though the scenario is medical, it would not be difficult for instructors to adapt the scenario for speech-language pathology or audiology students. (Examples can be obtained from the first author upon request of how three hypothetical critical thinkers—unreflective, beginning, and advanced— might respond to a clinical scenario in speech-language pathology, and another in audiology.)
Summary and Conclusions
The purpose of this tutorial was to provide instructors with a series of guidelines on how they might promote critical thinking.
The first guideline focused on the importance of instructors and students sharing the same understanding of what it means to think critically, especially in the context of evidence-based practice where the objective is to develop the best decisions for helping clients. The rationale and elements of an instructional definition were offered as one approach for meeting this objective.
The second guideline described the essential components of critical thinking that can help students make these decisions. The first component included a description of a set of cognitive skills based on asking the right questions and examples of how they might be taught. The second component consisted of relevant attitudes and metacognitive abilities that support critical thinking, such as open-mindedness and fair-mindedness. The third component included knowledge of some basic cognitive biases and suggestions on how to provide students with the experience of how their thinking can sometimes be led astray.
The third guideline provided an overview of four instructional approaches for teaching critical thinking. Specific examples of how these approaches might be implemented were described.
The final guideline highlighted that it is important for instructors and students to appreciate that learning and practicing critical thinking is a developmental process with different levels of proficiency. To provide some sense of that process, six developmental milestones of adult critical thinkers were profiled.
To conclude this tutorial, consider this final thought: Our future practitioners will face an ever-evolving and expanding knowledge base, within the context of an increasingly complex helping professions landscape. In order to prepare them for these challenges, we should provide our students with the knowledge and skills that will help them best to manage this future. Simply providing them with more knowledge will be insufficient if we don't also provide them with the ability to think about why they believe what they believe. Teaching and fostering their ability to think critically is an approach that is best-placed to give them an understanding that it is not just what they think that matters, but how they think.
Acknowledgements
This tutorial is based on an invited short course co-sponsored by SIG 10 Issues in Higher Education and SIG 11 Administration & Supervision that was presented at the American Speech-Language-Hearing Association National Convention in Denver, CO in November 2015.
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Figure 1.

Three Interactive Stages That Form the Basis of Critical Thinking Skills.

 Three Interactive Stages That Form the Basis of Critical Thinking Skills.
Figure 1.

Three Interactive Stages That Form the Basis of Critical Thinking Skills.

×
Figure 2.

An Example of the Reading Notes Worksheet for Facilitating Students' Reflection and Integration of Material Read in Chapters 3–5 from Browne and Keeley (2015) .

 An Example of the Reading Notes Worksheet for Facilitating Students' Reflection and Integration of Material Read in Chapters 3–5 from Browne and Keeley (2015).
Figure 2.

An Example of the Reading Notes Worksheet for Facilitating Students' Reflection and Integration of Material Read in Chapters 3–5 from Browne and Keeley (2015) .

×
Figure 3.

Examples From the Critical Thinking Section of the Graduate Student Development Profile (Hancock & Brundage, 2010).

 Examples From the Critical Thinking Section of the Graduate Student Development Profile (Hancock & Brundage, 2010).
Figure 3.

Examples From the Critical Thinking Section of the Graduate Student Development Profile (Hancock & Brundage, 2010).

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Table 1. Critical Thinking Questions Developed by Browne and Keeley (2015) .
Critical Thinking Questions Developed by Browne and Keeley (2015) .×
Interpretation
What are the issue and conclusion?
What are the reasons?
What words or phrases are ambiguous?
What are the assumptions?
Evaluation:
Are there fallacies in the reasoning?
How good is the evidence?
Are there rival causes?
Are the statistics deceptive?
What significant information is missing?
What reasonable conclusions are possible?
Table 1. Critical Thinking Questions Developed by Browne and Keeley (2015) .
Critical Thinking Questions Developed by Browne and Keeley (2015) .×
Interpretation
What are the issue and conclusion?
What are the reasons?
What words or phrases are ambiguous?
What are the assumptions?
Evaluation:
Are there fallacies in the reasoning?
How good is the evidence?
Are there rival causes?
Are the statistics deceptive?
What significant information is missing?
What reasonable conclusions are possible?
×
Table 2. Four-Part Model for Teaching Critical Thinking (Halpern, 2014).
Four-Part Model for Teaching Critical Thinking (Halpern, 2014).×
1. Explicit critical thinking skills instruction
2. Encouraging students' disposition or attitude toward effortful thinking and learning
3. Directing learning activities in ways that increase the probability of trans-contextual transfer
4. Making metacognitive monitoring explicit and overt
Table 2. Four-Part Model for Teaching Critical Thinking (Halpern, 2014).
Four-Part Model for Teaching Critical Thinking (Halpern, 2014).×
1. Explicit critical thinking skills instruction
2. Encouraging students' disposition or attitude toward effortful thinking and learning
3. Directing learning activities in ways that increase the probability of trans-contextual transfer
4. Making metacognitive monitoring explicit and overt
×
Table 3. Intellectual Traits Described by Paul and Elder (2012) .
Intellectual Traits Described by Paul and Elder (2012) .×
Intellectual Humility vs. Intellectual Arrogance
Intellectual Courage vs. Intellectual Cowardice
Intellectual Empathy vs. Intellectual Closemindedness
Intellectual Autonomy vs. Intellectual Conformity
Intellectual Integrity vs. Intellectual Hypocrisy
Intellectual Perseverance vs. Intellectual Laziness
Confidence in Reason vs. Distrust in Reason and Evidence
Fair-mindedness vs. Intellectual Unfairness
Table 3. Intellectual Traits Described by Paul and Elder (2012) .
Intellectual Traits Described by Paul and Elder (2012) .×
Intellectual Humility vs. Intellectual Arrogance
Intellectual Courage vs. Intellectual Cowardice
Intellectual Empathy vs. Intellectual Closemindedness
Intellectual Autonomy vs. Intellectual Conformity
Intellectual Integrity vs. Intellectual Hypocrisy
Intellectual Perseverance vs. Intellectual Laziness
Confidence in Reason vs. Distrust in Reason and Evidence
Fair-mindedness vs. Intellectual Unfairness
×
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