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

Figures & data

Figure 1. PRISMA flow diagram for included studies.

Figure 2. Infographic summarizing key findings.

Table 1. Results of the studies with impact on students’ critical thinking, whose research purposes were justification or justification and clarification.

Author	How CMs were used?	Measuring instrument	Outcome
Justification
Perception / Reaction (Kirkpatrick 1)
Langer et al. 2021	CMs constructed by faculty members. n = 113 (n = 57 P&S, n = 56 MUSC)	Likert-scale questionnaire	“CMs help me relate clinical presentations to underlying physiology”: 26.2% strongly agree, 47.6% somewhat agree, 23.3% neither agree nor disagree, 2.9% somewhat disagree.
Surapaneni and Tekian 2013	CMs constructed by students. n = 75 (intervention), n = 75 (control)	Open-ended questions	“Participants opined that by virtue of the concept mapping technique they were able to integrate the information and relate and link the basic concepts in biochemistry in terms of the clinical problem.”
Change in knowledge (Kirkpatrick 2b)
Aslami et al. 2021	CMs constructed by students. n = 54 (intervention), n = 54 (control)	CCTST (form B)	Pre-test CT scores: 6.68 ± 2.55 (intervention) and 6.64 ± 2.74 (control). Post-test CT scores: 11.64 ± 2.29 (intervention) and 10.04 ± 3.11 (control). CT scores in the intervention group significantly increased after intervention, p = 0.021. The intervention group performed much better on the CT levels than the control group, p = 0.004.
Bala et al. 2016	Pre-prepared CMs. n = 124	Problem-based questions	Problem-based questions score after CM = 60%, Problem-based questions score after traditional teaching = 32%, p < 0.01.
Bhusnurmath et al. 2017	CM constructed by students. n = 259	CM score MCQ	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).
Bixler et al. 2015	CMs constructed by students. n = 27	CCTST	Pre-test CT score 83.9 ± 6. Post-test CT score 85.6 ± 6.9. p = 0.57. Pearson correlation of USMLE step 1 and pre-test CT score showed r(25) = 0.276, p = 0.164. Pearson correlation of USMLE step 2 CK and pre-test CT score revealed r(25) = 0.214, p = 0.482.
Ezequiel et al. 2019	CMs constructed by students. n = 20	CM score	CM1 overall score 72 (18‐142) and CM2 overall score 139 (54–321), p < 0.001.
Saeidifard et al. 2014	CMs constructed by students. n = 37 (intervention), n = 39 (control)	Final exam (open-answer questions)	Diagnostic section score of the final exam: 81.08% (11.2) (intervention); 71.53% (8.1) (control), p < 0.001.
Justification and Clarification
Perception / Reaction (Kirkpatrick 1)
Addae et al. 2012	CMs constructed by students (PBL). n = 50 (4 groups of 11-13 students)	Likert-scale questionnaire	Questionnaire items specific to critical thinking: This method promoted critical thinking skills: M = 4.7, SD 0.6 (intervention); M = 3.9, SD 0.9 (control); p < 0.01. This method promoted integration of concepts from different disciplines: M = 4.6, SD 0.6 (intervention); M = 3.7, SD 0.9 (control), p < 0.01. This method promoted the use of knowledge gained for future clinical training: M = 4.7, SD 0.5 (intervention); M = 3.6, SD 0.9 (control), p < 0.01.
Choudhari et al. 2021	CMs and MMs constructed by students. n = 30 (intervention), n = 30 (control)	Likert-scale questionnaire	Intervention group: CMs “helped in understanding the topic and promoted rational thinking” (average 3.82/5); control group: Likert questionnaire not applied.
Thomas et al. 2016	CMs constructed by students (PBL). n = 7	MSLQ Interview	“A comparison of participant 7’s pre- and post-MSLQ tests demonstrated an increase in her scores for elaboration, organisation, critical thinking, and metacognition/self-regulated learning.”
Veronese et al. 2013	CMs constructed by students. n = 122 n = 9 (tutors)	Likert-scale questionnaire and open-ended questions	Think critically about a case: 25.6% almost always, 34.1% frequently, 22.0% occasionally, 15.9% rarely, 2.4% never. Open-ended question: CMs “Helped integrate knowledge”.
Wang et al. 2018	CMs constructed by students (cognitive tool). n = 25 (intervention), n = 24 (control)	Open-ended questions	“(…) cognitive-mapping approach was innovative in that it offered a vivid picture for logical thinking and reasoning with intertwined knowledge when solving a clinical problem.”
Wu et al. 2014	CMs constructed by students (cognitive tool). n = 29	Likert-scale questionnaire	Perceived learning gains in problem-solving ability 1.87/4, SD 0.88.
