medical education in review
Concept maps in medical education: an analytical
literature review
Barbara J Daley1 & Dario M Torre2
OBJECTIVES As the medical profession con-
tinues to change, so do the educational methods
by which medical students are taught. Various
authors have acknowledged the need for alter-
native teaching and learning strategies that will
enable medical students to retain vast amounts
of information, integrate critical thinking
skills and solve a range of complex clinical
problems. Previous research has indicated that
concept maps may be one such teaching and
learning strategy. This article aims to: (i) review
the current research on concept maps as a
potential pedagogical approach to medical
student learning, and (ii) discuss implications
for medical student teaching and learning, as
well as directions for future research.
METHODS The literature included in this
review was obtained by searching library data-
bases including ACADEMIC SEARCH, ERIC,
EBSCOHost, PsychINFO, PsychARTICLES,
PubMed MEDLINE, CINAHL and EMBASE.
This literature review is a summary of both
conceptual and empirically published literature
Medical Education 2010: 44: 440448
doi:10.1111/j.1365-2923.2010.03628.x
1
Department of Administrative Leadership, School of Education,
University of Wisconsin Milwaukee, Milwaukee, Wisconsin, USA
2
Department of Medicine, University of Pittsburgh, Pittsburgh,
Pennsylvania, USA
440 Blackwell Publishing Ltd 2010. MEDICAL EDUCATION 2010; 44: 440448
on the uses of concept mapping in medical
education.
RESULTS The 35 studies reviewed here indi-
cate that concept maps function in four main
ways: (i) by promoting meaningful learning;
(ii) by providing an additional resource for
learning; (iii) by enabling instructors to provide
feedback to students, and (iv) by conducting
assessment of learning and performance.
CONCLUSIONS This review provides ideas for
medical school faculty staff on the use of con-
cept maps in teaching and learning. Strategies
such as fostering critical thinking and clinical
reasoning, incorporating concept mapping
within problem-based learning, and using con-
cept mapping in group and collaborative
learning are identified. New developments in
medical education include the use of serial
concept maps, concept maps as a methodology
to assist learners with lower cognitive compe-
tence, and the combination of group concept
maps with structured feedback.
Correspondence: Professor, Dr Barbara J Daley, Department of
Administrative Leadership, School of Education, University of
Wisconsin Milwaukee, PO Box 413, Milwaukee, Wisconsin 53201,
USA. Tel: 00 1 414 229 4311; Fax: 00 1 414 229 5300;
E-mail: bdaley@uwm.edu
 Concept maps in medical education: an analytical review

set of concept meanings embedded in a framework of

INTRODUCTION
propositions. In this view, we think and learn with
concepts by linking new concepts to what we already
According to Shulman,1 the signature pedagogies of the
know.6 In addition, concepts are stored hierarchically
professions are not eternal and unchanging. Even
and differentiated as learning grows. Learning with
though they seem remarkably stable at any one point
concept maps means that the learner is making an
in time, they are always subject to change as condi-
intentional effort to link, differentiate and relate
tions in the practice of the profession itself and in the
concepts to one another.3,7
institutions that provide professional service or care
undergo larger societal change. Thus, changes in the
Theoretical framework
practice of medical education lead to many questions.
Is medical education preparing future practitioners
Ausubel and his co-authors believe that during the
for the inevitable changes in health care delivery? Are
process of thinking and learning with concepts, an
medical students learning in ways that will facilitate
individual uses three processes: subsumption, pro-
their future clinical practice? Are there more effective
gressive differentiation and integrative reconcilia-
educational strategies that can be used in the devel-
tion.5,8 In subsumption, lower-order concepts are
opment of medical practitioners? The rapid changes
subsumed under higher-order concepts.9 In progres-
in the science of medicine and the need for future
sive differentiation, concepts are broken down into
practitioners to remain competent as the medical
finer and finer components. In this way, progressive
environment evolves mean that todays medical stu-
differentiation is similar to the process of analysis.
dents must learn in meaningful and integrated ways.
Finally, integrative reconciliation occurs when the
Meaningful learning, the ability to understand and
learner attempts to reconcile and link concepts on
relate relevant medical concepts by linking them to
the left side of the map with those on the right.10,11
prior knowledge, is of great formative value to
This is similar to the process of synthesis.
medical students. Furthermore, critical thinking,
clinical reasoning and clinical problem solving are of
Figure 1, a concept map of a concept map, depicts
significant importance in the education of future
these three processes. It shows how lower-order
doctors. Despite attempts to foster new ways of
concepts are subsumed under higher-order concepts,
learning, mainly in graduate medical education,2 the
how concepts are differentiated, and how concepts
creation of new teaching tools has been limited by
are horizontally reconciled.
difficulties in developing, delivering and assessing
such strategies in undergraduate medical curricula.
