Ross, David MD; Loeffler, Kim MD; Schipper, Shirley MD; Vandermeer, Ben MSc; Allan, G. Michael MD
Education of health care practitioners is challenging and costly. To provide high-quality care and minimize errors, health care trainees must learn to perform data collection, clinical reasoning, and sensible management. A great deal of research has been completed to predict and identify trainees who may have difficulty during their education. Some of the previously evaluated predictors include admission tests,1 grade point averages (GPAs),2 socioeconomic characteristics,3 ethnicity,4 and gender.5 However, academic success is multifactorial, and more work is required to determine the factors involved.
An important element of both high-quality care and academic success is critical thinking. Critical thinking is the ability to identify a problem, select and evaluate pertinent information, recognize assumptions, formulate appropriate hypotheses, and draw valid conclusions and critical inferences.6,7 Although medical errors are unfortunately part of practice, clinicians and educators continually strive to reduce their frequency and severity. Mismanagement and diagnostic errors can arise from cognitive errors through incorrect information gathering, interpretation, and assessment.8 Critical thinking ability may help reduce these errors and improve care overall.8
Critical thinking is a highly valued educational outcome throughout the educational spectrum, but particularly in relation to higher and professional education.9 Critical thinking, particularly clinical reasoning, is felt to be an instrumental clinical skill. It has been proposed that critical thinking may improve diagnostic skills and reduce errors in management.8
Studies that examine critical thinking in correlating with academic success in health care trainees have provided conflicting results.10,11 A systematic review of the evidence would help to clarify the issue but has not been done to date. Our objective was to carry out such a review. Specifically, our goal was to determine whether the literature indicates that three commonly used measures of critical thinking correlate with academic success in medical professionals in training.
Three Commonly Used Measures of Critical Thinking
Critical thinking encompasses six core competencies, which are interpretation, analysis, evaluation, inference, explanation, and self- regulation.12 Several validated tools can measure critical thinking, including the California Critical Thinking Skills Test (CCTST), California Critical Thinking Disposition Inventory (CCTDI), and Watson-Glaser Critical Thinking Appraisal (WGCTA). These validated tools were developed by national experts in critical thinking, are easy to administer, and require minimal time to complete.
The CCTST is a 34-item multiple-choice question quiz, generating six total scores and five subscale scores. The CCTDI assesses the extent to which a person possesses the disposition of the ideal critical thinker and measures affective attitudinal dimensions of critical thinking. This tool has 75 items, generating a total score and seven subscale scores. The WGCTA has 80 items and produces a single score based on the assessment of five critical thinking skills.
We performed and reported this systematic review according to Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines,13 augmented by the more updated Preferred Reporting Items for Systematic Reviews and Meta-Analyses.14
A medical research librarian performed all literature searches. The initial search of five databases was performed in June 2010: Medline (from 1950), Health and Psychosocial Instruments (from the beginning of the database), Cochrane Library (from the beginning of the database), Embase (from 1980), and PsychINFO (from 1987). Original search terms were California Critical Thinking Skills Test or CCTST or California Critical Thinking Disposition Inventory or CCTDI, with medic* or doctor* or resident or physician* combined for the PsychINFO database.
For our updated search in November 2011, we broadened our search to six databases: Medline (from 1980), Embase (from 1980), Scopus (from the beginning of the database), Cochrane Library on Ovid (from 1980), Proquest Dissertations (from the beginning of the database), and PsychINFO (from 1980). Updated search terms were California Critical Thinking or Watson Glaser or CCTST or CCTDI or WGCTA. We restricted our search to English-language articles and excluded studies before 1980. The comprehensive search terms and search strings are available from us on request. We also reviewed references from all included studies and contacted selected authors by e-mail.
We included studies in which critical thinking was compared with the academic success of medical professionals in training. Critical thinking could be assessed using the CCTST, CCTDI, or WGCTA. Academic success could be quantified using grades on specific tests or courses, GPAs, or certification exams. Medical professionals in training could include trainee physicians (medical students, residents, or house staff), nurses, dentists, dental assistants/hygienists, pharmacists, chiropractors, dieticians, nutritionists, respiratory technicians, occupational therapists, physiotherapists, physical therapists, emergency medicine technicians, psychotherapists, or veterinarians. We excluded studies with a mixture of students if medical professionals in training could not be separated from nonmedical students. We also excluded studies of undergraduate psychology students because many of these students do not become medical professionals.
