For 20 years there has been a push to integrate the basic and clinical sciences in medical school curricula. Recently, studies have suggested that cognitive integration by the student is best achieved when the relationships between basic science and clinical domains are explicitly demonstrated. Concept mapping in response to a prompt, which asks students to create relationships among clinical and basic science concepts, should provide explicit connections that lead to a deeper conceptual understanding of the material. We designed a study to test the hypothesis that concept mapping improves the ability of students to diagnostically discriminate between multiple endocrinopathies when compared to students who were provided with similar resources. We also looked to see if knowledge retention was correlated with concept mapping or the type of notes taken during studying.https://dune.une.edu/cetl_minigrant_posters/1001/thumbnail.jp

Kilgallen, Sean M.

Rowe, Rebecca J.

Spicer, Douglas B.

Thompson, Kathryn H.

English

University of New England

Printing:Customizing	the	Content:Concept	Mapping	as	a	Tool	to	Promote	Cognitive	IntegrationIntroductionMethodsResourcesConclusionsDouglas	Spicer,	Sean	Kilgallen,	Rebecca	Rowe,	and	Kathryn	Thompson	University	of	New	England	College	of	Osteopathic	Medicine,	Biddeford,	ME	04005,	USA	Do	students	who	take	integrated	notes	retain	knowledge	better?Questions Addressed• Do	students	who	use	concept	mapping	retain	knowledge	better?• Does	the	type	of	resource	affect	the	type	of	notes	taken	by	the	students?• Do	students	who	take	integrated	notes	retain	knowledge	better?Does	the	type	of	resource	affect	the	type	of	notes	taken	by	the	students?Our	study	suggests	that	the	type	of	resources	can	influence	the	type	of	note-taking	done	by	students,	and	that	the	process	of	taking	integrated	notes	can	enhance	learning	and	retention.	This	was	a	pilot	study	and	is	limited	by	its	small	sample	size.	Additional	research	is	planned	to	confirm	and	expand	on	these	results.	We	are	unable	to	draw	any	conclusions	regarding	the	effects	of	concept	mapping	on	learning	due	to	the	study	design.	It	was	clear	that	the	students	could	not	finish	the	concept	mapping	task	within	the	time	period,	which	significantly	affected	their	performance	on	all	of	the	tests.	The	study	was	based	on	an	experimental	design	developed	by	Kulasegaram et	al.,	(2015)	and	was	approved	by	the	UNE	IRB.	Participants	in	the	study	were	recruited	from	the	first-year	medical	student	class.	The	students	who	volunteered	were	divided	into	5	groups	based	on	their	grade	in	the	fall	Osteopathic	Medical	Knowledge	(OMK)	course	and	were	randomly	assigned	from	each	group	to	one	of	the	three	experimental	groups.	The	average	OMK	grade	between	the	three	groups	was	not	significantly	different.	Students	in	each	of	three	experimental	groups	were	given	a	written	resource	about	related	clinical	disorders	associated	with	the	hypothalamic-pituitary-adrenal	axis,	where	the	resource	either	had	a	basic	science	section	followed	by	a	clinical	description	of	the	disorders	(BC	group),	or	the	same	information	that	was	rewritten	so	that	the	causal	links	between	the	basic	science	and	clinical	features	of	each	of	the	disorders	was	explained	(INT	group)	(Figure	1).	A	third	group	(BC-cMAP)	was	given	the	BC	resource	and	was	given	a	prompt	to	create	a	concept	map	to	show	the	basic	science	mechanisms	underlying	the	clinical	presentations	of	the	endocrinopathies.	Students	were	given	an	hour	to	study	the	material	or	create	the	concept	map.	Students	were	given	a	white	board	on	which	to	create	the	concept	map.		