1

ROLE OF ACTIVE LEARNING IN CRITICAL THINKING SKILLS

The Role of an Active Learning Environment in the Development of Critical Thinking Skills in Undergraduate Students

Kathryn P. Smith

University of CentralFlorida

Abstract

Critical thinking is a primary educational outcome of nursing education. The demographics of nursing students have changed with younger students expecting an active and engaging environment and adult learners wanting to be active participants. Active learning environmentsuse instructional methods like problem based learning, simulation, debate, and role play to encourage learners to use higher level thinking processes which in turn promote critical thinking. This integrated literature review exploreswhether an active learning environment promotes critical thinking skills in undergraduate students. A comprehensive literature search wasconductedin ERIC, Cochrane, Medline, and CINAHL using the search terms: active learning, simulation, gaming, problem based learning, group, case study, undergraduate, baccalaureate, andcritical thinking. Five articles were selected that met the inclusion criteria and focused on critical thinking as a student outcome. Findings indicated that there were significant increases in critical thinking and learner satisfaction among students when an active learning environment was present. This review also revealed that in the future, research should include more longitudinal studiesand better comparison methods.

The Role of an Active Learning Environment in the Development of Critical Thinking Skills in Undergraduate Students

Significance

Critical thinking has been the buzzword in nursing education for as long as many can remember. When talking about competencies and/or outcomes of nursing education, it is usually the first one to come to mind (Beckie, Lowry, & Barnett, 2001).The health-care arena is a constantly evolving environment where the nurse’s responsibility and accountability are continually increasing (Eugene, 2010). It is imperative that future nurses will be able to analyze, interpret, and problem solve in order to provide the highest quality care to their patients. Billings and Halstead (2009) describe a critical thinker as one with exceptional judgment, attitude and character.

Nurse educatorsface many challenges in trying to prepare students for future nursing practice. As times have changed, so have the students. In the past, when we referred to undergraduate students as “college age” it implied they were eighteen to twenty two years old. We now see a more diverse student population that spans several generations. Educators are constantly trying to find ways to bridge the generation gap and meet the needs of all of their learners. Many students, especially the younger generation, are now very reliant on technology and prefer more interactive teaching methods (Billings & Halstead, 2009). It is essential that educators are adaptable and willing to incorporate various teaching methods in order to engage this diverse group of learners (Bastable, 2008).

When discussing nursing education, it is important that educators reflect on the active nature of adult learning theory. Adults generally prefer learning that is self-directed and problem based (Eugene, 2010). In other words they are not content to be spectators, but rather prefer to be active participants. Traditionally, nursing education has mainly consisted of a lecture format instruction (Eugene, 2010). Learners are inundated with copious amounts of material, followed by formal testing. In recent years, there has been a push for reform in nursing education towards more innovative teaching methods (NLN, 2003). Billings and Halstead (2009) explain that in order for students to convert content into knowledge, they need to be actively involved in the learning process. It is the responsibility of the educator to create a learning environment that will facilitate learning while meeting the needs of the adult learner and developing critical thinking.

Billings and Halstead (2009) tell us that in order for students to become critical thinkers, they must be active participants in the classroom who use higher level thinking processes. Educators facilitate learning by sharing knowledge and creating an interactive environment that enables students to transform the content into their own knowledge (BillingsHalstead, 2009). Active learning instructional methods such as group discussion, simulation activities, case studies, debate, and role play (Chambers-Clark, 2008) encourage learners to uses higher level thinking such as application, analysis and evaluation (Patterson Johnson & Mighten, 2005). These higher level thinking processes are key components of critical thinking (Chambers-Clark, 2008).

The purpose of this integrated literature review was to summarize evidence addressing the question of whether an active learning environment promoted critical thinking skills in undergraduate students.

Methods

A thorough literature search was conducted using Educational Resources Information Center (ERIC), Cochrane Database of Systematic Reviews, Medline, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). The search terms used were: active learning, simulation, gaming, problem based learning, group, case study, undergraduate, baccalaureate, andcritical thinking. Articles were included if they were written in English, peer reviewed, and research reports. Exclusion criteria included thesis and dissertation articles.