Two of us (G.M.A. and S.S.) independently evaluated all identified studies for inclusion, and the two of us resolved any disagreement by consensus. We reviewed abstracts and titles initially and reviewed in full those articles identified for possible inclusion. We then calculated the agreement in study selection between the two independent reviewers.
For all included studies, data were extracted on study citation (primary author, year published, journal title, volume, pages, journal/thesis), study location/years (country, state/province, urban/rural, years of study), participants (profession, training levels, gender, ethnicity, training site), study method (sample, mode by which the critical thinking test was administered), numbers (number sampled, response rate, number responding), critical thinking assessment (type of test or tests), academic assessment (type of grade/mark), comparison (primary analysis, result, significance, and secondary analysis, result, significance), subgroup findings, mean critical thinking scores, and comments.
All of us reviewed the first study together to confirm an understanding and agreement on the template for extraction. Two of us (D.R. and K.L.) independently completed data extraction on all remaining included studies using a data template created in Excel. We calculated the agreement in data extraction between the two independent reviewers. Another one of us (G.M.A.) resolved any disagreement.
Risk of bias
There is controversy around quality and bias scoring systems for observational studies.13 For the primary analysis of quality, we assigned “higher risk of bias,” “lower risk of bias,” and “unclear” to the three study characteristics: response rate, sampling method, and mode by which the critical thinking test was administered. Response rates < 60% were assigned a higher risk of bias. Sampling methods using convenience sampling were assigned a higher risk of bias, whereas sampling the entire cohort or a random sample of the cohort was considered a lower risk of bias. Mode of administration of the critical thinking test was assigned a lower risk of bias if the administration of the test was most likely observed, such as in a preexisting class, face-to-face sessions, or a special session. We assigned a higher risk of bias if the tests were mailed to participants or if the test results were retrieved retrospectively.
Additionally, each characteristic was assigned 0 for low risk of bias and 1 for high risk of bias or unclear. Therefore, the quality score for each study could range from 0 to 3, with higher numbers indicating a higher risk of bias.
The primary analysis included correlation statistics between critical thinking and academic success. When studies used both CCTST and CCTDI, we used CCTST for meta-analysis. When studies used both GPAs and certification results, we used GPAs for meta-analysis. It is well established that meta-analysis of correlations is more accurate on the Fisher z scale than on the actual correlations (r).15 To meta-analyze correlations, data were first converted into Fisher z scale, with variance of z being estimated as V = 1/(n − 3). Two studies did not report a final sample size. We computed the sample size of Allen and Bond16 using its reported P value, whereas the final sample size for Bauwens and Gerhard17 was estimated using its initial sample size multiplied by the average response rate of all the other studies.6,10,11,18–68 We used the DerSimonian-Laird random effects methods to come up with a pooled estimate and 95% confidence interval (CI) of the average Fisher z value across studies. Heterogeneity was assessed using the I2 statistic. We estimated statistical differences between subgroups using the chi-square test.
We examined and compared subgroups by student type (nurse, medical doctor, etc.), publication type (journal or thesis), risk of bias (high, moderate, low), type of critical thinking test (WGCTA, CCTST, CCTDI), year of publication (1981 to 1997, 1998 to present), and measure of academic success (course mark, GPA, certification exam). We also performed subgroup comparisons on studies using two or more critical thinking tests or measures of academic success. This allowed direct comparison of variables within the same studies, reducing bias between study comparisons. Pooled Fisher z values and their 95% CI were transformed back into correlation values (r).
Figure 1 shows the search results and process of selecting the studies. The search located 557 studies after duplicates were removed. Fifty-six studies6,10,11,16–68 met inclusion, including 4 studies published as both journal articles and in thesis form, leaving 52 unique studies. Agreement by reviewers was 95% for study selection and 94% for data abstraction.
