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. 2024 Aug 14;34(6):1487–1496. doi: 10.1007/s40670-024-02143-4

The Effect of Concept Map Technique on Students’ Cognitive Load and Academic Success in Anatomy Course

Güneş Bolatli 1,✉, Zafer Bolatli 2
PMCID: PMC11699086  PMID: 39758492

Abstract

Introduction

Anatomy has too many details to memorize. Therefore, students need alternative means of education. The aim of this research was to investigate the effect of concept mapping techniques on anatomy learning.

Methods

The participants consisted of two groups: control and experimental. Before the training, the student introduction form and pretest were applied to both groups. The theoretical course was taught to the control group using classical methods and to the experimental group using a concept map. At the end of the lesson, the experimental group was asked to study with concept maps and the control group with textbooks and atlases for 3 days. Posttest and cognitive load scales were applied to both groups, and an attitude scale towards the concept map was applied to the experimental group.

Results

Both groups were more successful in the posttest than in the pretest. Posttest success was higher in the experimental group than in the control group. The cognitive load of the control group was significantly higher than the experimental group’s. It was observed that the attitude scale towards the concept map does not change according to gender, prior hearing about this technique, or its prior use.

Conclusion

This study showed that concept maps reduce cognitive load and increase academic achievement.

Keywords: Cognitive load, Concept map, Gross anatomy education, The attitude scale towards the concept map

Introduction

In order to ensure the students’ participation in the learning process and to increase their efficiency, new teaching methods have been developed. The concept map technique, which aims to provide a concrete and visual arrangement of concepts and their relations omit in mind, is among these methods [1].

Concept maps are an educational tool that provides meaningful learning by concretizing information [2]. It is based on Ausubel’s theory of meaningful learning [3]. According to Ausubel, most people try to expand their knowledge without using their existing knowledge and move away from meaningful learning. The main thing is creating meaningful connections between old and new knowledge. When students encounter a new concept, they try to put meaning into it and start thinking about their experiences. These experiences show how much the student can learn about the concept. Learning the new concept is completed by linking the newly learned concepts under the previously acquired concepts in a certain order. If this situation is taught to the student in a discipline, meaningful learning is achieved [2].

Mayer et al. [4, 5] have published several studies that have focused on multi-learning environments and they have stressed key points about images and important terms that they believe make learning easier for students. Multimedia learning, mainly through words and pictures, includes multimedia content, text, and illustrations in books. Computer-based exercises can include animations and oral narrations, as well as graphics and explanatory text [6]. Published data indicate that concept maps can facilitate student learning [7]. These maps help students organize factual information in a visual format and use a hierarchy that ranges from general to specific. This approach appears to facilitate more permanent student learning [8]. When students construct a concept map, both the right and left lobes of their brains are engaged. This mental activity not only improves student’s problem-solving skills and critical thinking, but also promotes creativity [9]. Simultaneously, generation of concept maps has also been reported to reduce cognitive load [10, 11].

Sweller introduced the concept of cognitive load [12]. This theory attempts to understand how the cognitive load created by learning tasks can impede students’ ability to process new information and create long-term memory [12, 13]. According to the cognitive load theory, the knowledge gained in the teaching process, according to its function, is processed in two categories in working memory. In working memory, instruction is used regardless of the technique. The cognitive load arising from the nature of the material is called “intrinsic” and the cognitive load arising from the instructional design “extraneous” [14]. In some sources, in addition to these two loads, a third load called “germane” cognitive load is defined, while in some sources, this third load is included in the scope of intrinsic load [15]. Working memory is both capacity and is also very limited in time. For learning to be effective, the total cognitive load should not exceed the current processing capacity of working memory. In this context, while preparing learning materials, they are not directly related to the learning content, so removing components from the material so that they do not create a load is recommended [16]. Germane load refers to the cognitive load created by the mental processes necessary for learning to occur. This burden arises from efforts to actively process and make sense of information during learning [15].