Creating concept maps
With that in mind, this article will review the current
research on concept maps as a potential pedagogical
To create a concept map, the learner engages in an
approach to medical student learning. Implications
active process that includes the following steps.
for medical student teaching and learning are
Firstly, the learner identifies the most general
outlined, along with directions for future research in
concepts and places them at the top of the map.
medical education.
Secondly, the learner identifies more specific con-
cepts that relate to the general concepts in some way.
Thirdly, the learner ties together the general and
CONCEPT MAPS: WHAT ARE THEY?
specific concepts with linking words that make sense
to him or her. Finally, the learner actively looks for
Before proceeding to the analysis of literature on
cross-linkages that tie concepts from one side of the
concept maps, it is helpful to review the definition
map to concepts on the other. Concept maps can
of concept maps, the theoretical framework support-
be created by hand with paper and pencil, or they can
ing their use, the steps needed to create them and
be created using one of many computer-based soft-
some of the challenges involved in using maps.
ware programs, for example CMAP Tools (see http://
cmap.ihmc.us/conceptmap.html).
Definitions
Challenges in using concept maps
The concept map, a graphic tool for organising and
representing knowledge, was developed by Novak and Concept maps are often considered a new way of
Gowin3 and is based on Ausubels4,5 assimilation learning by both students and faculty staff, and as
theory of learning. Novak and Gowin3 describe a such it takes time for both to understand and
concept map as a schematic device for representing a incorporate mapping as a learning strategy. Student

Blackwell Publishing Ltd 2010. MEDICAL EDUCATION 2010; 44: 440448 441
B J Daley & D M Torre

Figure 1 A concept map showing the key features of concept maps. Concept maps tend to be read from the top downward.
(Novak JD, Canas AJ. The Theory Underlying Concept Maps and How to Construct Them. Technical Report, Florida Institute for
Human and Machine Cognition 2006.12 Reprinted with permission)

resistance is sometimes seen during the initial stages

METHODS
of incorporating concept mapping into the medical
school curriculum. This resistance is usually related
In this study, we chose to investigate concept maps
to the time it takes to create maps. It may also be
over other learning strategies for two reasons. Firstly,
related to the students inability to understand how
there is a growing body of literature in this area and,
constructing maps and learning meaningfully will
secondly, the maps may be a learning strategy to assist
assist them in scoring well on standardised tests.2,3
medical students in learning clinical reasoning, crit-
ical thinking and clinical decision making. The
Another challenge in using maps involves helping
literature included in this review was obtained by
faculty understand that maps are designed to imple-
searching a variety of library databases for the years
ment the concept of meaningful learning. This
19892009. The databases included ACADEMIC
means that the faculty members focus shifts from
SEARCH, ERIC, EBSCOHost, PsychINFO, PsychAR-
teaching content to helping the student create and
TICLES, PubMed MEDLINE, CINAHL and
understand the meaning of the concepts within the
EMBASE. The key terms used in the search were
context of his or her medical practice. As students
concept mapping, meaningful learning, educa-
develop an understanding of meaning, their maps
tion, medical education, assessment and learning
will incorporate not only the content of the curric-
outcomes. The references of all retrieved articles
ulum, but also their experiences in clinical practice.
were scanned to identify additional articles. Over 350
This implies that as the students learning grows, the
articles were found in this search.
maps they create will change over time. Teaching staff
may see this as unreliability in the maps, when in
Because the purpose of this literature review was to
reality the idiosyncratic nature of the maps demon-
inform medical education, articles and studies were
strates how the students learning has grown and
included if they were perspective articles that de-
changed over time. This is analogous to the process
scribed the use of concept maps in medical or health
that takes place in the development of expertise. As
professions education curricula, courses or pro-
doctors develop their level of expertise, their under-
grammes, or if they were research articles in which the
standing of particular topics grows and deepens. If
participants were medical or health professions stu-
one asks two experts to develop maps on the same
dents. Health professions students included under-
topic, it is likely that these maps will look different
graduate and graduate nursing students,
because they reflect the cognitive structures of
undergraduate science students, dentistry students
different people, as well as the varied clinical expe-
and veterinary students. In addition, both quantitative
riences of those experts. As such, concept mapping is
and qualitative studies were included, as well as studies
a learning strategy that requires adjustment on the
in either basic or clinical sciences. Before any research
part of both students and teaching staff.

