Critical Thinking in the Texting Age

Objectives

Though texting has become a preferred way for clinicians to discuss patient care, surgeons report that texting detracts from trainees’ education. Little research has explored how texting relates to education and more specifically to critical thinking – the problem-solving and decision-making processes central to safe patient care. As such, we aimed to identify how trainees perceived the effect of texting on critical thinking.

Design

We undertook a qualitative study using a constructivist paradigm. Through interviews, we explored the relationship between texting and critical thinking. We approached interview data with a directed content analysis, generated themes in discussion with the study team, and corroborated findings through member checking.

Setting

We conducted this study at the University of California San Francisco.

Participants

Thirty surgical residents from multiple surgical specialties participated.

Results

We identified four themes: a new technocultural norm, altered practice patterns and demands, de-emphasis of critical thinking, and methods to promote critical thinking skills. A new technocultural norm has fundamentally changed communication. Furthermore, broader changes in medicine have affected the setting in which teams work, leading to altered practice patterns and demands. Together, certain aspects of the new technocultural norm combined with altered practice patterns have de-emphasized critical thinking, shifting the balance in team relationships towards communication and away from critical thinking. After establishing the de-emphasis of critical thinking in the setting of texting, participants posited possible methods to promote critical thinking skills. These methods centered on changing feedback and team culture and providing structured education to junior and senior residents.

Conclusions

Although texting has become an enduring fixture in clinical communication, it may detract from critical thinking in certain scenarios. Educators can harness this study's findings to build structured education and change the culture around text-based communication to allow for efficient clinical care without sacrificing critical thinking.