| Summary: | In medical education, critical thinking is held to underpin the key professional skills of clinical reasoning, clinical judgment and decision-making. The promotion of critical thinking is an intended learning outcome for the problem-based learning (PBL) component of medical curricula, but there is limited empirical evidence for critical thinking during PBL tutorials. Existing studies do not explicitly address the role of social interactions between group members, or the effect of scaffolding, on enabling or impeding critical thinking. Application of an adapted, socio-constructivist Community of Inquiry (CoI) framework allowed these issues to be addressed. The adapted CoI framework incorporated three constructs: cognitive presence, a proxy for critical thinking; social presence, reflecting the social environment and social interactions between CoI members; and teaching presence, reflecting hard and soft scaffolding. Six PBL groups were recruited from the early years of a Scottish medical curriculum. For each group, a two-hour PBL tutorial featuring two different scenarios was recorded and transcribed. The twelve discourses were subjected to interpretivist analysis, with contextual coding of utterances. From a CoI perspective, critical thinking was a function of the community; individual members generally contributed just one or two aspects of critical thinking per utterance. Different aspects of critical thinking were associated with different steps of the PBL process. There was no evidence for sustained progression through stages of critical thinking. The specific PBL context promoted the creative thinking component of critical thinking, and information-gathering. Social presence was evident throughout, and likely facilitated discourse, which in turn enabled aspects of critical thinking. Teaching presence manifest differently in the various steps of the PBL process and between discourses, the latter reflecting facilitator style, scaffolding interventions bystudents, and the specific scenario. The findings have implications for facilitator training, student induction, and scenario design.
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