442 Blackwell Publishing Ltd 2010. MEDICAL EDUCATION 2010; 44: 440448
 Concept maps in medical education: an analytical review
article was included in this review, its study design,
sample and methodology were assessed. Reliable and
valid studies were included as these articles were
identified as providing insight into the effectiveness
and applicability of concept mapping in medical
education. Articles about the use of concept maps in
patient education and understanding patient knowl-
edge structures were excluded from this review.
Table S1 briefly describes the purpose and findings
of the 35 articles1347 selected for this review. Of the
studies and articles included here, 19 refer to the
medical profession,2,911,15,16,19,21,30,32,33,35,37,3941,43,46
two of which relate to basic sciences,27,38 13 refer to
the nursing profession,13,14,17,2226,28,29,31,42,44 two to
the veterinary profession,18,20 and one to the dental
profession.34 To analyse these articles, researchers
reviewed each manuscript to identify the themes
discussed and the findings presented. Following this
review, researchers were able to reduce the initial
themes to four categories in which concept maps
were used in medical education.
RESULTS
The studies reviewed here indicate that concept maps
function in four main ways within medical education:
1 by promoting meaningful learning;
2 by providing an additional resource for learning;
3 by enabling instructors to provide feedback to
students, and
4 by conducting assessment of learning and per-
formance.
Each of these functions is explained in further detail.
Promoting meaningful learning
Concept maps have been successfully used in educa-
tion for over 25 years45 and a growing body of
literature indicates that their use in medical education
is increasing. The vast majority of articles in this review
indicate that concept maps foster the development of
meaningful learning, critical thinking and problem
solving in the learner.13,1720,22,24,26,37,40,42,46 As indi-
cated in these studies, meaningful learning occurs
when the student links new knowledge with previous
knowledge, thereby creating more integrated cogni-
tive knowledge structures. The studies indicate that
through the use of concept maps, students were able
to integrate basic and clinical science information,
move from linear thinking patterns to more inte-
grated holistic patterns, and demonstrate critical
Blackwell Publishing Ltd 2010. MEDICAL EDUCATION 2010; 44: 440448
thinking abilities within their disciplines. Ertmer and
Nour20 indicate that this type of meaningful learning
was also achieved using concept maps online. As
indicated in Table S1, these studies have established
the effectiveness of concept mapping in promoting
learning and yet the vast majority of them are limited
by, for instance, their use of small samples of conve-
nience, descriptions of single educational pro-
grammes and their limited generalisability.
Despite these limitations a number of interesting
findings are apparent in this review. Firstly, concept
maps are being integrated into the delivery of
problem-based learning (PBL) approaches in medi-
cal and health professions education. Hsu25 reports
the successful use of concept maps within the
discussion component of PBL. Her results indicate
that the experimental group had significantly higher
proposition and hierarchy scores for their concept
maps compared with the control group.25 Rendas
et al.37 describe similar findings and report that their
results appear to indicate the use of concept maps
stimulated meaningful learning within a PBL course.
They go on to state: PBL and concept mapping
proved to be complementary tools because the
method of information gathering, hypothesis gener-
ation, and identification of learning issues allowed for
the exposure of a broad range of knowledge needs
that were visualised in the concept maps.37
Secondly, concept maps are being used in medical
and health professions education to foster the devel-
opment of group and collaborative learning. For
example, Kinchin and Hay27 performed a qualitative
study that identified three major patterns or struc-
tures when analysing students concept maps. These
patterns or structures (spoke, chain and net) were
identified as indicators of different developmental
understanding. Kinchin and Hay28 went on to
expand this work and study concept mapping in
collaborative learning. They placed students in
groups of three and asked them to produce a
consensus concept map on the topic of pathogenic
microbes. Findings indicated that students who were
in triads of individuals with very different knowledge
structures showed greater improvements in their
learning than students who were in groups with more
similar knowledge structures. These findings are
similar to those of Boxtel et al.,11 who found signif-
icant learning gains when concept mapping was used
as a group task.
Thirdly, recent research has examined if and how
students with specific learning styles benefit from the
use of concept maps. Studies by both Kostovich
443
B J Daley & D M Torre
et al.29 and Laight30 indicate that learning style
does not play a role in ability to perform well on
concept maps. These researchers indicate that
concept maps can function well across groups of
learners with multiple and varied learning styles.
