Advancing Critical Thinking Through Learning Issues in Problem-Based Learning.

Health professions educators are increasingly urged to use learning designs that promote critical thinking and the development of interpersonal competencies. Problem-based learning (PBL) has a long, albeit contested, history as a collaborative and deep think-aloud process that participants use to reach conclusions about medical cases. In order to make progress, participants must assess what they do not know and what they must learn in order to continue. Answering these learning issues (LI) requires self-direction and cognitive presence. This study analyzes the discussions that participants used in the reporting phase of the LI process in an 8-week PBL module on cardiac-renal systems. Data were drawn from 10 class sessions and analyzed for critical thinking using a model based on Garrison and Newman et al. Participants at first presented LI reports didactically but over time initiated active learning strategies. The findings indicate large increases in the numbers of LI reports in which participants engaged in collaborative thinking. There were also large increases in the amount of time devoted to critical thinking as participants aligned the LI process more closely with the intent of PBL. Participants' identity development as experts also underwent changes and the fluidity of the expert roles increased. Thoughtful design of the LI process can help learners develop the habitus of self-direction and collaborative critical thinking that they need in order to develop clinical reasoning.