The Association Between Critical Thinking Skills and Academic Performance Among Undergraduate Medical Students of Different Educational Levels at Iran University of Medical Sciences
Abstract
Given the importance of Critical thinking (CT) skills in medical education and academic performance, along with the lack of recent studies on this topic after the medical education reform in Iran, we aimed to evaluate the association of CT skills with academic performance in undergraduate medical students of Iran University of Medical Sciences. In this cross-sectional study, using the convenience sampling method, 142 medical students entered the study. The Persian version of the California Critical Thinking Skills Test Form B (CCTST-B), previously validated for local populations, was used to measure CT skills, and the test's association with academic performance was measured using participants' cumulative grade point average (GPA). A significant correlation was observed between the total mean score of passed courses (0-20) and the CT skills score across all CT domains (P<0.05). The mean total CT skills scores were 17.53±4.39 for basic science students, 17.17±3.63 for physiopathology students, 16.54±3.77 for clerkship students, and 17.60±3.89 for internship students. Statistical analysis revealed that clerkship students had significantly lower scores compared to the other groups (P=0.011). There were no significant differences between males and females, nor between students living in dormitories and those living in personal accommodations. This study showed a significant positive correlation between CT skills and academic performance. On average, undergraduate medical students possess satisfactory CT skills. However, there is room for improvement in CT skills among undergraduate medical students and in enhancing their academic performance.
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5. Ross D, Loeffler K, Schipper S, Vandermeer B, Allan GM. Do scores on three commonly used measures of critical thinking correlate with academic success of health professions trainees? A systematic review and meta-analysis. Acad Med 2013;88:724-34.
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7. Bezanilla MJ, Fernández-Nogueira D, Poblete M, Galindo-Domínguez H. Methodologies for teaching-learning critical thinking in higher education: the teacher’s view. Think Skills Creat 2019;33:100584.
8. Behar-Horenstein LS, Niu L. Teaching critical thinking skills in higher education: a review of the literature. J Coll Teach Learn 2011;8:25-42.
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14. Mahapoonyanont N. The causal model of some factors affecting critical thinking abilities. Procedia Soc Behav Sci 2012;46:146-50.
15. Moslemi Z, Ghomi M, Mohammadi D. The relationship between critical thinking skills with mental health and academic achievement of Qom University of Medical Sciences students. J Med Educ Dev 2016;9:90-101.
16. Shakurnia A, Aslami M. Critical thinking skills of medical students at Ahvaz Jundishapur University of Medical Sciences. Iran J Med Educ 2017;17:420-7.
17. Mehrpour SR, Hoseini Shavoun A, Kheiltash A, Masoomi R, Nasle Seraji R. Evaluating and comparing critical thinking skills of residents of Tehran University of Medical Sciences. BMC Med Educ 2023;23:133.
18. Rezaeian M, Zare-Bidaki M, Bakhtar M, Afsharmanesh K. Comparison of the critical thinking skills among medical students in different educational levels in Rafsanjan University of Medical Sciences in 2013. J Rafsanjan Univ Med Sci 2015;13:715-24.
19. Khalili H, Hosseini ZM. Investigation of reliability, validity and normality Persian version of the California Critical Thinking Skills Test; Form B (CCTST). J Med Edu 2009;3:e105016.
20. Facione PA. The California Critical Thinking Skills Test—College Level: Technical Report No. 1. Millbrae, CA: California Academic Press; 1990.
21. Khazaei MR, Niromand E, Shahsavari A, Sepahi V. Evaluation of critical thinking skills in medical students of Kermanshah University of Medical Sciences. Educ Res Med Sci 2023;12:e131655.
22. Orhan A. The relationship between critical thinking and academic achievement: a meta-analysis study. Psycho-Educ Res Rev 2022;11:283-99.
23. Fong CJ, Kim Y, Davis CW, Hoang T, Kim YW. A meta-analysis on critical thinking and community college student achievement. Think Skills Creat 2017;26:71-83.
24. Rezaee R, Mazareie E, Momeni Danaei S, Mirzaei S. Critical thinking skills in Shiraz dental students. Interdiscip J Virtual Learn Med Sci 2014;5:35-43.
25. Darban L, Ashtari S, Forghani Z, Yazdani S. Evaluation of critical thinking skills among medical sciences students in Shahid Beheshti and Tehran University of Medical Sciences. Med Sci J Islam Azad Univ Tehran Med Branch 2016;26:229-37.
26. Mafinejad MK, Arabshahi SKS, Monajemi A, Jalili M, Soltani A, Rasouli J. Use of multi-response format test in the assessment of medical students’ critical thinking ability. J Clin Diagn Res 2017;11:LC10-3.
27. Leach BT. Critical thinking skills as related to university students’ gender and academic discipline [dissertation]. Johnson City (TN): East Tennessee State University; 2011.
28. Sefein M, Zaigham MT, Idrees Z, Shahzil M. Pedagogical practices that enhance medical students’ capacity for creative thought: a qualitative study. J Med Educ Dev 2024;17:1-8.