Finally, two studies have raised interesting and new
issues within the field of medical education that will
need additional research and exploration. In one of
the studies, All and Huycke14 used serial concept
maps in graduate education to demonstrate the
evolution of a students thinking over time. All and
Huycke14 define a serial concept map as a series of
evolving maps created about a single concept over a
specified time period. Serial concept maps have
provided a way to intermittently monitor student
progress, to clarify faulty conceptual relationships,
and to foster the connections between theoretical
information and clinical practice. In addition, new
work by Gonzalez et al.21 provides interesting infor-
mation on the use of concept maps in medical
education. These authors divided their students into
two groups: a control group, which attended a
traditional course in physiology, and an intervention
group, which constructed concept maps related to
cardiovascular physiology and used them to solve
problems related to this subject.21 Both groups of
students were tested using two types of examination: a
problem-solving examination and a multiple-choice
examination. Findings indicate that the group using
concept maps performed significantly better on the
problem-solving examination. Their performance on
the multiple-choice examination was similar to that of
the traditional group. These findings by Gonzalez
et al.21 seem to uphold those of Roberts,38 who found
no significant change in concept map scores over
time but did find significant correlations between
map scores and practical assignment scores. They also
appear to corroborate those of West et al.,2 who
indicate that assessments with concept maps may be
measuring different cognitive domains from assess-
ments with more standard tests. Even more interest-
ing in the Gonzalez et al.21 study is the finding that
using concept maps in problem solving had the most
impact on students who came into the study with the
lowest cognitive competence. This finding will need
additional research, but it is important nonetheless as
it may indicate that concept mapping represents a
method by which teaching staff can assist medical
students who are struggling to learn and perform.
Providing a resource for learning
The literature in this review reports that concept
maps function as a resource for student learning
444 Blackwell Publishing Ltd 2010. MEDICAL EDUCATION 2010; 44: 440448
within a curriculum and as a resource for knowledge
elicitation and curriculum development. However,
there is still a great need for additional research as
the vast majority of articles in this area tend to be
descriptive in nature.
As a resource for learning, concept maps allow
students to demonstrate their mastery of the concepts
associated with a particular body of knowledge.
Concept mapping is a creative activity that fosters
reflection on ones own understanding.6 According to
Pinto and Zeitz,9 concept maps can facilitate students
understanding of the organisation and integration of
important concepts. Torre et al.40 note that students
reported: the concept maps allowed for creativity
by developing a system of thinking that included
pattern recognition, the ability to think broadly on
topics, and finally, allowed for knowledge integration.
Laight30 designed a study to explore students
attitudes towards concept maps as an additional
learning resource. Pre-prepared concept maps were
integrated into traditional instructional methods.
Questionnaires asked whether the concept maps were
useful and allowed for other comments. A significant
majority of students reported that pre-prepared
concept maps were useful to their learning. Students
reported being motivated to think more deeply and
noted that they gained in understanding of concep-
tual inter-relationships. Therefore, according to
Laight30, pre-prepared concept maps may offer
alternative and innovative learning and teaching
opportunities and methods in large classes.
Patrick et al.36 and Weiss and Levison41 both describe
concept maps as a resource for learning and curric-
ulum development. Patrick et al.36 explain how con-
cept maps can assist in the development of
curriculum databases in medical schools, specifically
to support the development of PBL curricula. Weiss
and Levison,41 by contrast, describe using concept
maps as a blueprint for the development of curricular
goals and objectives. Weiss and Levison also indicate
that the maps can serve to assist with the integration
of curricular themes across and among departments
and disciplines, and describe how the maps assisted in
the development of a womens health medical edu-
cation collaboration.41
One of the most innovative ways in which concept
maps function as a resource for learning is articulated
by Castro et al.15 and Willemsen et al.43 These authors
indicate that concept maps can function in the
development of knowledge models. Castro
et al.15describe how they used concept maps to begin
 Concept maps in medical education: an analytical review
building a knowledge ontology within the nutrige-
nomics community. Willemsen et al.43 observe that,
within clinical genomics research, one of the main
challenges is the acquisition and integration of data,
information, and expert knowledge for specific bio-
medical domains and diseases. They created 155
concept maps linked together in a knowledge model
that allows for the visualisation of vast amounts of
information.43 These ontologies and knowledge
models have the potential to provide highly inte-
grated and organised knowledge frameworks that can
be applied to medical student learning and clinical
performance.
Providing feedback
In relation to feedback, concept mapping can assist
students in clarifying a topic, and teachers can use
maps to provide feedback and identify student
misunderstandings.38 According to Kinchin and
Hay,27 concept maps are seen as a tool for commu-
nication between student and teacher which reveals
the students constructions of connections.
