Abstract
BACKGROUND:
The fast growth of science and technology in the 21st century has made it necessary for advances in many sectors, including social, economic, educational, and health. Physiotherapists must have highly developed critical thinking abilities, such as creative, critical, problem-solving, and analytical thinking, to deal with these changes. Creativity is the capacity to view, shape, and organize the world in a unique way, whereas critical thinking is the ability to think outside the box, notice parts that others cannot see, be open to new ideas, and never be afraid to attempt new things. All of the continually developing and changing knowledge cannot be included in educational programs for physiotherapy students. The Six Thinking Hats were designed by Edward de Bono. The “Six Thinking Hats” concept is a teaching strategy for encouraging creative thinking by organizing and presenting ideas within a predetermined framework. The goal of the study was to apply the Six Thinking Hats model to physiotherapy themes in order to create a creative teaching technique and get feedback by fostering the critical thinking abilities of physiotherapy students.
MATERIALS AND METHODS:
During the 2021–2022 academic year, there were 42 students registered for III and IV BPT students enrolled for physiotherapy course; however, the research sample comprised 41 students. The course included 6 h of theory and 18 h of clinical sessions. Students were taught by two instructors via a PowerPoint presentation on SCI, obesity, and for further practice, they were given two case studies taught by Six Thinking Hats model. After the class, each group received a set of hats in one of six colors to use the Six Thinking Hats method effectively, and then students were asked to provide opinions on the Six Thinking Hats model of learning. Data analysis and response reporting were conducted, using literature and student comments.
RESULTS:
The Six Thinking Hats model was discovered to be more efficient in comprehending topics and provides all-encompassing care. The ability to understand patients’ views, see both the positive and negative aspects in conditions, develop their ability to think critically, and create with unique concepts all improved for the students. About 90.2% of students stated that they learned to think from different aspects, 85.4% of the students stated that it ensured they considered the patient holistically, 87.8% of the students stated that the method allowed for sharing different ideas and thoughts, 75.6% that it helped them to produce creative ideas. Overall, 95% of students agreed that the Six Thinking Hats approach was better than conventional lectures and case studies, with 5% disagreeing.
CONCLUSION:
This study concluded that the Six Thinking Hats model of learning is a creative teaching method that is useful for the development of physiotherapy students’ critical thinking. Skills and having this type of study in the physiotherapy literature add to the improvement and enrichment of physiotherapy education.
Keywords: CBR, Physiotherapy, students, teaching
Introduction
The rapid advancement of science and technology in the 21st century, characterized as the age of knowledge, in addition to changes in the structure of societies, has made it essential for innovations in all areas, for example, social, economic, education, and health.[1,2] For physiotherapists to be able to cope with the changes and increasing responsibilities, they need to have highly developed critical thinking skills which include creative, critical, problem-based, and analytical thinking. This will enable them to process data and form opinions to reach new understandings and take on new responsibilities.[3,4,5]
Creativity is one’s ability to see, shape, and uniquely arrange the world which intern helps in clinical reasoning in professional development. In other words, it is a process where an unprecedented synthesis is formed through a combination of independent ideas.[6] It involves some personality traits, such as the ability to follow a distinctive pattern in a new and unusual implementation process, to think outside the box, to see aspects that cannot be seen by others regarding the correlation of ideas, to be open to new ideas, and to never hesitate to try new ways.[7] It is not possible to be able to include all the rapidly expanding and changing information in educational programs to present to physiotherapy students. Due to this, it has become crucial for students to build creative critical thinking abilities so they can find the information they need on their own and fundamental understanding techniques.
Some researchers have recommended that physiotherapy educators use all aspects of critical thinking models in the educational setting and that in place of a teacher-focused process; they create a student-centered educational environment that can develop students’ critical thinking skills.[8] The purpose of this research was to test the “Six Thinking Hats” method of teaching which, rather than loading students with the knowledge, aims to have them use and produce knowledge that develops skills, such as creativity, synthesis, ability to design, problem-solving, and critical thinking, and to share students’ opinions about this method of learning.
Edward de Bono created the Six Thinking Hats role-playing technique in 1986. Each hat represents a distinct lens or perspective on a certain subject, and it is a thought-provoking practice that helps to prevent limiting thinking. It may be used to investigate challenges from many viewpoints to find solutions that would otherwise be neglected. De Bono suggested using the “Six Thinking Hats” approach to avoid this complexity during thought. This model is a system of conscious thinking that focuses an individual’s thinking in a specific direction for a specific period.[9]
The Six Thinking Hats’ fundamental belief is that, depending on their personality type, most people think and reason in a particular manner. An example of the benefit of using the Thinking Hats technique is to encourage different perspectives to be shared, seen, and discussed as part of the decision-making process.
