Date of Award


Document Type


Degree Name

Doctor of Philosophy


College of Education and International Services

First Advisor

Robson Marinho

Second Advisor

Stephen Corbett

Third Advisor

Shirley Freed



Graduating competent physicians is an imperative societal need. The development of critical thinking skills during medical school is important to meet this societal need and for the care of ill patients. Research shows this skill is key in decreasing medical errors, which in turn decreases cost. (Norman and Eva, 2010) Missing from the literature is a method to assess critical thinking in the setting of caring for the critically ill patient. This instrumental case study tests medical simulation as a method of assessing critical thinking, which incorporates all six competency domains, by looking at the assessment environment, summative patient experience, and participant's reflection on the case and environment.


A qualitative instrumental case study design was used to evaluate twelve senior medical students' critical thinking skills in the setting of identified competency domains. A single simulation patient encounter was administered to each student and data collected from the videotape of the encounter, their written documentation, and oral presentation of the case, mimicking the real-life scenario. The participants were also asked five questions regarding this case. These data were analyzed and presented in narrative format.


The analysis revealed six major themes: assessment environment, coalescence of knowledge and skills, decision-making and deep thinking/reasoning, integrative experience, lack of depth in thought process, and safe environment. This research identified gaps in the students' knowledge, skill, and behaviors of competency domains as they apply to critical thinking. Despite all students successfully completing medical school, errors were made in their individual care of the simulated patient. Four cases ended in "death" of the patient. The documentation of their patient encounter also lacked sufficient detail to allow other medical professionals to understand the issues during the case. The students' opinion of the patient encounter was positive. Several students noted they had not had similar encounters as the sole provider of patient care. The experience gave them the opportunity to apply what they had learned and reflect on their gaps in knowledge.


The ability for physicians to think critically is key in reducing medical errors. An effective instrument to assess critical thinking as it applies to competency is high-fidelity medical simulation. In addition, allowing senior medical students to manage the case as the physician in charge exposes knowledge, skills, and behaviors of critical thinking, making these processes accessible for assessment.

Subject Area

Critical thinking--Ability testing; Critical thinking--Simulation methods; Medical students