Edmondson and Smith18 performed a qualitative study
that analysed students responses to the integration of
concept maps as a teaching and learning tool. Almost
one-half of the students agreed that creating a concept
map was an effective learning device. As a teaching
method, the concept map provided the teacher with an
understanding of the students errors, thereby allow-
ing the teacher to provide feedback and clarify both
content and performance.
Morse and Jutras35 provide us with an ever-greater
understanding of the role that feedback can play in
teaching and learning with concept maps. In their
study, students in a cell biology course were divided
into three groups. The control group did not
construct concept maps; the second group con-
structed maps individually, and the third group
created maps individually and then discussed them in
teams that provided both peer and instructor feed-
back. Results from this study indicate that concept
maps without feedback had no significant effect on
student performance, whereas concept maps with
feedback produced a measurable increase in student
problem solving performance and a decrease in
failure rates.35 This finding is important because it
confirms one of the theoretical premises of concept
mapping. Novak and Gowin3 believe that a major
purpose of concept mapping is to foster the devel-
opment of shared meaning between the instructor
and the student. As instructors and students discuss,
think about and revise concept maps, their learning
Blackwell Publishing Ltd 2010. MEDICAL EDUCATION 2010; 44: 440448
and shared meaning-making processes deepen. This
study demonstrates how the discussion of concept
maps in a group, combined with feedback on the
maps provided by the instructor, fosters students
learning and performance.
Assessment of learning and performance
Concept maps have been used in a variety of studies
as an assessment tool to identify student clinical
performance, understand student thinking and rea-
soning processes, and compare student maps with
expert maps. Williams44 notes that concept maps
can be used to assess learning rather than just as an
end process of learning. However, according to
Roberts,38 because maps can vary greatly in style, a
scoring method which suits the particular type of map
must be chosen. The studies in this literature review
indicate researchers are working on methods by
which assessment activities and scores can be linked
to the development of concept maps.
Daley et al.17 used concept maps as both a learning
and an assessment strategy. Over the course of a
semester in a clinical setting, 54 students created
three concept maps depicting relationships among
the clients, pathophysiologic factors, pharmacologic
factors, and therapeutic nursing interventions. These
maps were used in post-conferences as discussion
tools to foster links between theoretical course
material and clients for which the students were
providing care.17 Results indicate a statistically
significant change between the first and last concept
map scores of the semester. Hicks-Moore and
Pastirik23 also conducted a study to assess the level of
critical thinking with concept maps. Their results
indicate that critical thinking, as measured by the
Holistic Critical Thinking Scoring Rubric, was
enhanced by developing maps in the clinical setting.23
Concept mapping was also used in a pre-test post-test
study carried out by West et al.2 Like Daley et al.,17 West
et al.2 found that concept mapping assessment (CMA)
scores improved after course instruction; however,
CMA scores did not correlate with final course or
standardised test scores. According to West et al.,2 the
absence of a positive correlation suggests that CMA
measures a different knowledge characteristic than do
multiple-choice examinations; therefore, CMA has
the potential to evaluate how students or residents
organise and use knowledge in a way that traditional
tests cannot. West et al.10 expanded on this work by
studying both a structural scoring method and a
relational scoring method. Structural scoring is based
on the maps organisation of hierarchical structure,
445
B J Daley & D M Torre
concept links and cross-links. Structural scoring assigns
points for each valid component in four categories.
Relational scoring is based on the quality or impor-
tance of each component, with no regard to the overall
structure of the map. West et al.10 found that structural
scores increased significantly, particularly with more
experienced residents, yet relational scores were not
significantly different.
McGaghie et al.32 conducted a quantitative study that
used Pathfinder scaling to evaluate concept maps for
internal consistency, studentinstructor similarity,
and correlational relationships to final examination
results. Although descriptive analysis did not show a
correlation between studentinstructor concept
map similarity scores and scores on examinations,
student scores were internally consistent and the
similarity of student maps with instructor maps
increased significantly following instruction.
McGaghie et al. also report on three additional studies
that attempted to compare concept maps developed
by faculty experts with maps prepared by medical
students. Findings indicate that after a 3-week unit in
pulmonary physiology, student and expert maps were
more similar.33 However, as a side note, McGaghie
et al. report a wide variety in the maps of experts.33
Most recently, the understanding of CMAs has moved
to the development of rubrics and multiple scoring
systems. For example, Moni and Moni34 developed an
assessment rubric for concept maps in a dentistry
programme. The rubric was based on the content,
logic and presentation of the maps. Students reported
that they viewed the rubric positively, but, more
importantly, the researchers were able to identify two
distinct patterns in the ways students used the rubric to
facilitate map construction and learning.34 DAntoni
et al.16 adapted the CMA scoring system developed by
West et al.2 and found that the depth of the map can be
assessed based on concept links, cross-links, hierar-
chies, examples, pictures and colours. Finally, Srini-
vasan et al.39 developed a study to test the reliability of
CMAs. They created four scoring systems and found
that the scoring systems that focused on the quality of
the map, on the quality and importance of concepts,
and a hybrid system had similar reliability and were
overall more reliable than the scoring system that
focused on the structure of the map alone.