They	were	allowed	to	 write	directly	on	the	resources	or	take	notes	on	a	blank	piece	of	paper	which	was	supplied.		All	resources	and	notes	were	collected	prior	to	the	testing	session	and	pictures	of	the	concept	maps	were	taken.	Factual	comprehension	and	the	ability	to	diagnostically	discriminate	between	disorders	was	tested	following	the	study	session	with	a	simple	memory	test	of	facts	about	the	disorders,	Memory	Test	1,	and	a	test	that	used	clinical	vignettes	to	test	clinical	reasoning	skills,	Diagnostic	Test	1.	A	week	later,	students	were	tested	for	their	retention	of	the	material.	Because	the	questions	on	the	second	set	of	tests	were	only	slight	modifications	of	the	questions	from	the	Memory	Test	1	and	Diagnostic	Test	1	and	assessed	the	same	concepts,	the	retention	rates	could	be	calculated	as	the	percent	of	the	questions	that	were	correctly	answered	on	the	first	tests,	which	were	also	answered	correctly	on	the	second	tests.	Following	the	second	testing	session	students	were	surveyed	regarding	their	impressions	of	the	study	materials	given,	including	if	they	thought	concept	mapping	helped	them	learn	the	material.Student	notes	taken	during	the	study	period	were	collected	and	reviewed	by	three	of	the	investigators.		These	reviewers	used	a	rating	scale	of	0-3	to	describe	and	enumerate	the	type	and	quantity	of	notes	each	student	took	based	on	the	categories	listed	in	Table	1.	The	averages	of	these	ratings	are	listed	in	Table	1. For	the	integration	category,	a	rubric	was	used	to	quantify	the	amount	of	integration	between	basic	and	clinical	concepts.	Do	students	who	use	concept	mapping	retain	knowledge	better?	For	20	years	there	has	been	a	push	to	integrate	the	basic	and	clinical	sciences	in	medical	school	curricula.		Recently,	studies	have	suggested	that	cognitive	integration	by	the	student	is	best	achieved	when	the	relationships	between	basic	science	and	clinical	domains	are	explicitly	demonstrated. Concept	mapping	in	response	to	a	prompt,	which	asks	students	to	create	relationships	among	clinical	and	basic	science	concepts,	should	provide	explicit	connections	that	lead	to	a	deeper	conceptual	understanding	of	the	material.		We	designed	a	study	to	test	the	hypothesis	that	concept	mapping	improves	the	ability	of	students	to	diagnostically	discriminate	between	multiple	endocrinopathieswhen	compared	to	students	who	were	provided	with	similar	resources.	We	also	looked	to	see	if	knowledge	retention	was	correlated	with	concept	mapping	or	the	type	of	notes	taken	during	studying.	Figure	1.	(Green =	clinical	concepts;	blue=	basic	science	concepts)Integrated	Basic	Science	and	Clinical	(INT)ExcerptCushing	syndrome	(CS)	is	a	disorder	of	chronic	hypercortisolism	(excessive	glucocorticoids)	and	is	characterized	by	a	constellation	of	patient	complaints	including	weight	gain	(particularly,	in	the	face,	upper	back	and	torso),	fatigue,	easy	bruising	and	physical	exam	findings	of	moon	facies,	central	obesity,	buffalo	hump,	violaceous	striae,	hyperglycemia,	hypertension,	edema	and	proximal	muscle	weakness.	Cortisol	is	the	primary	glucocorticoid	and	its	effects	are	felt	over	virtually	the	entire	body	and	impact	several	homeostatic	mechanisms	promoting	anti-stress	and	anti-inflammatory	pathways.	Expressed	at	the	highest	levels	in	the	early	morning,	cortisol	promotes	higher blood	sugar	levels	by	inhibiting peripheral	glucose	uptake	and	stimulating gluconeogenesis.	Cortisol	stimulates proteolysis,	providing	substrates	for	gluconeogenesis,	but	prolonged	elevation	can	lead	to	peripheral	muscle	wasting	and	weakness.	It	also	has	weak	mineralocorticoid	properties	inducing sodium	retention	and potassium	excretion	in	the	kidney.	