How to develop critical thinking skills in medicine as a medical student?

[deleted1139416]

With midlevel creep, automation, and the rise in personalized healthcare and novel therapeutics, it seems like physicians will eventually be handling more complex cases as opposed to “just give a pill” type of medicine that many doctors practice now. How should I prepare for this?

---

Members don't see this ad.

 

[Dr Meow]

 

[deleted1139416]

View attachment 358704

Not exactly sure what comparing med students to dogs accomplishes here…

 

[operaman]

School and training really do provide you the opportunities to develop that kind of thinking. As a student the key is to work hard and be engaged in the clinical care of patients and striving to understand the decision making involved. You can also go above and beyond what most students do in terms of reading.

Start making it a habit to read something about every single patient or disease you personally see. It’s easy to let these opportunities pass you by, but I’ve learned a ton from just reading about what I see. Most students do the bare minimum and focus more on shelf prep. If you have the bandwidth to do both, reading on what you see goes a long way toward helping you remember things.

Another piece of advice I got early that has helped immensely: read proportionally to the incidence of what you see. It’s tempting to read about rare things and that’s certainly part of the job, but more important is knowing common things well. In my field of ent that means things like chronic sinusitis, tonsilitis, hearing loss, skin and mucosal squamous cell carcinoma, etc. In IM it probably means diabetes, hypertension, coronary artery disease, lung cancer, etc. If you know the most common things extremely well, you have more time and bandwidth to handle the rare things.

The other key thing I’ve found is that you can usually figure something out if you just take the time to investigate it. As you go along, you’ll develop a sense of what normal looks like as well as the typical course of the diseases you treat. When something doesn’t seem to fit, don’t let it go until you’ve satisfied your intuition. That’s usually what predicates my unusual diagnoses- a sense that something isn’t right and continuing to investigate until I have an answer.

Which brings us back to now: take every opportunity you have to spend time with patients and start developing that sense of how things go. It takes years - you won’t get there as a student - but if you work at it you will start to in residency. I’m a new attending and still figuring this out, but the keys are time with patients, reading, and paying attention.

 

[Redpancreas]

I really like Operaman’s response above. If you were in residency I’d give you a different answer with more details but for right now, you are new to medicine.

It’s important to learn and experience what all you can and try not to cut corners by just focusing on Step 2 prep and research but to some extent you’ll have to because everyone else is. Like Operaman says, read about your patients because it sticks more and in proportion to incidence. I like that phrase.

Again, I don’t think you’ll have the bandwidth to hear about clinical reasoning/critical thinking yet because as a student you don’t understand the big picture in medicine yet and it takes time to understand what’s going on, what’s normal, abnormal, etc. The advice is also somewhat specific to which field you are in.

As a brief/general answer, you need to keep asking WHY especially if something doesn’t fit which if I remember correctly is basically the definition of critical thinking anyways. If you just blindly order tests as reactions to lab values and symptoms, you’re going to miss diagnoses. Nothing makes the patient better faster than the correct diagnosis and delaying that causes morbidity and excess cost. In my experience though, students often ask WHY too much because they don’t have a firm grip on medicine in general unless they’re perceptive or have a career in something medically related, but then some physicians stop asking why about in year 2 or so in residency because they don’t care anymore I feel. Revisit this topic once you become a resident. I think more than developing critical thinking deliberately as a skill as a defense to PA/NP encroachment; try to have an interest in what you end up doing and the critical thinking aspect will come naturally with experience and out of interest.

As much as I critique the process of getting into medicine, I do think it selects for people who at some point of their lives were inquisitive about the why and hows in science. The key is finding that again once you’re done with internship and above water in medical training.

 

[Hzreio]

Not exactly sure what comparing med students to dogs accomplishes here…

As a med student I can say that I confirm this sentiment

 

[Goro]

Not exactly sure what comparing med students to dogs accomplishes here…

If we have to explain it to you, you won't understand it.

What makes you that medical students aren't taught clinical critical thinking skills?

 

[Dr. Pineal Gland]

Not exactly sure what comparing med students to dogs accomplishes here…

Lighten up lol.

Also, to develop critical thinking skills at this stage of our lives (assuming your age and if you even are a medical student)- is much more difficult. I am starting to think differently about each thing I study as opposed to UG/MCAT and take it a step further to better integrate it into my memory and influence my approach and thinking for the next thing I study. Doing lots of research to supplement what you learn (again, I have no idea where in the process you are)-AmBoss or MedBullets is good to give you the gestalt.

At the end of the day, the experience will enhance your critical thinking after getting pimped out by attendings in front of your peers- that'll make you think extra the next time you are asked a question for sure.

