The effectiveness of concept mapping as a tool for developing critical thinking in undergraduate medical education - a BEME systematic review: BEME Guide No. 81

BACKGROUND

Concept maps (CMs) visually represent hierarchical connections among related ideas. They foster logical organization and clarify idea relationships, potentially aiding medical students in critical thinking (to think clearly and rationally about what to do or what to believe). However, there are inconsistent claims about the use of CMs in undergraduate medical education. Our three research questions are 1) What studies have been published on concept mapping in undergraduate medical education; 2) What was the impact of CMs on students' critical thinking; 3) How and why have these interventions had an educational impact?

METHODS

Eight databases were systematically searched (plus a manual and an additional search were conducted). After eliminating duplicate entries, titles and abstracts and full-texts were independently screened by two authors. Data extraction and quality assessment of the studies were independently performed by two authors. Qualitative and quantitative data were integrated using mixed-methods. The results were reported using the STructured apprOach to the Reporting In healthcare education of Evidence Synthesis statement and BEME guidance.

RESULTS

Thirty-nine studies were included from 26 journals (19 quantitative, 8 qualitative and 12 mixed-methods studies). CMs were considered as a tool to promote critical thinking, both in the perception of students and tutors, as well as in assessing students' knowledge and/or skills. In addition to their role as facilitators of knowledge integration and critical thinking, CMs were considered both a teaching and a learning methods.

CONCLUSIONS

CMs are teaching and learning tools which seem to help medical students develop critical thinking. This is due to the flexibility of the tool as a facilitator of knowledge integration, as a learning and teaching method. The wide range of contexts, purposes, and variations in how CMs and instruments to assess critical thinking are used increases our confidence that the positive effects are consistent.

Diversifying stem cell debates: Including Muslim contexts and perspectives

Greater transcultural and transdisciplinary engagement within Muslim contexts and deliberate inclusion of diverse Muslim voices in the development of international guidelines is required to improve understanding of the state of stem cell science, strengthen thinking about attendant ethical complexities, enhance compliance, deepen public deliberation, increase trust, and strengthen practice standards.

Revisiting the role of concept mapping in teaching and learning pathophysiology for medical students

Concept mapping methodology is a way of representing knowledge described as a useful tool in medical education. It was introduced in the pathophysiology curricular unit at NOVA Medical School in 2002, within an ongoing experience of problem-based learning. Our goal is to present a comparison between the students' opinions and performances in two academic years, 2017-18 and 2018-19, to evaluate the effects of pedagogical changes in the concept mapping methodology, applied in the last year, which is also described in detail. Our convenience samples were composed by 224 students in 2017-2018 and by 216 students in 2018-2019. The analysis used the students' responses to the yearly institutional questionnaire on the quality of teaching and to a specific questionnaire applied to evaluate the tutorial sessions of 2018-19. Both were anonymous, and the response rate was above 50%. A comparison was also made between the continuous assessment during the tutorial sessions, expressed as a final cumulative score, and the results of an obligatory multiple-choice final test. The students considered the introduced pedagogical changes useful in their different components, such as identification of core concepts, construction of mini-maps, and their inclusion in final global maps. The better performance of the tutors, signaled by the students in 2018-19, was probably due to the preparatory pedagogical sessions.

Os 17 Objetivos de Desenvolvimento Sustentável e a Presbiopia: Relações Entre Qualidade de Vida, Saúde e Produtividade

