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HOW WE TEACH
1 Department of physiology, Faculty of Medicine, Bucaramanga, Santander, Colombia 2 Faculty of Education, Universidad Autónoma de Bucaramanga, Bucaramanga, Santander, Colombia
Address for reprint requests and other correspondence: H. L. González, Universidad Autónoma de Bucaramanga, Facultad de Medicina, Calle 157, 19-55 Parque Campestre, Bucaramanga, Santander, Colombia (e-mail: hgonzalez4{at}unab.edu.co)
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Abstract |
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Key words: cardiovascular physiology
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Introduction |
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Students entering medical school are more prone to memorizing facts. However, sometimes they are unable to relate this new information to existing knowledge or to transfer it to solve novel problems. It is a challenge for medical educators to search for new pedagogical models that promote in their students the development of strong cognitive processes that allow them to select, integrate, and transfer the new learning and, therefore, to reach meaningful learning (2, 12, 13).
Cognitive psychology has demonstrated that the way knowledge is structured in memory determines the ability to retain, recall, and use it to solve problems (16). Meaningful learning occurs when the learner interprets, relates, and incorporates new information with existing knowledge and applies the new information to solve novel problems. Meaningful learning, then, involves building multiple representations (mental models) of knowledge (10, 12).
In medicine, meaningful learning implies that knowledge acquired by the students makes sense in their future medical practice and allows them to solve different problems (12, 15). This is easier in the clinical setting than during basic science instruction. During the latter, students receive a great amount of information, some of which does not have direct medical application. Thus, many students in the first semester use rote memorization to acquire a large amount of information that they will forget after the exams.
In physiology, meaningful learning means that the students are able to predict and explain the responses of a physiological system if it is disturbed and sometimes to solve quantitative problems (calculate something). In other words, they are able to apply what they know about physiology to novel situations. When they can do this, it is possible to say they "understand" physiology (9, 12).
In this study, we addressed the following research question: does the concept mapping methodology, articulated with the mediated learning experience, increase meaningful learning in students attending to the cardiovascular module of a medical physiology course?
Concept mapping is a pedagogical tool initially proposed by Joseph Novak as a method to represent the relationships between relevant concepts within a given subject area. This tool not only allows organizing and presenting the knowledge but also promotes meaningful learning (1, 2, 13, 14). As Novak (14) states:
Knowledge stored in our brain consists of networks of concepts and propositions. As meaningful learning proceeds, new concept meanings are integrated into our cognitive structure to a greater or lesser extent, depending on how much effort we make to seek this integration, and on the quantity and quality of our existing, relevant cognitive structure. If we learn strictly by rote, essentially no integration of new concept meanings occurs, and existing cognitive structure is not elaborated or reconstructed.
This research also uses the theoretical foundations of Reuven Feuerstein's cognitive modifiability theory and the mediated learning experience. The mediated experience describes a special quality of interaction between a learner and a teacher, in this case, called a "mediator." The intention of the mediator is different from that of a teacher or tutor. The mediator is not concerned with solving the problem at hand. Rather, the mediator is concerned with how the learner approaches the problem. The problem at hand is only an excuse to involve the mediator with the learner's thinking process. For the process to be successful, at least four important qualities must be present in the interaction:
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METHODS |
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At the beginning of the study, an index was obtained based on the following information from each student: 1) total score on the national high school graduate exam [called the Instituto Colombiano de Fomento de la Educacion Superior (ICFES) exam], 2) cumulative average grades of the previous semesters, and 3) the grade obtained for the construction of a conceptual mentifact (defined as graphical instruments to represent thoughts and human values). This mentifact helps to define how knowledge and mental operations are organized and represented in the human mind (20).
Based on this index, students were divided into quartiles as follows: quartile 1, students classified below percentile 25; quartile 2, students classified between percentile 25 and 50; quartile 3, students classified between percentile 50 and 75; and quartile 4, students classified above percentile 75. Thus, students allocated to quartile 1 were considered to have the lowest competence at the outset, and students in quartile 4 had the highest competency level. Students in each quartile were randomly allocated to the control or intervention group. To increase the possibility of finding significant differences between groups, researchers established approximately a 2:1 ratio of intervention students to control students.
Students in the intervention group were organized in small subgroups (4–5 students/group). They attended four 2-h mediated sessions to develop an approach to study the cardiovascular module (specifically cardiac output, arterial pressure, and their determinants). These sessions were distributed as follow: session 1, cardiac output (definitions and concept map construction); session 2, problem-solving activity using the cardiac output concept map; session 3, arterial pressure (definitions and concept map construction); and session 4, problem-solving activity using the arterial pressure concept map.
Students received reading material related to cardiac output and arterial pressure 1 wk before the first session. At the beginning of each session, the mediators (a role assumed by the professors, as defined by R. Feuerstein) briefly explained the activity and its importance in medicine. Students were also given instructions regarding the principles and construction of concept maps. Each subgroup received two sets of cards: one with propositions reflecting concepts and the other with definitions (see the example shown in Fig. 1). Students matched each concept with its corresponding definition. After discussing and clarifying doubts about concepts and definitions, students were prepared to elaborate the specific concept map.