29. Silberman D, Carpenter R, Takemoto JK, Coyne L. The impact of team-based learning on the critical thinking skills of pharmacy students. Curr Pharm Teach Learn 2021;13:116-21.
30. Mohamed AA, Garas AF, ElsawI KA. Effect of concept mapping on critical thinking skills of baccalaureate nursing students. Int J Res Appl Nat Soc Sci 2017;5:59-76.
31. Stuart E, O’Leary D, Rowntree R, Carey C, O’Rourke L, O’Brien E, et al. Challenges in experiential learning during transition to clinical practice: a comparative analysis of reflective writing assignments during general practice, paediatrics and psychiatry clerkships. Med Teach 2020;42:1275-82.
32. Amini M, Fazlinejad N. Critical thinking skill in Shiraz University of Medical Sciences students. Hormozgan Med J 2010;14:213-8.
33. Rezaei H, Mosavi A, Yousefi A, Larijani B, Rezaei N, Dehnavieh R, et al. Strengths of Iran for internationalization of medical sciences education. J Educ Health Promot 2020;9:92.
34. Mortaz Hejri S, Mirzazadeh A, Khabaz Mafinejad M, Alizadeh M, Saleh N, Gandomkar R, et al. A decade of reform in medical education: experiences and challenges at Tehran University of Medical Sciences. Med Teach 2018;40:472-80.
35. Izadabadi F, Amini M, Kiani M. Implementation and evaluation of extracurricular theme for undergraduate basic sciences medical courses at Shiraz Medical School. J Educ Health Promot 2021;10:98.
36. Mahmoodabad SSM, Nadrian H, Nahangi H. Critical thinking ability and its associated factors among preclinical students in Yazd Shaheed Sadoughi University of Medical Sciences (Iran). Med J Islam Repub Iran 2012;26:50.
37. Liu NY, Hsu WY, Hung CA, Wu PL, Pai HC. The effect of gender role orientation on student nurses’ caring behaviour and critical thinking. Int J Nurs Stud 2019;89:18-23.
38. Azizi-Fini I, Hajibagheri A, Adib-Hajbaghery M. Critical thinking skills in nursing students: a comparison between freshmen and senior students. Nurs Midwifery Stud 2015;4:e25721.
2. Lai ER. Critical thinking: a literature review. Pearson Res Rep 2011;6:40-1.
3. Croskerry P. Achieving quality in clinical decision making: cognitive strategies and detection of bias. Acad Emerg Med 2002;9:1184-204.
4. Chan ZC. A systematic review on critical thinking in medical education. Int J Adolesc Med Health 2018;30:20160120.
5. Ross D, Loeffler K, Schipper S, Vandermeer B, Allan GM. Do scores on three commonly used measures of critical thinking correlate with academic success of health professions trainees? A systematic review and meta-analysis. Acad Med 2013;88:724-34.
6. Ali-Abadi T, Babamohamadi H, Nobahar M. Critical thinking skills in intensive care and medical-surgical nurses and their explaining factors. Nurse Educ Pract 2020;45:102783.
7. Bezanilla MJ, Fernández-Nogueira D, Poblete M, Galindo-Domínguez H. Methodologies for teaching-learning critical thinking in higher education: the teacher’s view. Think Skills Creat 2019;33:100584.
8. Behar-Horenstein LS, Niu L. Teaching critical thinking skills in higher education: a review of the literature. J Coll Teach Learn 2011;8:25-42.
9. Tackett S, Grant J, Mmari K. Designing an evaluation framework for WFME basic standards for medical education. Med Teach 2016;38:291-6.
10. Schwarz MR, Wojtczak A. Global minimum essential requirements: a road towards competence-oriented medical education. Med Teach 2002;24:125-9.
11. Athari ZS, Sharif SM, Nasr AR, Nematbakhsh M. Assessing critical thinking in medical sciences students in two sequential semesters: does it improve? J Educ Health Promot 2013;2:5.
12. Soltani A, Mafinejad MK, Tajik M, Moosapour H, Bayat T, Mohseni F, et al. Effects of a curriculum integrating critical thinking on medical students’ critical thinking ability in Iran: a quasi-experimental study. J Educ Eval Health Prof 2021;18:14.
13. Soltani A, Allaa M, Moosapour H, Aletaha A, Shahrtash F, Monajemi A, et al. Integration of cognitive skills as a cross-cutting theme into the undergraduate medical curriculum at Tehran University of Medical Sciences. Acta Med Iran 2017;55:68-73.
14. Mahapoonyanont N. The causal model of some factors affecting critical thinking abilities. Procedia Soc Behav Sci 2012;46:146-50.
15. Moslemi Z, Ghomi M, Mohammadi D. The relationship between critical thinking skills with mental health and academic achievement of Qom University of Medical Sciences students. J Med Educ Dev 2016;9:90-101.
16. Shakurnia A, Aslami M. Critical thinking skills of medical students at Ahvaz Jundishapur University of Medical Sciences. Iran J Med Educ 2017;17:420-7.
17. Mehrpour SR, Hoseini Shavoun A, Kheiltash A, Masoomi R, Nasle Seraji R. Evaluating and comparing critical thinking skills of residents of Tehran University of Medical Sciences. BMC Med Educ 2023;23:133.