Table 1 shows the characteristics of the 52 included studies. Although 1 study16 did not include participant numbers, there were a total of 6,631 participants in the remaining 51 studies. Almost all studies were done in the United States (50 of 52). One of the remaining 2 was done in China,33 and the other was done in both Australia and the United States.27 Studies were of nursing, pharmacy, medical doctor, dental hygiene, physiotherapy, dentistry, and veterinarian students/trainees, with the majority of studies (41 of 52) being of nursing students. Thirty-five studies provided gender information, with 79% of participants being women.
Appendix 1 shows the quality assessment of included studies. There was a low risk of bias for sampling method in 28 studies (54%), for mode of critical thinking test administration in 28 studies (54%), and for response rate in 38 studies (73%). Overall, 12 studies (23%) had low risk of bias in all three areas. High or unclear risk of bias was found in two areas for 14 studies (27%) and in three areas for 4 studies (8%).
Eleven studies were not meta-analyzed, as 9 did not report correlation statistics and 253,60 did not provide adequate data for inclusion. Five of the 9 studies using t test, ANOVA, regression, chi-square, and ANCOVA reported statistically significant associations between critical thinking and academic success.
Figure 2 shows the primary meta-analysis of 41 studies using Pearson correlation (or Spearman correlation in 1 study). Critical thinking had a positive correlation to academic success, r = 0.31 (95% CI 0.26, 0.35), with a moderate statistical heterogeneity (I2 = 67%).
Figure 3 shows the subgroup and sensitivity meta-analysis. Because compared groups could include different studies, we considered these indirect comparisons. The correlation results did vary significantly by the type of student (subgroup difference, chi-square = 19.32, P = .002). This result should be interpreted with caution because three of the student types (dental hygienists, physiotherapists, and mixed) had only one study each, and the remaining three groups (doctors, pharmacists, and nurses) had overlapping CIs. Correlation results did not vary significantly by publication type, risk of bias, type of critical thinking test, year of publication, measure of academic success, or risk of bias. The subgroup differences were close to significant (P ≤ .1) for critical thinking test, year of publication, and measure of academic success.
Figure 4A shows the direct comparison of CCTST and CCTDI using the six studies that included both critical thinking tests. The correlation to academic success was higher for CCTST (r = 0.39, CI 0.33, 0.45) than CCTDI (r = 0.23, CI 0.15, 0.30), with a statistically significant subgroup difference (chi-square 11.93, P < .001). Figure 4B shows the direct comparisons of GPAs and certification exams in the five studies that used both outcomes. There were no differences between the correlations of critical thinking to certification exams or GPAs. Weighted mean scores of the CCTST, CCTDI, and WGCTA tests were 16.43, 310.13, and 55.40, respectively, across the studies.
Critical thinking was moderately correlated to academic success of health care trainees (r = 0.31, CL 0.26, 0.35). The correlation was not influenced by the measure of academic success, study year, study quality, or type of publication. Although there were statistical differences in the correlations of critical thinking to academic success among different professions’ trainees, this was subject to a high risk of bias because many professions had only one study. For those professions with more than one study, the CI of the correlation overlapped substantially, suggesting no reliable difference.
The choice of critical thinking test was the only factor to statistically and meaningfully affect the correlation of critical thinking to academic success. In the primary comparison between studies, the correlations to academic success for CCTST (r = 0.30, CI 0.23, 0.37) and WGCTA (r = 0.33, CI 0.27, 0.38) were very similar. However, for the CCTDI, these values were lower (r = 0.21, CI 0.12, 0.30) than they were for both the CCTST and WGCTA, and the P value for comparisons, although not significant, suggests the trend to a statistical difference. In the direct comparison using studies that measured both CCTST and CCTDI, the values for CCTDI (r = 0.23, CI 0.15, 0.30) were inferior (P < .001) to those for CCTST (r = 0.39, CI 0.33, 0.45). Therefore, when trying to correlate academic success of health care trainees, CCTST (and likely WGCTA) are superior to CCTDI. CCTDI is likely inferior because it was developed to measure the disposition to think critically rather than the ability to think critically.