The six types of “Thinking Hats” are as follows:
White hat: This way of thinking focuses on analytical, objective thinking with an emphasis on facts and practicalities, similar to the calm and pure emotions associated with the color white.
Red hat: As we identify red with wrath and heat, this hat signifies emotional thinking, subjective sentiments, perceptions, and opinions.
Black hat: The color black is stereotypically associated with doom and gloom; it fosters critical, suspicious thinking that is focused on risks and finding issues.
Yellow hat: Traditionally, this color is associated with sunlight and pleasure; the yellow hat represents optimistic, speculative, best-case possibilities.
Blue hat: The color blue, which represents the sky and the sky above, produces a sense of ordered thought, a high-level overview of the problem, and the big picture.
Green hat: The green hat, which is a color linked with nature and trees, stands for imaginative and associative thinking, original concepts, brainstorming, and thinking outside the box.
The “Six Thinking Hats” approach was built around six distinct colored hats that represent various points of view when thinking to foster creativity. This approach and headgear were summarized by De Bono and other authors in their studies.[10,11,12,13,14,15,16]
In learning-centered education, the students participate actively in the learning process by exchanging ideas with others, writing, discussing, making connections with the past, putting knowledge they have acquired into practice in daily life, solving problems, and thinking on their own. For a teacher to be able to develop a learning-centered class they need to think critically and creatively themselves and use these skills to create various stimuli and opportunities that will stimulate the students to think.[17]
Materials and Methods
Study design and setting
It is a pre-experimental pilot study research conducted at Nootan College of Physiotherapy, Visnagar, Mehsana, Gujarat, India.
Study participants and sampling
During the 2021–2022 academic year, there were 42 students registered for III and IV BPT students enrolled for physiotherapy course; however, the research sample comprised 41 students.
Ethical consideration: Ethical consideration was obtained from the administration of the educational facility at Nootan College of Physiotherapy to conduct the study.
Data collection tool and technique
To prepare a physical environment that would support the student’s critical thinking in class, the student’s seats were arranged in a “U” shape, so they could share the space with the teacher and communicate with each other. Before beginning the class, the students were given information about the lecture topics to be discussed, time schedule, study and its purpose, and written permission was obtained from the students who wanted to participate. The class plan consisted of 6 h of theory and 16 h of clinical session, with 1 h of theory and 1 h of practical in a day (total 24 sessions). The class was taught by two instructors in two classes simultaneously (21 students per class randomly) covering the topics assigned. The mode of teaching was in the form of a PowerPoint presentation on the related topics (SCI and obesity) after which a lecture was delivered, explained, and discussed. The topics listed above were chosen to promote good learning and interest in the class, which would be beneficial to students in their clinical practices. This will aid in the education of patients and their condition. Once the above topics were completed by instructors, six groups were distributed with six different colored hats implementing the Six Thinking Hats model for easy understanding and effective teaching and learning. The students retained information by associating it with different colored hats. They discussed and responded to the questions outlined in Tables 1 and 2. Once the Six Thinking Hats Approach for teaching had been introduced to the class, two case studies (case study 1, Table 3, and case study 2, Table 4) were also discussed, and the methodology was put into practice. This led to increased practice using the aforementioned strategy and subsequent actions.
Table 1.
Evaluation of physiotherapy care in obesity using the “Six Thinking Hats” model
| Types of Hats | Questionnaire |
|---|---|
| White hat | Explain what is meant by obesity |
| Yellow hat | What comforts are enjoyed by a person who is not obese? |
| Black hat | What are the negative effects of obesity? |
| Red hat | What would you think if you were obese? What would you think if you overcame obesity? |
| Green hat | What type of treatment/care you will provide to a person with obesity |
| Blue hat | What have we accomplished thus far? What can we do to accomplish more? Adopting the “Six Thinking Hats” concept to address obesity |
Table 2.
Evaluation of physiotherapy care in spinal cord trauma using the “Six Thinking Hats” model
| Types of Hats | Questionnaire |
|---|---|
| White hat | Give an explanation of spinal cord trauma |
| Yellow hat | What are those comforts who haven’t had spinal cord surgery experience? |
| Black hat | What are the risks of spinal cord injury? |
| Red hat | How would you feel if you had suffered spinal cord trauma? How carefully would you consider it if you had spinal cord damage and later recovered? |
| Green hat | What kind of care will you provide a patient who has suffered spinal cord damage? |
| Blue hat | What ought we to do next? What have we accomplished thus far? What can we do to accomplish more? |
Table 3.
