Basic Thinking Skills and Their Direct Instructional Approaches: A Narrative Review

Introduction

John Dewey defines thinking as “an active and continuous examination of beliefs based on evidence and reasons”¹ Building on this, Bloom² considers thinking as a conscious and active focus on a subject, analyzing and investigating it using logic and reasoning and obtaining logical and acceptable results and conclusions.

Experts have defined types of thinking as horizontal/vertical thinking, convergent/divergent thinking, critical thinking, creative thinking, and lateral thinking.^2,3 Regardless of these categories, the researchers of the American Curriculum Planning and Supervision Association, in their book Dimensions of Thinking: Framework for Curriculum and Instruction, have defined five dimensions for thinking used to analyze various teaching approaches. These dimensions include 1) basic thinking skills, 2) thinking processes, 3) creative and critical thinking, 4) metacognition, and 5) the relationship of content area knowledge to thinking.⁴

Basic thinking skills are fundamental cognitive operations necessary for analysis, comprehension, and problem-solving in varied contexts, including medical. These skills are fundamental cognitive operations utilized in various processes and types of thinking. For example, skills such as comparing and categorizing are often employed in decision-making and problem-solving.⁴ Basic thinking skills can be likened to a catalyst in a chemical reaction; while they do not create the initial conditions or the final product, they significantly increase the speed of the reaction.⁵ Since learning basic thinking skills is essential for developing critical and creative thinking, as well as metacognition and decision-making, understanding these skills and their teaching methods is crucial and should be considered the first step in teaching thinking.

After identifying the types of basic thinking skills, it is also important to determine the methods for teaching these skills. Two main approaches to teaching thinking are proposed: a) integrating topics related to teaching thinking into school lessons, and b) teaching thinking directly.^6–8 In the first approach, thinking skills are developed while teaching traditional school subjects. However, proponents of the second approach argue that thinking skills should be taught directly, suggesting that implicit teaching integrated with other lessons is insufficient. Consequently, a dedicated lesson on thinking skills should be included in the curriculum.⁸ In teaching higher-order thinking skills (HOTS, such as analysis and evaluation, build upon lower-order skills like remembering and understanding), a hybrid approach—where a skill such as critical thinking is taught independently while also developing field-specific critical thinking—has been reported to be more effective than other methods.⁹

Various programs have been designed for the direct training of thinking skills. In 1990, Nisbet and Davies identified more than 30 types of thinking skills training programs.¹⁰ Some of these programs are designed to develop discrete skills and processes such as categorization and ordering as a means of creating building blocks for thinking. Another type of thinking training program focuses on real-world and broader skills such as considering different perspectives, dealing with complex information, or creative problem-solving. Philosophy for Children and CoRT (Cognitive Research Trust) are examples of these programs.¹¹

In schools worldwide, De Bono’s Six Thinking Hats technique is widely used for teaching decision-making. For instance, Papakitsos et al¹² employed poetry, painting, and art to introduce the Six Hats to middle school students, who then applied the learned skills to solve real-life problems. For the post-simulation reflection phase in the emergency department, Zhang et al¹³ used De Bono’s Six Thinking Hats as a method to structure the debriefing conversations of medical assistants after the simulation event. The assistants who used the six-colored hats technique during the conversation were better able to stay in their respective thinking frames during the conversation compared to the participants who did not use this technique. Similarly, Mevlude et al¹⁴ used the Six Hats model to teach critical thinking to surgical nursing students, showing that this technique can enhance problem-solving and reflective abilities in various contexts.

In an intervention study, Khabaz et al¹⁵ taught 10 skills of CoRT Edward De Bono to a sample of 20 female students of Birjand University. The results show the significant impact of training on problem-solving skills and the subjective well-being of students. Ahmedbeigi et al¹⁶ taught thinking skills to undergraduate accounting students of Azad University and demonstrated that teaching skills related to critical thinking significantly increase collaborative learning in students. Zare¹⁷ taught the skills of analysis, interpretation, evaluation, inference, understanding, explanation, and self-management to undergraduate students of Payam Noor University in Tehran during 12 direct training sessions. This study showed that this training promoted self-directed learning and problem-solving in students.

Zulfiqari¹⁸ taught cognitive and metacognitive strategies such as reading aloud, questioning, and reviewing as effective factors in activating the mind for critical thinking, during seven one-hour sessions, to the students of Payam Noor University in Hamedan. The results of this study showed the improvement of students’ critical thinking skills.

