We sought to explore levels of CT, EI and CMM in medical undergraduates and this study is the first to assess the relationship between CT and EI, CMM in medical students in China. The results from our study suggest medical educators that they should take the characteristics of the students in to account, especially how EI and CMM can contribute to the capacity to foster CT skills. Furthermore, medical educators need to be conscious of how CT can be improved.
The status of CT
The CT mean score was 281.12, which was higher than the established standards by Facione . Our findings suggest that medical undergraduates showed a positive overall disposition to think critical. This result resembles the previous research conducted by Huang  and Raymond . Students met or exceeded the 40-point cut on the open-mindedness, analyticity, inquisitiveness, and cognitive maturity subscales. Similar to other studies, inquisitiveness was found to score the highest [7, 36]. High scores for inquisitiveness indicated a greater potential for the improvement of CT and clinical practice capabilities. CT skills are important for health professionals, as they need to meticulously analyse and solve problems -- making good use of inquisitiveness and questioning of information and decisions.
The findings indicated that students showed the weakest performance on the subscale of truth-seeking. In other words, students were lack of honest and objective attitude about pursuing for truth or to reconsider decisions based on new evidence. Disappointing as this may be, the subscale of truth-seeking score in fact is consistent with that in other studies with healthcare students [11, 36]. This suggested a potential area for the focus of courses that could facilitate the likelihood of medical students using their truth-seeking skills. Traditional medical education has been largely restricted to memorizing diseases knowledge. Traditional didactic course passively delivers information and relies solely on lectures, and does not require students active participation to reflect on the meanings being ‘delivered’, hence limiting the development on scores in the truth-seeking subscale. Hence, further strengthening truth-seeking characteristic in the medical education may be advantageous. This characteristic can provide patients with more responsible medical services.
The correlation between CT and EI, CMM
A statistically significant difference was observed between students’ gender and EI. The difference was attributed to female students as their EI was higher than male students’ at a significant level. The study conducted by Czabanowska et al. yielded similar result . Mostly the females are more sensitive and generally more concerned about other people's emotion as compared with males. Our study showed a positive correlation between CT and EI. Except the correlation between truth-seeking and use of emotions for the medical students statistically non-significant, the various subscales of CTDI-CV and EIS were a significant positive correlation. We found the perceived emotion and self-emotional regulation were the predictors of CT skills. Therefore, it is likely that medical students’ EI plays an important role in the regulation of CT skills, and that good critical thinkers are more effective in handling emotions when face with ambiguity . Higher EI is associated with increased cognitive competence, more rational behavior, and improved sociability . The students with higher EI are more flexible and more tolerant when confront with academic pressure, social anxiety, and complex clinical conflicts . Our findings indicated that medical educational professionals prepared specifically for the improvement of CT or EI can help to foster both abilities positively.
Undergraduate medical students in this study preferred to use integrating style to manage conflict. This result is similar to the previous study conducted by Chan . Integrating style which is the most effective in CMM may be the preferred CMM within the medical students. The total CT shows the conspicuous positive correlation with integration and compromise styles, significant negative correlation with domination and compliance subscales, but not with avoidance. Furthermore, integration, compliance and domination dispositions were significant predictors of CT. This result could manifest the significant presence of CMM effect on CT skills in medical education. Relationship conflicts are inevitable in the clinical work and cost a lot, including stress, burnout, medical error, and turnover. Complete elimination of workplace conflict is unrealistic . Dealing effectively with conflict is a crucial capability for teamwork and the provision of patient service. That may contribute to cultivating medical students for the various challenges of healthcare setting . The complex clinical environment requires effective collaboration, communication, decision thinking, and competencies to handle conflicts. Critical thinkers bring to conflict situations abilities that promote win-win conflict resolution . The strong positive correlation between CT and CMM may imply that our study provide a good foundation for further development of CT skills in the future.
The linear regression showed that perceived emotion, self-emotional regulation, integration, compliance and domination styles were significant predictors of CT. Therefore, EI and CMM can contribute to the capacity to foster CT skills. Students with stronger CT have better clinical performance and higher academic achievement . Medical educators can provide students with platform to work in teams. In the team, students can learn to manage emotions, deal with relationship and task conflicts, and learn to think critically. The application of situational teaching can also foster the development of medical students' CT, EI and conflict management skills.
Our study need to be considered in light of the following limitations. Firstly, a large proportion of our respondents were from the same university and not across China. Although this may cast a gloom over other results, given the homogeneity in responses and accordance with previous studies we think this does not deny our capacity for deducing meaningful findings. In addition, self-reported questionnaires, such as the CTDI-CV only measures the CT disposition not the application of these abilities in practice. As such, self-reported tools may be influenced by social desirability, and the ability of students to accurately self-reflect on their own skills. This could have influenced the results to our survey. However, all the scales used in this study have been shown to produce acceptable results and as such are appropriate for assessing CT, EI and CMM. Finally, because the study was cross-sectional in nature, correlations between CT and EI, CMM may be the result of the overall correlations, rather than the passage of time. Nevertheless, all the participants in this study were similar in age and educational background, lending credence to the findings of this research.