Evaluation of transplantation patients using the “Six Thinking Hats” model
| Types of Hats | Questionnaire |
|---|---|
| White hat | • How much do you believe Kanu knows and understands about her condition? • What worries and aspirations does Kanu have for the future? • What exactly is a kidney transplant? |
| Yellow hat | • Just before surgery, describe the family’s anguish at Kanu’s health. • What would you say about Kanu’s encounter with anger? • How would Kanu react if her kidney transplant was rejected? • What will be Kanu’s family reaction if she has kidney transplant rejection? |
| Black hat | • Might Kanu have kidney failure? • If Kanu loses her kidney, how would Kanu’s mother, who gave the kidney, feel? • How might a CMV infection, which is frequently experienced after kidney donation, affect Kanu? |
| Red hat | • What are your thoughts on providing Kanu and her mother with suitable holistic care? • What options are available for kidney transplantation, notwithstanding the lack of options? (Mom, Dad, Brother, Cadaver, etc.) |
| Green hat | • What are Kanu’s systems of support? What other kind of help is required? • Apart from her mother, who is Kanu’s main source of support? • What steps can be taken to identify who these individuals are? |
| Blue hat | • What do you think about Kanu’s medical care and post-physiotherapy management? |
Table 4.
Evaluation of transplantation patients using the “Six Thinking Hats” model: Case study 2
| Types of Hats | Questionnaire |
|---|---|
| White hat | • What do you think Geeta understands about her diagnosis? • What are Geeta’s concerns and hopes for her future? • What is kidney transplantation? |
| Yellow hat | • Explain the family’s feelings of sadness about Geeta’s condition after her surgery. • How can you explain Geeta’s experience with feeling angry? What did Geeta feel when she had kidney transplant rejection? • What did Geeta’s family feel when she had kidney transplant rejection? |
| Black hat | • Could Geeta die? • What does the family who gave Geeta the cadaveric kidney feel because she lost the kidney? How will Geeta be affected by CMV infection, frequently seen after kidney transplantation? |
| Red hat | • What are your opinions about giving Geeta and her mother appropriate holistic care? • What options are available for kidney transplants, despite the fact that they are few (Mother, father, sibling, cadaver, etc.)? • What are Geeta’s support systems? • What other support systems should she have? • Other than her family, who are the people who can support Geeta? What steps may be taken to identify who these individuals are? |
| Green hat | • What do you think about Geeta’s treatment process? |
| Blue hat | • What do you think Geeta understands about her diagnosis? • What are Geeta’s concerns and hopes for her future? • What is kidney transplantation? • What do you think about Geeta’s medical care and post physiotherapy management? |
Edward De Bono suggested that in order to encourage creative conversations, it is customary to ensure the participation of a wide range of perspectives and thinking styles. It also enables the team to recall the topics effortlessly on the basis of different colors of hats. At the end of the class, the form about the “Six Thinking Hats” model of learning, which had been prepared by the researchers, was given to the students and they were asked to fill it and return it the following day. The form had a questionnaire and was prepared from related information in the literature and positive and negative student feedbacks. The form uses a Likert-type scale for evaluation with choices from “I do not agree,” “I am undecided,” to “I agree.”
Case study 1
Kanu aged 10 was receiving dialysis for renal failure and received a kidney transplant from her mother in January 2004 at hospital. Kanu loves her mother and says she will never let her mother regret that she gave her a kidney; at present, she can run and play. Kanu’s current health status is good and her renal function tests are within normal limits [Table 3].
Kanu was asked several questions that were posed to her and she gave answers accordingly.
What is illness? Answer: Going to dialysis, being unable to play, and being restricted from moving freely as per your choice.
If you were a doctor, what you could have done? Answer: I would have created an additional kidney.
Where can a new kidney found? Answer: I received it from my mum as a present.
What do you think about your new kidney? Answer: Many times I place my hand on it and try to feel it; I want it to feel me.
How do you feel after post physiotherapy management? Answer: I used to have pain initially; I felt tiredness and breathing problems also, but after exercises, I felt nice.
