The amount of information that medical students are expected to master is voluminous[1]. Yet, there are limited learning strategies available to these students to master the volume of information required to succeed in medical school[2]. In recent years, the number of publications on learning strategies used in medical education that may help students learn and ultimately integrate information has increased[3–6]. Although these learning strategies may differ in efficacy and applicability, they are all based on a conceptual framework called the constructivist theory of learning, which states that meaningful learning, or learning with understanding, occurs when adult learners assimilate new information within their existing frameworks[7, 8].
Constructivist theory is rooted in the subjectivist worldview, which emphasizes the role of the learner within the context of his environment[9]. The interaction between the learner and his environment results in meaning or understanding; therefore, the two are inextricable[9]. Many learning strategies, such as case-based learning and PBL, assume the learner is committed to lifelong learning and will integrate previous knowledge with newly acquired knowledge[10, 11].
The theoretical basis of constructivism is depicted in Figure 1. In medical school, academic information is available to the medical student through reading, visualizing, or listening. Irrespective of the mechanism, information enters the mind of the student, who is actively trying to make sense of the information. Because the sensemaking of the student may be very different from that of the professor presenting the information,[12] one of the assumptions underlying constructivist theory is that the student will integrate the information into a personal framework so that it will be retained,[8] which results in meaningful learning.
Critical thinking
Meaningful learning is necessary for critical thinking. The operational definition of critical thinking is a metacognitive, nonlinear process of purposeful judgment that includes self-directed learning and self-assessment[13, 14]. How critical thinking should be taught and how it is learned are unclear,[15, 16] especially at the medical school level. Willingham[15] stated that critical thinking occurs when a student penetrates beyond the surface structure of a problem and recognizes how the problem can be solved, and in addition, possesses the content knowledge integral to solving the problem. Without both components, a student may be able to critically analyze one problem, but will falter when given a similar problem in a different context[15]. Graduating physicians should be able to critically evaluate novel cases that they encounter in the clinic using their previous, albeit limited, clinical experiences[17].
Concept mapping in medical education
In graduate medical education, West et al[17] used the concept map learning strategy developed by Joseph Novak[18] in resident physicians, and studied the validity and reliability of concept mapping assessment (CMA). They found that concept maps could be scored reliably and CMA could measure changes in the conceptual framework of physicians[17].
Mind mapping in medical education
Mind mapping was developed by Tony Buzan[19] and the inspiration for this strategy arose from the notebooks of Leonardo da Vinci[20]. Mind maps, like da Vinci's notes, are multi-sensory tools that use visuospatial orientation to integrate information, and consequently, help students organize and retain information[21, 22].
Mind maps can be used as a teaching tool to promote critical thinking in medical education by encouraging students (adult learners) to integrate information between disciplines and understand relationships between the basic and clinical sciences[21]. The ability to integrate information by finding valid relationships between concepts allows students who construct either mind maps or concept maps to reach a metacognitive level[15]. However, the added dimensions of pictures and colors that are unique to mind maps have not only been shown to facilitate memory,[23] but may appeal to a wide range of students withvisual- and linear-oriented learning styles. Consequently, the advantage of using mind maps in medical education is that this strategy may benefit more students with diverse learning styles.
Both mind maps and concept maps allow students to recognize the intra- and inter-relationships between concepts, which reflects the kind of real-world thinking predominant in the clinical setting[24].
Farrand et al[25] were the first group to investigate the potential role of mind mapping in medical education. These researchers explored whether the mind map learning technique was superior to traditional note taking in both short- and long-term factual recall of written information in medical students. They found that the mind map technique significantly improved long-term memory of factual information. Additionally, they found significant differences in self-reported motivation with the mind map group having lower levels of motivation than the self-selected study group. Although not supported by other literature, this finding may be explained by the fact that students were not given adequate time to adjust to using the mind map technique, and therefore, may have felt less comfortable using it. Although the results of the study were promising, the authors did not address critical thinking. Consequently, studies exploring the relationship between mind mapping and critical thinking are needed before the usefulness of mind mapping can be fully supported in medical education.
Wickramasinghe et al[26] were the second group to investigatethe effectiveness of mind maps in medical education. Using a similar study design as that used by Farrand et al,[25] these authors assigned new entry medical students into 2 groups: mind map and self-selected study groups. The authors also developed a method to score the mind maps based on structure and content; however, they did not describe the method nor did they provide any data to support it[26]. The authors reported that there was no significant difference in scores between groups[26]. They did, however, report that all of the subjects in the mind map group perceived that mind maps are useful for memorizing information. Based on their findings, the authors concluded that mind mapping may not be effective in improving retention of short-term information[26].
Mind maps and concept maps
Although concept maps and mind maps have similar characteristics, they are fundamentally different in design. Concept maps are devoid of color and pictures, and are constructed in a top-to-bottom hierarchy. Mind maps, in contrast, use a central theme in the middle of a page with categories and subcategories that radiate peripherally, thus making them truly non-linear. The cross-links among categories highlight their intrinsic relationships, and allow the student to compare and contrast information. Unlike concept maps, mind maps are multisensory--they include color and pictures, which facilitate the conversion of information from short- to long-term memory[23, 27]. An example of a mind map created by a medical student in this study can be found in Figure 2.
Since critical thinking is dependent upon both content (domain) knowledge and problem familiarity,[15] mind mapping may facilitate critical thinking because it fosters student retention of factual information, as well as relationships between concepts[25]. Currently, however, there are no data to support the hypothesis that mind maps facilitate critical thinking in medical students.
Purpose of the study
The primary purpose of this study was to investigate whether a relationship existed between the mind map learning strategy and critical thinking, as measured with the Health Sciences Reasoning Test (HSRT), and whether this relationship was stronger than one between the preferred learning strategy of standard note-taking (SNT) and critical thinking.
The secondary purpose of this study was to determine whether mind maps were superior to SNT in the short-term recall of factual information. Mind map depth was assessed using the previously published Mind Map Assessment Rubric[28].