Concept mapping a potential pedagogical strategy to foster meaningful learning in physiology students

Abstract

BACKGROUND:

Understanding of human physiology is critical for clinical practice and disease management. Escalating the teaching-learning method to improve conceptual knowledge may help the students to apply their knowledge in clinical scenarios. The present study was conducted to teach the use of concept mapping as a learning strategy to foster meaningful learning in physiology, compare its impact as a learning tool with traditional methods on meaningful learning, assess the cognitive gain, and find student’s perception regarding concept mapping.

MATERIALS AND METHODS:

The interventional study was conducted on first-year MBBS students. Depending upon marks obtained in previous internal assessments, the students were classified into “rapid learners” (RL) and “potential learners” (PL). By simple random sampling technique, both groups were divided into interventional (concept mapping) and control groups (question-answer discussion). After a pretest, all students had a lecture on glomerular filtration. The assignment was given to the interventional group to prepare a concept map on glomerular filtration, and question-answer were discussed for control groups. A surprise posttest was conducted after 2-3 days.

RESULT:

In our study, all four groups showed significant differences in the pretest and posttest scores using a paired t-test (P < 0.05). The mean score of gain in learning, raw gain (G0), absolute learning gain, relative learning gain, and average normalized gain compared between the interventional group and controls group showed statistically significant performance improvement in both RL and PL groups.

CONCLUSION:

The concept mapping strategy was more efficacious than the question-answer discussion. Concept mapping is an impactful learning tool to improve cognitive gain and potential pedagogical strategy to foster meaningful learning in physiology students.

Background

“Meaningful” learning implies that knowledge is acquired and integrated with another piece of knowledge by building multiple representations and retrieval from many different starting points that make sense and can be applied in problem-solving.[1,2]

Understanding of human physiology is critical for clinical practice and disease management. The majority of students study by “Rote learning.” It is easy to forget, and the application of knowledge for problem-solving and clinical reasoning is limited, or it is challenging to link present knowledge with previous knowledge.

The students should be able to study physiology through meaningful learning rather than rote learning. Successful physicians should be able to think critically and explain physiological responses and their variation in abnormal conditions. If they can do so, they have understood the subject.[1]

According to David Ausubel’s assimilation theory, “knowledge cannot be constructed just by memorization, but should be understood, relevantly integrated with previous knowledge.” “Meaningful” learning involves acquiring and storing well-integrated knowledge and building multiple representations that allow it to be accessed from many different starting points and applied.[3]

Conventional teaching approaches must be revised to prepare students for these dynamic clinical settings. Escalating the teaching-learning method to improve conceptual knowledge may help the students to apply their knowledge in clinical scenarios.

One of the evolving educational strategies to encourage problem-solving, critical thinking, and clinical reasoning skill in students is concept mapping. Concept maps are a multidirectional conceptual graphical representation expressing the relationship between concepts using linking words or phrases, thus integrating the previous knowledge with new one and linking theory to practice.[4]

Studies have shown that concept mapping increases critical thinking.[5,6] Critical thinking skills helps to build conceptual knowledge.[7,8] The authors from foreign universities have conducted studies to evaluate the use of concept mapping in case base learning and problem-based learning;[2,7,8,9] some studies were conducted in Indian medical colleges to study biochemistry,[10] pharmacology,[11] and community medicine.[12,13]

The present study was conducted to teach the use of concept mapping as a learning strategy to foster meaningful learning in physiology, compare the impact of the concept maps as a learning tool with traditional methods on meaningful learning, assess the impact of concept mapping on cognitive gain, and find students perception regarding concept mapping.

Materials and Methods

Study design and setting

The interventional study was conducted at the Department of Physiology, AIIMS Nagpur.

Study participants and sampling

The study was conducted on first-year MBBS students. Informed consent was obtained from the students. Students who were unwilling to participate or absent were excluded from the study. Ninety students participated in the study.

Depending upon marks obtained in the previous internal assessment, the students were arranged in ascending order, and the mid-point was derived as 66.5%. The students were classified into “rapid learners” (RL) (n = 44), scoring >66.5% and “potential learners” (PL) (n = 46), scoring <66.5%.

By simple random sampling, RL was divided into two groups interventional (group A) and control group (group B). PL were divided into two groups interventional (group C) and control group (group D). Thus, groups A, B, C, and D were obtained.