Cortisol also	enhances	the	vasoconstrictive effects	of	catecholamines.	This	combined	with	its	weak	mineralocorticoid properties	inducing	sodium	retention,	and	thus	water	retention,	can	chronically	promote	hypertension	and weight	gain.The	common	etiologies	that	result	in	a	state	of	hypercortisolism	include	the	use	of	excessive	exogenous	glucocorticoids,	tumors	that	secrete	ACTH,	such	as	pituitary	corticotrophs adenomas	and	ectopic	ACTH-secreting	tumors	(i.e.	small	cell	lung	cancer),	and	cortisol-secreting	tumors,	such	as	adrenocortical	adenomas.	Cortisol	secretion	from	the	adrenal	cortex	is	regulated	by	the	hypothalamic–pituitary–adrenal	axis	(HPA	axis).Separate	Basic	Science	and	Clinical	(BC)ExcerptCortisol	is	the	primary	glucocorticoid.	Expressed	at	the	highest	levels	in	the	early	morning,	cortisol’s main	function	is	to	restore	homeostasis	following	exposure	to	stress,	including	fasting.	The	effects	of	cortisol	are	felt	over	virtually	the	entire	body	and	impact	several	homeostatic	mechanisms	promoting	anti-stress	and	anti-inflammatory	pathways.	Cortisol	promotes	higher	blood	sugar	levels	by	inhibiting peripheralglucose	uptake	and stimulating gluconeogenesis.	Cortisol stimulates proteolysis,	providing	substrates	for	gluconeogenesis,	and	increases	appetite.	It	also	has	weak	mineralocorticoid	properties	inducing	sodium	retention	and potassium	excretion	in	the	kidney and	enhances	the vasoconstrictive effects	of	catecholamines to	increase	blood	pressure.	In	general,	low	levels	of	cortisol	have	the	opposite	physiological	effects.Cushing	syndrome	(CS)	is	a	disorder	of	chronic	hypercortisolism	(excessive	glucocorticoids)	due	to	multiple	etiologies.	The	common	etiologies	that	result	in	a	state	of	hypercortisolism include	excessiveexogenous	glucocorticoids,	pituitary	corticotroph	adenomas,	ectopic	ACTH	secreting	tumors	(i.e.	small	cell	lung	cancer),	and	adrenocortical	adenomas.	Clinically,	CS is	characterized	by	a	constellation	of	patient	complaints	including	weight	gain	(particularly,	in	the	face,	upper	back	and	torso),	fatigue,	and	easy	bruising.	Physical	exam	findings	typically	include	moon	facies,	central	obesity,	buffalo	hump,	violaceous	striae,	hyperglycemia,	hypertension,	edema	and	proximal	muscle	weakness.	Hyperpigmentation may	be	a	feature	depending	on	the	etiology.Figure	2.	Test	results	on	the	Memory	tests	and	Diagnostic	tests	of	the	three	groups.	Figure	2A shows	the	average	score	on	the	Memory	Test	1	and	Diagnostic	Test	1.	Figure	2B shows	the	retention	rate	for	these	groups	on	the	second	set	of	tests.Results• There	were	no	significant	differences	between	the	groups	regarding	the	quantity	or	type	of	notes	they	took.	• In	the	analysis	of	integration,	the	notes	of	students	in	the	INT	group	tended	have	more	connections	between	the	basic	science	and	clinical	concepts	when	compared	with	students	in	the	BC	group,	however,	the	differences	were	not	significant.	• Eight	of	17	in	the	INT	group	had	integration	scores	greater	than	1.5	while	only	4	of	18	in	the	BC	group	had	scores	greater	than	1.5.	Figure	3.	Test	results	on	the	Memory	tests	and	Diagnostic	tests	of	the	12	students	with	integrated	note	scores	above	1.5	(Integrated	group)	were	compared	with	test	results	of	the	23	students	with	scores	less	than	1.5	(Non-Integrated	group).	Figure	3A shows	the	average	score	of	the	Non-Integrated	and	Integrated	groups	on	the	Memory	Test	1	and	Diagnostic	Test	1.	Figure	3Bshows	the	retention	rate	for	these	two	groups	on	the	second	set	of	tests.ReferencesKulasegaram,	K.,	Manzone,	J.	C.,	Ku,	C.,	Skye,	A.,	Wadey,	V.,	&	Woods,	N.	N.	(2015).	Cause	and	Effect:	Testing	a	Mechanism	and	Method	for	the	Cognitive	Integration	of	Basic	Science.	