Critical thinking and health care training programs
Health care training programs could use critical thinking in a number of ways. Scores on critical thinking tests could be used as part of admission criteria to help select candidates most likely to have academic success in the program. Scores could also be used to identify trainees in programs who are more likely to have difficulty succeeding academically. In that case, resources could be directed earlier to the identified trainees. Because the correlation is at best moderate, scores on critical thinking tests could not be used alone.
Other criteria that we found for predicting academic success (reported in studies that were not part of those found in our systematic review) include the student’s GPA prior to a medical program69,70 and scores on admission tests such as the Medical College Admission Test (MCAT)71 and the multiple mini-interviews (MMIs).72 These investigations were performed for nurses,70 dental hygienists,69 dentists,73 pharmacists,74 and medical doctors.71 In meta-analysis, MCAT scores correlated to preclinical (r = 0.39) and clinical (r = 0.34) GPAs.71 The prior GPA correlated to scores on Step 1 of the United States Medical Licensing Examination (r = 0.34) and to scores on Step 2 of that same examination (r = 0.36).75 The MMI correlated to scores on clinical skills exams, ranging from 0.36 to 0.43.72 In pharmacy, the GPA (r = 0.44) and the score on the Pharmacy College Admission Test (r = 0.32) correlated with academic success.74 Many of these correlation statistics are similar to the numbers found in this meta-analysis.
Most studies assessing variables that may be predictive of academic success have looked at only one variable or assessed variables individually. Studies assessing the contribution of a collection of variables in predicting academic success have found mixed results. For example, within pharmacy students, Kidd and Latif37 found that only CCTST (not admission exam, CCTDI, or essay score) contributed significantly to predicting clerkship GPA. Alternatively, McCall et al45 found that after admission exam, prepharmacy GPA, and age, CCTST did not significantly contribute to a model predicting academic success.
Furthermore, it is likely that some of the variables, like admission exams and critical thinking tests, assess similar characteristics. McCall et al45 found that CCTST correlated with pharmacy admission exam subscores. However, inconsistent results challenge interpretation. For example, Kuykendall39 examined predictors of success on the licensing exam for nurses from two colleges and found that WGCTA added little to the GPA for one school but was helpful for another. At present, information is limited, mixed, and conflicting about the relative importance of difference predictors and their overlap. Future researchers should explore these relationships further; hopefully, a more consistent pattern will emerge to determine the best possible mix of predictors.
It is unusual that over half (56%) of the included studies came from gray literature (theses). However, sensitivity analysis showed that the results of these studies did not differ from those of published studies. Heterogeneity was high in most of the meta-analyses. Heterogeneity is expected among observational studies,13 and the large number of included studies increased it. We performed sensitivity analyses to explore possible causes of heterogeneity. Although we found that the critical thinking test contributed to heterogeneity, other results were less reliable. However, it is common for all causes of heterogeneity in observational studies to remain unclear, as explained in MOOSE guidelines for systematic review of observational studies.13
We did not perform correction or adjustment for the restricted range of participants (trainees). In most studies of correlations to academic success, study participants are in the professional program rather than from the applicant pool. Thus, the sample is a restricted subgroup and not necessarily representative of program applicants. When the objective is to assess a measure among applicants that could predict academic success in a program, the correlation should be adjusted for this restricted sample. Although some new studies have performed adjustments (e.g., see Meagher et al74), critical thinking studies included in this review have not. Meta-analyses of a predictive variable can also be adjusted (e.g., see Donnon et al71), but this change in correlation is small. We did not perform adjustments. First, we did not have complete information on some study populations. Second, our objective was not only to determine the correlation from applicant to academic success in the program alone but also to determine the correlation of critical thinking at any point (including within the program) to academic success. All adjustments increase the correlation, so the unadjusted correlations in our study are more conservative.
Acknowledgments: The authors would like to thank Sandy Campbell, medical librarian, for her assistance with our detailed search.
Other disclosures: None.
Ethical approval: Not applicable.
Previous presentations: Some of the findings of this study were presented to the residents and faculty in the Department of Family Medicine at the University of Alberta Faculty of Medicine and Dentistry on Family Medicine Research Day, June 8, 2012.