 

[Mr.Smile12]

"You've always had the power..."

You have basic critical thinking skills, but your success has been in applying them to undergraduate/postbaccalaureate courses and to "simple" tests like the MCAT. That said, as the scope of practice goes, physicians will be happy when the occasional "textbook case" comes along because the more "complex" cases often have no or any easy solution. The challenge is that the volume of information you have to handle is so much bigger, and the evidence is not always clear-cut. This evidence-based thinking and practice are what every curriculum is focused on throughout the health professions, and you will have to recognize when you don't know what you should know.

 

[deleted1139416]

Thank you for all the answers everyone. Let me just clarify because I think my post rubbed some people the wrong way: I never said med students or doctors don’t have critical thinking skills. However, I do strongly believe that the current state of healthcare doesn’t allow doctors to tap into their critical thinking skills as effectively due to high patient volumes. Once midlevel creep and automation increases, I think that doctors would be called upon to treat more complex cases whilst the routine ones are handled outside the care of an MD/DO. With new therapies coming out to treat varying diseases every year, I am hopeful that I will have a career that will be efficacious with regards to helping patients get to the route causes of their problems and using problem solving skills to improve health and QoL.

 

[eteshoe]

My school does a lot of mystery case-study type of things during preclinicals (small teams working w an attending through cases and how to think about certain lab values, weird presentations, alternate DDx, etc.). I learned how to synthesize what I saw in lectures, Anki, qbanks, etc. to a deeper level. And then being the nerd that I am, I'd go read research articles about the topics to gain even better understanding.

 

[greatnt249]

Once midlevel creep and automation increases, I think that doctors would be called upon to treat more complex cases whilst the routine ones are handled outside the care of an MD/DO.

This sentiment bugs me to no end, that there is such a thing as "routine" in medicine. Things become "routine" at an attending level through repeated exposure to the same medical issues over and over again and learning the nuances that make what would outwardly seem "routine," in fact, not routine. This is what people who are not physicians don't understand. We call it routine care because we don't value ourselves enough to emphasize that nothing in medicine is actually routine; we just make it look that way through time and experience.

 

[Gilakend]

You will be trained and taught to handle clinical situations 100x beyond that of a midlevel. The future is not "physicians handling more complex cases" that has always been the case. There have always been complex cases, physicians have always handled them. If you learn what any decent good is trying to teach you, go to a decent residency, and focus on learning at both of those places, you will have nothing to worry about.

However, as a soon-to-graduate M4, I fully agree with the above dog meme. I have said it before and I will say it again, I have never in my life been around a group of people with less common sense than medical students.

 

[deleted1139416]

However, as a soon-to-graduate M4, I fully agree with the above dog meme. I have said it before and I will say it again, I have never in my life been around a group of people with less common sense than medical students.

This is part of the reason why I made my original post: I’ve noticed a lot of my classmates just wanting to memorize and have pre-made Anki decks as opposed to understanding, applying, and learning.

 

[Mr.Smile12]

... I never said med students or doctors don’t have critical thinking skills. However, I do strongly believe that the current state of healthcare doesn’t allow doctors to tap into their critical thinking skills as effectively due to high patient volumes. Once midlevel creep and automation increases, I think that doctors would be called upon to treat more complex cases whilst the routine ones are handled outside the care of an MD/DO. ...

I slightly disagree. I think the rewards in a hospital system EMR and insurance reimbursements limit the critical thinking. Physicians will need to do high-volume work because that's how you will get paid until incentives change. At best, a pediatrician has to deal with so many cold and congestion cases (for example) that critical thinking isn't always the first thing you have to think about unless something is really out of place (where the critical thinking is needed), but a lot of Big Data and your own performance metrics by your hospital system and the insurance companies will dictate your behavior. Then imagine being paid on how compliant your patients are in getting better... your critical thinking skills will have to shift to persuasion.

 

[Gilakend]

This is part of the reason why I made my original post: I’ve noticed a lot of my classmates just wanting to memorize and have pre-made Anki decks as opposed to understanding, applying, and learning.

That's definitely normal though, I wouldn't worry about it. While you definitely learn how to apply some in med school, a lot of medical school is just learning the alphabet and words, residency is where you actually start learning how to talk.

