Laboratory Critical Thinking

Laboratory Critical Thinking
By Scott Warner

“Pop quiz, hotshot,” said Dennis Hopper’s character in the 1994 action thriller Speed. “There’s a bomb on a bus. Once the bus goes 50 miles an hour, the bomb is armed. If it drops below 50, it blows up. What do you do?” Laboratory work may not be as exciting as a thriller, but like Speed’s main characters we often need to think outside our comfort zones. These critical thinking skills are essential to your career.

From Nursing to the Lab
The dictionary defines critical thinking as “disciplined thinking that is clear, rational, open-minded, and informed by evidence.”[1] Critical thinking has been emphasized in nursing training and clinical practice for over fifty years. There are many definitions in this context, but the American Association of Colleges of Nurses says it “underlies independent and interdependent decision making.”[2] Thus, it is an intelligent approach to unstructured, independent problem solving.

Jennifer Olin, BSN, RN blogs that critical thinking includes being rational, reflective, inquisitive, creative and fair. She writes, “The thinking process that guides nursing practice must be organized, purposeful and disciplined because nursing decisions often profoundly affect their patients’ lives.”[3] As she points out, the autonomy of nursing necessitates this kind of thinking.

A similar autonomy mandates critical thinking on the bench. For example, in a blood bank, a technologist may need to troubleshoot weak reactions when the need for blood is urgent; in chemistry, a sequence of delta checks may suggest a method failure; and in microbiology, consulting with the physician will determine if an organism is reported as a possible contaminant or probable pathogen. These and other novel situations are unique to laboratory medicine, difficult to script in advance, and often need to be solved on the fly using critical thinking skills.

Boost Your Career
There are degrees of autonomy in any laboratory. Many decisions are predefined in writing, from how many times to attempt collecting a blood sample to troubleshooting quality control failure. Novel situations are often handled by supervisors. But critical thinking is necessary at all levels of an organization and applicable in many situations. They also enhance your brand and boost your career.

As Time reported last year, a lack of soft skills for new college graduates is leaving many jobs unfilled. These include communication, interpersonal, creativity and critical thinking skills. According to one survey, technical and computer-related proficiency rank much farther down the list of what employers value.[4] Developing your critical thinking skills early improves your marketability when competing with experience.

Despite this, colleges and schools don’t adequately challenge students to think critically. One study concluded among allied health programs that 64.9 percent of students had weak critical thinking skills; less than four percent had strong skills.[5] The technical details of laboratory medicine add to this challenge. Thus, each technologist must develop critical thinking skills on the job.

Core Skills
Critical thinking is about acquiring, understanding and applying knowledge to analyze and solve problems. All laboratory professionals can do this, but understanding basic steps can help enhance these core skills:[6]

– Knowledge – identification and recall of information on a subject (who, what, where, etc.).

– Comprehension – the ability to organize, interpret, and paraphrase knowledge.

– Application – using the knowledge to solve problems, especially in novel situations.

– Analysis – connecting or separating pieces of information to determine its significance.

Abnormal cell identification in hematology is a good example of when critical thinking skills are necessary. Knowledge includes cellular morphology and clinical context, and a technologist needs to be able to recall this knowledge in a way that fits the clinical setting. This comprehension is used when performing a manual differential count, and the final results are analyzed and reported to best help the physician and patient. Critical thinkers are able to describe abnormal cells that cannot be easily identified (e.g. large mononuclear cell with agranular cytoplasm) using knowledge of cellular anatomy where appropriate.

The best critical thinkers continuously learn new knowledge to be applied. They know the value of getting it right over being right. This sometimes difficult process can lead to over-analysis of a situation, however, leading to decision paralysis, but good critical thinkers learn how to avoid getting too bogged down in details. A good example of this is troubleshooting quality control results. It’s easy to ignore other factors, such as temperature, storage and water quality, which can affect method performance.

Finally, critical thinkers turn their skills upon themselves, asking, “Have I considered everything?” and “Am I being impartial enough?” Everyone makes mistakes, including critical thinkers. A common mistake is confirmation bias, a tendency to look for information or make conclusions that confirm one’s preconceptions. This and other cognitive biases can cause judgement errors. Good critical thinkers are aware of these tendencies and constantly strive to correct themselves.

Market Your Skills
Any laboratory is filled with opportunities to hone and test critical thinking skills to improve your marketability. Beyond education, employers want candidates who show they can apply knowledge and think critically. These “soft” skills, which also include likeability and time management, can be added to your resume as bullet points, but you also need to be ready to provide interesting examples during an interview.[7]

During an interview, for example, you may be asked “situational” questions intended to gauge how well you respond to a situation or apply knowledge.

Example: Can you give an example of how you handled a critical value when the ordering provider was not available?

These are chances to offer specific examples that highlight your critical thinking skills, showing a potential employer that you can think quickly on your feet in unusual situations — and it can make a difference when the employer has to make a hiring decision.

As Peter Facione, PhD, of Insight Assessment summarizes, “Critical thinking is skeptical without being cynical. It is open-minded without being wishy-washy. It is analytical without being nitpicky.”[8] It is also a hallmark of a laboratory professional who is able to acquire and apply knowledge in any clinical setting, ultimately using those skills to improve patient care.

Scott Warner is lab manager at Penobscot Valley Hospital, Lincoln, ME.


1. the definition of critical thinking. Available at: Accessed September 15, 2014.

2. Benner P, Hughes R, Sutphen M. Clinical Reasoning, Decisionmaking, and Action: Thinking Critically and Clinically. Agency for Healthcare Research and Quality (US). 2008. Available at: http: // Accessed September 15, 2014.

3. Olin J. 7 Characteristics of Critical Thinking | Notes from the Nurses’ Station. Notes from the Nurses’ Station. 2011. Available at: Accessed September 15, 2014.

4. White M. The Real Reason New College Grads Can’t Get Hired | TIMEcom. 2013. Available at: Accessed September 18, 2014.

5. Hicks J. Critical Thinking Skills of Allied Health Science Students: A Structured Inquiry | EduPerspectives. Eduperspectivesahimaorg. 2013. Available at: Accessed September 18, 2014.

6. Dunn J. The 4-Step Guide To Critical Thinking Skills | Edudemic. Edudemic. 2013. Available at: Accessed September 19, 2014.

7. 5 Keys to Demonstrating Critical Soft Skills on Your Resume | The Savvy Intern by YouTern. 2014. Available at: Accessed September 19, 2014.

8. Facione P. Critical Thinking: What It Is And Why It Counts. 2014:25. Available at: Accessed September 19, 2014.

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