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An analytical study for pharmacology students with example of concept map of sedative hypnotic drugs
Typology: Schemes and Mind Maps
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Pharmacology is generally perceived by the students as a subject difficult to conceptualize and retain. Students, therefore, resort to memorization. Rote learning is easily forgotten and students are unable to apply this knowledge to problem-solving situations or to link this to previous knowledge. 1 Cognitive psychology has shown that the way knowledge is structured in the memory that determines the ability to retain, recall and use it to solve problems.^2 Concept mapping is a technique that is well established in helping students build useful mental frameworks.3,4^ According to Michael, meaningful learning implies “acquiring useful learning which is stored in a way that can be accessed from various
points, which is well integrated with previous knowledge and which is accompanied by building mental models connected with other models for many other phenomena.”^1 A big challenge for medical educators is to search for pedagogical tools that will promote meaningful learning and discourage rote learning. 5 In pharmacology meaningful learning implies the ability to understand the mechanism of action of drugs on the body systems and to be able to relate these actions to systemic effects and adverse drug effects, and in turn associate these effects to clinical uses and contraindications to the use of these agents. Current teaching strategies appear to be inadequate in enhancing and improving knowledge of pharmacology due to which students lack depth of knowledge and experience difficulties in using pharmacological concepts in clinical practice settings. 6 Concept mapping, initially proposed by Novak, is an innovative approach that helps the learner to organize knowledge. 7 Concept maps communicate knowledge graphically instead of relying on lengthy textual explanations. They have been used in many disciplines and at all levels of education to provide a very useful and extremely appealing way of illustrating concepts.^8
Objective: To assess whether students find concept mapping a useful learning methodology to conceptualize and organize topics studied in CNS module of Pharmacology; and to evaluate whether addition of concept mapping assignment could help to improve examination scores. Study Design: An analytical study. Place and Duration of Study: College of Dentistry, Jinnah Medical and Dental College, Karachi, Pakistan, from March to May 2009. Methodology: A class of 50 BDS students was recruited for the study. Two randomly selected groups of 12 students each, prepared concept maps in topics from CNS pharmacology which were displayed and discussed during tutorial sessions. The other two groups (n=25) following the traditional teaching methodology, served as controls. Scores from best choice questions and short essay questions were compared between the investigational and control groups using the student's t-test with significance at p < 0.05. Feedback obtained after completion of the study was evaluated as percent response. Results: One-best-choice test of the control group showed a mean grade of 57.1 + 16.7 vs. test group mean of 58.8 + 13. For the short essay questions, control group obtained a mean of 52.3 + 18.8 vs. test group mean grade of 53.8 + 22.5. Both results were not significantly different (p > 0.05). However, feedback about concept mapping showed that the technique helped the students to conceptualize difficult topics in CNS pharmacology (86.36%). Concept mapping was particularly beneficial in preparing for exams as it provided a quick overview of the entire subject (68.68%). Conclusion: Students found concept mapping as a useful pedagogical tool which could potentially be used to acquire meaningful learning in Pharmacology as a supplement to traditional teaching techniques. It was not found beneficial in improving examination grades probably because standard examinations and concept mapping measure different cognitive domains.
Key words: Concept mapping. Medical education. Critical thinking. Teaching and learning.
(^1) Department of Pharmacology, Liaquat National Medical College, Karachi. (^2) Department of Biochemistry, Jinnah Medical and Dental College, Karachi. Correspondence: Dr. Farida Qadir, Department of Pharmacology, Liaquat National Medical College, Stadium Road, Karachi. E-mail: faridaqa100@hotmail.com Received January 19, 2010; accepted June 13, 2011.
