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JEMS. 2010 Apr;35(4):48-53. doi: 10.1016/S0197-2510(10)70094-2.

Critical thinking a new approach to patient care.


As EMS responders, we're challenged with complex patient care situations, and we often make decisions using past experiences, protocols and medical consultation to guide us through treatment "mazes." Using our natural problem-solving process, we tend to see a problem and think about similar past experiences, which we believe will help us implement a workable solution to the problem.(1,2,3) As we strive toward patient care excellence, however, we need to also look for the best solution for our patient care needs. Research continues to reveal that EMS responders may benefit from increasing their practice of critical thinking, problem-solving and decision-making in initial and continuing education.(4-13) Studies are finding that increased practice and exposure to triage, airway management and medication administration decision-making will allow us to achieve an increased quality of patient care.(7,14-22) Research has also found many reasons for patient care deficiencies, but a common theme is that EMS students and providers may not be getting enough practice or exposure to thinking "outside of the box" in difficult, critical-thinking scenarios.(12,14,18,20,21,23-25) This lack of exposure is why EMS educators should continue to challenge students with skills practice and competency assessments. Even with minimal time and practice in the classroom and clinical settings, EMS educators and instructors should infuse the curriculum with complex scenarios and problems to stimulate students' critical thinking and problem-solving skills.(26-30) This can be accomplished by using patient simulation, team-based thinking scenarios, realistic scenarios with variable outcomes and student-group-facilitated presentations.(12) All of these combined will have a greater meaning to students as they navigate through the many requirements to achieve competence and real-life experience in the patient care setting.(31) In response to this need, EMS educational materials are placing more emphasis on critical thinking and encouraging educators to challenge students to think through complex patient care situations.(28,32,33) THOUGHT PROCESS & DECISION-MAKING MODELS: These critical thinking and problem solving skills can't be taught by using only local protocols as gospel in the classroom, nor should we be teaching by a "cookbook" methodology alone.(12) Problem solving and decision-making processes in the public safety professions have developed and evolved over many years, allowing researchers to explore the thought processes decision-makers use when confronted with real-life situations.(1,2,34,35).

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