Wu et al. 2016	CMs constructed by students (cognitive tool). n = 26 (intervention), n = 26 (control)	Likert-scale questionnaire	Both groups reported their perceived learning gains to be moderate in the reasoning process (intervention: M = 2.17, SD 0.97 /4; control: M = 2.11, SD 0.90/4).
Change in attitudes (Kirkpatrick 2a)
Veronese et al. 2013	CMs constructed by students. n = 122 n = 9 (tutors)	Tutor interview	Tutors identified several benefits of using CMs as a learning tool in tutorials. Tutors described CMs as enhancing critical thinking (‘‘I think CMs force you to think about a problem in a rigorous fashion, because by definition you have to diagram and explicitly link mechanisms to symptoms and mechanisms to other mechanisms. By being forced to make those connections you are forced to consider a problem holistically as opposed to just superficially.’’) Tutors also felt that CMs provided more structure to tutorial, helping students to better focus and participate and allowing tutors to better observe students’ thinking and reasoning.
Change in knowledge (Kirkpatrick 2b)
Anand et al. 2018	CMs constructed by students and pre-prepared CMs.	MCQs (higher cognitive learning)	Group A: exposed to CMs. Group B: pre-prepared CMs and traditional lectures and demonstrations. Group C: lecture and demonstrations. Pre-test scores: 2.80 ± 1.64 (group A), 3.30 ± 1.62 (group B), 2.14 ± 1.90 (group C). Post-test scores: 6.50 ± 1.82 (group A), 4.60 ± 1.78 (group B), 3.80 ± 2.14 (group C). Group A post-test score is better than group B (p = 0.0019) and group C (p = 0.00001).
Baig et al. 2016	CMs constructed by students. n = ?	Problem-solving questions	Problem-solving questions marks: 12.23 ± 0.20 (intervention); 11.01 ± 0.20, p < 0.001.
Choudhari et al. 2021	CMs and MMs constructed by students. n = 30 (intervention), n = 30 (control)	Written examination	Mean score of the written examination: 29.85 ± 3.22 (intervention) and 23.06 ± 4.09 (control), p < 0.05.
González et al. 2008	CMs constructed by students. n = 83 (intervention), n = 39 (control)	Problem-solving exam	Exam results: M = 3.6, SD 1.18 (Intervention); M = 2.79, SD 1.39 (control), p = 0.0013.
Wang et al. 2018	CMs constructed by students (cognitive tool). n = 25 (intervention), n = 24 (control)	Problem-solving report	Data capture: 2.94, SD 0.94 (intervention); 3.09, SD 0.84 (control), p = 0.598. Hypotheses formulation: 2.4, SD 0.68 (intervention); 1.72, SD 1.02 (control), p = 0.014. Justification by reasoning: 2.96, SD 1.08 (intervention); 2.13, SD 1.09 (control), p = 0.021. Diagnostic conclusion: 3.98, SD 1.03 (intervention); 2.91, SD 1.24 (control), p = 0.005. Identification of underlying knowledge: 3.04, SD 0.98 (intervention); 2.88, SD 1.07 (control), p = 0.615.
Wu et al. 2014	CMs constructed by students (cognitive tool). n = 29	Map score	First case map score 0.24 (SD 0.11), last case map score 0.38 (SD 0.14), p < 0.001.
Wu et al. 2016	CMs constructed by students (cognitive tool). n = 26 (intervention), n = 26 (control)	Map score	First case map scores: 0.39, SD 0.13 (intervention), and 0.38, SD 0.13 (control). Last case map scores: 0.55, SD 0.25 (intervention), and 0.39, SD 0.13 (control). Paired difference in the overall performance in the intervention group = 0.16, t = 2.61, df = 25, p < 0.05.

Abbreviations: CCTST: California critical thinking skills test; CM: concept map; CT: critical thinking; M: mean; MCQ: multiple-choice question; MM: mind map; MSLQ: motivated strategies for learning questionnaire; MUSC: Medical University of South Carolina; PBL: problem-based learning; P&S: Columbia University College of Physicians & Surgeons; SD: standard deviation; USMLE: United States Medical Licensing Examination.

Table 2. Educational impacts of CMs on undergraduate medical students.

Themes	Educational impact	n	Total
Facilitator of knowledge integration and critical thinking	Promoting critical thinking skills	22	31
	Supporting clinical reasoning	13
	Integrating basic sciences and clinical concepts	10
	Visual representation of knowledge	9
	Enhancing problem-solving ability	6
	Facilitate information synthesis	6
	Reflective tool	2
	Pattern recognition	1
Learning method	Stimulating knowledge acquisition	19	31
	Better assessment performance	16
	Promoting meaningful learning	15
	Promoting deep learning	11
	Identify knowledge gaps	6
	Progressive construction	3
Teaching method	Teaching tool	13	20
	Stimulating collaborative learning	8
	Assessment tool	4

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