The mentioned evidence shows the effectiveness of direct teaching of basic thinking skills to learners. However, a comprehensive and unified summary of specific direct teaching tools and methods for these fundamental skills, particularly within the context of health professions education (HPE), remains largely underexplored. While many tools and strategies for teaching thinking skills have originated in K-12 education, their applicability and limitations in the distinct, high-stakes environment of medical education require careful consideration. There is a clear need to synthesize existing knowledge on direct training approaches to equip educators with appropriate methods for fostering these foundational cognitive abilities in future health professionals.

This review aims to address this gap by systematically identifying basic thinking skills and the available tools and methods for their direct training. Specifically, this study seeks to answer the following research questions:

RQ1: What are the key basic thinking skills identified in the literature?

RQ2: What specific tools and direct training methods are available for teaching these basic thinking skills?

Method

This current narrative review study was conducted to identify basic thinking skills and their teaching methods from 2021 to 2023. The two research questions of this study were as follows: “What are the basic thinking skills?” and “What tools and methods have been used to teach basic thinking skills directly?” Searching for resources with keywords “Core Think* skill*”, “General Think* skill*”, “Basic Think* skill*”, “Essential Think* skill*” Train*Pedagog*Teach*Educat*Techni*Method*Activit * and strategy* and their Farsi equivalents were done in various search engines and databases including SID, Google Scholar, Google, ERIC, ISI, PubMed, Scopus, Proquest, and Magiran without time limit. The search was done twice in each: to answer the first research question, only keywords related to basic thinking skills were used, and to answer the second research question, all keywords were used. It should be noted that the current research was focused on direct methods of teaching thinking, but in the search strategy, the directness of the method was not considered in order not to eliminate appropriate benefits. In the next step, the indirectness of the teaching method was considered as an exclusion criterion.

All studies and documents related to types of basic thinking skills and direct training courses and methods were included in the study, regardless of the methodology used. Studies or documents that dealt with specific types of thinking, such as critical thinking, creative thinking, design thinking, or systemic thinking, or did not directly contribute to developing thinking skills, were excluded from the study.

In the initial search, 1587 records were obtained for the first question and 3110 records for the second question (4697 records in total). In the next step, after studying the title of the records, 1549 records from the first question and 2837 records from the second question (4386 records in total), which were unrelated or duplicates, were deleted. Then, abstracts of articles and content of non-article records were studied for 38 records related to the first question and 273 records related to the second question. After studying the abstracts of the articles and checking the content of non-article documents, 255 records unrelated to the article were identified and discarded.

Finally, a detailed study of 9 sources for the first question and 58 sources for the second question, which were the most suitable for the title and purpose of the study, was conducted. In the detailed study of the articles and documents, it was intended to obtain the answers to the two research questions. In fact, by careful study, what was considered basic thinking skills in that source and the methods that were recommended or used for its direct training were extracted.

Ethical considerations: This research is a part of research project number 399880 and has the ethics code number IR.MUI.MED.REC.1399.981.

Results

In this review study, after examining 67 sources, basic thinking skills and their direct teaching methods were identified. In response to the question “What are the basic thinking skills?” based on 9 sources analyzed^19–27 several classifications for basic thinking skills were obtained (see Table 1). Although the answer to the research question is the types of basic thinking skills, the categories that considered the whole range of thinking skills, including both basic thinking skills and higher-level thinking skills, were also reported. These categories share much in common, and Marzano⁵ believes that these lists should not be considered inviolable.

Table 1 Summary of Classification of Thinking Skills (Answer to the Question “What are the Basic Thinking Skills?”)

One of the classifications presented for basic thinking skills is Mishra and Kotecha’s classification.¹⁹ They have described thinking skills based on Bloom’s taxonomy in two categories: higher-order thinking skills (analysis, evaluation, and generating) and lower-order thinking skills (remembering, understanding, and applying).

In response to the question “What tools and methods are used for direct training of basic thinking skills”, the programs, methods, and tools found under the title of activities related to direct training of basic thinking skills, are in three categories:

1. The general thinking skills training programs are taught separately from the official curriculum and were placed in the following categories based on the nature of the program manager:

• Programs implemented in schools
• Programs are provided in institutions, systems, or virtual databases
• Programs offered in thinking schools, thinking clubs
• Programs that are offered in free training courses
• Programs offered in universities

2. Programs that are taught as part of a subject in the curriculum of schools or universities

3. Programs that are infused throughout the curriculum in schools or universities

The types of thinking training programs, the nature of the implementation of the programs, and the number of documents obtained for each case are given in Table 2.

Table 2 Types of Direct Training Programs for Basic Thinking Skills

Tables 3–9 present the themes and sub-themes of the reviewed articles and documents.