According to cognitive load theory, as the complexity of mental processes increases, the limited capacity of working memory may hinder the process of transferring information to long-term memory [15]. In the study conducted by Paas and Van Merrienboer [17], three main factors affect the cognitive load in the learning environment: the nature of the job, the quality of the student, and the interaction between these two factors. Considering the complexity and nature of medical education, the cognitive load is expected to be intense. In this context, schematic representations are important for the active use of working memory.

When the student is exposed to unnecessary prompts, the task of processing information becomes more complicated than it is, resulting in an increased extraneous cognitive load. These prompts include unnecessary distractions in a classroom and inadequate methods teachers use to explain a topic. New information can be easily learned when the cognitive load is well managed [12]. Using the Cognitive Load Theory-based Lecture Model positively affects anatomy education [18–20].

Anatomy is one of the basic science medical school courses. It is the oldest basic branch of medicine that studies the normal shape, structure, position, and functions of the structures that make up the human body and the relationship between each other at the macroscopic level [21]. Basic knowledge of medical terminology and human morphology is included in the anatomy curriculum. Most medical faculties in our country (Turkey) complete their anatomy education in the first and second years. In contrast, clinical science education usually starts in the third year or later [22].

In practical anatomy lessons, using models, especially cadavers, is very important to make the theoretical information concrete [23]. The studies show that most anatomical knowledge is not permanent [24, 25]. A study conducted with physicians stated that anatomy education is important both as a student and during the study period and that they need an anatomy atlas and a book when performing their profession [26].

It has not yet been proven whether the methods used in studies on anatomy education are superior to each other [27, 28]. We think well-designed teaching material, such as concept maps, will help manage students’ cognitive load and improve their learning performance. For this reason, the study aims to investigate the effect of the concept map technique, prepared by both students and the instructor, on anatomy learning.

Methods

This study was initiated because with decision No. 236 dated 05.11.2021, taken from the Ethics Committee of Siirt University in Turkey. The students who made up the research sample were informed about the research’s purpose, plan, duration, and procedures. For this reason, informed consent was obtained for their voluntary participation in the study.

Learning Environment

Anatomy courses are included as a separate course in the Nursing Department curriculum at the Faculty of Health Sciences. Anatomy classes are conducted 2 h a week as theoretical and 1 h as practical. A total of 42 h of anatomy classes is given in 14 weeks. The circulatory system anatomy course is completed in a 3-h course. All students participating in the study (68 females and 67 males) participated in 2 h of theoretical and 1 h of practical classes in the classroom. The experimental group was taught the theoretical lesson using the concept map technique, and the control group used the classical method (2 h of theoretical lecture over the lecture notes prepared by the lecturer in the class). The course content prepared for both groups was similar. The students were given an anatomy book [29] for the theoretical course and an anatomy atlas [30] for the practical course.

Participants

This research was a randomized controlled study. The participants consisted of 135 students who participated in the anatomy course at the Nursing Department of the Faculty of Health Sciences (first-year students) (Fig. 1). Students who had previously taken anatomy courses were not included in the study. For research, at least 45 observation units are needed in groups to achieve a power level of 0.95 at a 5% error level with an effect size of 0.5. The analysis was performed with G*Power software [31]. Randomization of the study was done using the website [32]. Students were assigned to control (classical education group, n = 66) and experimental (using concept map method, n = 69) groups.

Fig. 1.

Fig. 1

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Sample of the study flow chart (CONSORT 2010 flow diagram)

Data Collection Tools

Research data were collected through the “Structured Student Introduction Form,” “Attitude Scale Towards Concept Map,” “Cognitive Load Scale,” and “Circulatory System Anatomy Knowledge Exam.”

Structured Student Information Form

This form included two questions regarding students’ characteristics: age and sex.

