concept mapping-pudelko et al-postprint.pdf

8/16/2019 Concept Mapping-Pudelko Et Al-postprint.pdf

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Published in Medical Education, 2013, 46, 1215-1225 Mapping as a learning strategy in healthprofessions education a critical analysis Pudelko, ,B., Young, M., Vincent-Lamarre, P, Charlin, B.

Post-Print

Published in Medical Education, 2013, 46, 1215-1225

Mapping as a learning strategy in health professionseducation a critical analysis

Pudelko, ,B., Young, M., Vincent-Lamarre, P, Charlin, B.

Abstract

Context: Mapping is a means of representing knowledge in a visual

network that is becoming more commonly used as a learning strategy

in medical education. The driving hypothesis behind the development

and use of concept mapping is the assumption that it supports and

furthers meaningful learning.

Purpose: The goal of this paper is to examine the eectiveness of

concept mapping as a learning strategy in health professions

education.

Methods: The authors conducted a critical analysis of recent literature

regarding the use of concept mapping as a learning strategy in the

area of health professions education.

esults: !mong the "# articles identi$ed% "&' were classi$ed as

empirical work% with the ma(ority )*#."'+ of these being pre,

experimental designs. -nly /.&' of empirical articles assessed the

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0. Context

Concept mapping is a techni4ue used to graphically represent

conceptual knowledge through the use of labeled nodes and

connecting links between nodes. 5t was developed primarily by 6oseph

7ovak0,& as a way to represent meaningful relationships between

concepts. Mind mapping refers to another graphical knowledge

representation techni4ue% developed by Tony 8u1an/," to meet the

re4uirements of the multimodal representation of knowledge. 8oth

techni4ues represent knowledge as propositions in which the map

9nodes )terminology used in concept mapping+ or 9branches

)terminology used in mind mapping+ help identify key ideas. These key

ideas are connected by links that refer to relationships that may or

may not be verbally described. Concept maps are organi1ed in a

hierarchical manner% often top,down% with the more inclusive concept

at the top )tree,like map+% while mind maps 9should start from the

center or main idea and branch out as dictated by the individual ideas

and general form of the central theme )spider or radial maps+ )8u1an%*

p. ;0+.

8oth techni4ues were primarily designed as self,study and thought,

organi1ation learning strategies intended to help students organi1e and

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develop conceptual knowledge in the context of text,based learning.

The driving hypothesis behind the two techni4ues is constructivist in

nature: when learners actively identify main ideas and create links

between them% they interpret% relate% and incorporate new information

into their previous knowledge to elaborate complex semantic networks.

This so,called meaningful or deep learningaley

and Torre; focused on a variety of uses of concept mapping: as a

learning strategy% but also as an assessment tool% an instructional

design tool% a course evaluation method% and even a techni4ue to elicit

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expert knowledge. Aeveral studies in $elds other than health

professions education were also included in their analysis. Bastly% the

authors emphasi1ed the existence of methodological limitations

without examining them in depth. The analysis conducted in this paper

aims to clearly and speci$cally assess the eectiveness of mapping as

a learning strategy in health professions education.

. -b(ectives

2e propose to review existing literature examining the possible

bene$ts of mapping speci$cally for learning in health professions

education. !s a complement to the critical analysis conducted by >aley

and Torre%; we propose to examine research regarding the use of

mapping solely as a teaching and learning strategy. 5n other words% we

will examine available evidence supporting the use of mapping as a

means to encourage meaningful learning by students in health

professions education. 2e will also analy1e some methodological

aspects seen in this research area. inally% we will discuss some

implications of this analysis and of the theoretical framework of

educational practice and research on mapping in a medical or health

professions education context.

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&. Methods

2e carried out a literature search in MD>B57D% for the years ???E

?00% using the key words concept map* and mind map*. The

references of all retrieved articles were scanned to identify additional

papers that were in line with mapping as learning,teaching strategy.

!dditional searches were performed using D8AC-@ost and !C!>DM5C

AD!C@ combining the keywords: medical- % nursing- % or health-

education% teach* or learn*. !s a result% ? articles related to the use

of concept or mind mapping in health professions education or

professional activities were retrieved.

etrieved articles were then analy1ed to identify those that dealt

speci$cally with mapping as a learning,teaching strategy% i.e. when

students actively put together or used a map in the context of learning.

