3D Character and Question MarkSocratic questioning, a dialectic approach to acquiring knowledge, has been around for ages. If done appropriately, it’s a rigorous method of learning. Questioning reveals our knowledge base, reasoning, and want for clarification; invites a dialogue; and establishes a relationship with others. Socratic questioning can also aid in the development of critical thinking.

Critical Thinking: Need for but challenging to teach 

Although facts are needed for critical thinking, rote memorization plays a secondary role in critical thinking. There are various definitions of critical thinking, but the one that I have seen more often is that of Scriven and Paul1:

“Critical thinking is the intellectually disciplined process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and/or evaluating information gathered from, or generated by, observation, experience, reflec-tion, reasoning, or communication, as a guide to belief and action. In its exemplary form, it is based on universal intellectual values that transcend subject matter divisions: clarity, accuracy, precision, consistency, relevance, sound evidence, good reasons, depth, breadth, and fairness.”

As noted by Papp et al2 on their recent publication of critical thinking, a milestone in a complex system, it is difficult to assess. And yet it is essential for acquiring knowledge and patient care in a world full of misinformation and uncertainty. The authors call for critical thinking to be explicitly taught and not assume it will occur automatically. Novices do not become experts or critical thinkers by merely observing more senior practitioners. A clear distinction should also be specified, as stated in the article “although content expertise and critical thinking may correlate, the command of knowledge typical of master clinicians should not be conflated with the ability to rationally solve problems.” This is quite important as most assessments are geared towards remembering, recall, and recognition and these should not be confused with critical thinking.

This video gives a good explanation of what critical thinking is and how to achieve it. 

In a chapter entitled “Bloom’s Taxonomy and Critical Thinking Instruction: Recall is not Knowledge3, the author Richard Paul states that in Bloom’s Taxonomy, recall is often confused with knowledge. He also notes that learning how to think critically as “just a matter of asking higher order level of thinking is misleading.” More specifically the chapter states:

“…those who advocate critical thinking instruction hold that knowledge is not something that can be given by one person to another. It cannot simply be memorized out of a book or taken whole cloth from the mind of another. Knowledge, rightly understood, is a distinctive construction by the learner, something that issues out of a rational use of mental process.”

According to Paul, encouraging memorization without rational thinking strategies is not knowledge or fostering critical thinking. He also adds that following Bloom’s taxonomy as a strict hierarchical order instead of using the levels of thinking interdependently is not conducive to rationality.

Here are the requirements for successful instruction in critical thinking, according to Paul:

  • Teachers should have a full range of insights into cognitive processes and their complex interrelationships
  • Bloom’s hierarchy becomes two-sided (higher order / lower order thinking).
  • Teachers should see that rational learning is a process – rather than product-oriented. The process brings comprehension, analysis, synthesis, and evaluation into every act of the mind that involves the acceptance, however provisional, of beliefs or claims to truth, and that thereby fosters rational habits of thought and rational learning.
Bloom's taxonomy

Bloom’s Taxonomy

Critical Thinking: Perils in the Information Acquisition Process 

Critical thinking are essential when acquiring knowledge. Since we cannot just memorize what’s on the page or what someone has told us and call it knowledge, it is important to assess our sources and draw our own conclusions. But our thinking may also be flawed with lots of cognitive bias, and arguments may be full of logical fallacies. We should train to diminish our cognitive bias and spot logical fallacies in order to acquire the best possible objective information. Another important feature is for information to be as relevant and up to date as possible.

Textbooks are usually good expert information repositories, in which information has been peer-reviewed, conveniently packaged, and organized in a hierarchical order. There are, however, disadvantages in textbooks that might impair critical thinking. In a recent study by Powell et al4 the authors found that intravenous fluid therapy was not adequately covered in a number of undergraduate textbooks used in the UK. By the time a print textbook is published, the information might be outdated and erroneous compared to updated and corrected standards. This drawback has also been found in online textbooks where you would think peer reviewed information would be more up to date.5

In addition to the lack of timeliness for textbooks, the practice of peer-review is also not perfect and prone to bias, especially if conflict of interest is present. If the information in textbooks is not thoroughly scrutinized, we run the risk of memorizing something erroneous, outdated, or inadequately covered. It is also important to note that exams which test outdated and erroneous information might interfere with critical thinking habits, as the information being memorized may interfere with correct information when needed. These setbacks can also be found in journal articles, which also bring their own set of biases that comes with research.6,7 If we are not being cautious, our critical thinking fails even at the initial step of just acquiring information.

Internet resources, on the other hand, can be updated readily if done properly, but otherwise run the same risks as printed media. Transparency in Internet resources have other advantages that may aid in the acquisition of less bias and more up to date information. These resources may be easily accessible, very portable, and in some instances openly peer-reviewed. Other than textbooks, journals, and online resources, experts and peers can also be used for knowledge building and acquire information.