Farida Qadir^1 , Tabassum Zehra^1 and Imrana Khan^2
In constructing a concept map, the key concepts are enclosed in circles or boxes. Relationship between concepts are indicated by connecting arrows linking two concepts. Words on the arrow specify relationship between the two concepts. Concept maps are represented in a hierarchical fashion with the more general concepts at the top of the map and less general and more specific concepts below. Cross links or arrows indicate how knowledge in one domain is related to knowledge in another domain. It is best to construct concept map with reference to some particular question we wish to answer (focus question) or a situation we wish to understand. Specific examples, given at the bottom, help to clarify meaning of a map. They are not enclosed in boxes as they indicate specific situations and not general concepts. To the best of our knowledge, concept mapping as a learning methodology has not been investigated in Pakistan. The purpose of this study was to determine the usefulness of concept maps in developing pharmacological concepts and to obtain students feed back on its value and acceptability and to assess the usefulness of concept maps in improving test scores.
This analytical study was conducted between March and May 2009, with 50 undergraduate students, enrolled in the second year of dentistry. The names of students, arranged in alphabetical order, was divided into 4 sections A, B, C, D comprising an average of 12 students each. Through randomization by ballot method, two groups A and C (n=25), were assigned to the intervention group, and groups B and D (n=25), served as controls. The intervention was in the form of a concept mapping assignment added to the tutorials. The class was taught the assigned topics by giving classical style lectures using MS power point presentations. They were instructed to study the topics covered during the week for discussion in the tutorial classes the following week. For test groups A and C, two introductory sessions were arranged. First session was a workshop in which they were explained the purpose and process of concept mapping and relevance to their education. The method of creating concept maps was explained by simple examples. The second session was followed by hands on experience during which students created concept maps of a topic from their existing knowledge. Each student in test groups A and C was asked to create concept maps on various topics from CNS pharmacology. During the tutorial class, the students presented the concept maps, elaborated on the concepts, clarified misconceptions and shared their experience with building the concept maps (example of a concept map given in Figure 1). Emphasis was placed
on the mechanism of action of drugs and how drugs alter normal physiological processes leading to their systemic effects. The actions of drugs were related to their uses and adverse effects which in turn were correlated with contraindications to their use. Pharmacokinetic and pharmacodynamic aspects of drug interactions were also emphasized. Links to related topics in physiology, anatomy or biochemistry were also elaborated upon wherever relevant. The tutor guided the students to correct their cognitive difficulties in organizing and clarifying the concepts and in removing misconceptions. Control groups B and D attended the same lecture and had the same number of tutorials comprising of discussion sessions during which an equally qualified tutor asked questions to clarify doubts. At the end of the unit, module tests based on the best choice questions (BCQs) and short essay questions (SEQs) were taken to assess the theoretical knowledge of all the students. The intervention group was asked to fill in a questionnaire in which they recorded their impression about the concept mapping assignments. For the quantitative data, statistical analysis was done using on-line Graphpad p-value calculator. Mean and standard deviation was calculated for the test scores. Student's t-test was used for determining the difference between the test scores. P-value < 0.05 was taken as significant. Proportions were computed for qualitative variables like student's degree of satisfaction with the concept mapping, usefulness of the mapping in understanding difficult concepts, benefit of extra time spent with the new method etc.
Results were analyzed using Student’s t-test. For best choice questions (BCQ), a mean of grade of 57.1 + 16. was obtained by the control group and 58.8 + 13 by the test group (p=0.72) which was not statistically significant. In short essay questions (SEQ) test, the average grade for the control group was 52.3 + 18.8 and for the test group it was 53.8 + 22.5 which was not found significant (p=0.84). To evaluate students’ perception regarding concept mapping, a questionnaire was filled by students at the end of the project (Table I). This showed that 86.36% of the students found concept mapping very useful in understanding the topic and 54.54% in retaining the knowledge acquired; 68.18% thought that the major benefit of the concept map was that it helped in quick revision before a test and 50% could clear misconceptions during discussion of the maps. However, 45.45% of students spent more than 2 hours and 40.9% spent more than 1 hour in making a map.
Use of concept mapping as a facilitative tool to promote learning in pharmacology
Nevertheless 68.18% felt that the extra time spent benefited them in understanding the subject. Majority (76.19%) said they preferred concept mapping over the traditional tutorial format and 68.18% favoured use of concept mapping in other subjects as well. On the other hand, 72.72% had difficulty in correlating pharmacological concepts with the knowledge acquired in previous years in other basic sciences.