Examination of Knowledge in the Anatomy of the Circulatory System

The anatomy of the circulatory system was chosen as the research topic. Because the circulatory system is one of the specific topics that health professionals need to learn in detail and frequently encounter in the clinic. The most preferred taxonomy in the literature, designed to make effective and accurate assessments in education and determine the thinking levels in the field, is Bloom’s Taxonomy, developed by Bloom in 1956 [33]. The taxonomy was restructured in 2001 [34]. According to the new regulation, the cognitive process dimension consists of remembering, understanding, applying, analyzing, evaluating, and creativity. The prepared questions include the steps of remembering and understanding this taxonomy. The exam consists of a total of 20 questions. Four of these are visual questions using atlas images. The other 16 questions are multiple-choice. The lowest score that can be obtained from the exam is 0, and the highest score is 10 points. Each question is equivalent to 0.5 points. The pretest and posttest exam questions are the same. Pretest and posttest applications were conducted similarly. The students were not told that they would be asked the same questions and the exam was prepared again by mixing the order of questions.

Cognitive Load Scale

The “Cognitive Load Scale” developed by Paas and Van Merrrienboer [17] measures how much students are cognitively loaded while performing the given tasks. It has a single-factor and nine (very very little, very little, little, partly little, neither more nor less, partly much, much, very much, very very much) rating scale. The lowest point of the scores taken from the scale was determined as 1.00, the midpoint was determined as 5.00, and the highest point was determined as 9.00. Participants who scored below 5 points were considered “not cognitively overloaded,” while participants who scored above 5 points were considered “cognitively overloaded” [17].

The Attitude Scale Towards the Concept Map

A two-component scale was developed to determine students’ attitudes towards the concept map method [35]. On the scale, since 13 items consisted of positive attitude statements towards the concept map method, the factor was named positive attitude; since 10 items consisted of negative attitude statements towards the concept map method, the factor was named negative attitude. Positive and negative statements are evenly distributed over odd and even numbers. After the scale was applied, positive sentences were scored as 3, 2, 1 starting from the “I agree” category, and negative sentences were scored as 3, 2, 1 starting from the “I disagree” category. Confirmatory factor analysis examined the concept map scale’s level of agreement. The study used the highest likelihood estimation (maximum likelihood) technique. As a result of the analysis, the ratio of the chi-square statistics to the degrees of freedom obtained for the attitude scale towards the concept map, the root mean square approximation error (RMSEA = 0.077), the Tucker-Lewis index (TLI = 0.915) value, and the comparative fit index values (CFI = 0.908; TLI = 0.915) were examined. A model fits well, especially if the comparative fit index values are 0.90 or more.

Collection of Data

The students were divided into two groups: control and experimental. Groups were determined by random sampling method with equal probability. Both groups were given a structured student introduction form and a knowledge exam on circulatory system anatomy (pre-test) and were expected to answer them. The pretest was administered under the supervision of an instructor. The students were asked to answer the exam in 30 min without looking at the book and lecture notes.

Application in the Control Group

After explaining the theoretical lesson, the students were taken to the anatomy laboratory. The trainer explained the anatomy of the circulatory system with models of the subject. After that, the students’ questions were answered, and they were allowed to study individually until the end of the course. At the end of the course, students were told that the textbook, atlas, and lecture notes should be studied for 3 days. Students were informed that no other sources were permitted. After 3 days, an examination of knowledge in the anatomy of the circulatory system (posttest) and a cognitive load scale were performed.

Application in the Experimental Group

The concept map technique explained the theoretical course (Fig. 2). After that, the students were taken to the anatomy laboratory. The trainer explained the anatomy of the circulatory system with models of the subject. At the end of the course, students were told that the textbook, atlas, and lecture notes (prepared with the concept map technique) should be studied for 3 days. At the same time, they were asked to prepare a concept map related to a section they had difficulty understanding within the context of the described topic. While preparing the concept map, they were asked to design it using pen and paper. Students were warned, except that no source other than these sources was used. After 3 days, the knowledge exam on the anatomy of the circulatory system (posttest), the cognitive load scale, and the attitude scale for the concept map were performed.

Fig. 2.

