Effect of a Critical Reasoning Course on Students' Willingness to Think and Reflect


The purpose of this study was to explore the effectiveness of a one credit Critical Reasoning course on students’ awareness of and willingness to think and reflect critically.


A one credit Critical Reasoning course was designed to introduce students to the nature of critical reasoning in the field of physical therapy. The class considered types of bias and the effects of assumptions as well as the differences between inference and deduction. The class explored and discussed Physical Therapy frameworks for clinical reasoning and the differences between expert and novice clinicians. Students watched an example of an expert physical therapist evaluating a patient using a think aloud protocol and then had two opportunities to practice reasoning through a case in a small group with mentorship from faculty.

The study was a pre/post test design with two cohorts of students (n = 117). All subjects completed two outcome measures, the California Critical Thinking Disposition Inventory (CCTDI) and a Self Reflection and Insight Scale (SRIS). The CCTDI is a 75 item tool in which responders agree or disagree using a six-point Likert scale ranging from “strongly agree” to “strongly disagree” with statements related to seven constructs related to attributes of critical thinkers drawn from a Delphi study on critical thinking. The SRIS is based on theories of metacognition and self-regulation and is designed to measure the readiness of individuals for purposeful behavioral change. The tool includes three domains, the ‘need for reflection’, ‘engagement in self-reflection’ and ‘insight’ (Roberts 2008, p.1055). The SRIS is built on the premise that self-reflection and insight are essential for self-regulation.


Scores for the CCTDI increased from the beginning to the end of the course t (111) = -2.88, p < .002. Scores also improved on all but the open-mindness and maturity of judgement subcales. Scores for the Engagement in Reflection t (111) = 4.02, p <.01, Insight t (111) = 2.16, p < .05 and Total Reflection t (111) = 2.52, p < .05 scores improved as well. The Total Reflection score is calculated by adding the Need for reflection and Engagement in reflection scales.

Conclusions/Relevance to the conference theme: Shaping the Future of Physical Therapy Education

The SRIS is the first tool that allows educators to focus on the assessment of the skills of reflection and insight. The study provides initial evidence of the effectiveness of the Critical Reasoning course. Additionally, it is the first study to use the Self Reflection and Insight Scale to assess physical therapy students’ readiness for purposeful behavioral change related to thinking. Although a lack of insight and poor recognition of limitations has been anecdotally reported by faculty and clinical instructors as reasons for a students’ poor performance in the clinic, little research has been completed in this area. The SRIS provides educators with a tool that may be useful in helping to identify those students at risk for poor performance due to limited insight and self reflection skills.


Assessment, I. 2013a. California Critical Thinking Disposition Inventory CCTDI Manual, San Jose, CA, The California Academic Press.
Grant, A. M. 2002. The Self-Reflection and Insight Scale: A New Measure of Private Self-Consciousness. Social Behavior and Personality, 30, 821-836.
Norman, G. 2006. Building on experience-The development of clinical reasoning. N Engl J Med, 355, 2251-2252.
Jensen, G., Resnik, L. & Haddad, A. 2008. Expertise and clinical reasoning. In: HIGGS J, J. M., LOFTUS, S, CHRISTENSEN, N (ed.) Clinical Reasoning in the Health Professsions. Third ed. London: Elsevier.
Paul, R. & Elder, L. 2014. Critical Thinking Concepts and Tools. Tomales: Foundaton for Critical Thinking.
Roberts, C. & Stark, P. 2008. Readiness for Self-Directed Change in Professional Behaviors: Factorial Validation of the Self-Reflection and Insight Scale. Medical Education, 42, 1054-1065.

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  • Control #: 2290306
  • Type: Posters
  • Event/Year: ELC2015
  • Authors: Dr. Karen Huhn
  • Keywords:

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