Decision-making that involves rationality and reflective thinking

When it comes to decision-making, we all run the risk of inadvertently introducing cognitive bias into our decisions and intuitions. This can be good or bad depending under what circumstances the decision is taking place. Daniel Kahneman and Gary Klein disagree about the process of decision-making and the role of intuition. Kahneman cautions that intuition is flawed, and Klein states an expertise’s intuition after years of experience is not flawed.8,9 On the other hand, Gigerenzer goes as far as saying not to rely on experts’ decision processes, but rather on heuristics instead.10 Although, based on years of experience, there is no guarantee that these examples of decision-making involve critical thinking or rationality.  

Keith Stanovich, a psychologist and expert in rationality, reports that intelligence tests do not directly measure rationality.11 Rationality has two goals, asking why we believe what we believe and behave in ways to approach our goals in life. Stanovich’s studies have also uncovered that learning cognitive skills does not shield us from more bias.12 Judging by Stanovich’s account, we should not confuse decision-making with rational thinking as our reasoning are full of some of the most common biases, such as confirmation, overconfidence, and myside bias. We should make sure we train in a rational manner to detect what might go wrong in our decision-making and behaviors.

Sometimes our decisions are more like cognitive misers, and if used in the wrong context it might lead us astray. Wolff and Frederick have found that performance in the cognitive reflection test correlates with reflective thinking — a trait needed for analytical reasoning.13,14 We probably don’t have thinking styles, but rather thinking strategies that vary from setting to setting. Sometimes we’re probably satisficers while other times maximizers — just like we might use Bayes’ in some settings but not in others. Along a spectrum, information from experts is probably the most reliable that we may acquire, but that does not mean we should turn off our habits of critical thinking and rationality. Sometimes we might defer thinking and rely on our peer group for a consensus. But groups also have their disadvantages as well and run the risks of social cognition bias, especially when high coherence takes the priority in the group.15


Learning is a complex process, and recalling information does not equate to knowledge. In order to develop critical thinking, we need to go beyond higher levels of Bloom’s Taxonomy. Some of our repositories of information are flawed due to bias, lack of timeliness, and sometimes even wrong information. Similarly, experts and their clinical reasoning, while highly regarded, can also be flawed. The same goes with peers and groups.

In the end, we are left with our own reasoning, critical thinking, and decision making. If our critical thinking is not well equipped, it might lead us to make serious mistakes. We should be aware of cognitive bias, fallacies, and the fact that memorized information and not constructed knowledge. The best tool we have, as noted by Socrates, is questioning in order to uncover our ignorance. If we do not actively seek knowledge and only depend on information given to us by our peers, experts, and publications, we run the risk of not knowing what we don’t know.

Scriven M, Paul R. Defining Critical Thinking. The Critical Thinking Community. http://www.criticalthinking.org/pages/defining-critical-thinking/766. Accessed May 2014.
Papp K, Huang G, Lauzon C, et al. Milestones of critical thinking: a developmental model for medicine and nursing. Acad Med. 2014;89(5):715-720. [PubMed]
Bloom PR. Bloom’s Taxonomy and Critical Thinking Instruction. Educational Leadership. http://eric.ed.gov/?id=EJ319813. Published May 1985. [Source]
Powell A, Paterson-Brown S, Drummond G. Undergraduate medical textbooks do not provide adequate information on intravenous fluid therapy: a systematic survey and suggestions for improvement. BMC Med Educ. 2014;14:35. [PubMed]
Jeffery R, Navarro T, Lokker C, Haynes R, Wilczynski N, Farjou G. How current are leading evidence-based medical textbooks? An analytic survey of four online textbooks. J Med Internet Res. 2012;14(6):e175. [PubMed]
Ioannidis J. Why most published research findings are false. PLoS Med. 2005;2(8):e124. [PubMed]
Dwan K, Altman D, Arnaiz J, et al. Systematic review of the empirical evidence of study publication bias and outcome reporting bias. PLoS One. 2008;3(8):e3081. [PubMed]
Kahneman D, Klein G. Conditions for intuitive expertise: a failure to disagree. Am Psychol. 2009;64(6):515-526. [PubMed]
Gigerenzer G, Gaissmaier W. Heuristic decision making. Annu Rev Psychol. 2011;62:451-482. [PubMed]
Stanovich KE. Rational and Irrational Thought: The Thinking That IQ Tests Miss. Scientific American Mind. 2009;20(6):34-39. doi: 10.1038/scientificamericanmind1109-34
West R, Meserve R, Stanovich K. Cognitive sophistication does not attenuate the bias blind spot. J Pers Soc Psychol. 2012;103(3):506-519. [PubMed]
Frederick S. Cognitive Reflection and Decision Making. Journal of Economic Perspectives. 2005;19(4):25-42. doi: 10.1257/089533005775196732
Toplak M, West R, Stanovich K. The Cognitive Reflection Test as a predictor of performance on heuristics-and-biases tasks. Mem Cognit. 2011;39(7):1275-1289. [PubMed]
Karrasch A, Gunther H. The Power of Discourse. Small Wars Journal. http://smallwarsjournal.com/jrnl/art/the-power-of-discourse. Published May 2, 2014.
Javier Benitez, MD

Javier Benitez, MD

ALiEM Featured Contributor
Javier Benitez, MD


Medical doctor, tweets not medical advice or endorsements. Interested in #MedEd & technology. Always learning. I'm no expert. No financial conflict of interest.
Javier Benitez, MD