IMPLICATIONS FOR MEDICAL EDUCATION AND
FUTURE RESEARCH
Based on this literature review, it appears that the
concept map has a potential role to play in medical
446 Blackwell Publishing Ltd 2010. MEDICAL EDUCATION 2010; 44: 440448
education as a teaching, learning and assessment
strategy. Despite the limitations of each individual
research article cited here, there is a growing body of
evidence on the effectiveness of mapping as a method
to promote meaningful learning, as a resource for
learning, as a methodology for providing student
feedback, and as an assessment strategy in medical
education. The research cited in this review demon-
strates that concept maps can assist in medical
student learning. The reviewers could find no studies
that indicate detrimental effects of using this strategy
in medical education. Additionally, for teaching staff
in medical schools, this review provides ideas on how
to use concept maps to foster critical thinking and
clinical reasoning in medical students, how to incor-
porate concept mapping within PBL approaches, and
how to use concept mapping in group and collabo-
rative learning. New developments in medical and
health professions education include the use of serial
concept maps, concept maps as a methodology to
assist learners with lower cognitive competence, and
enhancing the use of concept maps in group settings
by providing specific feedback to students.
Nonetheless, specific research on the validity of
mapping within the medical school curriculum
remains necessary. This review includes a preliminary
analysis of the different ways in which maps can be
used in assessments and a number of proposed scoring
formulas for concept maps, both quantitative and
qualitative. However, for maps to be used widely within
medical education, the area of assessment and scoring
needs to be developed much further. How can we
use concept maps to assess and document learning
and change in meaning and understanding for learn-
ers? Can a simplified scoring method that clearly
documents learning outcomes be developed? Further
research is also needed into how concept mapping as
an assessment tool correlates with standardised
assessments within medical education. Validity and
reliability testing of concept mapping compared with
other measures of learning is also needed.
Additionally, longitudinal studies on the use of
concept mapping in medical education are virtually
non-existent. Longitudinal research is needed to
determine if concept maps can play a role in assisting
medical students as they make the transition to
practising doctors. This type of research would need
to focus on how thinking and learning patterns
develop and change over the course of a doctors
career. It is this type of longitudinal work that may
have implications for understanding how concept
maps can assist in developing clinical reasoning
processes in doctors.
 Concept maps in medical education: an analytical review
Finally, as Nesbit and Adesope47 state: investigators
should examine the processes by which students learn
with concept maps and their effects on higher-level
learning goals such as problem-solving transfer,
application, and analysis; conceptual change and the
development of learning skills. We believe that
further research into the relationships between con-
cept mapping and clinical reasoning, medical prob-
lem solving and diagnostic errors in clinical practice
is also needed in medical education. As Novak and
Canas state: While at first glance concept maps may
appear to be just another graphic representation of
information, understanding the foundations for this
tool and its proper use will lead the user to see that
this is truly a profound and powerful tool. It may at
first look like a simple arrangement of words into a
hierarchy, but when care is used in organising the
concepts represented by the words, and the propo-
sitions or ideas are formed with well-chosen linking
words, one begins to see that a good concept map is
at once simple, but also elegantly complex with
profound meanings.12
Contributors: BJD and DMT both made substantial
contributions to the study conception and design, data
acquisition, analysis and interpretation, and the drafting
and critical revision of the article. Both authors approved
the final manuscript for publication.
Acknowledgements: none.
Funding: none.
Conflicts of interest: none.
Ethical approval: not applicable.
REFERENCES
1 Shulman L. The signature pedagogies of the profes-
sions of law, medicine, engineering, and the clergy:
potential lessons for the education of teachers.
Presented at Teacher Education for Effective Teaching and
Learning. Workshop of the National Research Council Center
for Education, Irvine, CA, 68 February 2005. http://
hub.mspnet.org/index.cfm/11172. [Accessed 29
March 2006.]
2 West DC, Pomeroy JR, Park JK, Gerstenberger EA,
Sandoval J. Critical thinking in graduate medical edu-
cation: a role for concept mapping assessment? JAMA
2000;284 (9):110510.
