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

Abstract

Introduction: Basic thinking skills serve as fundamental cognitive operations that underpin all forms of thought, acting as catalysts to enhance the speed, efficiency, and quality of mental processes. These skills are prerequisite for developing higher-level abilities such as critical thinking, problem-solving and clinical reasoning, which are essential pillars of medical education. Addressing the existing gap in practical instructional methods, this narrative review aimed to define basic thinking skills and identify specific tools and approaches for their direct instruction. Methods: A narrative review was conducted by searching authoritative databases. Keywords such as “basic thinking skills”, “direct instruction”, and their equivalents were utilized. From an initial pool of 4,697 records, following the removal of duplicates and a rigorous screening process, 56 sources (9 regarding the identification of skills and 47 regarding instructional methods) that were most relevant to the study objectives were selected and analyzed. Results: Basic thinking skills align largely with frameworks such as Bloom’s taxonomy (remembering, understanding, applying) and Marzano’s dimensions. Identified direct instructional tools and methods were classified into three main categories: 1) Standalone programs independent of the formal curriculum (eg, CoRT, Philosophy for Children P4C, and thinking schools); 2) Programs embedded within specific academic subjects (eg, the use of Six Thinking Hats or concept mapping in nursing and medical courses); and 3) Programs infused throughout the entire curriculum (eg, ACTS). Recent evidence (2020–2025) highlights the significant effectiveness of these tools in enhancing clinical reasoning and ethical decision-making in health professions education. Conclusion: The findings demonstrate that direct instruction of basic thinking skills via structured tools efficiently fosters higher-order thinking. Versatile tools like concept maps and Six Thinking Hats adapt well to medical education. Educators and curriculum planners should adopt hybrid approaches for systematic integration into pre-clinical and clinical training, building foundations for professional competence and lifelong learning. © 2026 Vafamehr et al.