O número de setembro deste ano da revista Lancet Global Health publica um artigo original1 baseado num ensaio randomizado, realizado na Índia, que mostra o efeito favorável da correção da presbiopia na produtividade de trabalhadores das plantações de chá. Os autores efetuaram detalhadas revisões da literatura, a partir de julho de 1975 e até novembro de 2017, não tendo encontrado qualquer estudo randomizado desta natureza em países de baixo e médio rendimento (low-income and medium-income countries). Numa altura em que o mundo se encontra a tentar reequacionar o conceito e as consequências da globalização e em que enfrenta problemas complexos de desenvolvimento sustentável, vale a pena assinalar estes projetos científicos, ligados à saúde, que utilizam metodologias internacionalmente aceites para provar, de uma forma clara, aquilo que muitos profissionais da saúde sabem ser incontestável nos respetivos espaços de intervenção. As mesmas convicções têm sido assumidas relativamente aos 17 Objetivos de Desenvolvimento Sustentável que as Nações Unidas promovem desde 2016. Todos concordamos que, até 2030, é essencial: erradicar a pobreza, erradicar a fome, garantir uma saúde e uma educação de qualidade, alcançar a igualdade de género, garantir água potável e saneamento, garantir fontes de energia renováveis e fiáveis, promover o trabalho digno e o crescimento económico, promover a industrialização inclusiva e fomentar a inovação, reduzir as desigualdades, garantir padrões de consumo e de produção sustentáveis, adotar medidas urgentes para combater as alterações climáticas, proteger a vida marinha e a vida terrestre, promover a paz, a justiça e construir instituições eficazes, reforçar parcerias para o desenvolvimento sustentável. No entanto, a questão de fundo é saber como vão ser postas em prática estas iniciativas e por quem. O estudo acima mencionado aborda um problema de saúde, agravado com o envelhecimento, que é global e que afeta a qualidade de vida de uma percentagem crescente de habitantes de qualquer continente do nosso planeta. A relação com a produtividade, avaliada neste caso num contexto agrícola, pode ser extrapolada para outras sociedades mais “avançadas” até à “aldeia digital”. Medir o impacto destas intervenções, que melhoram a qualidade de vida, junto de cada indivíduo e em grupos profissionais bem caraterizados, será essencial para provar como se podem cumprir, com rigor, as metas definidas nos 17 Objetivos de Desenvolvimento Global. Neste caso são visados os objetivos 1 (pobreza), 3 (saúde), 5 (igualdade de género) e 8 (trabalho digno e crescimento económico). Um outro objetivo que este estudo demonstra é a importância do trabalho científico em parceria porque o grupo de investigadores engloba elementos de prestigiadas instituições médicas e de saúde situadas nos seguintes países: Índia, Estados Unidos da América, China e Canadá. Investigar nas áreas da medicina e da saúde é, cada vez mais, uma atividade destinada não só a estimular as descobertas científicas mas também a promover a melhoria da qualidade de vida das pessoas em qualquer local do mundo onde se encontrem. António RendasNova Medical School, Faculdade de Ciências Médicas,Universidade Nova de Lisboa. Referências:1. Reddy PA, Congdon N, MacKenzie G, Gogate P, Wen Q, Jan C, et al. Effect of providing near glasses on productivity among rural health Indian tea workers with presbyopia (PROSPER): a randomized trial. Lancet Global Health. 2018;6:1019-27.

A computer simulation designed for problem-based learning

OBJECTIVES

As problem-based learning is increasingly used in medical education, there is a growing need to capture the diversity of the events occurring during problem-based learning sessions in order to understand the way in which students learn. The computer simulation described attempts to analyse a posteriori how students reason and learn during such sessions.

DESIGN

A computer simulation was designed to perform a detailed analysis of the following features: pattern of information searched, formulation of working hypothesis and identification of learning issues. The program, which has been running successfully for 2 years, was developed using local resources and accepts any clinical problem, provided it is written in a suitable text file format. The program has been applied in the discipline of pathophysiology.

SETTING

Faculty of Medical Sciences of Lisbon, Portugal.

SUBJECTS

Medical students.

RESULTS

An example is presented of how prints were analysed in order to evaluate the 'progression profile' of the students, and a comparison is made with other similar instruments.

CONCLUSIONS

The program improved understanding of the relationships between the inquiry strategy and hypothesis formulation and also of how self-learning (triggered by learning issues) influenced further analysis of the cases.

Pulmonary vasculature of piglets after correction of aorta-pulmonary shunts

In a previous article we described the functional and structural changes produced in the pulmonary arterial circulation of the growing pig by an aorta-pulmonary shunt. The present work describes the hemodynamic and morphologic adaptation that follows correction of the shunt. In four piglets, aged 5 weeks, an anastomosis was made between the thoracic descending aorta and the pulmonary trunk and left patent for 5 weeks. At the end of that time the mean pulmonary artery pressure (PAP) was 20 +/- 3.8 mm Hg (mean +/- SD), compared with 9 +/- 2.1 mm Hg in a group of four age-matched sham-operated control piglets. The shunt was then surgically closed. After 10 weeks' recovery, the PAP was similar and normal in the two groups. We have already shown that pulmonary hypertension of similar degree and duration to that at the end of the patent shunt period produces the following structural changes, assessed by quantitative techniques: (1) preacinar arteries of normal external diameter but with a thicker medial coat than normal and (2) intra-acinar arteries in normal concentration, of smaller external diameter than normal, but with a medial coat appropriate to the external diameter: Smooth muscle is found in more peripheral arteries than is normal. In the present study, at the end of the recovery period, the shunt animals were compared with the sham-operated animals and had thicker medial coats in preacinar and intra-acinar arteries, muscle in more peripheral arteries than is normal, and an increased arterial and alveolar concentration for unit lung area. These results indicate that, in the growing porcine lung, "recovery" from an aorta-pulmonary shunt that was associated with moderate pulmonary hypertension restores external arterial diameter to normal but leaves a thicker medial coat at the preacinar and intra-acinar levels and muscle more peripheral in the arterial bed. In addition, after shunt correction, multiplication of alveoli and arteries proceeds at a faster rate than normal, at least during the first 10 weeks of recovery.

