Making the Connection: Using Concept Mapping to Bring the Basic Sciences to the Diagnosis

Designing Concept-Mapping Sessions

The concept mapping exercise helped students visualize how the basic science concepts explained the clinical presentation's pathophysiologic characteristics in a specific case. This approach helped students focus on the patient. Students started and ended their concept map with the patient (Figure 1). The map contained basic science concepts that explained the basis of the clinical concepts, which included the clinical symptoms, signs, and the diagnostic test results. The students arranged these concepts by linking terms to create logical connections that could be followed from the patient through every part of the map.

Figure 1.

A simplified concept map exemplifying how students might move from the patient to the clinical signs, symptoms, and history and link the basic science concepts and diagnostic tests to support the diagnosis. Depending on the prompt, treatment and its effects may be linked to these concepts.

The materials for the case-based learning (CBL) activity were designed through collaboration between basic science faculty and physicians and included the clinical case, prompt, rubric, and an exemplar concept map. The case included a complete history, physical examination, diagnosis, diagnostic tests, and management. The faculty decided on a prompt to limit the scope of the basic science and clinical concepts for the concept map based on the learning objectives for the week. The prompt helped direct the students to explain the underlying pathophysiologic characteristics and defend their primary diagnosis by connecting the key elements of the history, physical examination, and diagnostic tests. In addition, the students used these elements informed their decisions regarding treatment and management as appropriate (eAppendix 1). Once the prompt was generated, the faculty developed an example concept map and a rubric that outlined the information on the concept map to help facilitators guide their groups (eAppendix 2 and eAppendix 3).

A meeting was convened a week before each concept mapping session to prepare the faculty facilitators and standardize the experience for each group. In these meetings, a physician presented the case providing a clinical perspective for the facilitators, who were often basic scientists. The basic science and clinical concepts underpinning the patient's clinical presentation were presented by the faculty who generated the rubric and concept map for the case (eAppendix 2 and eAppendix 3). These sessions oriented the facilitators to the content and instructed them on how to guide the students through the session.

Implementation

Each CBL group, which comprised 6 students and a facilitator, met weekly for the 2-hour concept mapping session. Students were provided with the case and prompt ahead of time to prepare for the session. The session began with 1 student giving an oral presentation of the case, which included identification of the key elements of the history, physical examination, and diagnostic tests that informed the diagnosis. This activity required the students to explore the connections between the basic science and clinical domains, which were centered on the patient's clinical presentation and provided an opportunity for students to practice presentation skills.

The students used the prompt to create their concept map using CmapTools (IHMC). The map was projected on a large monitor to allow the whole group to view its construction. The discussion centered on reaching consensus about concept placement and linking terms. The group was required to use all of the terms provided in the prompt on their concept map, and they were encouraged to also add their own concepts to describe certain processes better. Students referred to lectures and other resources from the week, and substantial peer-to-peer teaching occurred. The rubric and exemplar concept map were provided as a resource for the facilitator, whose role was to keep the students focused on the appropriate concepts without being too directive or restrictive. The facilitator also provided guidance on group process as the students engaged in decision-making, task performance, and conflict resolution.

Grading

To provide immediate feedback to the group on their concept map, the faculty-generated rubric and concept map were available to students after completion of their map (eAppendix 2 and eAppendix 3). Before grading, the maps were deidentified and coded to prevent bias. The maps were initially graded by second-year students who used the rubric and exemplar concept map to grade and provide commentary. The final grade was determined by 2 faculty facilitators whose responsibility was to review the maps and standardize the grading process. Facilitators were not assigned to review and grade the map of their own group(s). The activity was designed primarily as an opportunity for learning rather than assessment, so grading was primarily formative, but with enough weight to be taken seriously. The concept maps were graded using a 20-point scale. A total of 4 points were given for including all of the required basic science and clinical concepts on the map. The remaining 16 points were designated for the content on the map. Rather than assigning specific point amounts for each correct link made, the point distribution was more subjective, with more weight given to important general concepts rather than every specific detail. Identifying the important concepts and realizing that they can be shown in different ways on a concept map took some practice for the student graders. The faculty who supervised them provided feedback, and they soon became adept at grading. Having experienced concept mapping during the previous year, their comments were very relevant and they often identified bridges between the first- and second-year curriculum, as well as the board examinations. First-year students responded to these comments by incorporating the feedback into their subsequent maps.

Before returning the graded concept maps to the groups, the numeric score was converted to an “exceeds expectations” (18-20 points), “meets expectations” (16-<18 points), and “needs improvement” (<16 points). Groups receiving a “needs improvement” grade were required to meet with the faculty member who graded the concept map to review the map, clarify any misconceptions, and edit their map based on the comments.

Benefits

Concept mapping, as described in this article, is a method to integrate basic science concepts with clinical medicine. Since 2014, course evaluations have indicated that at least 80% of students agreed or strongly agreed with the statement, “The Facilitated Case Based Learning activities (CBL)/Concept Mapping provided opportunities to integrate the basic science and clinical science concepts from the objectives.” Student comments from the course evaluation suggested that concept mapping helped them to contextualize basic science concepts underpinning clinical medicine (Figure 2). The process of discussing concepts to reach a consensus on the map challenged students to defend their understanding and explain their rationale to others. Others have shown that this enhances learning and retention of the material.^6,16 Many students also found the maps to be useful study tools. Additionally, working in these small-group sessions helped students understand the elements of effective team dynamics and reflect on their strengths and weaknesses.

Figure 2.

Comments from first-year students at the University of New England College of Osteopathic Medicine who participated in concept-mapping sessions. Abbreviation: CBL, case-based learning.

Second-year student graders found the experience helpful for reviewing basic science concepts and appreciated revisiting first-year content as they prepared for the board examinations. Concept map grading allowed these students to practice assessment and provide constructive feedback.

The collaborative effort to create materials for each concept mapping session brought faculty from different basic science and clinical disciplines together, and basic scientists learned which concepts are critical for application to clinical medicine. These experiences helped faculty to understand the importance of integration and develop new skills to emphasize this in their teaching.

The process of concept mapping can be challenging for both students and faculty. Robust orientation programs to help faculty and students appreciate the value of cognitive integration for developing clinical reasoning skills can help address these challenges. Students and facilitators should be educated about team building and supported throughout the process of team development.