 

[Redpancreas]

Thank you for all the answers everyone. Let me just clarify because I think my post rubbed some people the wrong way: I never said med students or doctors don’t have critical thinking skills. However, I do strongly believe that the current state of healthcare doesn’t allow doctors to tap into their critical thinking skills as effectively due to high patient volumes. Once midlevel creep and automation increases, I think that doctors would be called upon to treat more complex cases whilst the routine ones are handled outside the care of an MD/DO. With new therapies coming out to treat varying diseases every year, I am hopeful that I will have a career that will be efficacious with regards to helping patients get to the route causes of their problems and using problem solving skills to improve health and QoL.

I don’t think you rubbed anyone the wrong way. Midlevel encroachment is one of many concerns in medicine, but I don’t think you should worry about developing critical thinking skills now as a response. You likely already have them if you’ve made it to medical school. Your scholastic achievement is at least above average. You just need to apply them to medicine. The first years or so in medical school are literally just learning the language/world of medicine followed by clinical experience where you focus on developing trained reflexes. When you develop that and choose your field/residency, you overall commitment to that training (dedicating and applying yourself to do the correct processes with the correct form) every single day is what differentiates you from a midlevel, someone who more or less is practiced in a much narrow scope without any plans for independent training.

There was a meme/quote I like where a patient asks a doctor why he’s paying $100s of dollars for a 15 minute appointment and the doctor says you’re not paying for 15 minutes of time, you’re paying for the blood, sweat, tears that allows me to sit here today, open your chart, grasp your medical biography within a minute, ask pertinent questions, deduce what’s going on, anticipate future problems, and prescribe a treatment plan all in 15 minutes.

Work hard in medical school. Learn all the things they’re trying to make you memorize. If you don’t do it as efficiently as your neighbor, relax. You still did it well. Next, work hard in residency. Learn what to never miss and what to always look out for. Afterwards, learn to be efficient. When you’ve done this and you’re a senior resident; don’t stop caring about medicine and stop asking questions. Question things when they don’t fit. Try ordering things based off instincts. You’ll look like an idiot, but slowly you’ll start catching things. You’ll start recognizing patterns and realize when it’s appropriate to consult, order advanced testing, etc.

 

[Redpancreas]

That's definitely normal though, I wouldn't worry about it. While you definitely learn how to apply some in med school, a lot of medical school is just learning the alphabet and words, residency is where you actually start learning how to talk.

This exactly OP. We have all been through it. There was a phase in M1 where I questioned why all of the medical education was even necessary when we could just look it all up and doctors could be replaced by college students with a medical encyclopedia. In M2 the views were challenged a bit, but it wasn’t until the first year of residency where you learn that this, like everything else, is truly a craft.

 

[LunaOri]

That's definitely normal though, I wouldn't worry about it. While you definitely learn how to apply some in med school, a lot of medical school is just learning the alphabet and words, residency is where you actually start learning how to talk.

While this is somewhat true, the sooner you begin understanding, integrating and applying those memorized facts, the easier it will be to remember them and use them. I wouldn’t recommend waiting until residency to start thinking.

 

[Redpancreas]

While this is somewhat true, the sooner you begin understanding, integrating and applying those memorized facts, the easier it will be to remember them and use them. I wouldn’t recommend waiting until residency to start thinking.

Definitely not! Early integration of clinical application is great, but especially in M1 there is just some stuff you have to tough out and grind out like verb conjugations in a foreign language, etc to move on. Later you may not need it (ie embryology), but you realize what it is and “it was a whole thing”. If you do internal medicine and you hear a patient had a congenital issue, you know very well you don’t manage that the same as an adult patient with normal anatomy as you get flashbacks to how the heart twists/develops.

 

[DOVinciRobot]

This is part of the reason why I made my original post: I’ve noticed a lot of my classmates just wanting to memorize and have pre-made Anki decks as opposed to understanding, applying, and learning.

You have to learn what all the buttons in the cockpit are named and what they do before you can begin to practice learning to flying the plane.

 

[Osminog]

Listen carefully to the clinical reasoning of your attendings—the variables they seem to care most about, the algorithms and heuristics they use, the questions they tend to ask, etc. Adopt the aspects of their reasoning that seem most rational and conducive to effective patient care.

Over time, also try to recognize attendings’ potential missteps—their biases, misapprehensions, unreasonable shortcuts, etc. Attending physicians are not perfect; some will help you purely by serving as examples of the sort of physician you would hate to become.

 

[deleted1139416]

You have to learn what all the buttons in the cockpit are named and what they do before you can begin to practice learning to flying the plane.

Flight attendants aren’t trying to take pilot’s jobs

 

[DOVinciRobot]

Flight attendants aren’t trying to take pilot’s jobs

Not relevant to the analogy…

How can you critically think about things you don’t have in your memory? The eye can’t see what the mind doesn’t know