Concept Maps in the Medical Education

The Role of Concept Maps in the Medical

Education
O Papel dos Mapas Conceituais na Educao
Mdica
Andria Patrcia GomesI
Udson Chandler Dias-CoelhoII
Priscila de Oliveira CavalheiroII
Rodrigo Siqueira-BatistaIII

ABSTRACT

As part of the medical education, due to the compelling changes required to produce a professional
who learns how to learn, the meaningful learning construct proposed by David Ausubel provides a
true contextualization of the knowledge needed for medical practice, allowing in this way a more effective learning and allowing it to be used in an interdisciplinary and complex context. Accordingly, this
manuscript aims to present the role of concept maps in medical education.

KEYWORDS:
Learning
Concept Maps
Medical Education.

RESUMO

No mbito da educao mdica, diante das imperiosas mudanas necessrias para a formao de um
profissional que aprenda a aprender, a aprendizagem significativa de David Ausubel permite uma
genuna contextualizao dos conhecimentos necessrios prtica mdica, facultando, portanto, um
aprendizado mais efetivo e permitindo a atuao em um contexto complexo e interdisciplinar. Em
conformidade com o exposto, o presente manuscrito objetiva apresentar o papel dos mapas conceituais
na educao mdica.

PALAVRAS-CHAVE:
Aprendizagem
Mapas Conceituais
Educao Mdica.

Recebido em: 18/04/2010

Aprovado em: 18/06/2010
I

Universidade Federal de Viosa, Viosa, RJ, Brasil

II

275

Centro Universitrio Serra dos rgos, Terespolis, RJ, Brasil.

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Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.

Centro Universitrio Serra dos rgos, Terespolis, RJ, Brasil; Universidade Federal de Viosa, Viosa, RJ, Brasil;

Andria Patrcia Gomes et al.

Concept Maps in the Medical Education

INTRODUCTION
Health professionals face new challenges every day. The medical profession has suffered changes not only in the quantity
of knowledges needed to be learned, but also in how this material is incorporated by the student. As such, the traditional
teaching model used in medical education has been questioned. Recognizing that knowledge grows in a spiral and that it
is shaped by the society to which it belongs, preserving a disciplinary perspective one that is dissociated from practice and
with teaching objectives focused primarily on the disease and
not on patient healthcare is not the most appropriate proposal for success. Taking these aspects into account, pedagogical
changes have been proposed which begin to configure a new
paradigm in the medical teaching1 aiming to transform the
student into a critical, reflexive individual who is able in his
practice to fully learn how to learn. Supported by this point of
view, this article broaches the concept of concept maps (CM),
aiming to open the discussion of this tool as an instrument to
be applied effectively to contribute to the realization of forming an effective physician2. Aiming to provide learning in
an individual way through the known meaningful learning
theory, a concept proposed by psychologist David Ausubel3,
in which knowledge is better spread when its built in an idiosyncratic way, the needs and limitations of the apprentice are
respected, exposing one to situations where learning is based
on previous knowledge, which is carried in ones own cognitive net. By doing so, an interaction between the individual
and the concept occurs, resulting in learning4. In this situation,
concept maps are tools used to expose the learner to previous
knowledge and to make it easier to visualize the existing links
in the process of the construction of knowledge.
1. CM: What are they? Where do they come from?
The concept map was developed as a tool to organize knowledge and as a way to represent it to oneself and for others5. Joseph Novak and collaborators developed this tool from David
Ausubels theory the meaningful learning theory , which proposes that knowledge cannot be properly constructed in an
arbitrary manner and based exlusively on memorization, but
rather should be (1) understood, (2) significantly relevant and
(3) well-integrated6. This is made possible by the assimilation
of the new proposals through pre-existing cognitive structures, as reasoned by Ausubel. Although the maps have not been
mentioned in the meaningful learning theory, they represent
an important tool for preparing previous organizers7.
Concept maps are also based on constructivist theories
such as Jean Piagets Genetic Epistemology theory, which postulated that previous knowledge is used as a net to understand