Response of the pulmonary circulation to acute hypoxia in the growing pig

In a previous article we have analyzed the structure of the growing pig lung and correlated the findings with cardiorespiratory function studies on the same animals (J. Appl. Physiol: Respirat. Environ. Exercise Physiol. 45: 806-817, 1978). The present study analyzes the pulmonary and systemic vascular responses to acute hypoxia in some of those animals at three ages, 2-4, 5-8, and 9-12 wk, the lung of the 12-wk-old pig being structurally similar to that of the adult. In all anesthetized animals, acute hypoxia (5 min 10% fractional inspired oxygen concentration) increased mean pulmonary arterial pressure (Ppa) and total pulmonary resistance (TPR). The increase over base line of Ppa was 41.3% in animals aged 2-4 wk; 83.0% in those aged 5-8 wk, and 136.9% in those aged 9-12 wk; for TPR the increase in the three age groups was 66.4, 92.4, and 138.9%, respectively. This difference in vasoactivity with age is associated with the progressive extension of smooth muscle into the intra-acinar arterial tree, which we have previously shown is an important feature of the structural remodeling that occurs during postnatal lung development in both man and swine.

Prematurity, hypoplasia of the pulmonary vascular bed, and hypertension: fatal outcome in a ten-month-old infant

The present report describes an infant weighing 610 g who did not develop respiratory distress at birth, but who failed to thrive, and died at 10 months of age with suprasystemic pulmonary hypertension of unknown cause. Morphometric analysis of the lung, including the pulmonary artery circulation and serial reconstruction of several arterial pathways, revealed hypoplastic arteries both for age and lung size, and also arterial dilatation lesions and interpulmonary artery anastomoses. Pulmonary hypertension of this degree, which is noncardiac in origin, has not been reported before in a premature infant within the first year of life.

Aorta-pulmonary shunts in growing pigs. Functional and structural assessment of the changes in the pulmonary circulation

Aorta-pulmonary shunts were produced in growing pigs, 4 to 12 weeks of age, by anastomosing the thoracic descending aorta to the pulmonary trunk, and the animals were followed for periods of 1 to 3 months. Correlation between the hemodynamic findings and the lung structure, analyzed by quantitative methods, showed that the young group (operated upon at 4 weeks of age) developed more severe pulmonary hypertension with increased muscularization of arteries of all sizes and reduction in the size of those running with respiratory bronchioli and beyond. Since this response is similar to that seen in cases of left-to-right shunt associated with congenital heart defects and pulmonary hypertension early in life, it seems that the present experiments reproduce the early response of the growing lung to such hemodynamic disturbance.

Growth of pulmonary circulation in normal pig--structural analysis and cardiopulmonary function

Morphometric analysis of the postnatal development of the pig lung, with emphasis on alveoli and vessels, shows features of growth similar to man, but occurring at a much faster rate in the pig, which telescopes in the first 3 mo the changes seen in human childhood and adolescence. During the first weeks, arteries (birth to 2 wk) and alveoli (1--12 wk) increase in number, whereas increase in size continues until adulthood. Wall thickness decreases soon after birth in arteries 15--200 micrometer, and by 8 wk in those 200-1,000 micrometer. At this age the adult left ventricular predominance in weight is already present. Throughout growth the venous wall thickness does not change. Cardiopulmonary function studies in pigs, from 2 to 16 wk, show that, during the period of rapid postnatal lung growth, there is no change in tidal volume, dynamic compliance, and thoracic gas volume as related to body weight; right ventricular and pulmonary arterial pressures also remain unchanged, whereas pulmonary vascular resistance decreases during the 1st mo.