Table 3 Resources Related to Teaching General Thinking Skills in Schools Separately from the Curriculum

Table 4 Courses, Institutes, Systems, or Virtual Bases for Teaching General Thinking Skills Separately from the Curriculum

Table 5 Resources Related to Teaching Basic Thinking Skills in Thinking Clubs Separately from the Curriculum

Table 6 Resources Related to Teaching Basic Thinking Skills in the Form of Free Training Courses and Separate from the Curriculum

Table 7 Resources Related to Teaching Basic Thinking Skills in Universities Separately from the Curriculum

Table 8 Resources Related to Teaching Basic Thinking Skills Integrated in One or Several Lessons

Table 9 Resources Related to Teaching Basic Thinking Skills Infused Throughout the Curriculum

Discussion

This narrative review synthesizes the literature on basic thinking skills—fundamental cognitive operations such as recalling, understanding, applying, analyzing, evaluating, and creating, as framed by Bloom’s taxonomy¹⁹ and the direct instructional approaches for their development. The findings highlight a diverse array of tools and programs, categorized into standalone programs (eg, CoRT, Philosophy for Children), subject-embedded methods (eg, Six Thinking Hats in specific courses), and curriculum-infused strategies (eg, ACTS, i-Think). These approaches align with the dimensions of thinking outlined by Marzano,⁴ emphasizing their role as catalysts for higher-order thinking skills (HOTS) like critical thinking and problem-solving in educational contexts. While much of the evidence originates from K-12 settings, emerging applications in health professions education (HPE) demonstrate potential for fostering clinical reasoning and professional competence. The review extends prior frameworks by integrating recent studies, particularly those from 2020 to 2025, to address the evolving demands of medical education amid complexities like multimorbidity and interdisciplinary care.

Strength of Evidence

The quality and relevance of studies vary across tools, with assessments based on design rigor (eg, randomized controlled trials [RCTs] as high, quasi-experimental as moderate, descriptive or expert opinion as low) and applicability to HPE. For the CoRT program, evidence is moderate, primarily from quasi-experimental studies in K-12 (eg, Doğan Dolapçıoğlu & Doğanay, 2021;²⁸ Maniam et al 2020²⁹) showing improvements in creativity and problem-solving, but limited HPE-specific RCTs; recent applications in higher education (eg, Mousa, 2022⁵³) suggest moderate relevance for university-level critical thinking, though generalizability to clinical settings is low due to small samples. Philosophy for Children (P4C) has moderate evidence from mixed-methods and experimental designs in K-12 (eg, Ventista & Maria, 2019;⁶⁹ Naderi et al, 2012³⁵), enhancing reasoning and moral judgment, with emerging low-to-moderate relevance in higher education (eg, using P4C for discussion facilitation; Demissie et al, 2025³⁸), but scant HPE-specific data limits its strength in medical contexts.

Six Thinking Hats demonstrates high evidence, supported by RCTs and quasi-experimental studies in both K-12 and HPE (eg, Ibrahim & Darweesh, 2021;³⁹ Alshurman, 2017⁴¹), with recent 2025 studies in nursing confirming significant gains in critical thinking and skills retention (eg, Elbilgahy et al, 2025;⁴⁸ Soylu et al, 2025⁴⁵). Concept mapping also has high evidence from systematic reviews and RCTs (eg, Aein & Aliakbari, 2017;⁵⁷ Bixler et al, 2015⁶⁰), with 2020–2025 meta-analyses in nursing and medical education showing robust improvements in critical thinking (eg, Faraji et al, 2025;⁷⁰ Fonseca et al, 2024⁴⁹). Infused programs like ACTS and i-Think have moderate evidence from longitudinal and scoping reviews in K-12 (eg, Hamzah & Wan Yusoff, 2021;⁶⁴ McGuinness, 2000⁶⁷), but low relevance to HPE due to minimal adaptation studies. Overall, HPE-focused evidence is stronger for tools like Six Thinking Hats and concept mapping, with calls for more RCTs to address publication bias and heterogeneity.