The intervention was the application of Concept mapping as a learning tool for first-year MBBS students for the subject physiology. The interventional group was sensitized about concept mapping and the technique to draw it in a two-hour session.[4]

Data collection tool and technique

Pretest and posttest questionnaires were prepared and validated. The pretest was conducted on the topic of glomerular filtration. A lecture was conducted on the topic of glomerular filtration for all students. The assignment was given to an interventional group to prepare a concept map on glomerular filtration. For control groups, question-answer was discussed in the tutorial session.

After submitting the assignment by the interventional group and the question-answer discussion for control groups, a posttest was conducted as a surprise class test after 2-3 days, including MCQs and problem-solving questions. 30% of questions were recall type, and 70% were clinical scenario-based. Validation of the interventional module was conducted by external validation.

The mean gain score in learning was calculated as the difference between the mean posttest and mean pretest.

Raw Gain (G0) was calculated as the difference between the percentage scored in the posttest and the percentage scored in the pretest (G0= % posttest score-% pretest score).

Absolute learning gain was calculated as the difference between posttest and pretest scores divided by the maximum score times a hundred. AGL = (posttest-pretest/max score) × 100.

Relative learning gain was calculated as the difference between posttest and pretest scores divided by pretest score times a hundred. RGL = (posttest-pretest/pretest score) × 100.

Average normalized gain (G1) was calculated as the difference between Posttest and pretest scores divided by a hundred minus the pretest score. G1= (Posttest-pretest/(100-pretest).[14]

The average normalized gain was used to evaluate the effectiveness of the intervention. A score of more than 30% was considered statistically significant as per Hake’s criteria for the effectiveness of an educational tool.[14,15]

Entry of data and its analysis was performed on Microsoft Excel. Paired Student’s T-test was used to compare the pre- and posttest scores. Unpaired Student’s T-test was used to compare the scores of interventional groups with controls. P <0.05 was considered statistically significant.

After the completion of the study, feedback on concept mapping was obtained from the interventional group. Validation of the feedback questionnaire was performed by external validation. The control group students were sensitized about concept mapping and assigned to draw concept mapping on the same topic.

Ethical consideration

The study was conducted after receiving ethical clearance letter no. IEC/Pharmac/42/20 dated March 13, 2020, from the Institutional Ethical Committee.

Results

A total of 90 first-year medical undergraduate students participated in the study.

The mean pretest score by the rapid learner intervention group A (n = 22) was 4.20 ± 0.93 out of 20, and for control group B mean score was 4.22 ± 0.33. On using an unpaired t-test, a statistically significant difference was not found between the two scores (P > 0.05).

The mean posttest score by the rapid learner intervention group A (n = 22) was 17.15 ± 1.03 out of 20, and for control group B mean score was 15.11 ± 1.30. On using an unpaired t-test, a statistically significant difference was found between the two scores (P < 0.05).

The mean score of the pretest and posttest by the rapid learner intervention group A showed statistically significant performance improvement using a paired t-test (P < 0.05).

The mean score of the pretest and posttest by the rapid learner control group B showed statistically significant performance improvement using a paired t-test (P < 0.05) [Table 1].

Table 1.

Pretest score, % Pretest, Posttest score % Posttest and P for rapid learners Group A and B

Rapid learners	Pretest score max marks (20)	% Pretest	Posttest score max marks 20	% Posttest	P
Interventional Group A (n=22)	4.20±0.93	21.02±4.68	17.15±1.03	85.79±5.18	<0.05
Control group B (n=22)	4.22±0.33	21.13±3.67	15.11±1.30	75.56±5.18	<0.05
P	0.93	0.93	<0.05	<0.05

The mean score of gain in learning, Raw Gain (G0), Absolute learning gain, Relative learning gain, and Average normalized gain compared between the interventional group (A) and controls group (B) showed statistically significant performance improvement on using an unpaired t-test (P < 0.05) [Table 2].

Table 2.