and learn new information. From his studies with children,

the biologist conceived that psychological development started at birth and ended in adulthood. For Piaget, this development was considered a progressive balance8. These references
bring a significant contribution to the discussion, since they
suggest evolution and conflict as driving forces in the search
for balance, characterizing moral and cognitive abilities not
as completely inherent, but as a result of complex interactions
between the individual and his environment9. The teaching-learning process is complex, dynamic, and doesnt happen in
linear form as an addition of subjects to those previously established or learned10. Therefore, teaching requires respect for
the autonomy and the dignity of each individual especially
in the core of a progressive approach, foundation for an education that takes into account the individual as a being who
builds his own history11 as are the aims at the core of adult
education. To educate is mainly to build12 and as such, the role
of the educator and educational institutions is certainly not
only to inform or simply transform the educational experience
into pure technical training12. Rather than simply depositing
inert subjects into the students mind, the teacher should also
learn alongside the student13. To achieve this, all available technology must be employed, including concept maps.
2. What is their importance?
Concept maps hold great potential for the student, both to
help in the formulation of new concepts as well to evaluate
the student in relation to learning14,15, mainly in the student-focused curriculum for example, based on active teaching-learning methodologies but also in the traditional educational curriculum14.
One of the main utilities of the CM in medical education
courses is the possibility of integrating various concepts16
which are frequently fragmented in many cognitive compartments CMs may help evidence the existing connections between these concepts, allowing establishment of probable means for integration. In a further analysis, the distinct concepts
are not static, representing a web that is joined by the relations
between the concepts that evolve in the cognitive structure of
the student, supported by the existing concepts that, handled
in an articulated way and respecting its own abstraction levels,
provides a solid base to be used daily17. The establishment of
a well-elaborated net of knowledge is a fundamental step in
the construction of any given subject10. Accordingly, the use of
concept maps prioritizes a meaningful learning experience and
this learning will promote creative production in real life18-20.
The health sciences area mainly when we think about
the education of physicians has significantly benefited from

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the use of this tool21. In fact, medical practice requires the development of critical thinking for problem solving and decision making, which contribute in a positive way to communication, diagnosis, and treatment of patients. Critical thinking
is an active process, considering that it evaluates and reflects
on all the evidence presented, proir to deciding what action
will be taken. This ability can be practiced, and most of all,
stimulated with the use of concept maps22. In fact, in a practice clinical situation, the student needs to assess the patients
history in order to properly develop the diagnosis and therapeutic conduct, which is very difficult when the knowledge is
simply memorized23. In this situation, concept maps may help
students in the establishment of a net of connections between
theoretical knowledge and real life24.
3. How is a concept map organized?
Concept maps can be organized in different ways, depending
mostly on the person that constructs them. The layout can be
organized25:
1. as a web, in which the main subject-matter is placed in
the middle of the map;
2. in a hierarchical fashion: showing the information on a
descending scale of importance;
3. as a flowchart: organizing the information in a linear
way similar to a books structure;
4. in a conceptual way: organizing the information in a
format similar to that of a flowchart, but with the possibility of inserting and excluding new concepts;
5. in a landscape structure: to be used in situations that
are required to display information in panoramic contexts;
6. the multidirectional structure (3-D): uses depth to represent relationships that cannot be shown with 2-dimensional maps;
7. the mandais: presents the information in geometric
forms, in which the telescopic characteristic allows a
visual effect focusing on ways to represent the users
thought process25.
A concept map must show how one piece of information
is related to another, why it is included, and what is its importance. This aspect must be visually clear in the map, in its
hierarchical structure and also in the connections made between the concepts inside the map through short sentences
like, need of, leads to, cause, inhibits, and
many other possibilities11,16. This is an essential part of the map
and cannot be underestimated; other peoples comprehension
of this part of the map and the correct interpretation of these

