Critical thinking with aspirin, socks and sports | MEDICUS 2023 Issue 4

Teaching critical thinking with aspirin, lucky socks and sports teams

By Levin Tan, Writer

Duke-NUS second-year students attend one of the Research and Critical Thinking classes, where Professor Roger Vaughan challenges them to unpack the reasoning behind their decision-making

When Duke-NUS second-year medical students turn up for the Research and Critical Thinking class, the first challenge Course Director Professor Roger Vaughan puts to them is to rate their level of belief in the causality of two events: aspirin alleviating a headache, and wearing of lucky socks and having their favourite sports team win.

Typically, Vaughan said, students will rate the “cause” of lucky socks and team winning as about a three, on scale of one to ten, but perhaps ascribe sevens and eights for the aspirin.

“But what heuristic did they use to ascribe these values?” said Vaughan, who is also the director of the Centre for Quantitative Medicine. “What factors contributed to those ratings? So, we unpack it.”

“I don’t teach them biostatistics. I’m trying to impart critical thinking; biostatistics is just a vehicle.”
Prof Roger Vaughan

That’s how Vaughan reels the students into the revamped course, which since last year was moved to the second year of the Doctor of Medicine (MD) programme and arranged to run over 12-months. It aims to have students ready to embark on their third-year research project, fully equipped with the necessary critical thinking skills.

By focusing on clinically oriented research papers, Vaughan also makes sure that the concepts he instills have stickiness with the students who are at the same time completing their clinical clerkships.

“It really adds to the depth of the class,” said Mr Sean Asahara Thio, a second-year student at Duke-NUS, who could see the real-world impact during his rotation to a respiratory medicine ward.

Mr Sean Asahara Thio, a second-year medical student, has seen the real-world impact of the concepts taught in the Research and Critical Thinking course

“In the respiratory ward, we have a lot of asthma patients, and they recently switched to a different kind of inhaler therapy. And that was all based on a clinical trial that was done to compare outcomes from the old versus the new version of the inhaler therapy,” he said.

The students also relish the hands-on approach of the course—they are challenged to dissect the hypotheses and outcomes of papers, pick apart numbers to uncover statistical errors, and tinker with R, an open-source programme used in clinical research for statistical analysis and reporting.

Thio’s classmate Ms Nichole Tan treasures the interactive nature of the class. “Even though our first session was over Zoom, I could feel like him trying to really ask us questions and interact with the class.” Tan said.

Getting to try the tools and programmes, like R, early on in the course was one of the highlights for Tan: “We get to learn as we practise, rather than just learn everything like head knowledge and then we get to practise.”

Ms Nichole Tan, a second-year medical student, appreciates the interactive nature of this course

Another memorable moment for both students was the opportunity to crack the sanctity surrounding research papers published in top journals. Thio recalled, “Using the data from a paper published in a prestigious journal, Prof Roger asked us to determine if there was a statistically significant difference or not. All of us got to the opposite conclusion from the authors of the paper because they had used an inappropriate statistical test for that sample size.”

He added: “This really drove home that so much of what we do is based on research, which we don’t really think about, we don’t really take a step back to analyse and vet on our own.”

And that is precisely what Vaughan wants students to get used to: “Uncertainty is good because it makes you struggle to figure it out. And I try to get them to used to the notion that you never know—just keep at it.”

Since taking over the course, Professor Roger Vaughan has focused on equipping students with the critical thinking skills needed to stay on top of rapidly changing clinical practice

He also wants them to see the limitations of a study not necessarily as weak points but opportunities for further research.

“They might have had a 20-percent loss to follow up, or horrible compliance,” he said. “A smarter scientist would actually celebrate these “pitfalls” and continue to interrogate them, to try and help others both be aware of the limitation, and help solve the problem for the next time.”

And how does Vaughan test his students on whether they’ve absorbed the concepts? The answer is—he doesn’t. Instead, he has the students find articles relevant to their rotations, which they then analyse according to what they’ve learned before uploading their analysis to a shared site. There, it’s easy to see what the students might be struggling with individually.

And the feedback from students on the course has been overwhelmingly positive.

“I really appreciate that there are no tests; medical school is very stressful already,” laughed Thio, who feels that the importance and gravity of what they are learning in their careers is motivation enough.

After having attended several of Vaughan’s classes, Thio has observed how his reading of primary research has become more astute. Most of all, the module has served as a welcome reminder of the kinds of decisions he’ll have to make as a clinician and the responsibility that comes with those decisions.

“He’s trying to inculcate in us is a way of thinking, and that’s something that you will only gain over multiple sessions,” reflected Thio.

Applying Vaughan’s teachings, Tan shared that her approach to doing research has become more open-minded. “Regardless of the result, whether it’s significant or not, I keep the mindset of just trying to learn as much as I can.”