1. Julian ER. Validity of the Medical College Admission Test for predicting medical school performance. Acad Med. 2005;80:910–917
2. Wilkinson D, Zhang J, Byrne GJ, et al. Medical school selection criteria and the prediction of academic performance. Med J Aust. 2008;188:349–354
3. Andujar P, Bastuji-Garin S, Botterel F, Prevel M, Farcet JP, Claudepierre P. Factors affecting students performance on the National Ranking Examination in a French medical school. Presse Med. 2010;39:e134–e140
4. Woolf K, Potts HW, McManus IC. Ethnicity and academic performance in UK trained doctors and medical students: Systematic review and meta-analysis. BMJ. 2011;342:d901
5. Ali PA. Admission criteria and subsequent academic performance of general nursing diploma students. J Pak Med Assoc. 2008;58:128–132
6. Scott JN, Markert RJ, Dunn MM. Critical thinking: Change during medical school and relationship to performance in clinical clerkships. Med Educ. 1998;32:14–18
7. Dressel PL, Mayhew LB General Education: Explorations in Evaluation. 1954 Washington, DC American Council on Education
8. Harasym PH, Tsai TC, Hemmati P. Current trends in developing medical students’ critical thinking abilities. Kaohsiung J Med Sci. 2008;24:341–355
9. Daly WM. The development of an alternative method in the assessment of critical thinking as an outcome of nursing education. J Adv Nurs. 2001;36:120–130
10. Gross YT, Takazawa ES, Rose CL. Critical thinking and nursing education. J Nurs Educ. 1987;26:317–323
11. Williams KB, Schmidt C, Tilliss TS, Wilkins K, Glasnapp DR. Predictive validity of critical thinking skills and disposition for the national board dental hygiene examination: A preliminary investigation. J Dent Educ. 2006;70:536–544
13. Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: A proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000;283:2008–2012
14. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. PLoS Med. 2009;6:e1000100
15. Borenstein M, Hedges LV, Higgins JPT, Rothstein HR. Introduction to Meta-Analysis. 2009 West Sussex, UK John Wiley & Sons
16. Allen DD, Bond CA. Prepharmacy predictors of success in pharmacy school: Grade point averages, pharmacy college admissions test, communication abilities, and critical thinking skills. Pharmacotherapy. 2001;21:842–849
17. Bauwens EE, Gerhard GG. The use of the Watson-Glaser Critical Thinking Appraisal to predict success in a baccalaureate nursing program. J Nurs Educ. 1987;26:278–281
18. Bachman ML. Anxiety, Critical Thinking and Age as Performance Predictors of Community College Nursing Students [PhD thesis]. 1998 Colorado State University
19. Behrens PJ. The Watson-Glaser Critical Thinking Appraisal and academic performance of diploma school students. J Nurs Educ. 1996;35:34–36
20. Bentz PM. The Relationship Between Clinical Performance and Critical Thinking Disposition of Nursing Students [PhD thesis]. 1996 Seattle Pacific University
21. Berger MC. Clinical thinking ability and nursing students. J Nurs Educ. 1984;23:306–308
22. Bowles KS. Effects of Critical Thinking, Grade Point Average, and College Experience on the Clinical Judgment Skills of Baccalaureate Nursing Students [PhD thesis]. 1997 University of Southern California
23. Bowles K. The relationship of critical-thinking skills and the clinical-judgment skills of baccalaureate nursing students. J Nurs Educ. 2000;39:373–376
24. Brigham CF. Critical Thinking Skills in Nursing Students Progressing Through a Nursing Curriculum [PhD thesis]. 1989 Ball State University
25. Crawford AH. An Investigation of the Critical Thinking Abilities of Nursing Students in a Selected Baccalaureate School [PhD thesis]. 2002 Texas A&M University
26. Crouch SJ. Predicting Success in the Associate Degree Nursing Program [PhD thesis]. 1999 Florida Atlantic University
27. Duphorne PO. The Effect of Three Computer Conferencing Designs on Critical Thinking Skills of Nursing Students at a Distance [PhD thesis]. 2000 University of New Mexico