Fig. 2

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Circulation system concept map [36]. The images used were taken from the anatomy atlas [37]

Creation of a Concept Map

The instructor did not receive any professional training on the concept map technique. However, he did his research and received support from an educator interested in this subject. Detailed information about the technique and how to apply it was given to the students by the instructor. The concept map on the subject was designed on a computer using Adobe Illustrator CC 2021 program. The trainer ordered concepts related to the subject in a hierarchical order from general to specific. The basic concept (the visual expression of the circulatory system) was placed in the middle of the page in an oval shape. The concepts were placed around the basic concept with the help of arrows in order of importance. Then, the connections between the concepts were then combined with the help of lines to complete the concept map (Fig. 2).

Statistical Analysis

The licensed SPSS statistical package program, version 25.0 for Windows (IBM Corp., Armonk, NY), was used for data analysis. The distribution of demographic information by groups was analyzed using chi-square. The mean age difference between the independent groups was investigated using a t-test. Pretest and posttest comparisons, t-tests in dependent groups, and comparison of measurements based on t-tests in independent groups and study groups were examined. Linear regression analysis was performed to understand the relationship between the increase in academic achievement and the use of concept maps. Results were evaluated as p < 0.05 at a 95% confidence interval and significance level, and effect sizes were calculated using Cohen’s d [38].

Results

The control group comprised 66 students, and the experimental group comprised 69. When the distribution by gender was examined, the proportion of men in the control group was 51.5%, and the proportion of women was 48.5%. In the experimental group, the proportion of men was 47.8%, and the proportion of women was 52.2% (X2 (2;135) = 0.184; p = 0.399). The students’ mean age was 19.21 (mean age of the experimental group 19.15, mean age of the control group 19.28) (Table 1).

Table 1.

Distribution of students’ sociodemographic characteristics

Sex Control group Experimental group
Male 34 33
Female 22 36
Mean age 19.28 19.15
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According to the test results in independent groups, there was no significant difference between the groups (p > 0.852). There was a significant difference between the pretest and posttest in the control and experimental groups (p = 0.000). The pretest mean of the control group (0.242 ± 0.528) was significantly lower than the posttest mean (3.409 ± 2.15), and the experimental group pretest mean (0.261 ± 0.610) was significantly lower than the posttest mean (5.014 ± 2.026). There is a significant difference between the mean of the posttest-pretest differences according to the groups and these averages (p = 0.000). The score increase is significantly higher in the experimental group than in the control group (Cohen’s d = 0.759) (Table 2) (Fig. 3).

Table 2.

Comparison of knowledge exam scores of students

Mean (± SD) p-value
Control group Pretest 0.242 (0.528) 0.000*
Posttest 3.409 (2.105)
Experimental group Pretest 0.261 (0.610) 0.000*
Posttest 5.014 (2.026)
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Control group (n = 66): using the standard curriculum; experimental group (n = 69): using the concept maps. SD, standard deviation. *p < 0.05

Fig. 3.

Fig. 3

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Differences in pretest and posttest exam results between groups. Control group: education with the classical method (n = 66; male = 34, female = 32). Experimental group: education with the concept map technique (n = 69; male = 33, female = 36). Two sample t-tests were used to compare examinations’ performance between the two groups. The effect sizes were confirmed using Cohen’s d (Cohen, 1988). ap < 0.05

There is a significant difference between the control group and the experimental group in terms of cognitive load averages (p = 0.000), and the control group average (7.06 ± 1.87) is significantly higher than the experimental group average (5.85 ± 1.94) (Fig. 4).

Fig. 4.

Fig. 4

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Cognitive load difference between groups. It has a single-factor and nine (very very little, very little, little, partly little, neither more nor less, partly much, much, very much, very very much) rating scale. The lowest point of the scores taken from the scale was determined as 1.00, the midpoint was determined as 5.00, and the highest point was determined as 9.00. p = 0.000, Cohen’s d = 0.635

When the change of the attitude scale towards the concept map according to gender was examined, it was found that there was no significant difference according to gender (positive attitude p = 0.777, negative attitude p = 0.613). The attitude levels of men and women towards the concept map are the same (Table 3). When the change of the attitude scale towards the concept map was examined according to the state of having heard the concept map before, it was seen that there was no significant difference (positive attitude p = 0.474, negative attitude p = 0.080). The attitude levels of those who have heard the concept map before and those who have not are the same (Table 4). When the change of the attitude scale towards the concept map was examined according to the situation of using the concept map before, it was seen that there was no significant difference compared to the situation of using the concept map before (positive attitude p = 0.982, negative attitude p = 0.976). The attitude levels of those who have used the concept map before and those who have not are the same.