Integration of Recent Literature in Health Professions Education

While the review’s core sources emphasize K-12 applications, recent literature (2020–2025) shifts focus to HPE, balancing the emphasis. For instance, in nursing education, Elbilgahy et al (2025) used Six Thinking Hats in a quasi-experimental design with 160 students, yielding significant critical thinking improvements (p<0.001) via structured case analysis.⁴⁸ Similarly, Soylu et al (2025) found it superior to video or traditional methods for insulin administration skills in an RCT (n=90), with median scores rising from 6.50 to 23.00.⁴⁵ In medical education, Sethi et al (2025) applied Six Thinking Hats in bioethics, simplifying decision-making for undergraduates through role-based thinking.⁴⁶ For concept mapping, Faraji et al (2025) meta-analyzed 44 studies (2005–2022), reporting a standardized mean difference of 1.693 (p<0.001) in performance⁷⁰ and Fonseca et al (2024) showed enhanced clinical reasoning in multimorbidity.⁴⁹ Collaborative concept maps in virtual patient scenarios (Mayer et al, 2025) fostered interdisciplinary clinical reasoning, though student preferences varied on scope and presentation.⁴⁷ These studies underscore adaptations for HPE, such as integrating tools into simulations or ethics modules, to address gaps in traditional curricula.

Mechanisms of Pedagogical Impact and Conditions for Effectiveness

Each tool strengthens specific basic thinking skills through distinct mechanisms, rooted in cognitive theories like constructivism¹ and metacognition.⁷¹ CoRT directs attention via tools (eg, PMI for positives/minus/interesting), enhancing generating and clarifying ideas by breaking down complexity; it is most effective in small groups with facilitator guidance, particularly for problem-solving in low-stakes environments.¹⁵ P4C promotes inquiry through Socratic dialogue, building reasoning and evaluation by encouraging justification and concept definition; effectiveness peaks in collaborative settings with diverse participants, though it requires trained facilitators to avoid superficial discussions.⁶⁹

Six Thinking Hats fosters balanced analysis by assigning modes (eg, black hat for risks), reducing bias and promoting comprehensive exploration; mechanisms include parallel thinking for creativity and emotional awareness, most effective in team-based clinical simulations where time constraints mimic real-world decisions.^45,48 Concept mapping externalizes mental models hierarchically, aiding organization and inference by visualizing connections; it strengthens analysis and synthesis, performing best when integrated with feedback in clinical rotations, especially for novices.^47,70 Infused programs like ACTS embed skills across curricula via sustained practice, reinforcing metacognition through reflection; effectiveness depends on teacher training and curriculum-wide adoption, ideal for longitudinal HPE programs.⁶⁷ Conditions for optimal impact include learner readiness (eg, prior basic knowledge), group size (<10 for interaction), and integration with domain-specific content; challenges like time demands or resistance are mitigated by hybrid approaches.⁸

The evidences map, which summarizes the tools, contexts, and results along with study quality indicators, is shown in Table 10.

Table 10 Evidence Map Table Summarizing Tools, Contexts and Outcomes, Along with Study Quality Indicators

Practical Contributions and Implementation Guidance

To enhance utility in HPE, the identified tools can be linked to stepwise implementation. In pre-clinical settings: (1) Assess learner baseline skills via pre-tests; (2) Introduce tools through workshops (eg, CoRT for idea generation in lectures); (3) Apply in small groups with case studies; (4) Provide feedback and reflection prompts; (5) Evaluate via post-tests. In clinical settings: (1) Integrate into rotations (eg, Six Thinking Hats in team huddles); (2) Use simulations for practice; (3) Facilitate debriefs focusing on skill application; (4) Monitor transfer to patient care; (5) Adjust based on outcomes. This bridges theory to practice, aligning with calls for hybrid approaches.⁹

Conclusion

This review identifies key basic thinking skills (eg, recalling, understanding, applying) and direct teaching methods (eg, CoRT, Six Thinking Hats, concept mapping), demonstrating their efficacy in fostering HOTS through structured, collaborative approaches. In HPE, these tools enhance clinical reasoning, problem-solving, and self-directed learning, with recent evidence (2020–2025) confirming superior outcomes in nursing and medical contexts compared to traditional methods.

Practical implications for medical educators include ready-to-use tools: (1) Six Thinking Hats for ethics workshops (assign hats to analyze cases); (2) Concept mapping for care planning modules (students map patient scenarios, with peer review); (3) CoRT for problem-solving sessions (use PMI in group discussions); (4) P4C for debriefs (facilitate inquiry on moral dilemmas). These can be scaled via online platforms for hybrid learning.

Limitations include the narrative review design, lacking formal quality appraisal (eg, no AMSTAR-2 scoring), potential publication bias toward positive results, and language bias (English/Persian sources dominant). Search strategies may have missed gray literature.

A research agenda proposes: (1) RCTs comparing tools in diverse HPE settings (eg, pre-clinical vs clinical); (2) Longitudinal studies assessing long-term retention and patient outcomes; (3) Investigations into digital adaptations (eg, AI-assisted mapping). These steps will refine evidence for impactful HPE curricula.