Case study 2
Geeta, who is 7 years old, was on dialysis prior to having a cadaveric kidney transplant in May 2001. Unfortunately, graft rejection happened in July 2006, necessitating a graft nephrectomy. She is now on the organ donation waiting list [Table 4].
Geeta answered a number of questions that were posed to her.
What is disease? Answer: Being unable to eat ice cream because you are dieting.
While you are in the hospital, who do you want to stay with you? Answer: Mother. If she can’t stay with me, it’s just me and the universe.
What guidance would you be able to offer to someone just beginning dialysis? Answer: You won’t experience pain if you don’t become furious.
What would you do as a doctor, if you were one? Answer: Do the surgery nicely without complications.
How do you feel after post-physiotherapy management? Answer: It was painful, I used to sleep after exercises but later I felt good.
Result
After analyzing the data on the basis of the feedbacks received, 87.8% of the students stated that the method allowed for sharing different ideas and thoughts [Figure 1]; 85.4% of the students stated that it ensured they considered the patient holistically, 85.4% of the students stated that it made it easier for them to empathize with the patient; 82.9% of the students stated that it helped them look at positive and negative aspects of the subject; 90.2% of the students stated that they learned to think from different aspects; and 75.6% of the students stated that it helped them to produce creative ideas [Figure 2].
Figure 1.
Figure shows Opinion of Six Thinking Hats for providing different ideas and thoughts
Figure 2.
Figure shows the Benefits of Six Thinking Hats model by the Students
It was also found 24.4% of the students thought that the method was time-consuming; 7.3% of the students thought that the black hat activity had a negative effect on their thoughts; and 12.2% of the students thought that it turned their empathy into sympathy and had a negative effect [Figure 3].
Figure 3.
Figure shows the Effectiveness of Six Thinking Hats model by the Students
As per the feedback by students, understanding the topics was more effective followed by the Six Thinking Hats model. They also stated verbally that the case study discussion using the “Six Thinking Hats” model was different from other case studies that had been presented; in particular, they realized they had neglected the patient’s and family’s feelings both in the case study and in the care they had provided in the hospital.
Additionally, it was noted that 95% of students believed that applying the Six Thinking Hats model was more beneficial than regular lectures and case discussions, while 5% disagreed.
Discussion
Students and physiotherapists on the wards use the system of thinking represented by the “Six Thinking Hats” in the physiotherapy process used in planning and implementing physiotherapy care without being aware of it, also applicable in the nursing profession.[18,19,20]
For example in the data collection and analysis stage of the physiotherapy process, they have to use the “white hat” thinking system, when planning individualized patient care, the “green hat,” and when evaluating the outcomes of care, the thinking system is represented by the “blue hat.” The “Six Thinking Hats” system organizes the thought processes to consider a subject and simplifies the thinking process for focusing on one aspect of a subject and facilitates considering a subject from every aspect.
Conclusion
The “Six Thinking Hats” model is a method of learning that not only improved the students’ creative and critical thinking abilities; it also had a positive effect on their empathy skills and getting to know themselves.
In addition, the system of thinking used in the method will not only help the individuals in their professional lives but also will help them make the right decisions in their personal lives.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Acknowledgments
First and foremost, I want to thank God for all of my daily experiences and direction. I would like to convey our heartfelt appreciation to the Nootan College of Physiotherapy’s Ethics Committee for approving the study’s execution. All the students who supported us are also to be thanked. Our sincere gratitude goes out to the co-authors for their unwavering assistance, worthwhile labor, and knowledge. My parents, friends, and others deserve our deepest appreciation for all of their assistance in both direct and indirect ways.