Conse4uently% we excluded many papers that dealt mainly with

mapping as an evaluation of learning or assessment method. ollowing

review% "# Dnglish,language papers meeting these criteria were

selected. The content of these papers was then analy1ed in four main

phases% by two independent coders. The few discrepancies were

discussed until a consensus was reached.

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2e began by examining all papers according to a set of predetermined

categories: type of paper )e.g. theoretical% empirical+% health

professions education $eld )e.g. nursing+% and theoretical background

)for example 7ovakFs theory+.

7ext% we examined and categori1ed all empirical articles according to

the following categories: instructional or learning goal )e.g. improving

critical thinking+ and instructional or learning strategy or method that

incorporated mapping techni4ue. !t this stage% we also examined the

methodological aspects of the research work by classifying the

empirical articles by methodology used.0? Three main empirical

research categories were used:

• Pre,experimental studies: e.g. one shotG case design )known

also as 9after only design+% one group pre,post design )or single

case study+H

• Iuasi,experimental studies: pre,post design% non random

assignmentH

• Dxperimental studies: pre,post design or post,test only design%

random assignment.

• 5nsert igure 0 approximately here

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2e then categori1ed and described the measures of learning eects

reported in the empirical research according to JirkpatrickFs four,level

training evaluation model.00 The four levels are:

• 0, eaction of students E what students thought and felt about

the trainingH

• , Dvaluation of Bearning E the measurement of the increase in

knowledge or intellectual capability% before and after the learning

experienceH

• &, Dvaluation of 8ehavior E the extent to which trainees applied

the learning and how it changed their behaviorH

• /, Dvaluation of esults E the eect on the business or

environment resulting from the improved performance of

trainees.

Bastly% we critically analy1ed the overall results of the empirical and

methodological aspects by situating these results and the theoretical

background of mapping in a broader educational psychology and

cognitive psychology perspective.

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/. esults

/.0. -verall analysis

Type of paper

-f the "# papers analy1ed% / )&*'+ were theoretical in nature: they

described the theoretical framework% the techni4ue% the bene$ts% and

means of incorporating mapping as a learning,teaching strategy in

health professions education.;% 0,&/ Those remaining were considered to

be empirical papers )nK/0% or "&'+.,*#

@ealth professions education $eld

Publications in nursing education were the most common% accounting

for /? )"'+ of published papers. ! total of 0/ papers )0.#'+

discussed the use of mapping as a learning strategy in medical

education. The remaining papers reported the use of mapping in other

health sciences education $elds such as dentistry%0% #% &;% #;% "#

veterinary medicine%/#% /* pharmacology%"% "& chiropractic medicine%/&

and nutrition."/

Theoretical background

Most papers )nK/"% or *0'+ discussed the mapping approach as

theori1ed by 7ovak. 8u1anFs mapping approach was included in

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papers )&/'+. Bastly% " papers% all in nursing education% used

mapping as an alternate representation for care plans as suggested by

Achuster.;% &? 8ear in mind that in this last approach% the terms concept

map and mind map are often used interchangeably% and this approach

is sometimes linked to that of 7ovak or 8u1an.

/.. !nalysis of empirical research

5nstructionalLlearning goal

The use of mapping to facilitate learning can be motivated by a variety

of pedagogical ob(ectives. 5n order to examine the breadth of reasons

why mapping has been applied% we documented the various learning

ob(ectives described in the empirical work we reviewed. 7ote that a

study can have several ob(ectives simultaneously. igure portrays the

distribution of the three main ob(ectives mentioned in dierent $elds of

health professions education.

5nsert igure approximately here

-ur analysis revealed that 9meaningful learning was the main

ob(ective for using mapping as learning strategy )nK/% or #*.#' of

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empirical papers+ in most $elds% except in nursing education and

nutrition. 5n these two $elds% the ob(ective mentioned most often is to

promote critical thinking% mainly when using mapping as a

representation of care plans. !nother ob(ective proposed only in

medical education is to foster memori1ation and recall )nK/+.

5nstructional strategiesLmethods

Mapping was initially proposed as a self,study strategy to encourage

text,based learning )for example//% /=% *0% */+. @owever% in most cases the

use of mapping is incorporated into various instructional methods%

primarily collaborative learning )nK0?% or /.&' of empirical papers+

and in concert with feedback and scaolding,centered methods

provided by instructors )nK0?% or /.&'+% sometimes using instructor,

made maps )nK/% or ;.*'+.

