Using root cause analysis to promote critical thinking in final year Bachelor of Midwifery students

Amanda G. Carter, Mary Sidebotham, Debra K. Creedy, Jennifer Fenwick, Jenny Gamble

Research output: Contribution to journalArticlepeer-review

14 Citations (Scopus)


Background: Midwives require well developed critical thinking to practice autonomously. However, multiple factors impinge on students' deep learning in the clinical context. Analysis of actual case scenarios using root cause analysis may foster students' critical thinking and application of 'best practice' principles in complex clinical situations. Objective: To examine the effectiveness of an innovative teaching strategy involving root cause analysis to develop students' perceptions of their critical thinking abilities. Methods: A descriptive, mixed methods design was used. Final 3rd year undergraduate midwifery students (n = 22) worked in teams to complete and present an assessment item based on root cause analysis. The cases were adapted from coroners' reports. After graduation, 17 (77%) students evaluated the course using a standard university assessment tool. In addition 12 (54%) students provided specific feedback on the teaching strategy using a 16-item survey tool based on the domain concepts of Educational Acceptability, Educational Impact, and Preparation for Practice. Survey responses were on a 5-point Likert scale and analysed using descriptive statistics. Open-ended responses were analysed using content analysis. Results: The majority of students perceived the course and this teaching strategy positively. The domain mean scores were high for Educational Acceptability (mean = 4.3, SD = .49) and Educational Impact (mean = 4.19, SD = .75) but slightly lower for Preparation for Practice (mean = 3.7, SD = .77). Overall student responses to each item were positive with no item mean less than 3.42. Students found the root cause analysis challenging and time consuming but reported development of critical thinking skills about the complexity of practice, clinical governance and risk management principles. Conclusions: Analysing complex real life clinical cases to determine a root cause enhanced midwifery students' perceptions of their critical thinking. Teaching and assessment strategies to promote critical thinking need to be made explicit to students in order to foster ongoing development.

Original languageEnglish
Pages (from-to)1018-1023
Number of pages6
JournalNurse Education Today
Issue number6
Early online date4 Nov 2013
Publication statusPublished - Jun 2014
Externally publishedYes


  • Assessment
  • Critical thinking
  • Decision-making
  • Midwifery students
  • Root cause analysis
  • Teamwork

ASJC Scopus subject areas

  • Nursing(all)
  • Education


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