The level of evidence and quality of articles was determined using the criteria in the Melnyk & Fineout-Overholt (2011) text. This rigorous process included critically appraising each article individually and analyzing the study’s validity, results, and application to practice.

Results

Search Results

The search in ERIC produced forty-five matches, Medline produced twenty-four matches, and CINAHL produced eighty-six matches. There were zero matches in the Cochrane Database of Systematic Reviews. After applying inclusion and exclusion criteria, the total articles were narrowed down to a smaller selection based on whether or not the results of the study focused on development of critical thinking skills as an outcome of an active learning environment. The final number of articles yielded by the searches was fifteen articles. Six of these remaining articles were eliminated because they were level VII evidence articles and four were eliminated because the abstract was misleading and the outcomes measured were not critical thinking outcomes. Ultimately, five articles were chosen based on their success in meeting the above criteria as well as their ability to demonstrate the proposed outcome.Table 1 provides a summary of the design, level of evidence, sample, characteristics of the intervention and results for each of the studies included in this review. Upon analysis of these articles, two themes became apparent. Active learning improves critical thinking and active learning is satisfying to students.

Table 1

Primary Studies Reviewed

Primary Study,
Country / Design, Level of Evidence, Sample / Characteristics of Intervention / Results
Beckie et al., 2001
United States / Longitudinal Study
Level 4
Undergraduate nursing students entering their junior year in a BSN program (n= 183)
Cohort 1/traditional learning approach, before curriculum revision
(n= 55)
Cohort 2/Active learning approach & first class to use “new” curriculum (n= 55)
Cohort 3/ Active learning approach & second class to use “new” curriculum
(n= 73) / The purpose of the study was to determine if the critical thinking skills of nursing students improved after the curriculum was revised from a more passive learning environment to a more active learning environment.
The students (cohorts 1, 2, & 3) were given a pre-test on the first day of class, another test one year later at the beginning of their senior year, and the third test was administered upon exit from the program. The test used was the California Critical Thinking Skills Test (CCTST), Form A. It consists of a 34 item multiple choice test which gives an overall critical thinking score and also breaks down critical thinking into 5 critical thinking subscales. / The students in cohort 2 (first group to use the new curriculum) scored higher than cohort 1 (the old curriculum) in critical thinking skills on both the second and third test. However, cohort 3 (second group to use the new curriculum) scored lower than cohort 1 and 2 on critical thinking skills on both the second and third tests.
Test 2 (1 yr post test) total CCTST score
Cohort 1= 15.7 + 3.7
Cohort 2= 18.1 + 4.4
p= < 0.001
Cohort 3 = 15.2 + 4.9
Not significant
Test 3 (exit test)
total CCTST score
Cohort 1= 16.3 + 3.7
Cohort 2= 18.5 + 5.9
p= <0.001
Cohort 3 = 13.6 + 5.4
Not significant
Lin et al., 2011
Taiwan / Experimental design study, randomization.
Level 2
Senior undergraduate nursing students
(n= 142)
Peer tutored Problem based learning (PTPBL) (n= 72)
Traditional (n= 70) / A comparison was done between senior nursing students in a nursing ethics course to examine educational results when different teaching methods were used. Students were randomly assigned to either the traditional (lecture format) class (control group) or the PTPBL class (experimental group).
The tools used in this study were teaching plans, the nursing ethical discrimination ability scale (NEDAS), and the level of satisfaction with critical thinking (LOSCT) survey. The NEDAS consisted of 41 questions measured on a Likert scale. All students were administered a NEDAS pre-test prior to the beginning of class. After completion of the nursing ethics class, the students were given the NEDAS post-test and a level of satisfaction with critical thinking (LOSCT) survey. / The PTPBL class scored higher than the traditional class, but both groups actually showed improvement from their nursing ethical discrimination baseline scores to post test scores.
Post-test NEDAS
PTPBL= 3.65 + 0.32
Trad. = 3.58 + 0.32
p= <0.001
Additionally, the students in the PTPBL class scored higher on level of satisfaction with critical thinking (LOSCT) on the learning satisfaction survey than the students in the traditional class.