The preparation of care plans through the use of maps that is

described in 0" studies )&;' of empirical papers+% often incorporates

collaboration% feedback% and guidance. -ther instructional methods

used with mapping include problem,based learning )nK/% or ;.*'+% a

mix of assessing and learning strategies )nK#% or 0'+ and online or

blended learning )nK&% or *.&'+.

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Methodological aspects

5n analy1ing the methodologies used in the empirical papers% we found

that &0% or *#."'% of empirical papers describe the pre,experimental

research work.

-f the latter% " papers )or "&./' of empirical papers+ were considered

to be one shot case studies &"% &;,/&% /*% #?% #% #&% ##% #*% #;% "?% "% "&% "#,"*% ";,* and #

)or 0.'+ studies were pre,post one,group design.% /"% #/% "/% *#

The other 0? empirical articles )/./'+ are split between 4uasi,

experimental research&*% #=% "0% *& and experimental research.//% /=% /;% #0% #"% */

5nsert igure & approximately here

-ur analyses indicated that in all empirical research work% only the $rst

two levels of JirkpatrickFs four,level training evaluation model )??"+

were assessed% i.e. level 0 E reaction of students% and level E

evaluation of learning. 5n one shot case studies, only one group is

exposed to the intervention% i.e. mapping activity and only a post test

is given to measure the eect of the intervention% most often reaction

of students )JirkpatrickFs level 0+. 5n this style of study there is no

control group. 2hen these studies do investigate student learning

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)JirkpatrickFs level +% they typically score maps generated by

students% but often only a subset of generated maps.

5n the pre,post one group design studies% learning was assessed

through maps )pre, and post,maps+ in / out of # studies.% #/% "/% *# 5n

these studies% researchers evaluated the dierence between the score

)means of which varies across studies+ assigned to the $rst map

produced on a topic )or a pre,map+ and the score of a later map

produced )post, map+. -nly one pre,post one group design research/"

used measures other than pre, and post,maps% which included

4uestionnaires evaluating critical thinking.

Bearning in 4uasi,experimental and experimental research was

evaluated using MCI tests% pre,validated 4uestionnaires% problem,

solving exams% or map scores. Two studies examined the relationship

between the scores on graded maps and performance on the $nal

exam% and both showed low correlation./*% "?

The reaction measures )JirkpatrickFs level 0+ in the empirical papers

varied from student informal reports )sometimes anecdotal data+ to

surveys whose results may also address various aspects of the

instructional method that incorporated mapping. The surveys usually

used #,point Bikert scales% and less fre4uently included open,ended

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4uestions. The number of students 4uestioned in the surveys varied

widely% from # to 0"=.

8elow we have included a summary of the results for both the reaction

of students and evaluations of learning reported in the empirical

papers. 2ith respect to learning% we excluded from our analysis studies

using one shot case study designs% due to their poor internal validity. 5n

the 9learning category )JirkpatrickFs level + we have also included

the evaluation of learning that involves complex cognitive or

metacognitive skills such as critical thinking and studentsF approach to

learning.

Dvaluation of student appreciation

2ith respect to the student responses to the use of mapping% informal

reports suggest a very positive general appreciation of mapping by

students.&;,/% #?% #% ";% *? Dight additional articles using surveys only report

on 4ualitative data% and $nd that most students appreciated

mapping.% #0% #/% "/% ""% *0% * 5n papers describing 4uantitative results of

surveys regarding student response to mapping% the fre4uency of

positive views range between /' and =0'./&% /#% /*% #*% "?,"&% */% *# ! single

paper reported a very high rate );*'+ of positive student responses%

speci$cally regarding the future use of mind mapping as a self,study

techni4ue.*/ @owever% several other studies indicated that there are

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many students who do not believe they would use mapping in the