small links is essential; this way, it is possible to be sure that

the ideas displayed in the concept map wont be changed or
misunderstood20.
It is important to note that the concept maps structures
are not rigid, even having been the product of logical thought.
Actually, the maps are very flexible and are in constant change as new knowledge is acquired22. When new information is
obtained especially if it diverges from the concepts shown
in the map the student should place this new concept, changing part of the map and its structure, in a manner that the
harmony between the concepts is preserved when the whole
map is viewed. This type of change requires, in a way, a solid
foundation in the context of meaningful learning to be performed correctly13.
Early on, the elaboration of the maps depends on the
persons know-how to make them and on ones knowledge to
identify the relevant concepts and existing relations between
them. However, the ability acquired from working with the
maps will results in greater efficiency in their elaboration
therefore, with continued exercise, one tends to develop a higher competence to establish knowledge relationships. Figure
1 demonstrates an example of a web with little complexity and
another, more complex and well-established web is displayed
in figure 226.
4. How is a concept map built?
Although there are no strict rules for building a concept map,
usually the diagrammatic representation of concept maps are
created using arrows, but must not be confused with charts or
flow diagrams, as they do not have a sequence, temporality or
directionality, nor are they organized as or posses a power hierarchy. What is really important is that the map serves an instrument, able to evidence meanings given to concepts and the relations between them in the context of a given body of knowledge.
Nowadays there are softwares that facilitate the construction of maps, like the Cmap Tools developed and available
free of charge by IHMC University of West Florida (http://
cmap.ihmc.us/ )7,27,29.
To make a concept map under the view of an apprentice/
student, the following steps should be considered as a guide:
1) Brainstorming; 2) Organize the ideas; 3) Organize the concepts on the maps; 4) Relate the concepts; 5) Review the ideas,
concepts and the organization, making changes if necessary.
When under the view of a professor/master/organizer/teacher: 1) Identify the structure according to the teaching subject context; 2) Identify advanced organizers needed to reach
the meaningful learning of the subject; 3) Identify pre-existing
meanings in the apprentice/student cognitive structure; 4) Se-

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F IGUR A 1:
Mapa conceitual construdo por estudantes do curso de graduao em Medicina.

F IGUR A 2:
Mapa conceitual construdo por mdico com experincia em doenas infecciosas e parasitrias. Observar a maior riqueza de
conexes.

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quentially organize the subject and select the curricular tools,

using progressive differentiation and integrative reconciliation as programmatic principles; 5) Teach using previous organizers, to build links between the concepts that the student
already has and the ones that are required to learn, as well as
for the establishment of explicit relations between the new and
the preexisting knowledge that are able to give significance to
the new learning material15.
Based on these considerations, construction of the CM
should address the aspects described in Table 115.
TABLE 1
How to make a concept map
1

Identify the key concepts of the subject that will be mapped

and list them. Limitation between 6 and 10 (number of
concepts).

Order the concepts, placing the more general, more inclusive

ones at the top of the map and, gradually the others until the
diagram is complete according to the principle of progressive
differentiation.

Connect the concepts with lines and name these lines with
one or more keywords that make explicit the relationship
between the concepts, the concepts and the keywords must
suggest a proposition that expresses the meaning of the
relation.
Avoid words that point only to simple relationships between
the concepts. Search for horizontal and crossed relations

Include examples to the map, optionally, below the

corresponding concepts; the examples are placed at the
lower part of the map..

Review the CM thinking about another way to make it, other

ways to categorize the concepts. Remember there is no one
way to draw a concept map. As the understanding about
the relationships between the concepts changes, or as you
learn, your map also changes. A concept map is a great and
dynamic tool, reflecting the understanding of the maker at
the moment when it is built.

Share your concept map with friends and take time to

examine their maps. Ask what the relations mean, question
the location of some concepts, the inclusion of some that
dont seem important to you, the omission of some that you
consider essential. The concept map is a good instrument to
share, trade and negotiate significances.

Notes: 1 If for example, the map concerns a paragraph of text, the

number of concepts is limited by the paragraph. If the map
also incorporates your knowledge about the subject, beyond
the content of the text, more specific concepts can be included
in the map.
2 Avoid the use of words that indicate trivial relations between the concepts. Look for horizontals and crossed relations.
3 Usually, the first draft of the map has poor symmetry and
some concepts or groups of concepts are misplaced in relation
to others that are better related. The review is important to improve these aspects.