3 Novak JD, Gowin DB. Learning How to Learn. New York,
NY: Cambridge University Press 1984.
4 Ausubel DP. Educational Psychology: A Cognitive View.
New York, NY: Holt, Reinhart & Winston 1968.
5 Ausubel DP. The Acquisition and Retention of Knowledge: A
Cognitive View. Boston, MA: Kluwer Academic Publish-
ers 2000.
Blackwell Publishing Ltd 2010. MEDICAL EDUCATION 2010; 44: 440448
6 Canas AJ, Coffey JW, Carnot MJ, Feltovich PJ, Hoffman
RR, Feltovich J, Novak JD. A Summary of Literature
Pertaining to the Use of Concept Mapping Techniques and
Technologies for Education and Performance Support.
Technical report submitted to the Chief of Naval
Education and Training. Pensacola, FL: Institute for
Human and Machine Cognition 2003.
7 Irvine LM. Can concept mapping be used to promote
meaningful learning in nurse education? J Adv Nurs
1995;21:11759.
8 Ausubel DP, Novak JD, Hanesian H. Educational
Psychology: A Cognitive View, 2nd edn. New York, NY:
Werbel & Peck 1986.
9 Pinto AJ, Zeitz HJ. Concept mapping: a strategy for
promoting meaningful learning in medical education.
Med Teach 1997;19 (2):11422.
10 West DC, Park JK, Pomeroy JR, Sandoval J. Concept
mapping assessment in medical education: a com-
parison of two scoring systems. Med Educ
2002;36:8206.
11 Boxtel CV, Linden JV, Roelofs E, Erkens G. Collabo-
rative concept mapping: provoking and supporting
meaningful discourse. Theory Pract 2002;41 (1):406.
12 Novak JD, Canas AJ. The Theory Underlying Concept Maps
and How to Construct Them. Technical Report IHMC
CmapTools 2006-01. Pensacola, FL: Institute for
Human and Machine Cognition 2006. http://cmap.
ihmc.us/Publications/ResearchPapers/TheoryCmaps/
TheoryUnderlyingConceptMaps.htm. [Accessed 12
June 2009.]
13 Abel W, Freeze M. Evaluation of concept mapping in
an associate degree nursing programme. J Nurs Educ
2006;45 (9):35664.
14 All AC, Huycke LI. Serial concept maps: tools for
concept analysis. J Nurs Educ 2007;46 (5):21724.
15 Castro AG, Rocca-Serra P, Stevens R, Taylor C, Nashar
K, Ragan MA, Sansone SA. The use of concept maps
during knowledge elicitation in ontology development
processes the nutrigenomics use case. BMC Bioinfor-
matics 2006;7. http://www.biomedcentral.com/1471-
2105/7/267. [Accessed 23 September 2009.]
16 DAntoni A, Zipp GP, Olson V. Inter-rater reliability
of the mind map assessment rubric in a cohort of
medical students. BMC Med Educ 2009;9. http://
www.biomedcentral.com/1472-6920/9/19. [Accessed
23 September 2009.]
17 Daley BJ, Shaw CR, Balistrieri T, Glasenapp K, Piacen-
tine L. Concept maps: a strategy to teach and evaluate
critical thinking. J Nurs Educ 1999;38 (1):427.
18 Edmondson KM, Smith DF. Concept mapping to
facilitate veterinary students understanding of fluid
and electrolyte disorders. Teach Learn Med 1998;10
(1):2133.
19 Eitel F, Steiner S. Evidence-based learning. Med Teach
1999;21 (5):50613.
20 Ertmer P, Nour A. Teaching basic medical sciences at a
distance: strategies for effective teaching and learning
in Internet-based courses. J Vet Med Educ 2007;34
(3):31624.
447
B J Daley & D M Torre
21 Gonzalez HL, Palencia AP, Umana LA, Galindo L,
Villafrade MLA. Mediated learning experience and
concept maps: a pedagogical tool for achieving mean-
ingful learning in medical physiology students. Adv
Physiol Educ 2008;32 (4):3126.
22 Hicks-Moore SL. Clinical concept maps in nursing
education: an effective way to link theory and practice.
Nurse Educ Pract 2005;5:34852.
23 Hicks-Moore SL, Pastirik PJ. Evaluating critical think-
ing in clinical concept maps: a pilot study. Int J Nurs
Educ Scholarsh 2006;3 (1):115.
