Measuring Critical Thinking in Midwifery Students

Abstract

Well-developed critical thinking skills are essential for autonomous midwifery practice but strategies to develop these skills are often not made explicit in undergraduate education. There is a dearth of studies investigating the development of critical thinking in undergraduate midwifery students and no published tools that specifically measure critical thinking in relation to midwifery practice. This program of work aimed to evaluate and measure midwifery students’ critical thinking skills in preparation for autonomous midwifery practice. The thesis is presented as a series of published and unpublished works, comprising of six sequential and interlinked studies with five overarching aims. The methodology used in this body of work was a sequential mixed methods design, where the data and results from one study provided a basis and direction for the next study. Initially, a pilot study examined the effectiveness of an innovative assessment item involving root cause analysis on the development of critical thinking abilities of undergraduate midwifery students. Although the results indicated that this assessment item increased critical thinking skills, only participants’ perceptions were measured and there was no validated measure of critical thinking. There was also no baseline and post-intervention measure of critical thinking to demonstrate causal effects of the teaching intervention. In recognition of the need to use robust, reliable and valid tools to measure critical thinking, the second study involved a systematic review of the literature. This review aimed to identify an appropriate tool to measure critical thinking in midwifery. The review is presented in two publications on 1) the reliability and validity of tools used to measure critical thinking in nursing and midwifery undergraduate students; and 2) the efficacy of teaching methods used to improve critical thinking in nursing and midwifery undergraduate education. These systematic literature reviews found no measures specifically for midwifery and no tools that measured the application of critical thinking in midwifery practice. Conclusions of the reviews established the need to develop discipline specific instruments to explicitly measure the application of critical thinking in midwifery practice. Given the complexity of critical thinking in midwifery practice, a multimethod approach to the measurement of students’ critical thinking was chosen. The next three studies involved the development, piloting and testing of three tools designed to measure critical thinking in midwifery practice for undergraduate midwifery students. The tools were named the Carter Assessment of Critical Thinking in Midwifery (CACTiM) - (Preceptor/Mentor, Student, and Reflection). Psychometric testing of the three tools during each pilot study provided preliminary evidence that all tools were reliable and valid measures of critical thinking skills in midwifery practice. The final study aimed to further establish the validity and reliability of the three CACTiM tools. A matched cohort of students (n = 55) was used. Positive correlations were found between the three scales and student characteristics, including Grade Point Average, year level and previous qualifications. Results also indicated good reliability and concurrent validity. Critical thinking skills are vital for safe and effective midwifery practice. Assessment of midwifery students’ critical thinking development throughout their degree program makes these skills explicit, and could guide teaching innovation to address identified deficits. Adopting a multimethod approach to the measurement of critical thinking in midwifery captures the complexity of critical thinking in midwifery practice, and provides students with useful and objective feedback from multiple sources. The use of reliable, valid and freely available tools promotes and facilitates ongoing research into the development of critical thinking in education and practice. It is therefore recommended that the three CACTiM tools are implemented routinely and used in the longitudinal measurement of students’ critical thinking development throughout midwifery education programs. The tools could also be used to measure critical thinking for midwifery graduates and midwives in practice. Further testing of these tools with a larger, more diverse student sample is recommended.