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Year : 2017  |  Volume : 60  |  Issue : 2  |  Page : 226-231
Concept map as an adjunct tool to teach pathology

Department of Pathology, School of Medicine, St. George's University, Grenada, West Indies

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Date of Web Publication19-Jun-2017


Context: Concept maps (CMs) were tested for their effectiveness in teaching pathology in a conceptual manner. Aims: To correlate the quality of CMs drawn by students with their performance on tests involving clinical problem-solving. Subjects and Methods: Students were taught “how, why, and so what” about CMs at the start of the course. Each student drew one CM every week and a minimum of ten throughout the course and submitted them for evaluation and corrections. The course which is offered twice a year (approximately 600 students in each class) generates approximately 12,000–13,000 CMs each year. Two thousand nine hundred CMs from 290 students in one class were included in the study. Each CM was scored by three authors independently. The students' scores on the CMs were correlated with their scores on the midterm and final examinations. Statistical Analysis Used: Wilcoxon signed-rank test and Spearman's rank-order correlation. Results: The mean scores for the CMs at the course's midterm and final were 59% and 69.7%, and the mean scores for the examinations were 76% and 84.2% on the midterm and finals, respectively. There was a highly significant correlation between the CM scores and examination scores (P < 0.0001). Conclusion: CMs proved to be a great tool to teach pathology effectively.

Keywords: Active learning, clinical applications, concept map, conceptual learning, curricular integration, curriculum development, independent learning, learning styles, medical education, pathology education, problem-solving, rote memory, student advising, surface learning

How to cite this article:
Bhusnurmath SR, Bhusnurmath B, Goyal S, Hafeez S, Abugroun A, Okpe J. Concept map as an adjunct tool to teach pathology. Indian J Pathol Microbiol 2017;60:226-31

How to cite this URL:
Bhusnurmath SR, Bhusnurmath B, Goyal S, Hafeez S, Abugroun A, Okpe J. Concept map as an adjunct tool to teach pathology. Indian J Pathol Microbiol [serial online] 2017 [cited 2023 Feb 2];60:226-31. Available from:

   Introduction Top

Concept mapping is a technique for visualizing the relationships among different concepts and facts. It was developed by Novak et al.[1] and his team at Cornell University in the 1970s.

According to Novak and Gowin, concept maps (CMs) are defined as a graphic tool that organizes and illustrates the student's understanding of the relationships between different concepts in a particular subject.

Based on the “visual argument” theory, the human mind has a better capacity to quickly analyze patterns and images as seen on CMs than to interpret an essay word-based structure.[2],[3],[4]

CMs provide a platform for integration and implication of facts as compared to linear learning strategies where students prefer specifics and fact memorization. They encourage active learning, independent learning, and conceptual learning [Figure 1] and [Figure 2].
Figure 1: Linear learners: The relationship between learned concepts and facts in linear learners. Linear learners memorize facts in a unidirectional way starting from the beginning on the left side. They keep adding more facts as they continue to memorize. They can only respond to a question on this information if tested as a memorized set of facts. They may not be able to apply it as a concept with variable inputs to analyze and solve problems

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Figure 2: Integrative learners: The relationship between learned concepts and facts in integrative learners. Integrative learners are able to put the facts in a conceptual manner to understand the whole relationship. They can analyze and interpret the variable inputs as depicted by arrows with their implied associations and thus identify and solve problems

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The arrangement of facts and ideas in a conceptual framework allows for easy recall and application.[5]

In addition, the use of CMs facilitates comprehension [6] by linking newly learned concepts to what was previously known and helps in developing meaningful and active learning.[7],[8] The learner will be able to focus on the big picture of the subject rather than being distorted with details.[9]

CMs have been widely used in various academic settings. They have been utilized as an efficient tool to assess learning, identify misconceptions, show gaps in knowledge, and promote effective learning.[10] They can also be used as tools in maintaining communication among students and with teachers providing a good basis for feedback to the students.[11] The use of CMs has emerged as an effective tool to facilitate learning of medical subjects in an integrated and highly organized manner.[12] CMs might be promising if applied to the learning of pathology which bridges between basic sciences and clinical medicine. Pathology cannot be learned by rote memorization of a set of data or a sequence of events. All the correlations and permutations cannot be given in lecture handouts or textbooks. In this regard, the use of CMs is important in directing the student to moving from linear learning patterns to more integrated ones. It helps in the development of critical thinking abilities.[13]

Tracking the different CMs submitted by students over time, the teachers would be able to provide effective feedback and evaluate the degree of evolution of the students' thinking over a period of time.[14]

The use of CMs in course work has been supported by many researchers who demonstrated the effectiveness of student-generated concept mapping for improving mastery of the course material. Students who submitted CMs were found to achieve better examination scores [15],[16] and to perform better in problem-solving skills.[17]

Despite the growing body of literature that supports the use of CMs in promoting meaningful learning and integrative thinking among undergraduate students, very few studies have been conducted to evaluate the effectiveness of CMs in the field of medical education.[18] Nursing, veterinary, pharmacology, and biomedical sciences all have some documentation on concept mapping.[19] The purpose of this study is to assess the correlation between student's performance in CMs and their final score on pathology examinations in a medical school with a large class size.