References
- 1.Aybek B. Elestirel düsünmenin ögretiminde Ögretmenin rolü (Teacher’s role in critical thinking education) Bilim Egitim ve Düsünme Dergisi. 2007;7:88–98. [Google Scholar]
- 2.Tiwari A, Lai P, So M, Yuen K. A comparison of the effects of problem-based learning and lecturing on the development of students’ critical thinking. Med Educ. 2006;40:547–54. doi: 10.1111/j.1365-2929.2006.02481.x. [DOI] [PubMed] [Google Scholar]
- 3.Horng JS, Hong JC, Chanlin LJ, Chang SH, Chu HC. Creative teachers and creative teaching strategies. Int J Consum Stud. 2007;29:352–8. [Google Scholar]
- 4.Maudsley G, Strivens J. Promoting professional knowledge, experiential learning and critical thinking for medical students. Med Educ. 2000;34:535–44. doi: 10.1046/j.1365-2923.2000.00632.x. [DOI] [PubMed] [Google Scholar]
- 5.Demirci C. Elestirel Düsünme (Critical Thinking) 2003 Available from: http://www.epo.hacettepe.edu.tr. [Last accessed on May 2005]. [Google Scholar]
- 6.Nicole Christensen and others, Clinical Reasoning: Survey of Teaching Methods, Integration, and Assessment in Entry-Level Physical Therapist Academic Education, Physical Therapy. https://doi.org/10.2522/ptj.20150320. 2017 February;97(2):175–186. doi: 10.2522/ptj.20150320. [DOI] [PubMed] [Google Scholar]
- 7.Tiwari A, Lai P, So M, Yuen K. A comparison of the effects of problem-based learning and lecturing on the development of students’ critical thinking. Med Educ. 2006;40:547–54. doi: 10.1111/j.1365-2929.2006.02481.x. [DOI] [PubMed] [Google Scholar]
- 8.Berber F, Akbulut F, Maden H, Gezer M, Keser S. Düsünme ve elestirel düsünme (Thinking and critical thinking) 2002 Available from: http://www.sevketkeser.net/docs/alldoc/dusunmeveelestireldusunme.pdf. [Last accessed June 2007]. [Google Scholar]
- 9.De Bono E. Altı Düsünme Sapka Teknigi (Six thinking hats technique) In: Tuzcular E, editor. Remzi Kitabevi; Istanbul, Turkey: 1997. [Google Scholar]
- 10.Erginer E. Pegem A Yayıncılık. Ankara, Turkey: 2008. Öğretimi Planlama, Uygulamave Değerlendirme: Etkinlik Öğretimi Temelli Yaklaşım (Instructional planning, implementation and evaluation: activity teaching based approach) [Google Scholar]
- 11.Erginer E. Anı Yayıncılık. Ankara, Turkey: 2000. Öğretimi Planlama, Uygulama ve Değerlendirme (Instructional planning, implementation and evaluation) [Google Scholar]
- 12.Erginer E, Bayçu S. Altı Düşünce Şapkası Etkinliğinin Resim Derslerinde Uygulanabilirliği (Applicability of the six thinking hats activity in art classes) Yaşadıkça Eğitim Dergisi/Yaşadıkça Educ J. 2004;81:9–16. [Google Scholar]
- 13.Goebel G, Seabert D. Put on your thinking hats. J Sch Health. 2006;76:393–5. doi: 10.1111/j.1746-1561.2006.00131.x. [DOI] [PubMed] [Google Scholar]
- 14.Bonk CJ, Smith GS. Alternative instruction strategies for creative and critical thinking in the accounting curriculum. J Account Educ. 1998;16:261–93. [Google Scholar]
- 15.Ergin Erginer. “Using the ‘six thinking hats’ model of learning in a surgical nursing class: sharing the experience and student opinions’’. AJAN. 2009;26(3) Available from: https://www.researchgate.net/publication/285639929_Using_the_’six_thinking_hats’_model_of_learning_in_a_surgical_nursing_class_Sharing_the_experience_and_student_opinions . [Google Scholar]
- 16.Gözütok FD. Ekinoks; Ankara, Turkey: 2006. Öğretim Ilke ve Yöntemleri (Teaching principles and method) [Google Scholar]
- 17.Maudsley G, Strivens J. Promoting professional knowledge, experiential learning and critical thinking for medical students. Med Educ. 2000;34:535–44. doi: 10.1046/j.1365-2923.2000.00632.x. doi: 10.1046/j.1365-2923.2000.00632.x. [DOI] [PubMed] [Google Scholar]
- 18.Seferoglu S Akbıyık C. Elestirel düsünme ve ögretimi (Critical thinking and education). H.Ü. Eğitim Fakültesi Dergisi (H.U. Journal of Education) 2006;30:193–200. [Google Scholar]
- 19.Marwa Fathallah Mostafa, et al. “The Effectiveness Of Using The Six-Hats Teaching Method On Improving Thinking Skills Among Critical Care Nursing Students”. 2523-5508/IAJHMN. 2(1):1–11. [Google Scholar]
- 20.Edward DE BONO. 6 Şapkalı Düşünme Tekniği, Remzi Kitabevi E3-14, 34337 Etiler-İstanbul Sertifika no: 10705 ISBN 978-975-14-2009-1. Available from: https://www.remzi.com.tr/files/books/1690/dosya/alti-sapkali-dusunme-teknigi-on-izleme.pdf . [Google Scholar]