24 Hinck S, Webb P, Sims-Giddens S, Helton C, Hope K,
Utley R, Savinske D, Fahey E, Yarbrough S. Student
learning with concept mapping of care plans in com-
munity-based education. J Prof Nurs 2006;22 (1):2339.
25 Hsu LL. Developing concept maps from problem-based
learning scenario discussions. J Adv Nurs 2004;48
(5):5108.
26 Hsu L, Hsieh S. Concept maps as an assessment tool in
a nursing course. J Prof Nurs 2005;21 (3):1419.
27 Kinchin IM, Hay DB. How a qualitative approach to
concept map analysis can be used to aid learning by
illustrating patterns of conceptual development. Educ
Res 2000;42 (1):4357.
28 Kinchin I, Hay D. Using concept maps to optimise the
composition of collaborative student groups: a pilot
study. J Adv Nurs 2005;51 (2):1837.
29 Kostovich C, Poradzisz M, Wood K, OBrien K. Learn-
ing style preference and student aptitude for concept
maps. J Nurs Educ 2007;46 (5):22531.
30 Laight DW. Attitudes to concept maps as a teach-
ing learning activity in undergraduate health profes-
sional education: influence of preferred learning style.
Med Teach 2004;26 (3):22933.
31 MacNeil M. Concept mapping as a means of course
evaluation. J Nurs Educ 2007;46 (5):2324.
32 McGaghie WC, McCrimmon DR, Mitchell G, Thomp-
son JA, Ravitch MM. Quantitative concept mapping in
pulmonary physiology: comparison of student and
faculty knowledge structures. Adv Physiol Educ 2000;23
(1):7281.
33 McGaghie WC, McCrimmon DR, Mitchell G, Thomp-
son JA. Concept mapping in pulmonary physiology
using Pathfinder scaling. Adv Health Sci Educ Theory
Pract 2004;9:22540.
34 Moni R, Moni K. Student perceptions and use of an
assessment rubric for a group concept map in physi-
ology. Adv Physiol Educ 2008;31 (1):4754.
35 Morse D, Jutras F. Implementing concept-based learn-
ing in a large undergraduate classroom. CBE Life Sci
Educ 2008;7 (2):24353.
36 Patrick T, Worth E, Hardin L. Using concept maps
on the world-wide web to access a curriculum data-
base for problem-based learning. Proceedings of the
1996 Annual Fall Symposium of the American
Medical Informatics Association. Washington, DC:
AMIA 1996;326.
37 Rendas A, Fonseca M, Pinto P. Toward meaningful
learning in undergraduate medical education using
448 Blackwell Publishing Ltd 2010. MEDICAL EDUCATION 2010; 44: 440448
concept maps in a PBL pathophysiology course. Adv
Physiol Educ 2006;30:239.
38 Roberts L. Using concept maps to measure statistical
understanding. Int J Math Educ Sci Technol 1999;30
(5):70717.
39 Srinivasan M, McElvany M, Shay J, Shavelson R, West D.
Measuring knowledge structure: reliability of concept
mapping assessment in medical education. Acad Med
2008;83 (12):1196203.
40 Torre DM, Daley BJ, Stark-Schweitzer T, Siddartha S,
Petkova J, Ziebert M. A qualitative evaluation of medi-
cal student learning with concept maps. Med Teach
2007;29:94955.
41 Weiss LB, Levison SP. Tools for integrating womens
health into medical education: clinical cases and con-
cept mapping. Acad Med 2000;75 (11):10816.
42 Wilgis M, McConnell J. Concept mapping: an educa-
tional strategy to improve graduate nurses critical
thinking skills during a hospital orientation pro-
gramme. J Contin Educ Nurs 2008;39 (3):11926.
43 Willemsen AM, Jansen GA, Komen JC, van Hooff S,
Waterham HR, Brites PM, Wanders RJ, vanKampen
AHC. Organisation and integration of biomedical
knowledge with concept maps for key peroxisomal
pathways. Bioinformatics 2008;24 (16):217.
44 Williams M. Concept mapping a strategy for assess-
ment. Nurs Stand 2004;19 (9):338.
45 Novak JD. Concept maps and Vee diagrams: two
metacognitive tools to facilitate meaningful learning.
Instr Sci 1990;19:125.
46 Kinchin IM, Cabot LB, Hay DB. Using concept map-
ping to locate the tacit dimension of clinical expertise:
towards a theoretical framework to support critical
reflection on teaching. Learn Health Soc Care 2008;7
(2):93104.
47 Nesbit JC, Adesope OO. Learning with concept and
knowledge maps: a meta-analysis. Rev Educ Res 2006;76
(3):41348.
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