   Subjects and Methods Top

The pathology course is offered twice a year (approximately 600 students in each class) and hence generated approximately 12,000–13,000 CMs each year. Over the past 11 years, we have collected over 100,000 such maps and analyzed them for formative feedback to the students.

The data used for the present study were selected from the pool of CMs collected from one class. All students who attended the course and regularly submitted all their CMs were included in the study. Accordingly, a sample of 259 students was selected. For each selected student, all the CMs from general pathology (submitted during the beginning weeks of the course) as well as all the CMs from systemic pathology (submitted toward the end of the course) were selected.

The students were instructed on how to draw CMs at the beginning of the pathology course at a special 2 h laboratory session. During the same session, students were actively enrolled in a group exercise that allowed them to collaborate in drawing a single CM using a randomly selected topic from general pathology.

Each student was subsequently required to draw and submit one CM per week on any topic taught previously within the course. Each student was required to submit a minimum of ten CMs throughout the course. Thus, a total of 2590 CMs were included in the study. These CMs were evaluated by trained faculty who provided feedback on the quality of the CM to the respective student.

The students were encouraged to first select an important topic from the course material taught in the preceding week, then identify and list the key points relevant to that topic. The main concepts were first written inside a box or circle. In addition, a list of key points was similarly written and organized in a hierarchical manner around the main concepts and according to their relevance in a two-dimensional diagram. Different concepts were then connected with lines, arrows with linking phrases that showed the relationship between concepts [Figure 3].[20],[21]
Figure 3: Concept map on topic anemia: An example of a high-scoring concept map that shows well-structured layout and nonlinear organization with multiple interconnections between concepts. The various pieces of information have been laid out in boxes, and the arrows depict the associations and correlations. This map reflects a deeper understanding of the learner of all the important facts related to anemia and their relationship with one another. Such depictions help in demonstrating their understanding and also assist in a quick revision of all related issues by just looking at the map, thus assisting in analysis and problem-solving

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Each CM in the study was evaluated by at least three authors independently, and the scores entered into a grading system [Table 1].
Table 1: Rubric for the evaluation of concept maps (points)

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The grading system utilized is a 20-point scoring system which evaluates CMs according to (1) organization, (2) interconnectivity, (3) clarity and comprehension, (4) accuracy of information, and (5) layout. The maximum weightage was given to the interconnectivity and linkage of concepts. In 23 maps, there were differences in points between the three evaluations. They were reviewed together by the three evaluators to conclude a common score.

The results were analyzed and correlated with student performance on the general pathology examination as well as the total scores on the final pathology examination. The general pathology and final examinations each consisted of 150 clinical vignette-based problem-solving multiple choice questions (MCQs) with pathology as the basis. The general pathology examination was administered as a midterm examination after that segment of teaching was completed in the initial weeks of the course. The final examination was comprehensive including topics taught in the first half of the course.

   Results Top

The mean score for the CMs at midterm was 59% and the mean score for the general pathology examination was 76% (at alpha = 0.05, P≤ 0.0001 using Wilcoxon signed-rank test). The mean score for CMs at the final was 69.7% and the mean score on the final examination was 84.2% (at alpha = 0.05, P≤ 0.0001 using Wilcoxon signed-rank test).

The data were further analyzed for nonparametric correlation coefficient using Spearman's rank-order correlation (referred to as Spearman's rho using SPSS software version 17.0) IBM, NY, USA.

General pathology CM grades correlated with general pathology examination grades: Spearman's rho = 0.433 (at alpha = 0.01, P= 0.0001, n = 259) [Figure 4].
Figure 4: Correlation between the score of concept maps on general pathology (X axis) and the corresponding student grade on midterm pathology examination (Y axis). Correlation between scores on concept maps on general pathology on the X axis and corresponding student grade in the midterm examination on the Y axis. There is an excellent correlation as depicted by the cross line ascending from the left to the right. Students who drew high scoring concept maps scored high in the examination and vice versa

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Systemic pathology (final) CM grades correlated with final examination grades.

Spearman's rho = 0.621 (at alpha = 0.01, P= 0.0001, n = 259).

The correlation is significant [Figure 5].
Figure 5: Correlation between the score of concept maps on systemic pathology (X axis) and the corresponding student grade on the final pathology examination (Y axis). Correlation between the scores on concept maps on systemic pathology on the X axis and the corresponding student grade on the final pathology examination on the Y axis. There is an excellent correlation as depicted by the cross line ascending from the left to the right. The quality of concept maps correlated very well with the scores of the students in the final comprehensive examination

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   Discussion Top

There had been a general observation in the years before 2002 that most of the students felt that their examination scores in pathology did not reflect their efforts. Some students with “A” grades in prior courses were getting “C” or “F” grades in the pathology course. Approximately, 4–6 students were seeking appointments each day for advice on their study habits. It was noticed that a considerable proportion of students were relying on pure memorization of facts as it had helped them succeed in the courses before pathology. This study habit was not helpful in learning pathology.