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The control group attended the same number of sessions and also received the reading material. These sessions were conducted by the same teachers, but, in contrast with the mediated sessions, the teachers assumed the role of the "traditional" teacher. (The qualities described by R. Feuerstein–intentionality, reciprocity, mediation of meaning, and transcendence–were not manifested.) The pedagogical methodology used traditionally in our medical school consists of discussion sessions focused on specific topics, in which teachers ask questions and students clarify doubts. Control students also participated in sessions to solved the same problems used by the intevention group. The other activities of the course were identical for both groups (theoretical classes, laboratories, etc.).
During every session, two researchers from the school of education acted as observers to record academic, cognitive, attitudinal, and behavioral performances of both students and mediators. Mediators (who also acted as "traditional" teachers in the control group) were physicians from the physiology department who had a background in medical education, concept maps, and the theory of the mediated learning experience.
Two types of exams were used to evaluate students. First, multiple-choice exams with only one correct answer were used. In this type of exam, the students had to recall the precise information related to the question that could or could not be related to a specific problem (see the example shown in Table 1). Second, problem-solving exams were used. In this kind of exam, the students were asked to resolve specific problems using hierarchial structuring, sequencing, or proposing alternatives (see the example shown in Table 1).
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Control and intervention groups were compared based on the following variables: 1) average grades on the exams, and 2) percentage of students who failed the exams (on a scale from 1 to 5, a grade below 3.0). Data are presented as averages (means) and SDs for continuous variables and as a percentage (%) for discrete variables. Significant differences between the groups were determined with a t-test (for a comparison of two means) and a Mann-Whitney test. A P value of <0.05 was used to determine statistical significance. All statistical comparisons were done using Stata 8.0 SE software.
This project was approved by the Institutional Review Board for Human Experimentation and was considered without risk for human health.
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RESULTS |
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The grade averages were generally higher for the intervention group than for the control group, but only the problem-solving exam grades showed a statistically significant difference between the groups (P = 0.0013; Table 2).
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Some difficulties observed by the researchers in the cognitive performance of students were problems in concept categorization, selection of the right concept links, and impulsiveness. However, some improvements could also be implemented throughout the intervention process.
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DISCUSSION |
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In this study, we intendeded to amplify the advantages of concept maps by combining this methodology with the mediated learning experience based on the cognitive modifiability theory. Through this experience, a new learning atmosphere was presented to the students that facilitated their cognitive performance in the construction of concept maps and stimulated changes in students’ mental structures and learning styles. Mediated learning occurs when environmental events are selected, ordered, filtered, and invested with specific meaning by mediating agents. In this way, significant cognitive modifications produce a structure by which the organization and elaboration of the transmitted information will become increasingly complex and function more efficiently (7). Thus, it was expected that students were prepared to reach meaningful learning by articulating concept maps with a mediated learning experience.
The statistically significant differences found between the control and intervention groups on the problem-solving exams show that the intervention facilitated the development of meaningful learning. This can be explained because these kind of exams demand a greater level of cognitive functions and mental operation than multiple-choice exams. To solve a problem, it is necessary to recall, transfer, and apply knowledge using mental processes such as identification, comparison, proposition, and argumentation. It is possible that the intervention facilitates in students the skills to identify and evaluate the significant and hierarchic relationships between concepts and to transfer the knowledge to the resolution of problems related to the discipline (11).
No significant differences between the groups were found on the multiple-choice exams. One explanation is that this kind of test does not challenge the students in the same way as the problem-solving exams. Although multiple-choice exams have been the most common tool used to evaluate medical students, in fact, they are generally designed to recall rote memory more than to assess transference of meaningful learning (4).
Even though the intervention group globally benefitted from the implemented strategy, the results showed a greater impact on the students allocated to quartile 1, those with the lowest initial competence. It is possible that intervention stimulated the development of cognitive functions that already were present in the rest of the students in this group.
It is also important to mention that a mediated learning experience stimulates metacognition in students. For many years, psychologists and educators have recognized that, in addition to learning subject matter knowledge, students can also acquire knowledge about learning or the nature of knowledge. Metacognition was coined to label "learning about learning." This includes the ability to learn to plan, monitor success, correct errors, recognize unsuccessful problem approaches, etc. (18). In this experience, students had the possibility of becoming more consciencious about their own learning style and the mental operations needed to organize concept maps and solve problems.
Qualitative analysis suggests that the intervention increases students’ motivation and stimulates a better attitude to actively participate in the construction of personal knowledge.
In summary, the results suggest that mediation through concept maps is an effective alternative for learning physiology (at least in the module of the cardiovascular system) that can also be used in other disciplines related to medicine.
A caveat of this research is that it does not allow us to draw conclusions on the impact of the intervention on the permanence of meaningful learning and in the ability to transfer knowledge to other and more complex contexts. This could be studied by tracking the student participants through subsequent semesters.
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GRANTS |
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Acknowledgments |
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Received for publication April 2, 2007. Accepted for publication September 24, 2008.
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