The pharmacology curriculum is loaded with information which the teachers expect the students should know. This makes the student simply memorize the facts without acquiring a deep understanding of the subject. A review of a concept map made by a student on pharmacology of sedative hypnotics like benzodia- zepines and barbiturates (Figure 1), shows that students after thoroughly reading through the topic analyzed the content to identify key concepts and structured the information such that a glance shows the key concepts and their relationships thereby allowing a holistic understanding of the topic. This is reflected in the students’ response where majority found that concept maps effectively summarize the subject and is very useful in revision before exams when not enough time is available to go through lengthy texts. Summarizing is important because it aids memory, makes review more efficient and encourages high level critical thinking. Concept maps encourage creativity as each map is unique and reflects the thinking process of the builder. Different colours used to group sections of the map
Use of concept mapping as a facilitative tool to promote learning in pharmacology
Table I: Students’ opinion about concept mapping (CM). Questions Number of Percentage students
Open ended questions: What in your opinion are the main disadvantages of making concept maps?
make it visually appealing. Information is structured in a manner which allows the students to see how complex ideas fit together - how the mechanism of action relates to the systemic effects which in turn relates to adverse effects and indications for use of sedative hypnotics. Concept maps also provide an opportunity for holistic understanding of a subject as it discern overlaps and commonalities allowing cross-disciplinary linking, for example between physiology of action potential and mechanism of action of sedatives as shown in Figure 1. Also links were discerned to other topics in pharmacology - pharmacokinetics, pharmacodynamics, drugs of abuse, antiepileptic and general anaesthetic agents, this encourages highly divergent lateral thinking.
To our knowledge, use of concept maps as a pedagogical tool in Pharmacology has so far not been reported. However, in other medical disciplines, like physiology, microbiology internal medicine, and medical research, 11-14^ concept mapping has been used effectively. It has been shown that concept maps can promote meaningful learning in medical education.15, Several health-related fields like veterinary medicine,^9 and nursing,^10 have also found concept mapping to be a successful learning strategy.
This study found no significant difference in scores of one best choice and essay type tests between the intervention and control groups. However, average grades were generally higher for intervention than control group. This result is consistent with findings of various other studies which have found no correlation between conventional measures of learning like grades of standardized tests and concept mapping assessment scores. 17,18^ This could be due to the fact that the assessments do not test concepts rather they rely on memorization of trivial facts not covered in the concept maps. Students learning physiology by concept mapping have performed significantly better at problem- solving exams, but the difference was not significant in multiple-choice exams.^19 However, concept mapping was found to benefit students in the lower percentiles in acquiring significantly higher grades in MCQ tests, this difference was not observed in high-achievers. 19 Moreover, comparative study of classical teaching method with concept mapping technique has shown to produce a significant improvement in OSCE scores in a plastic surgery course.^20
The questionnaire designed to evaluate perception of the students at the end of the project showed that students found constructing concept maps to be helpful in understanding CNS pharmacology. A majority of the students agreed that concept maps assisted and enhanced thinking and learning of Pharmacology, however, they found the process time intensive. It was found that the response was less favourable when asked about establishing interrelationships between other basic sciences. This might reflect difficulty faced
by the students in moving from simpler and basic subjects to subjects involving greater conceptualization and application. It would probably be more useful to expose students to a wide range of maps at the beginning of the project in order to better familiarize the students to the techniques of concept mapping. Also much time could be saved by using computer-based concept mapping software like Inspiration or CMap. The most encouraging aspect of this study was that most students stated that they would like to use concept maps as a learning tool for future studies in Pharmacology and other subjects. We suggest that concept mapping as a pedagogical tool could be applied to the entire subject of Pharmacology. It could also be included in text books of Pharmacology as an explicit overview at the end of each chapter.
Students found that concept maps enhanced their capacity to develop clear concepts in Pharmacology and in getting a comprehensive and accurate overview of the entire topic. This helped in quick revision before exams. This learning methodology did not help to improve scores of one best-choice and essay-type tests likely to be due to differences in cognitive domains involved.
Farida Qadir, Tabassum Zehra and Imrana Khan