future as it was 9too dicult% too time consuming to make.&= Atudents

also reported feeling that they were 9frustrated and apprehensive*

with building maps and express 9negative feelings."? The results of

>ivakarFs study/# showed that *&' of students surveyed 9do not like

mapping% even if #0' found it 9useful in learning. Aimilar results are

reported by Drtmer/* where the 9ma(ority indicated that they did not

like creating maps and by Moni"# who found that 9an unexpected

$nding was that the concept mapping task was not generally favored

by the cohort. -n the whole% the ma(ority of the studies reviewed that

employed student response 4uestionnaires report that at the very

least% some students do not appreciate mapping. -ne negative aspect

that stands out most often is the 9time consuming aspect of

mapping.% &=% /*% #0% #/% "?% ""% "=% *0% */% *#

Dvaluation of learning

5n the 0# studies )or &".#' of all empirical papers+ that evaluated the

in3uence of mapping on learning% three main clusters of research

emerged.

The $rst cluster includes research evaluating the eects of mapping on

memori1ation and factual recall from written information.//% /=% */ !ll

studies in this cluster were experimental or 4uasi,experimental% and

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were all carried out using medical student participants. The results of

these three studies did not show any signi$cant dierence between the

intervention and control groups for the immediate recall test. ! study

conducted by Nhanbari/; that used maps prepared by the instructor

can also be placed in this cluster. The results show a signi$cant

dierence only in women who performed better in the mapping group

than in the control group. 7o interpretation was provided for this

$nding.

The second cluster includes studies evaluating the eects of mapping

on 9meaningful learning. Atudies in this cluster were experimental%

4uasi,experimental or pre,post single case studies assessing

understanding% problem solving%#0% #/% #"% "0 and critical thinking.% //% /"% "/%

*&% *# These studies were carried out with nursing% medical% and nutrition

students as participants.

5n studies conducted by Jumar%"0 Non1ale1%#0 and @su%#" mapping was

used in con(unction with other teaching techni4ues intended to

facilitate guided learning and informative feedback. These three

studies did $nd signi$cant improvements in understanding and

problem solving for students who used mapping rather than a

traditional teaching method. @owever in Non1ale1F work%#0 the

signi$cant improvement was found only in students with lower

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academic performance. 5n the work by @su%#" learning was evaluated

through a post,test using maps on the concepts studied in the course.

Niven that students in the control group had been using maps for the

$rst time for this test% while students in the treatment group used them

" times during the 0",week semester% we can suggest that the score

dierence in the two groups may not indicate learning dierences% and

may perhaps re3ect the dierence in familiarity with the mapping

techni4ue.

our studies noted a signi$cant improvement in scores between the

pre, and post,maps% used as a means to 9comprehend multifaceted

care or to improve critical thinking.% #/% "/% *#

Two studies use 4uestionnaires developed to speci$cally evaluate

critical thinking: CCTAT )California Critical Thinking Akills Test+*& and

@AT )@ealth Aciences easoning Test+.// They did not show any

dierence between groups on the overall score in the posttest.

5n a study conducted by Dllerman%/" a signi$cant improvement of

critical thinking was noted. Oet in this study the evaluation is carried

out retrospectively by students as they rated at the end of the program

what they believed their level of critical thinking was when they began.

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5n summary% of six studies evaluating meaningful learning using

measurements other than maps% two studies found no signi$cant

dierence along the above,mentioned dimensions. Two others

presented methodological problems that challenge the positive impact%

and two found learning improvement.

The third cluster of studies evaluated the eects of mapping on

studentsF approach to learning. This cluster includes a single case

study in nursing.&* The research was designed to examine if the

construction of maps has an eect on )i+ the approach to learning

)surface vs. deep+ as measured by the Atudy Process Iuestionnaire*"

and )ii+ the self,regulation of learning )adaptative% in3exible% irresolute

control beliefs+ as measured by the Atrategic lexibility

Iuestionnaire**. 7o signi$cant pretest,posttest dierences were found

in the mapping group with respect to the approach to learning. The

only signi$cant dierence deals with the 9adaptative control aspect

for which the mapping group showed an improved score.