LOSCT
PTPBL= 3.92 + 0.60
Trad. = 3.59 + 0.48
p= <0.001
Ozturk et al., 2008
Turkey / Descriptive analytical study.
Level 6
Senior undergraduate nursing students
(n= 147)
Problem based learning (PBL)
(n= 52)
Traditional (n= 95) / A comparison was done between two schools of nursing to study the effect of learning environment on critical thinking dispositions. One school used a traditional learning environment and the other school used a problem based learning (PBL) approach.
Students were given a Turkish version of the California critical thinking disposition inventory (CCTDI) to compare the two educational programs. It was given in the middle of the final semester of the final year of the programs. The CCTDI used a Likert-type scale and posed 51 questions that measured the student’s critical thinking disposition. The CCTDI also further broke down the results into six subscales of specific critical thinking qualities. / The students in the PBL program scored higher in overall critical thinking disposition than the students in the traditional program.
PBL = 266.0 + 24.0
Trad. = 255.8 + 23.7
t = 2.48 (p = 0.01)
Tiwari et al., 2006
China / Randomized controlled trial (RCT).
Level 2
First year nursing students (n= 79)
Problem based learning (PBL)
(n= 40)
Lecture (n= 39) / First year nursing students were randomly assigned to a two semester course using either a PBL format or a lecture format. The courses were both on nursing therapeutics and both courses had the same objectives. The purpose was to measure the student’s critical thinking disposition and compare the two types of learning environments.
Students were the California critical thinking disposition inventory (CCTDI) to compare the two educational styles. The CCTDI used a Likert-type scale and posed 75 questions that measured the student’s critical thinking disposition. The CCTDI also further broke down the results into seven subscales of specific critical thinking qualities.
The CCTDI was given as a pretest, at the end of the second semester (end of the course), at the one year interval, and then again at the two year interval. The intervention (PBL) was only used the first year, and then the remaining three years everyone was taught the same via lecture. By using the CCTDI at various times throughout the four years, the intent was to assess longitudinal effects of the two teaching methods.
There were also individual interviews conducted at the second, third and fourth time points to evaluate student perceptions of their learning experience. / The students in the PBL course scored higher in overall critical thinking disposition than the students in the lecture course at the end of the course (2nd test) and for the two years following (3rd and 4th test).
Difference in overall CCDTI score between test 1 and 2
PBL= 5.03 + 24.67
Lect.= -10.47 + 20.88
p= 0.0048
Difference in overall CCDTI score between test 1 and 3
PBL = 8.38 + 19.42
Lect.= -4.52 + 16.22
p = 0.0083
Difference in overall CCDTI score between test 1 and 4
PBL= 2.31 + 3.40
Lect.= 0.21 + 4.71
p= 0.0440
Yuan et al., 2008
China / Quasi-experimental study, with randomization
Level 2
Second year undergraduate nursing students (n= 46 )
Problem based learning (PBL)
(n= 23)
Lecture (n= 23) / Second year undergraduate nursing students were equally and randomly assigned to two different “Introduction to Nursing” classes. The experimental class utilized a PBL teaching method and the control class used a lecture approach. The PBL class used active learning methods such as group discussions, group care planning, and evaluation/reflection activities.
The instrument used to measure critical thinking skills was a Chinese Taiwan version of the California Critical Thinking Skills Test Form A (CCTST-A). It consists of a 34 item multiple choice test which gives an overall critical thinking score and also breaks down critical thinking into 5 critical thinking subscales. The test was administered as a pre-test and then again as a post-test at the completion of the course.
PBL students were also given the opportunity to share their opinions regarding PBL at the completion of the course with a survey. / The students in the PBL class showed greater improvement in overall critical thinking than the students in the lecture based class. They also had positive responses to the PBL learning experience when completing their personal surveys.
Comparison of the change in scores of critical thinking from pre-test to post-test
PBL= 2.43 + 3.17
Lect.= -0.217 + 2.63
p= 0.003
PBL students’ survey responses to PBL
Improved critical thinking = 91.3%
Enhanced problem solving = 91.3%

Active learning improves critical thinking.

