Educational Papers

Integration of Cognitive Skills as a Cross-Cutting Theme Into the Undergraduate Medical Curriculum at Tehran University of Medical Sciences


Nowadays, improvement of thinking skills of students is one of the universally supported aims in the majority of medical schools. This study aims to design longitudinal theme of reasoning, problem-solving and decision-making into the undergraduate medical curriculum at Tehran University of Medical Sciences (TUMS). A participatory approach was applied to design the curriculum during 2009-2011. The project was conducted by the contribution of representatives of both basic and clinical faculty members, students and graduates at Tehran University of Medical Sciences. The first step toward integrating cognitive skills into the curriculum was to assemble a taskforce of different faculty and students, including a wide variety of fields with multidisciplinary expertise using nonprobability sampling and the snowball method. Several meetings with the contribution of experts and some medical students were held to generate the draft of expected outcomes. Subsequently, the taskforce also determined what content would fit best into each phase of the program and what teaching and assessment methods would be more appropriate for each outcome. After a pilot curriculum with a small group of second-year medical students, we implemented this program for all first-year students since 2011 at TUMS. Based on findings, the teaching of four areas, including scientific and critical thinking skills (Basic sciences), problem-solving and reasoning (Pathophysiology), evidence-based medicine (Clerkship), and clinical decision-making (Internship) were considered in the form of a longitudinal theme. The results of this study could be utilized as a useful pattern for integration of psycho-social subjects into the medical curriculum.

Illing J, Morrow G, Kergon C, Burford B, Spencer J, Peile E, et al. How prepared are medical graduates to begin practice? A comparison of three diverse UK medical schools. (Accessed March 2016, 14, at to_begin_ practice_September_08.pdf_29697834.pdf).

Goldacre MJ, Taylor K, Lambert TW. Views of junior doctors about whether their medical school prepared them well for work: questionnaire surveys. BMC Med Educ 2010;10:78.

Dent J, Harden RM. A practical guide for medical teachers: Elsevier Health Sciences; 2013. (Accessed March 2016, 14, at _ Guide _ for_Medical_Teachers.pdf).

Bordage G, Harris I. Making a difference in curriculum reform and decision-making processes. Med Educ 2011;45:87-94.

Harden RM. Outcome-based education: the future is today.Med Teach 2007;29:625-9.

Huang GC, Newman LR, Schwartzstein RM. Critical thinking in health professions education: summary and consensus statements of the Millennium Conference 2011. Teach Learn Med 2014;26:95-102.

Nelms TP, Lane EB. Women's ways of knowing in nursing and critical thinking. J Prof Nursing 1999;15:179-86.

Simpson E, Courtney M. Implementation and evaluation of critical thinking strategies to enhance critical thinking skills in Middle Eastern nurses. Int J Nurs Pract 2008;14:449-54.

Peach BE, Mukherjee A, Hornyak M. Assessing critical thinking: A college's journey and lessons learned. J Educ Bus 2007;82:313-20

Albanese MA, Mejicano G, Mullan P, Kokotailo P, Gruppen L. Defining characteristics of educational competencies. Med Educ 2008;42:248-55.

Mirzazadeh A, Hejri SM, Jalili M, Asghari F, Labaf A, Siyahkal MS, et al. Defining a competency framework: the first step toward competency-based medical education. Acta Med Iran 2014;52:710-6.

Harasym PH, Tsai TC, Hemmati P. Current trends in developing medical students' critical thinking abilities. Kaohsiung J Med Sci 2008;24:341-55.

Redding DA. The development of critical thinking among students in baccalaureate nursing education. Holist NursPract 2001;15:57-64.

Davis MH, Harden RM. Planning and implementing an undergraduate medical curriculum: the lessons learned. Med Teach 2003;25:596-608.

Kitzes JA, Savich RD, Kalishman S, Sander JC, Prasad A, Morris CR, et al. Fitting it all in: integration of 12 cross- cutting themes into a School of Medicine curriculum. Med Teach 2007;29:437-42.

Wilkes MS, Slavin S, Usatine R. Doctoring: a longitudinal generalist curriculum. Acad Med 1994;69:191-3.

Scott JN, Markert RJ, Dunn MM. Critical thinking: change during medical school and relationship to performance in clinical clerkships. Med Educ 1998;32:14-8.

Cox M, Irby DM, Bowen JL. Educational strategies to promote clinical diagnostic reasoning. N Engl J Med


Victor-Chmil J. Critical thinking versus clinical reasoning versus clinical judgment: differential diagnosis. Nurse Educ 2013;38:34-6.

Kim HJ, Jaung AH. Analysis Relationship of Critical Thinking, Clinical Decision Making and Job Satisfaction of Dental Hygienists. Korean J Health Serv Manag 2013;13:322-30.

Fuks A, Boudreau JD, Cassell EJ. Teaching clinical thinking to first-year medical students. Med Teach


Barrow M, McKimm J, Samarasekera DD. Strategies for planning and designing medical curricula and clinical teaching. South East Asian J Med Educ 2011;4:1-8.

Choi H. The effects of PBL (Problem-Based Learning) on the metacognition, critical thinking, and problem solving process of nursing students. Taehan Kanho Hakhoe Chi 2004;34:712-21.

McInerney MJ, Fink LD. Team-based learning enhances long-term retention and critical thinking in an undergraduate microbial physiology course. Microbiol Educ 2003;4:3-12.

IssueVol 55, No 1 (2017) QRcode
SectionEducational Papers
Thinking Problem solving Clinical reasoning Curriculum Integration

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How to Cite
Soltani A, Allaa M, Moosapour H, Aletaha A, Shahrtash F, Monajemi A, Arastoo T, Ahmadinejad M, Mirzazadeh A, Khabaz Mafinejad M. 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(1):68-73.