Development of critical thinking in health professions education: A meta-analysis of longitudinal studies

Curr Pharm Teach Learn. 2018 Jul;10(7):826-833. doi: 10.1016/j.cptl.2018.04.019. Epub 2018 Apr 26.


Introduction: While reports of critical thinking exist in the health professions literature, development of critical thinking across a broad range of health-professions students has not been systematically reviewed.

Methods: In this meta-analysis, multiple databases and journals were searched through February 2016 to identify longitudinal studies using standardized tests of critical thinking [California Critical Thinking Skills Test (CCTST), Health Science Reasoning Test (HSRT), and Defining Issues Test (DIT)] in any language. Two reviewers extracted information and collected information regarding primary author, publishing journal, health profession, critical thinking test, and time1/time2 means and standard deviations. Standardized mean differences (SMD) with 95% confidence intervals (CI) were reported using a random-effects model.

Results: Four hundred sixty-two studies were screened, and 79 studies (representing 6884 students) were included. Studies contained 37 CCTST, 22 DIT, and 20 HSRT. Health professions comprised nursing, pharmacy, physical therapy, occupational therapy, dentistry, medicine, veterinary medicine, dental hygiene, clinical laboratory sciences, and allied health. Cohen's kappa was strong (0.82) for inter-reviewer agreement. Both the CCTST (SMD = 0.37, 95% CI = 0.23-0.52) and DIT (SMD = 0.28, 95%CI = 0.18-0.39) demonstrated significant increases in total scores, but the HSRT (SMD = 0.03, 95%CI = -0.05-0.12) did not show improvement.

Discussion/conclusions: In this meta-analysis, students from the majority of health professions consistently showed improvement in development of critical thinking. In this diverse population, only the CCTST and DIT appeared responsive to change.

Keywords: California Critical Thinking Skills Test; Critical thinking development; Defining Issues Test, Health Sciences Reasoning Test; Health professions education.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Curriculum / standards
  • Curriculum / trends
  • Education / methods*
  • Education / trends
  • Educational Measurement / methods
  • Health Occupations / education*
  • Humans
  • Longitudinal Studies*
  • Thinking*