#. >iscussion

-ur analysis sheds light on the existence of many methodological

limitations of empirical studies% of which *#."' were pre,experimental

in nature. 7early =/' of these pre,experimental studies were one shot

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case studies which certainly provide interesting information on the

views and reactions of students to the use of mapping% but their poor

internal validity did not enable us to draw reliable conclusions as to the

eect of mapping on learning. Then% in the =?' pre,post one group

studies% the mapping eect on learning was evaluated through

comparison of map scores. The pre,post one group designs can provide

convincing data if systematic replication of the eect within and across

dierent contexts or studies is found )Jratochwill*=+. @owever% in order

to summari1e multiple $ndings for the purposes of building evidence%

the measurement of the outcome variable must occur after the

manipulation of interest% since 9this se4uencing ensures the presumed

cause precedes the presumed eect )Jratochwill%*= p. =+. !ssessing

the eects of mapping on learning solely through the evaluation of

dierences in the maps makes it dicult to disentangle cause from

eect. 5n addition% the validity and reliability of map evaluation

methods is controversial.*;,= 5n summary% only ; of 0# articles

evaluated the eects of mapping on learning by using measures other

than maps themselves.&*% //% /"% /=% /;% #0% "0% *&% */ -nly two studies among

them clearly indicated positive eects on aspects of meaningful

learning. 8ut since in these studies the mapping activity is carried out

in con(unction with other instructional strategies% like collaborative

learning% providing feedback% and scaolding% it is still dicult to

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isolate an improvement that can be attributed to mapping from those

of other strategies% especially considering that the positive eects of

these strategies are well documented in educational psychology

research.=&

Moreover% the observations and opinions collected in the empirical

research reviewed here suggest that the student responses to concept

mapping are rather mixed. 2hen taking into account the various

possible biases related to expectancy )sub(ect,expectancy or

observerLteacher expectancy eect+ and the fact that papers published

more often report the positive than the negative eects of an

intervention% the negative comments generated and expressed by

students in regards to concept mapping should not be disregarded.

Niven these $ndings% in contrast to >aley and Torre%; it is 4uite dicult

to conclude that there is growing evidence that mapping itself

encourages meaningful learning% which is the primary ob(ective of its

use in health professions education. urthermore% experimental studies

comparing mapping and other self,study strategies typically do not

show any signi$cant dierence in knowledge memori1ation and recall.

These results corroborate the results of the latest meta,analysis on the

eects of concept mapping on learning )7esbit and !desope=/+% which

suggest that when concept mapping strategies are compared to

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learning activities re4uiring similar levels of cognitive engagement%

such as generating summaries or outlines% the reported eect si1e

favoring concept mapping is often small. !s a result% these researchers

have expressed doubts regarding the stability of the eect and its

pedagogical signi$cance.=/

-ne criticism of the studies that rely on recall tests is that they may

not have evaluated the 9right element of using mapping as learning

strategy% since the recall tests are not appropriate for evaluating

learning in a constructivist perspective%=# which is the basis of mapping

in education. emember% however% that in 7ovakFs constructivist

approach )the most elaborated and cited as a theoretical framework+%

concept mapping is designed to promote meaningful learning through

eective encoding in long,term semantic memoryH that is% 9getting

knowledge in memory. 2e suggest that this assumption can be

challenged from a theoretical standpoint% which in turn can lead to

various implications in terms of the design of instructional strategies

that include mapping in health professions education.

irstly% we can emphasi1e% as Jarpicke and 8lunt=" did recently% the

contribution of retrieval activity to the process of learning. These

researchers challenged the driving assumption behind concept

mappingH speci$cally that elaborative activity favors the encoding of

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semantic knowledge in long,term memory stores% and% in this manner%

improves learning. They compared the eectiveness of retrieval

practice and elaborative studying with concept mapping for

encouraging the meaningful learning of science materials. The results

demonstrated that students in the retrieval practice condition

performed signi$cantly better )#?' improvement+ than students in

elaborative studying with concept mapping condition% which itself was

not signi$cantly better than spending additional time reading. These

results support those found in our current analysis% and that of the

meta,analysis of 7esbit.=/ Jarpicke et al. put forward that 9research in

cognitive psychology has challenged the assumption that retrieval is

neutral and unin3uential in learning. 7ot only does retrieval produce

learning% but a retrieval event may actually represent a more powerful

learning activity than an encoding event )p. **+. 2ith this in mind%

the learning strategies that encourage retrieval developed

spontaneously by students% or instructional strategies like test,

enhanced learning=*% == could eectively be more bene$cial to learning

than elaborative strategies like concept mapping.