28. Giddens JF. The Relationship of Critical Thinking to Performance on the National Council Licensure Examination for Registered Nurses (NCLEX-RN) [PhD thesis]. 2002 Colorado State University
29. Giddens J, Gloeckner GW. The relationship of critical thinking to performance on the NCLEX-RN. J Nurs Educ. 2005;44:85–89
30. Hall GH. Critical Thinking in Nursing Education [PhD thesis]. 1995 University of Minnesota
31. Henriques MAM. Predictors of Performance on the National Council Licensure Examination for Registered Nurses [PhD thesis]. 2002 University of Southern Mississippi
32. Hulse JA, Chenowith T, Lebedovych L, Dickinson P, Cavanaugh GB, Garrett N. Predictors of student success in the US Army graduate program in anesthesia nursing. AANA J. 2007;75:339–346
33. Ip WY, Lee DT, Lee IF, Chau JP, Wootton YS, Chang AM. Disposition towards critical thinking: A study of Chinese undergraduate nursing students. J Adv Nurs. 2000;32:84–90
34. Ircink-Waite RM. A Measurement of Critical Thinking in Senior Baccalaureate Nursing Students [PhD thesis]. 1989 Marquette University
35. Keller R. Effects of an Instructional Program on Critical Thinking and Clinical Decision-Making Skills of Associate Degree Nursing Students (Nursing Education) [PhD thesis]. 1993 University of South Florida
36. Kennison MM. The evaluation of students’ reflective writing for evidence of critical thinking. Nurs Educ Perspect. 2006;27:269–273
37. Kidd RS, Latif DA. Traditional and novel predictors of classroomand clerkship success of pharmacy students. Am J Pharm Educ. 2003;67:Article 109
38. Kokinda MA. The Measurement of Critical Thinking in a Selected Baccalaureate Nursing Program [PhD thesis]. 1989 University of Pennsylvania
39. Kuykendall JW. The Relationship Between Critical Thinking Scores, Other Selected Variables, and Success in a Community College Nursing Program [PhD thesis]. 1995 North Carolina State University
40. Lebeck LL. Correlation of Student Factors With Performance on the National Certification Examination for Nurse Anesthetists [PhD thesis]. 2003 Rush University
41. Lee LAM. Pre-Nursing Cognitive and Non-Cognitive Variables as Predictors of Performance on State Board Test Pool Examinations for Registered Nurses [PhD thesis]. 1980 Texas Tech University
42. Leuner JD. An Exploration of the Relationship Between Diagnostic Reasoning and Critical Thinking in Nontraditional Students in Nursing [PhD thesis]. 1994 Boston College
43. Lobb WB, Wilkin NE, McCaffrey DJ, Wilson MC, Bentley JP. The predictive utility of nontraditional test scores for first-year pharmacy student academic performance. Am J Pharm Educ. 2006;70:128
44. Marra SE. An Exploration of Critical Thinking, Learning Style, Locus of Control, and Environmental Perception in Baccalaureate Nursing Students [PhD thesis]. 1997 West Virginia University
45. McCall KL, MacLaughlin EJ, Fike DS, Ruiz B. Preadmission predictors of PharmD graduates’ performance on the NAPLEX. Am J Pharm Educ. 2007;71:1–7
46. McDade DC. Relationships Between Learning Styles and Critical Thinking Ability Among Health Professional Students [PhD thesis]. 1999 University of Georgia
47. Miller CL. The Relationship of Three Higher-Order Thinking Variables to the Academic Achievement of Second-Year Nursing Students in an Associate-Degree Program [PhD thesis]. 2001 University of Tennessee
48. Miller DA, Sadler JZ, Mohl PC. Critical thinking in preclinical course examinations. Acad Med. 1993;68:303–305
49. Miller MA. Impact of a Baccalaureate Registered Nurse Program on the Critical Thinking Skills of Students [PhD thesis]. 1987 University of Colorado
50. Miller MA. Outcomes evaluation: Measuring critical thinking. J Adv Nurs. 1992;17:1401–1407
51. Morris BC. Relationships Among Academic Achievement, Clinical Decision Making, Critical Thinking, Work Experience, and NCLEX-RN Pass Status [PhD thesis]. 1999 Arizona State University
52. Morris MC. The Relationship Between Critical Thinking Ability and Selected Educational Variables in Baccalaureate Nursing Students [PhD thesis]. 1998 University of Southern Mississippi