Academic	Medicine,	90,	S63–S69.	Patton,	M.Q.	Qualitative	Research	&	Evaluation	Methods, 3rd ed.;	Sage	Publications,	Inc.:	Thousand	Oaks,	CA,	2002;	pp	462-466.0.0010.0020.0030.0040.0050.0060.0070.0080.0090.00100.00Memory	Test Diagnostic	TestImmediate	Memory	and	Diagniostic	Test	ResultsBC INT BC-cMAP0102030405060708090100Memory	Test Diagnostic	Test%	Retention	after	on	Memory	and	Diagnostic	testsBC INT BC-cMAPRepresentative	response	to:	Did	concept	mapping	help	you	learn	the	material?	• I	don't	think	concept	mapping	helped	me	very	much	because	I	was	so	rushed.	I	think	if	I	had	more	time,	I	would	be	able	to	learn	the	material	rather	than	just	focusing	on	putting	things	on	the	board.	Results• In	this	study,	concept	mapping	did	not	help	immediate	learning	or	retention.	• 14	of	the	19	student	who	did	concept	mapping	commented	that	they	were	not	given	enough	time	to	complete	or	review	the	concept	map.• There	was	no	significant	difference	between	the	BC	and	INT	groups	on	immediate	learning,	however	the	INT	group	had	better	retention	in	the	Memory	Test	(p>0.1)	but	not	the	Diagnostic	Test.Notes Graphics IntegrationUnderline/highlight Notes in marginsOutline/bullets Tables Pathways Drawings Based on rubricBC 1.69 0.708 1.83 0.389 1.32 0.444 0.89INT 1.41 0.912 2.24 0.279 1.31 0.324 1.35Integration    Cushing syndrome à excessive Cortisol secretion à Ø Chronic Proteolysis à muscle wasting à Muscle weakness Ø Increased Sodium and Water retention à increased Blood volume à Hypertension and Edema à Weight gain Excessive Cortisol secretion à due to: Ø Exogenous glucocorticoid à find in history Ø Adrenocortical adenoma à increased Cortisol à represses secretion of ACTH  Ø Pituitary corticotroph adenoma à secretes ACTH à repressed by Dexamethasone suppression test  Ø Ectopic ACTH-secreting tumor à secretes ACTH à not repressed by Dexamethasone suppression test  Chronic adrenal insufficiency due to: Ø Autoimmune adrenalitis à decreased secretion of § Cortisol à lose repression of pituitary secretion of ACTH à increased ACTH à increased MSH à Skin hyperpigmentation  § Aldosterone à decreased Sodium and Water retention à decreased Blood volume à Hypotension and Dehydration à Weight loss  Ø Hypopituitarism à loss of Pituitary gland secretion of ACTH à loss of Corti ol   Ø Hypothalamic failure à loss of Hypothalamus secretion of CRH à loss of Pituitary gland secretion of ACTH à loss of Cortisol § CRH stimulation test à stimulates ACTH and Cortisol à in Hypothalamic failure but not in Hypopituitarism  Acute adrenal insufficiency à rapidly precipitated by an acute physiologic stressor à can occur after Bilateral adrenal hemorrhage, or as the initial presentation of an undiagnosed Autoimmune adrenalitis  Ø Decreased secretion of both Cortisol and Aldosterone à Hypotension and Dehydration 0102030405060708090100M1 D1Immediate	Memory	and	Diagnostic	Test	ResultsSimple	NotesIntegrated	Notes020406080100120M2 D2%	Retention	on	Memory	and	Diagnostic	TestsSimple	NotesIntegrated	NotesResultsThe	results	of	the	Memory	tests	showed	that	students	who	took	integrated	notes	had	higher	scores	than	those	who	took	non-integrated	notes.	This	difference	was	significant.	The	results	of	the	Diagnostic	tests	showed	a	similar	trend	although	the	difference	between	the	groups	did	not	reach	significance.	ABTable	1AB

Concept Mapping As A Tool To Promote Cognitive Integration

https://dune.une.edu/cgi/viewcontent.cgi?article=1001&amp;context=cetl_minigrant_posters

Concept Mapping As A Tool To Promote Cognitive Integration

Abstract

Similar works

Full text

Available Versions

University of New England