Mean score of gain in learning, average learning gain, raw gain (G0), absolute learning gain, relative learning gain (RLG), and average normalized gain (G1) for rapid learners Groups A and B

Rapid learners	The mean score of gain in learning = (mean posttest – mean pretest)	Raw gain (G0) = % posttest score-% pretest score	Absolute learning gain = (posttest- pretest/max score) ×100	Relative learning gain = (posttest- pretest/pretest score) ×100	Average normalized gain (G1) (Posttest- pretest/(100- pretest score)
Interventional group, Group A (n=22)	12.95±1.43	64.77±7.06	75.42±9.4	330.16±106.30	0.99±0.11
Control group, Group B (n=22)	10.88±1.20	54.43±6.02	71.10±0.99	266.62±61.9	0.69±0.07
P	<0.05	<0.05	<0.05	<0.05	<0.05

The mean pretest score by the potential learner intervention group C (n = 23) was 3.44 ± 1.46 out of 20, and for control group D mean score was 3.38 ± 1.25. On using an unpaired t-test, a statistically significant difference was not found between the two scores (P = 0.87).

The mean posttest score by the potential learner intervention group C (n = 23) was 15.98 ± 1.93 out of 20; for control group D, the mean score was 14.16 ± 1.02. On using an unpaired t-test, a statistically significant difference was found between the two scores (P < 0.05).

The mean score of the pretest and posttest by the potential learner intervention group C showed statistically significant performance improvement using a paired t-test (P < 0.05).

The mean score of the pretest and posttest by the potential learner control group D showed statistically significant performance improvement using a paired t-test (P < 0.05) [Table 3].

Table 3.

Pretest score, % Pretest, Posttest score % Posttest, and P for rapid learners Group C and D

Potential learners	Pretest score max marks (20)	% Pretest	Posttest score max marks 20	% Posttest	P
Interventional group, Group C (n=23)	3.44±1.46	17.2±7.32	15.98±1.93	79.7±7.69	<0.05
Control group, Group D (n=23)	3.38±1.25	16.9±6.25	14.16±1.02	70.8±5.13	<0.05
P	0.87	0.87	<0.05	<0.05

The mean score of gain in learning, Raw Gain (G0), Absolute learning gain, Relative learning gain, and Average normalized gain compared between the interventional group (C) and controls group (D) showed statistically significant performance improvement on using an unpaired t-test (P < 0.05) [Table 4].

Table 4.

Mean score of gain in learning, average learning gain, raw gain (G0), absolute learning gain, relative learning gain (RLG), and average normalized gain (G1) for rapid learners Groups C and D

Rapid learners	The mean score of gain in learning = (mean posttest – mean pretest)	Raw gain (G0) = % posttest score-% pretest score	Absolute learning gain = (Posttest- pretest/max score) × 100	Relative learning gain = (Posttest- pretest/pretest score) ×100	Average normalized gain (G1) (Posttest- pretest/(100- pretest score)
Interventional group, Group C (n=23)	12.54±2.24	62.7±11.20	78.66±14.8	531.01±428.24	0.75±0.46
Control group, Group D (n=23)	10.78±1.54	53.9±7.74	75.28±13.54	383.88±190.34	0.64±0.06
P	<0.05	<0.05	<0.05	<0.05	<0.05

Students’ feedback about working with concept mapping (CM) was obtained on a five-point Likert Scale question [Figure 1]. 86.36% of students agreed that CM allowed them to visualize the concepts, 77.26% of students agreed that CM stimulated the activation of previous knowledge, 90.9% of students agreed that CM stimulated the integration of previous knowledge with the new one, helped in creating a better understanding of the subject, and help them to memorize relevant information for the test, enhanced their interest in the subject, enhanced self- directed learning, 59.05% students agreed that CM is Fun to construct, 95.9% students agreed that CM consumed time to draw, 59.05% students agreed that CM was difficult to construct, 86.36% students agreed that they would like to use the CM in future for learning, 90.9% students agreed that CM should be incorporated in teaching the subject.

Figure 1.

Shows the response in the percentage of students for the 5-point Likert Scale question on the concept mapping learning method

Discussion

Understanding physiological processes is essential for diagnosing, treating, and preventing diseases. Students should not only learn the subjects but should be able to retain and apply the knowledge in abnormal and critical conditions. Students should perceive the subject as the bridge connecting to clinical subjects and learn physiology through “Meaningful” rather than “rote” learning.

Most students study by “Rote learning,” which is easy to forget and critical thinking, or applying knowledge for problem-solving and clinical reasoning or linking to previous knowledge, is impossible.