53. Nathan YH. Critical Thinking: Impact on Two Classes of Nursing Students in an Academic Year [PhD thesis]. 1997 Columbia University Teachers College
54. Pitts LN. Critical Thinking Skill and Disposition as Predictors of Success in Associate Degree Nursing Education [PhD thesis]. 2001 University of Florida
55. Prestholdt CAO. The Influence of Expert Status and Learning Style Preference on Critical Thinking Abilities of Professional Nurses [PhD thesis]. 1995 Louisiana State University
56. Redding DA. The Relationship Between Critical-Thinking Disposition and Academic Achievement in Baccalaureate Nursing Education [PhD thesis]. 1999 Illinois State University
57. Scott JN, Markert RJ. Relationship between critical thinking skills and success in preclinical courses. Acad Med. 1994;69:920–924
58. Sheaffer EA. Predictors of Academic Performance at a Technology-Based School of Pharmacy [PhD thesis]. 2005 George Mason University
59. Smith ML. A Quantitative Analysis of Critical Thinking Abilities, Learning and Study Strategies, and Academic Achievement in Associate Degree Nursing Students [PhD thesis]. 1995 Boston College
60. Stewart S, Dempsey LF. A longitudinal study of baccalaureate nursing students’ critical thinking dispositions. J Nurs Educ. 2005;44:81–84
61. Stewart G. The Relationship Between Critical Thinking Skills and Grades Obtained by Associate Degree Students in Nursing [MSc thesis]. 1997 Clarkson College
62. Sullivan EJ. Critical thinking, creativity, clinical performance, and achievement in RN students. Nurse Educ. 1987;12:12–16
63. Tiessen J. The Contribution of Selected Variables to the Critical Abilities Enrolled in a Four Year Based Accredited Program in Nursing [PhD thesis]. 1983 University of Cincinnati
64. Tiessen JB. Critical thinking and selected correlates among baccalaureate nursing students. J Prof Nurs. 1987;3:118–123
65. Vendrely AM. An investigation of the relationships among academic performance, clinical performance, critical thinking, and success on the physical therapy licensure examination. J Allied Health. 2007;36:e108–e123
66. Wacks GJ. Relationships Among Pre-Admission Characteristics in Associate Degree Nursing Programs as Predictors of NCLEX-RN Success [PhD thesis]. 2005 University of Alabama
67. Welch RA. Analysis of the Critical Thinking Ability of Registered Nursing Students at Entry and Nearing Completion of a Non-Traditional Baccalaureate in Nursing Program [PhD thesis]. 1994 Pepperdine University
68. Wilson DG, Wagner EE. The Watson-Glaser Critical Thinking Appraisal as a predictor of performance in a critical thinking course. Educ Psychol Meas. 1981;41:1319–1322
69. Ward ST, Downey MC, Thompson AL, Collins MA. Predictors of success in dental hygiene education: A follow-up study. J Dent Hyg. 2010;84:24–28
70. Newton SE, Smith LH, Moore G, Magnan M. Predicting early academic achievement in a baccalaureate nursing program. J Prof Nurs. 2007;23:144–149
71. Donnon T, Paolucci EO, Violato C. The predictive validity of the MCAT for medical school performance and medical board licensing examinations: A meta-analysis of the published research. Acad Med. 2007;82:100–106
72. Eva KW, Reiter HI, Trinh K, Wasi P, Rosenfeld J, Norman GR. Predictive validity of the multiple mini-interview for selecting medical trainees. Med Educ. 2009;43:767–775
73. De Ball S, Sullivan K, Horine J, Duncan WK, Replogle W. The relationship of performance on the dental admission test and performance on Part I of the National Board Dental Examinations. J Dent Educ. 2002;66:478–484
74. Meagher DG, Pan T, Perez CD. Predicting performance in the first-year of pharmacy school. Am J Pharm Educ. 2011;75:81
75. Gilbert GE, Basco WT Jr, Blue AV, O’Sullivan PS. Predictive validity of the Medical College Admissions Test writing sample for the United States Medical Licensing Examination Steps 1 and 2. Adv Health Sci Educ Theory Pract. 2002;7:191–200