Critical thinking evaluation in reflective writing: Development and testing of Carter Assessment of Critical Thinking in Midwifery (Reflection)

Midwifery. 2017 Nov;54:73-80. doi: 10.1016/j.midw.2017.08.003. Epub 2017 Aug 18.


Objective: develop and test a tool designed for use by academics to evaluate pre-registration midwifery students' critical thinking skills in reflective writing.

Design: a descriptive cohort design was used.

Sample: a random sample (n = 100) of archived student reflective writings based on a clinical event or experience during 2014 and 2015.

Methods: a staged model for tool development was used to develop a fifteen item scale involving item generation; mapping of draft items to critical thinking concepts and expert review to test content validity; inter-rater reliability testing; pilot testing of the tool on 100 reflective writings; and psychometric testing. Item scores were analysed for mean, range and standard deviation. Internal reliability, content and construct validity were assessed.

Findings: expert review of the tool revealed a high content validity index score of 0.98. Using two independent raters to establish inter-rater reliability, good absolute agreement of 72% was achieved with a Kappa coefficient K = 0.43 (p<0.0001). Construct validity via exploratory factor analysis revealed three factors: analyses context, reasoned inquiry, and self-evaluation. The mean total score for the tool was 50.48 (SD = 12.86). Total and subscale scores correlated significantly. The scale achieved good internal reliability with a Cronbach's alpha coefficient of .93.

Conclusion: this study establishedthe reliability and validity of the CACTiM (reflection) for use by academics to evaluate midwifery students' critical thinking in reflective writing. Validation with large diverse samples is warranted.

Implications for practice: reflective practice is a key learning and teaching strategy in undergraduate Bachelor of Midwifery programmes and essential for safe, competent practice. There is the potential to enhance critical thinking development by assessingreflective writing with the CACTiM (reflection) tool to provide formative and summative feedback to students and inform teaching strategies.

Keywords: Critical thinking; Journal writing; Midwifery; Pre-registration; Reflection; Students.

MeSH terms

  • Cohort Studies
  • Education, Nursing, Baccalaureate / methods
  • Educational Measurement / methods
  • Educational Measurement / standards
  • Humans
  • Midwifery / education
  • Midwifery / methods
  • Midwifery / standards*
  • Psychometrics / instrumentation*
  • Psychometrics / standards*
  • Reproducibility of Results
  • Students, Nursing / psychology
  • Thinking*
  • Writing / standards*