The use of CMs was introduced in the course to help students learn in a meaningful manner, to improve critical thinking, problem-solving skills, and at the same time get them to attain high scores on their examinations.[22],[23]

The use of CMs is known to fit well for students with different academic backgrounds and learning styles. It has been documented that the increase in student performance correlates with the number of CMs submitted as well as the quality of the CMs.[15]

Coffey et al.,[7] Novak and Cañas [10],[20] have provided a detailed description of the utilization of CMs in developing critical thinking and a better understanding of the subject. However, the role of CMs in learning pathology has not yet been assessed. Our study documents a direct correlation between student performance in CMs and their score on the midterm as well as the final pathology examinations. It was possible to observe the progression in concept mapping skills throughout the course of our study.

Novak [10],[20] had stated that students might feel reluctant and insecure in changing their traditional reading habits into meaningful learning methods. Their resistance is particularly seen at the initial stages of implementing the use of CMs into the medical school curriculum.[24] The students would consider concept mapping as a time-consuming activity,[25] and they find it difficult to perceive its value in achieving meaningful learning that can lead to better performance on standard examinations.[26] All these limitations were considered while introducing the use of CMs in our pathology course. The students did not take it seriously until the general pathology examination and were drawing CMs merely to earn a point. However, their performance on the general pathology examination which consists of clinical vignette-based MCQs made them realize the importance of developing concepts instead of only memorizing facts. Most of them started putting more thought into drawing a good CM after that. The results of our study showed a significant correlation between the quality of CMs and the scores on the examinations. They also showed a significant improvement in the quality of CMs and examination scores as the course progressed. Although it does not statistically establish a cause and effect relationship between CMs and examination scores, it does show that encouraging students to practice concept mapping helps them perform better on examinations. The number of students seeking individual guidance on study techniques significantly decreased after the CMs became a standard part of the course. The number of “F” grades in the course dropped from about 10%–12% to 3%–5%.

CMs have been proven to be an effective and powerful tool in learning that replaces the traditional use of long essays as assignments. There are many advantages for using the CMs. The students would find it easy to pen down keywords and link them together. This would consume less time in summarizing the topic and would allow the students to focus on learning the core concepts. It would be easier for instructors to evaluate CMs, as there is less cognitive effort needed to review a single page with key points and associations than to read a lengthy text. Such evaluation of submitted CMs should be based on appropriate design that covers optimum structure and sensible clear relations among the various concepts.

CMs can also be incorporated in group tasks to foster collaborative learning. For example, when a group of students shares in constructing a single CM, the exchange of information among group members carrying different knowledge backgrounds helps them to improve their learning.[11],[27],[28]

Previous research has shown the importance of immediate feedback in assessing the value of using the CMs.[29] It was noted that the use of CMs requires continuous evaluation by instructors as the lack of effective and immediate feedback would effectively limit the benefit of using CMs.[30] Providing such feedback by instructors has been shown to be a challenging task that creates an extra load to teachers evaluating the CMs.[29]

Our department has a large cadre of clinical tutors who are trained in a 2-year teaching fellowship program. The tutors are trained to evaluate the CMs and provide constructive feedback to individual students. Groups of seven students are under direct supervision of a clinical tutor, who is responsible for the evaluation of every student, as well as, providing them with guidance and critical feedback on a daily basis in the teaching laboratories. The feedback also included the CM developed by each student every week.

Each CM reflects a concrete and precise understanding of the words and relations. Each map is unique for each student and the level of learning. On a subjective level, many students have anecdotally informed us, during their subsequent courses and after the USMLE Step 1 examinations that CMs have become the default method for their daily study irrespective of the topic and course and that this method of study helped them perform very well on the examinations.

Our study indicates that graphical display of information helps the students understand the core concepts and learn the material better. This is in contrast to the study of Guri-Rozenblit [31] who assumed that students would face some challenges related to the use of graphic displays.

Thus, the CMs have proved to be useful not only for the development of critical thinking but also in improving the learning of integrated subjects in a clinical context and in boosting the performance on the examinations in the pathology course.


We are grateful to Dr. Andre Havenga, Director, Office of Institutional Research and Data Analysis. St. George's University, Grenada, West Indies, for assisting with the statistical analysis, and Dr. Vajinder Singh, Clinical Instructor, Department of Pathology, for assisting in the preparation of the manuscript.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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Correspondence Address:
Shivayogi R Bhusnurmath
Department of Pathology, School of Medicine, St. George's University, P.O. Box 7, St. George's, Grenada
West Indies
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0377-4929.208410

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  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]

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