5. What are the benefits of concept mapping?

The benefits obtained with the application of concept maps
are many. Difficult concepts are approached in steps, improving learning and making them easier to understand5. The
information on the map can be shown in a long way or in a
short way, with no loss of information, complexity or significance22. Concept maps can also be a great studying tool when
reviewing ideas, as they facilitate the organization of information for the student5,14, since they can use concept maps
to integrate, reconcile and differentiate concepts11. The maps
facilitate learning a subject because the students use logic to
reach their own conclusions22. They also take into account the
students previous knowledge, recognizing it as essential to
the acquisition of new concepts and theories20.
Furthermore, the maps have the benefit of visually displaying the information acquired, which helps students who
have a visual memory and who learn by seing24. Equally
important, the maps help the students to have inter- and
multidisciplinary learning28. Oftentimes otherwise excellent
students have difficulties associating concepts from different
disciplines, they may see things more clearly with concept
maps20. Students may become more independent and responsible for their learning, developing self-confidence, and
attaining a more significant and personalized learning30. As
the study process becomes more autonomous, students with
greater difficulties have more chances of obtaining help from
the teachers5,30. Nothing prevents that other students help the
ones with difficulties, since in this situation no one is the sole
holder of knowledge.
As an instrument of evaluation of learning, concept maps
can be used to obtain visualization of the concept organization that the apprentice gives to certain knowledge15. Additionally, concept maps have been shown to be an effective tool
in associating practice and theory, extinguishing the distance
between them and allowing a dynamization of subjects while
facilitating contextualization. Another point to be emphasized
is the association the various concept maps, which provides
for the creation of more complex and comprehensive structures, and can even assess the understand and learning in a
study module within a course. This design also allows, depending on the timing of the CM, for verification of the content in
the students memory, both immediately after study and later
over the course of his education31.
6. Which are the challenges?
Some studies show limits with the use of concept maps, which
are mainly related to the lack of ability in dealing with this
instrument or even to inexperience with the method31-33. These

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limitations decrease as the students get grow accustomed to

the method and its applications.
Marangos e Alley32 demonstrated that despite the fact that
students pointed out the maps as useful tools in the process of
test preparation and subject summaries, few of them used the
maps effectively. In this case, the students used the concept
maps mainly for test preparation32.
Another difficulty concerns to the application of the CM,
in a fast and practical way for the performance of some activities, such as an outline of an essay to be written33. There are
also obstacles for the capacitation of individuals in the access
and use of the software, which allows for the construction of
maps in a fast and effective way31. In this context some knowledge and ability to work with computers is required, which
may limit its use in areas with poor technological structure
and low digital inclusion.

the maps and the ones who gave correct estimates of their caloric intake showed more knowledge about the restriction of
food intake when on a diet.
IN CONCLUSION
The cognitive processes implicated in teaching-learning are
widely varied, and based on this diversity, it is important to
use varied tools to enhance the construction of knowledge.
Considering medical education specifically, more and more it
seems that the use of an isolated method, whether traditional
or expositive classes or problem-based learning, brings limitations, depending on the peculiarities of each student. Supported by this premise, the discussion about the increase in
learning from the use of new techniques, new methods, and
new tools a genuine methodological plurality must always
be present and conscious. The use of the concept map can represent another strategy for medical education.

7. What are the applications of concept maps?

In the area of medical education, concept maps can be used
to15,17,15,34: (1) organize and analyze a curriculum into a logical
sequence of concepts, (2) facilitate refinement and improvement of concepts in the cognitive structure as a didactic technique, (3) present the knowledge through its hierarchical
structures, (4) allow the student to internalize his concepts,
building his own conceptual map, (5) lead the student to meaningful learning and (6) as an assessment tool. About this last
topic, the first step for the use of concept maps in the evaluation of a student is to identify and formulate the assessment
criteria. Accordingly, grading is based on the organization and
quality of each component of the map14. The number of connections and overall integration of the exposed ideas can also
be analyzed. West et al. propose that concept maps and traditional tests measure distinct cognitive domains, therefore they
may complete each other26.
Another application of the concept map is in the facilitation of learning a second language, through a positive impact
on the process of planning and organization of the study or
even in preparation for the execution of tasks and in preparation for testing, which can be also be useful in the health area
(for example, in relation to the Spanish language)33. There are
many well-structured studies in the area of medical education
and also in health education area about the application of
the CM in the process of teaching-learning13,35. For example,
Frana et al 35 used concept maps to explore the existing knowledge of obese patients in order to determine how best to
educate them35. The results with concept maps showed some
differences between the patients: those who underestimated
their caloric intake, for example, expressed more feelings on

ACKNOWLEDGEMENTS
The authors are grateful to Prof. Dr. Mauro Geller by thorough
review of article.
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CONFLICTS OF INTEREST
The authors had no conflicts of interest.

AUTHORS CONTRIBUTIONS

MAILING ADDRESS

Andria Patrcia Gomes conceived the research project. All the

authors participated in the development and final version of
the article.

Andria Patrcia Gomes

Departamento de Medicina e Enfermagem
Universidade Federal de Viosa
Av. PH Rolfs, s/n Campus Universitrio
Viosa - CEP 36570-000 MG
E-mail: andreiapgomes@gmail.com

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