Exploring The Factors Influencing Critical Thinking Disposition And Inquiry Among Clinical Medical Students By Structural Equation Model

Objective: Critical thinking is crucial for clinician to evaluate,diagnose and treat patients.The cultivation of critical thinking for medical students has also drawn more and more attention.However,research on influencing factors of medical students’ critical thinking is relatively insufficient compared to nursing.Inquiry is the key to students’ innovation,but there is no research on the influencing factors of clinical medical students’ inquiry.This study aimed to investigate the status of clinical medical students’ critical thinking disposition and to explore the direct or indirect influences of various factors and pathways on critical thinking disposition and even inquiry.Methods: We enrolled 307 third-year clinical medical students for a combined questionnaire survey in Tongji Medical College of Huazhong University of Science and Technology.The combined questionnaire included factors related to critical thinking disposition and the Chinese Version of critical thinking disposition inventory revised by Peng.We extracted latent variables by exploratory factor analysis and constructed a theoretical model to present the factors and pathways that influenced critical thinking disposition and even inquiry using structural equation model.Results:(1)The total score of critical thinking disposition of third-year clinical medical undergraduates tends to be positive overall(294.19 ± 34.04),but 32.2% of the students was non-positive.All dimensions did not reach the strong positive disposition.The mean score of truth-seeking(39.80)and self-confidence(37.77)did not reach the positive disposition and the mean score of the Systematicity dimension(40.36)was on the positive edge.By comparison,the female clinical medicine students have a higher score of critical thinking total grade,truth-seeking,open-mindedness,cognitive maturity than the male students.The students without religious beliefs have a higher score of critical thinking total grade,open-mindedness,and analyticity of Scores higher than students with religious beliefs,Self-confidence scores of medical students from provincial cities or regional cities are higher than those from county-level cities,townships or rural sources.(2)The model shows a good fitting state(RMSEA = 0.048,CFI = 0.94,TLI =0.93).Our study found that high school learning experience(participating in interest groups or second class,free high school class style,teacher-student lecture mode)(β =0.27,P = 0.010)、whether medical work requires critical thinking(β = 0.24,P < 0.001)effects critical thinking disposition directly.Family characteristics(the only child,father’s high education level,and mother’s high education level)effects critical thinking disposition indirectly through the mediating variable of high school learning experience(β = 0.10,P = 0.032).Furthermore,extracurricular reading(having any extracurricular reading habits now,more kinds of extracurricular reading)(β = 0.49,P = 0.012)、critical thinking disposition(β = 0.30,P < 0.001)effects inquiry(self-reflection,using evidence to prove own opinion,analysing information source authenticity)directly.Family characteristics effects inquiry indirectly through the mediating variable of extracurricular reading(β = 0.15,P = 0.0014).Whether medical work requires critical thinking effects inquiry directly(β = 0.27,P = 0.011),and also effects inquiry indirectly through the mediating variable of critical thinking disposition(β = 0.07,P = 0.003).Conclusions: Clinical medical students’ critical thinking disposition tends to be positive overall,but a considerable part of students have not reached the positive critical thinking disposition.The critical thinking of clinical medical students needs to be strengthened urgently.Family characteristics,high school learning experience,and whether medical work requires critical thinking are influencing factors of critical thinking disposition.Family characteristics,extracurricular reading,critical thinking disposition and whether medical work requires critical thinking are influencing factors of inquiry.