All five studies arrived at the conclusion that active learning improves critical thinking in students (see Table 1). In every study, the comparison was made between classes taught via lecture format and courses utilizing an active learning approach. In the Beckie et al. (2001) study, active learning encompassed various instructional strategies including Socratic questioning, reflective journal writing, and small group activities while the remaining studies referred to active learning as problem based learning. Four of the studies assessed critical thinking using the California critical thinking disposition inventory (CCTDI) (Beckie et al., 2001, Ozturk et al., 2008, Tiwari et al., 2006, & Yuan et al., 2008) and one study (Lin et al., 2010) used the nursing ethical discrimination ability scale (NEDAS). The assessment tools were given as a pre-test and a post-test in four of the studies (Beckie et al., 2001, Lin et al., 2010, Tiwari et al., 2006, & Yuan et al., 2008) to assess whether critical thinking scores increased after exposure to an active learning environment. In the Lin et al. (2010) study, the post-test scores of the control group werecompared to post-test scores of the intervention group to assess which group saw a significant increase in critical thinking scores. While the peer tutored problem based learning (PTPBL) class scored higher than the traditional class, both groups actually showed improvement from pre-test to post-test in regards to their nursing ethical discrimination scores.In the other three studies (Beckie et al., 2001, Tiwari et al., 2006, & Yuan et al., 2008) the post-test scores of the control group were compared to post-test scores of the intervention group and found that thecritical thinking scores of the students in the active learning environment improvedsignificantly in comparison to the students who were taught via traditional lecture. One study (Ozturk et al., 2008) only administered the CCTDI once at the midpoint of the course; however it did reveal a significant difference in critical thinking scores between the students in the problem based learning (PBL) course and the lecture course. The Beckie et al. (2008) study however, showed some discrepancy between the second and third cohorts in regards to critical thinking scores.Cohort three actually saw a progressive decrease in critical thinking scores between the first, second and third tests. This leaves one to wonder if the third cohort scored lower because they were disinterested in participating in the study/taking the test, or if this group of students truly did not develop critical thinking skills like the previous group of students.

Active learning is satisfying to students.

Three studies (Lin et al., 2010, Tiwari et al., 2006, &Yuan et al., 2008) administered some type of learning satisfaction survey to obtain feedback from the students regarding their learning experience (see table 1). All three of the articles revealed that students find active learning to be satisfying. Lin et al. (2010) found that the students in the PBL course were more highly satisfied with the self-motivated learning and critical thinking than the students in the lecture format course. The PBL students in the Tiwari et al. (2006) and Yuan et al. (2008) studies described their courses as inspiring, motivating, and encouraging in regards to getting them to analyze, investigate, and synthesize knowledge. PBL, and other active learning environments, allow students to be active participants in the learning process (Billings & Halstead, 2009). Having a learning environment where students can collaborate and openly work together through the course content can give them a sense of independence and ownership of the material, thus enhancing satisfaction.

There were, however, some aspects of the active learning/PBL experience that were perceived less positively by students participating in these studies. These included increased time commitment (Yuan et al., 2008), the workload (Yuan et al., 2008), and the stress associated with increased class participation/public speaking (Lin et. al., 2010). Interestingly, these two studies were both conducted in Asian countries (China and Taiwan) where lecture format is the norm (Lin et al., 2010). Having to convert from a passive learning environment to a course using PBL can be a dramatic switch and one that causes stress to those who are uncomfortable with public speaking and forced participation.