18. Rezaeian M, Zare-Bidaki M, Bakhtar M, Afsharmanesh K. Comparison of the critical thinking skills among medical students in different educational levels in Rafsanjan University of Medical Sciences in 2013. J Rafsanjan Univ Med Sci 2015;13:715-24.
19. Khalili H, Hosseini ZM. Investigation of reliability, validity and normality Persian version of the California Critical Thinking Skills Test; Form B (CCTST). J Med Edu 2009;3:e105016.
20. Facione PA. The California Critical Thinking Skills Test—College Level: Technical Report No. 1. Millbrae, CA: California Academic Press; 1990.
21. Khazaei MR, Niromand E, Shahsavari A, Sepahi V. Evaluation of critical thinking skills in medical students of Kermanshah University of Medical Sciences. Educ Res Med Sci 2023;12:e131655.
22. Orhan A. The relationship between critical thinking and academic achievement: a meta-analysis study. Psycho-Educ Res Rev 2022;11:283-99.
23. Fong CJ, Kim Y, Davis CW, Hoang T, Kim YW. A meta-analysis on critical thinking and community college student achievement. Think Skills Creat 2017;26:71-83.
24. Rezaee R, Mazareie E, Momeni Danaei S, Mirzaei S. Critical thinking skills in Shiraz dental students. Interdiscip J Virtual Learn Med Sci 2014;5:35-43.
25. Darban L, Ashtari S, Forghani Z, Yazdani S. Evaluation of critical thinking skills among medical sciences students in Shahid Beheshti and Tehran University of Medical Sciences. Med Sci J Islam Azad Univ Tehran Med Branch 2016;26:229-37.
26. Mafinejad MK, Arabshahi SKS, Monajemi A, Jalili M, Soltani A, Rasouli J. Use of multi-response format test in the assessment of medical students’ critical thinking ability. J Clin Diagn Res 2017;11:LC10-3.
27. Leach BT. Critical thinking skills as related to university students’ gender and academic discipline [dissertation]. Johnson City (TN): East Tennessee State University; 2011.
28. Sefein M, Zaigham MT, Idrees Z, Shahzil M. Pedagogical practices that enhance medical students’ capacity for creative thought: a qualitative study. J Med Educ Dev 2024;17:1-8.
29. Silberman D, Carpenter R, Takemoto JK, Coyne L. The impact of team-based learning on the critical thinking skills of pharmacy students. Curr Pharm Teach Learn 2021;13:116-21.
30. Mohamed AA, Garas AF, ElsawI KA. Effect of concept mapping on critical thinking skills of baccalaureate nursing students. Int J Res Appl Nat Soc Sci 2017;5:59-76.
31. Stuart E, O’Leary D, Rowntree R, Carey C, O’Rourke L, O’Brien E, et al. Challenges in experiential learning during transition to clinical practice: a comparative analysis of reflective writing assignments during general practice, paediatrics and psychiatry clerkships. Med Teach 2020;42:1275-82.
32. Amini M, Fazlinejad N. Critical thinking skill in Shiraz University of Medical Sciences students. Hormozgan Med J 2010;14:213-8.
33. Rezaei H, Mosavi A, Yousefi A, Larijani B, Rezaei N, Dehnavieh R, et al. Strengths of Iran for internationalization of medical sciences education. J Educ Health Promot 2020;9:92.
34. Mortaz Hejri S, Mirzazadeh A, Khabaz Mafinejad M, Alizadeh M, Saleh N, Gandomkar R, et al. A decade of reform in medical education: experiences and challenges at Tehran University of Medical Sciences. Med Teach 2018;40:472-80.
35. Izadabadi F, Amini M, Kiani M. Implementation and evaluation of extracurricular theme for undergraduate basic sciences medical courses at Shiraz Medical School. J Educ Health Promot 2021;10:98.
36. Mahmoodabad SSM, Nadrian H, Nahangi H. Critical thinking ability and its associated factors among preclinical students in Yazd Shaheed Sadoughi University of Medical Sciences (Iran). Med J Islam Repub Iran 2012;26:50.
37. Liu NY, Hsu WY, Hung CA, Wu PL, Pai HC. The effect of gender role orientation on student nurses’ caring behaviour and critical thinking. Int J Nurs Stud 2019;89:18-23.
38. Azizi-Fini I, Hajibagheri A, Adib-Hajbaghery M. Critical thinking skills in nursing students: a comparison between freshmen and senior students. Nurs Midwifery Stud 2015;4:e25721.
| Files | ||
| Issue | Vol 64 No 9 (2026) | |
| Section | Original Articles | |
| Keywords | ||
| Critical thinking Medical students California critical thinking skills test-form B (CCTST-B) | ||
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How to Cite
1.
Shirani A, Haj-sheykholeslami A, Morovati Sharifabadi P, Khalili N. The Association Between Critical Thinking Skills and Academic Performance Among Undergraduate Medical Students of Different Educational Levels at Iran University of Medical Sciences. Acta Med Iran. 2026;64(9):557-563.