Table 3.

Comparison of concept map attitude scale by gender

Gender Mean (± SD) p-value
Positive attitude Male 55.09 (7.19) 0.777
Female 54.61 (6.83)
Negative attitude Male 20.15 (7.78) 0.613
Female 20.97 (5.54)
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Experimental group: using the concept maps (n = 69; male = 33, female = 36). SD, standard deviation

Table 4.

Comparison of concept map attitude scale according to prior hearing and prior use

n Mean (± SD) p-value
Prior hearing Positive attitude Yes 40 54.33 (6.75) 0.474
No 29 55.55 (7.30)
Negative attitude Yes 40 21.78 (7.06) 0.080
No 29 18.93 (5.81)
Prior use Positive attitude Yes 16 54.88 (6.43) 0.982
No 53 54.83 (7.17)
Negative attitude Yes 16 20.63 (5.99) 0.976
No 53 20.57 (6.91)
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Experimental group: using the concept maps (n = 69; male = 33, female = 36). SD, standard deviation

The regression model, in which the level of achievement was taken as the dependent variable and the sub-dimensions of the concept map scale as the independent variable, was tested. The tested model was not significant (F = 0.585; p = 0.560). Positive (beta value = 0.075) or negative (beta value 0.156) attitude towards the concept map does not affect the posttest (Fig. 5).

Fig. 5.

Fig. 5

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Linear regression analysis between concept map scale sub-dimensions and posttest. The regression model in which the posttest was taken as the dependent variable and the concept map scale sub-dimensions as independent variables. F = 0.585, p = 0.560, R.2 = 0.017

The compatibility of scale and test scores with normal distribution was examined by the Kolmogorov–Smirnov test and Shapiro–Wilk test (Table 4). Accordingly, it was seen that the sources obtained were in accordance with the normal distribution. Cronbach’s alpha coefficients were obtained to determine the reliability level of the cognitive load scale and the concept map scale. It was obtained as 0.825 for the cognitive load scale, 0.847 for the overall concept map scale, 0.758 for the positive attitude sub-dimension, and 0.808 for the negative attitude sub-dimension. KR 20 and KR 21 reliability levels were obtained for the achievement tests. For the pretest, the KR 20 coefficient was 0.856, and the KR 21 coefficient was 0.789. For the posttest, the KR 20 coefficient was 0.812, and the KR 21 coefficient was 0.785.

Discussion

Anatomy is the foundation of medicine, and understanding the complexity of the human body is a prerequisite for becoming a competent healthcare professional [39]. However, healthcare professionals express their lack of anatomy knowledge during their professional practice [40]. The widespread belief that anatomy learning techniques do not keep up with today’s education standards [40] and the lack of consensus on which teaching method is effective for adequate learning of anatomy [41] became the impetus for this research. This study showed that concept mapping technique in anatomy education has positive effects. Therefore, the concept map technique can support classical anatomy education.

The concept map technique has many benefits, such as addressing individual differences, being easy to use, embodying the knowledge taught, and increasing permanence [1]. It can be used in the education and training process and evaluation stage. Educators note that concept maps allow students to evaluate their knowledge from a conceptual point of view [2]. It is known that using concept maps increases the academic success of students and the permanence of information [42]. Although research has yielded results in this direction, a study on concept maps and nursing education indicated that the method did not make a difference in academic success but did reduce cognitive load [43]. Data are supported by the data generated in this study. It was determined that the experimental group that received training with the concept map was more academically successful than the control group.