This is one possible explanation for student reticence with regard to

mapping as a learning strategy. 2e can put forward that students in

health sciences% especially medical students% may have already


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developed eective study strategies% perhaps based mainly on

knowledge retrieval. These strategies are viewed as more eective

because they are congruous to the context and the methods of

institutional assessment. eplacing usual and proven strategies with

other strategies may be cognitively costly and suboptimal from

studentsF point of view.

Aecondly% 7ovakFs approach postulated that concept mapping

promotes learning because the concept map re3ects the form in which

semantic knowledge is encoded in long,term memory% speci$cally by

means of a propositional language,like network. This hypothesis% in a

way that resembles the assumptions behind general problem,solving

skills%=; explains why concept mapping is usually considered as a

domain,free cognitive strategy. 5n other words% structuring knowledge

in propositional form can improve teaching and learning in any $eld of

knowledge% regardless of its nature. 8y contrast% cognitive psychology

research suggests that external representations can make the

properties of conceptual structure of the knowledge area more

salient%;?,; and thus enhance problem representation%;& or stimulate

dierent cognitive processes. or educational practice% this can be

expressed by representational techni4ues that provide explicit

guidance on the deep structures of knowledge. That said% we have

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observed that the use of mapping in nursing education is more focused

on the representation of care plans% hence on 9schemata,type goal,

oriented knowledge structures that could be intensi$ed through script

theory.;/ 8y contrast% in medical education% researchers and instructors

are primarily interested in the representation and learning of cause and

eect relationships )causal or functional structures+ underlying

biomedical knowledge. 2e think that future studies should focus more

on the representational guidance provided by various mapping

techni4ues based on the $eld of knowledge in 4uestion.

Thirdly% many studies indicate that upon construction of maps% the

greatest diculty which is also the most conducive to learning is

verbally specifying the type of relationship between the concepts.;#

7ote that mind mapping and concept mapping techni4ues dier with

respect to the verbal representation of relationships between concepts:

it is inexistent in mind mapping% and it is optional in concept mapping.

@owever% none of the analy1ed research explicitly takes these

dierences into consideration in mapping representational properties.

5n fact% researchers often consider the two techni4ues to be similar%

which led us to not distinguish them in our analysis.

rom an instructional point of view% this tends to a proposal that

representational guidance of mapping techni4ues should also focus on

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verbali1ing knowledge about relationships% which can be achieved

through discussion% asking 4uestions% informative feedback% or self,

explanation. @ere again the role of teacher guidance seems important

to direct learner attention to more relevant aspects of a $eld of

knowledge and optimi1e its conceptuali1ation. 8ut% from this

standpoint% the use of mapping is moving signi$cantly away from

7ovakFs or 8u1anFs initial vision% according to which learning is

encouraged when learners develop their own idiosyncratic maps

without any structuring other than the propositional and vaguely

hierarchical format suggested by mapping techni4ues% and with little

guidance from experts. epresentational strategies that comprise more

guidance% informational feedback% and instructor scaolding may be

more directly relevant to the education of health professionals.

". Conclusion

The use of mapping in health sciences education over the last ten

years has been carried out mainly in the context of 7ovakFs theoretical

framework% developed primarily for the purpose of meaningful science

learning among students at the elementary and secondary levels.;"%;*

>uring the development of concept mapping% it represented a genuine

educational solution;* based on the identi$cation of what constitutes a

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problem


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types of external representations and if adopting it 9as is might

immediately limit re3ection on other types of representational

guidance that might prove to be more appropriate for health

professions education. This is why the current challenge of educational

research in this $eld is to suggest a re$ned problem setting and more

in,depth theori1ation of mechanisms underlying learning with graphical

representations of knowledge )of which mapping is one example+. This

is certainly a long,term challenge that deserves the development of a

collaborative research approach0? drawing from current health

professions education and cognitive psychology research% and so set

sights on more esearch that is Conceptual and Thoughtful0?& in this

$eld.

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igures

!igure 1. low diagram of methods applied for the critical analysis of

literature

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meaningful learning

critical thinking

memori1ationLrecall

!igure 2" 7umber of articles discussing various instructional goals by

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!igure 3" Rarious types of empirical papers% and the percent

fre4uency of each )7ote: -AACKFone shotF case studiesH PP-NKpre,

post one groupH IDK4uasi,experimentalH DKexperimental+

concept mapping-pudelko et al-postprint.pdf

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