Is critical thinking potential correlated to critical appraisal skills of medical literature?


Mona Mlika
Abdelmajid Naceur
Georges Kpazai
Faouzi El Mezni
Lilia Zakhama
Iheb Labbene
Mohamed Jouini


Introduction: Critical appraisal of medical literature is a mandatory skill to practice evidence-based medicine. 

Aim: To assess the relation of critical thinking potential to critical appraisal of medical literature competencies. 

Methods: This was a mixed study associating a quantitative and a qualitative approach. It included second year (SYME), third year (TYME) and postgraduate medical students (CME) and family doctors (FD) from the same faculty of medicine. All the students received the same active training focused on critical appraisal of medical literature. They were asked to fulfil a pre-requisite test and a self-assessment questionnaire before the training session and a final test after the training. The self-assessment questionnaire was conceived by an expert committee and assessed the main characteristics of critical thinking consisting of sensitivity to context, self-correction and search for criteria. Three months after the training, the students were interviewed using a semi-structured interview. 

Results: 58.9% of the students presented a high critical thinking potential profile. Their scores varied according to their levels with better scores in SYME and FD and intermediate scores in TYME and CME. The pre-requisite test scores varied according to the critical thinking profile and the level. Final test scores didn’t differ according to the critical thinking profile or the level.

Conclusion: Our results put emphasis on the variation of the critical thinking potential according to the students’ levels and the necessity of changing curriculum in order to enhance the sensitivity and the inclination of the students.



  1. Bhandari M, Giannoudis P. Evidence-based medicine: What it is and what it is not. Injury. 2006;37(4):302–6.
  2. Lipman M. Moral education higher-order thinking and philosophy for children. Early Child Dev Care. 1995;107(1):61–70.
  3. Kpazaï G, Daniel MF. Manifestations of Critical Thinking in Health and Physical Education Teachers: An Examination of Three Case Studies. Intell Transport Sys J. 2011;3:1-15
  4. Facione NC, Facione PA. Externalizing the Critical Thinking in Knowledge. Develop and Clin Judgment. 1996;1:12-22
  5. Perkins DN, Jay E, Tishman S. Invitational Issue: The Development of Rationality and Critical Thinking. JSTOR.1993;39:12-34
  6. Skipper CP, Pastick KA, Engen NW, Bangdiwala AS, Abassi M, Lofgren SM, et al. Hydroxychloroquine in nonhospitalized adults with early covid-19: A randomized trial. Ann Intern Med. 2020;173(8):623–31.
  7. Lisboa Bastos M, Tavaziva G, Abidi SK, Campbell JR, Haraoui LP, Johnston JC, et al. Diagnostic accuracy of serological tests for covid-19: Systematic review and meta-analysis. The BMJ. 2020;370.
  8. Shehata GM, Zaki A, Dowidar NL, Sayeda I el. Critical thinking and attitude of physicians toward evidence-based medicine in Alexandria, Egypt. J Egyp Pub Health Assoc. 2015;90(3):115–20.
  9. Atler K, Stephens J. Pilot use of the adapted Fresno Test for evaluating evidence-based practice knowledge in occupational therapy students. Am J Occup Ther. 2020;74:34-42
  10. McCarthy P, Schuster P, Zehr P, McDougal D. Evaluation of critical thinking in Baccalaureate Nursing Program. J Nurs Educ. 2013;1:12
  11. Zettergren K, Beckett R. Changes in critical thinking scores: An examination of one group of physical therapist students. J Physic Ther Educ. 2004;18:2
  12. Profetto-Mcgrath J. The relationship of critical thinking skills and critical thinking dispositions of baccalaureate nursing students. Issues and innov in nursing education. 2013;12:12-16
  13. Scott JN, Markert RJ, Dunn MM. Critical thinking: change during medical school and relationship to performance in clinical clerkships. Medical Education. 1998;32:14-18
  14. Solberg BL. Critical Thinking as a Predictor of Certification Exam Performance in Medical Laboratory Science. Clin lab science. 2015;15:23-32
  15. Martindale R, Ward C, Fraser M. How effective are your questions when training students on the bench. CJMLS. 2011;1:12-13
  16. Krupat E, Sprague JM, Wolpaw D, Haidet P, Hatem D, O’Brien B. Thinking critically about critical thinking: Ability, disposition or both? Med Educ. 2011;45(6):625–35.
  17. Godwin M, Seguin R. Critical appraisal skills of family physicians in Ontario, Canada. BMC Med Educ. 2003;3:10.
  18. Pieterse T, Lawrence H, Friedrich-Nel H. Critical thinking ability of 3rd year radiography students. Health SA Gesondheid. 2016;21:381–90.
  19. Kpazaï G, Daniel MF. Manifestations of Critical Thinking in Health and Physical Education Teachers: An Examination of Three Case Studies. PHEnex J. 2011;3 :12-20