Ghojazadeh et al. [44] stated that concept maps increase critical thinking, provide meaningful learning, and help establish a relationship between theoretical knowledge and practice. It is also known that concept maps are effective in developing reading comprehension and writing skills. It was stated that the method would be more useful if the students knew concept maps, but it increased the learning performance even in the beginning stage [45]. We found no difference in attitude between those who have previously heard of and used concept maps and those who have not, as well as between genders. In summary, it appears that regardless of the stage at which concept maps are used, there is an increase in success. The factor contributing to success is increasing learning performance by reducing cognitive load [46–48]. Our findings support the statement in Abdel-Hamid et al.’s study that “more research is needed on students’ perceptions of this technique” [49].

The element that most impacts the cognitive load is the number of objects that need to be learned. Excessing the object increases the cognitive load and makes learning difficult [1]. Instructional materials create an intrinsic and extraneous cognitive load on the learner. Instructional designs are used to reduce extraneous cognitive load, and working memory resources guide coping with the intrinsic cognitive load associated with the learning process [50, 51].

Determining the method used in the learning process according to the principles of cognitive load theory allows learning to be more effective and efficient [17]. The cognitive load level is associated with students’ academic achievements [52]. There are studies investigating cognitive load in anatomy teaching. They evaluated the effects of techniques such as interactive and dynamic visualizations [53], mobile augmented reality [20], e-learning [54], problem-based teaching [55], and ultrasound teaching [56]. As a result of the research, it was observed that the cognitive load decreased and the academic success increased in the experimental group in which the concept map was used, compared to the traditional method. It is known that learning anatomical structures and their relationships requires a serious cognitive effort [57]. Therefore, it can be said that this method, which is different, can help understanding by reducing the cognitive load.

It is known that anatomy courses are lessons that can be forgotten if they are not repeated and explained together with the clinic; the anatomical structure becomes more complicated as it becomes regional, and the student’s interest decreases [26]. After intensive and efficient processing of anatomy courses in the early stages of all faculties providing health education, they are not included in the internship or assistant periods. Therefore, anatomy repetitions are needed, especially in specialties such as surgery, where anatomy knowledge is important [26]. It is stated that concept maps are an important educational strategy in both clinical and theoretical teaching [8], and they ensure that anatomy information is kept in both short-term and long-term memory [58]. Additionally, concept maps facilitate clinical reasoning by managing different thought processes and helping students relate basic science knowledge to clinical practice [59, 60].

Technological methods support anatomy teaching, such as computer-aided learning, three-dimensional interactive dissection tables, and VR technology [61, 62]. However, these techniques require extra equipment, are often expensive, and are not available to everyone [39, 63]. Although it is stated in the literature that educational technologies should support anatomy teaching, there is not enough information about different teaching techniques [39]. In the literature, we can find few studies on concept maps and anatomy education, and most of them were conference papers [58, 64–66]. It would be beneficial to use this cost-free technique actively.

Limitations of the Study

Although concept maps are teaching materials that support the learning-teaching process in many ways, they have limitations. These limitations are as follows: It is not easy to develop a concept map for all students, students who are introduced to concept maps for the first time cannot create a concept map at the desired level the first time, and it is difficult for educators to follow the behavior changes in students in cases where class sizes are large [67]. In addition, the study was conducted in a single faculty, the same questions (n = 20) were used in the pretest and posttest 72 h apart, and other factors contributing (or degree of contribution) to the cognitive load could not be excluded.

Conclusions

There is insufficient evidence to prove which method for teaching human anatomy to future healthcare professionals is most effective in terms of the time required for such learning as well as the permanency of this learning [68]. The research presented here supports the conclusions that concept maps are beneficial in terms of both reducing cognitive load and increasing academic achievement. This technique should thus be considered an additional and beneficial teaching strategy in medical school anatomy courses. Future research that critically evaluates other innovative teaching strategies in anatomy courses is essential to promote efficient and long-lasting retention of this medically important topic.

Declarations

Conflict of Interest

The authors declare no competing interests.

Footnotes

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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