David Ausubel’s assimilation theory states that knowledge cannot be constructed just by memorization but should be understood and relevantly integrated with previous knowledge. “ Meaningful” learning comprises the acquisition and storage of well-integrated knowledge, accompanied by building multiple representations that allow it to be accessed from many different starting points and applied.[3]

According to Ausubel, in the process of thinking and learning with concepts, the minor-ranked concepts are added to major-ranked concepts; the process is known as subsumption. It is followed by a process of analysis where the concepts are fragmented into small-scale mini components; the step is known as progressive differentiation. Then finally, the process of synthesis starts when the learner attempts to accommodate and bridge concepts; the step is known as integrative reconciliation.[3]

Joseph Novak and Bob Gowin at cornell university 1972 developed a CM tool based on meaningful learning and assimilation.[3] CM organizes information, themes, or their relationships visually and considers the thinking process’s integrity and logicality.

In our study, all four groups showed significant differences in the pretest and posttest scores using a paired t-test (P < 0.05), indicating that both the teaching method CM and question-answer discussion were effective.

Nevertheless, when we compared the mean posttest score of rapid learner intervention group A (17.15 ± 1.03) and control group B (15.11 ± 1.30), a significant difference was observed (P < 0.05). Similarly, potential learner intervention group C (15.98 ± 1.93) and control group D (14.16 ± 1.02) (P < 0.05) showed significant differences, indicating the CM technique was more effective than the question-answer discussion.

The mean score of gain in learning, raw gain (G0), absolute learning gain, relative learning gain, and average normalized gain compared between the interventional group and controls group showed statistically significant performance improvement using an unpaired t-test (P < 0.05) in both RL and PL group, which indicates that CM is an effective learning tool and improve cognitive gain.

Saeidifard et al. conducted a study on 76 sixth-year students of the 7-year MD curriculum clerkship phase on the topic “Diabetic Ketoacidosis” (DKA). The scores of students in the intervention group (CM) were significantly higher than the control group (group discussion) in the physiopathology section of questions but not in the scores of answers to the treatment section of questions.[6]

Gonza’lez et al. conducted a study on applying the concept map strategy to meaningful learning of the cardiovascular system of physiology at Universidad Autonoma de Bucaramanga. The intervention group (CM) performed significantly better than the control group (traditional methodology) on the problem-solving exams, but the difference was not significant in the multiple-choice.[8]

Ghosh et al. conducted a study on using CM for biochemistry students. Relative gain between the concept maps group and tutorial group was not significant in high-scorer students but was significant in low-scorers. They observed a highly significant change in the posttest scores among the concept maps group but not in the tutorial.[9]

Mukhopadhyay et al. conducted a study on using CM for pharmacology students on the topic “Drugs affecting Calcium Metabolism.” They found significant improvement in student performance in the interventional group (concept map method) and Control group (traditional tutorial methods). But no significant difference was found between the groups in both low scorers and high scorers [Figures 2 and 3].[11]

Figure 2.

Shows a flow diagram of the division of study participants into various groups

Figure 3.

Shows flow diagram of the study design

Baliga et al. conducted a study on the topic of tuberculosis on III MBBS students of Community Medicine. They observed a significant difference between pretest and posttest scores and received a positive response (82.09%) on using concept maps.[12]

A study by Choudhary et al. reported that students using visual mapping techniques, both mind maps and concept maps, in community-based teaching-learning scored significantly better than the question-answer session (conventional method).[13]

Students gave positive feedback on the use of concept maps for meaningful learning. CM allowed them to visualize the concepts, CM stimulated the activation of previous knowledge, and helped to integrate previous knowledge with the new one, which created better subject understanding. It helped them to memorize relevant information for the exams, enhanced their interest in the subject, and enhanced self-directed learning. Students agreed that CM is an exciting activity but difficult and time-consuming to construct. 86.36% of students agreed they would like to use the CM for learning, and 90.9% agreed that CM should be incorporated into teaching-learning activities.

Limitation and recommendation

This is a single-center pilot study with a small sample size. A similar study should be conducted at a multicentric level including a large sample size. Further studies should be conducted considering vertical and horizontal interdepartmental and interdisciplinary integration to maximize its effectiveness.

Conclusion

Both the teaching method, viz CM and question-answer discussion, were effective, but the CM technique was more effective than question-answer discussion. CM is an effective learning tool to improve cognitive gain. CM is a potential pedagogical strategy to foster meaningful learning in physiology students.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.