How to Develop and Utilize Cognitive Learning Theory-Supported Mind Maps for Health Professional Students and Educators

As new information is continuously added to medical school curricula,¹ surgical educators and students are required to develop new methods to learn and retain knowledge.^1–3 Cognitive learning theory (CLT) posits learning can be easier if the processes that support effective cognitive functions are upheld. However, because of the somewhat frenetic pace of most school curricula, many students instead develop information overload—the difficulty of comprehending and making appropriate decisions due to the presence of large amounts of information.^4,5

Graphic organizers are a well-established learning method in the K–12 literature.⁶ Specifically, graphic organizers help enhance critical thinking by organizing thoughts, create associations between concepts, and help assimilation of new knowledge into an existing schema.^7,8 A mind map is an example of a graphic organizer and is defined as a visual nonlinear representation of ideas and their relationships to each other.⁹ A mind map is a radial graphic representation of ideas. It is comprised of a central idea, main or primary branches, and secondary or child branches that describe a certain topic and, at the same time, create hierarchy. Colors and pictures are added to facilitate learning and arrows are added to create relations between concepts.⁹ Mind mapping differs from concept maps in that it is a more flexible, pictorial, and rapid visual technique of associations between ideas. On the other hand, concept maps are more structured and permit a relational analysis of concepts.^10–12

Different studies have started exploring the potential efficacy of mind mapping in the medical field.^11,13–15 A meta-analysis evaluating academic achievement, attitude, and retention through a pretest and posttest approach found that mind mapping had a positive effect on all measures compared with traditional learning methods.¹³ In contrast, other results have shown no difference between mind map versus standard note taking in terms of short-term recall or critical thinking.^14,15 This conflicting evidence in the literature is likely related to the different instructional methods that are used when mind maps are being taught and implemented as a learning and teaching tool.

A minimum amount of time is required for students to become familiar with the process of drawing a useful mind map.^7,14,16 Learners are typically taught how to create a mind map in a rapid introductory class lasting only a few weeks before a topic examination. Quick training periods require students to change their previous note-taking schema in a short period of time, which may increase student anxiety and affect their understanding as well as motivation to learn.¹¹ Although mind maps are flexible and creative, CLT emphasizes that engaging a new study strategy can be initially suboptimal, time-consuming, and cognitively challenging for medical students.^8,16 With the goal of simplifying the process of implementing mind mapping as a learning and teaching tool in medicine, we present a practical guide on how to develop medical mind maps. In addition, learning theory principles will be used to explain the reasoning behind each one of the steps needed to develop a medical mind map.

This paper will discuss the advantages of using mind maps in the context of CLT with the aim of encouraging readers to begin using mind maps as a teaching and learning tool. This guide could be used to develop mind maps in different contexts, including:

• A medical student trying to learn a topic during a clinical rotation or in preparation for an exam
• A faculty member trying to teach a lecture
• During rounds

The following example is described in the context of a clinical medical student who is trying to learn the differential diagnosis of acute right-upper quadrant (RUQ) abdominal pain on his/her/their surgical clerkship. The same steps can be used by a faculty that wants to teach about the differential diagnosis of acute RUQ pain during a lecture or during rounds. The steps necessary to develop a mind map based on CLT can be divided into a pre-mind mapping phase and a mind mapping phase.

Pre-Mind Mapping Phase

Prior to drawing a mind map, it is important to activate prior knowledge about the chosen topic by exploring the layout of the text that will be mapped. Quickly scan through the text’s title, subtitle, heading, and visual representations. This will help to focus attention and reduce the complexity of the topic.¹⁷ Additionally, it will help to start the process of thinking about the central idea and its branches. In this example, the student will develop two mind maps—one of the RUQ anatomy and one of the RUQ pathology.

Mind-Mapping Phase

Creating a Central Idea

Think about the central idea as the title of the mind map. Create a central idea by writing it in the center of a landscape-oriented paper. Next, draw a picture that will represent the central idea. Finally, draw a circle or square around the central idea and the central idea picture (Figure 1).

Branching Out the Mind Map

There are two types of branches: primary branches and secondary branches.⁹ The primary branches are basic ordering ideas that represent the main topics of the material to be learned. In this case, we chose to organize them using the RUQ abdominal structures.

• Selection of primary branches: Select between four to seven important topics that describe the central idea. Those will become the primary branches. Figure 2 shows the central idea and four primary branches: hollow viscera, abdominal wall, other organs, and vessels. By limiting the number of branches to less than seven, the learner is reducing the information overload or cognitive load. Cognitive load can be defined as the mental resources activated when completing a task.¹⁸ Based on CLT, short-term memory or working memory (WM) is limited in capacity and duration, meaning that it can only receive determined amount of information in a short amount of time.¹⁹ Regarding its capacity, the “magic number seven,” or Miller´s law, describes that WM is limited to retain 7 +/- 2 chunks of information at once.^20–22 Therefore, branches coming out of the central idea should be limited to avoid overloading WM and allow transfer of information to be saved in long-term memory (LTM). Nonetheless, creating the map with limited main branches creates an organized schema, exactly as LTM does when it receives new information.

• Selection of keywords per branch: It is very important to limit the amount of words used for each branch. Using less words facilitates learning by decreasing extraneous load. Extraneous load is one of the three types of cognitive load that constructs WM. It represents how the information is presented and it does not interfere with the instructional goal of learning.²³ In medicine, it might be hard to follow this rule because as complex descriptions will appear, but you should try your best to chunk, classify, or associate concepts.
• Coloring branches: Each main branch must have a different color and should be followed by secondary branches with the same color. Color is a variable that enhances retrieval and memory performance. It stimulates sensory memory, which is the first memory that receives information, and facilitates transfer of information to WM.²⁴ It also creates a visual identification of categories. Besides being part of the sensorial memory, color is identified inside the theoretical definition of WM. Colors and words will stimulate the visual sketchpad of WM and help perceive information as easier to understand. Choose colors that contrast (purple/orange) as they attract more attention and increase visibility.²⁴
• Hierarchy: It is important to demonstrate hierarchy between primary and secondary branches. As described by Buzan’s model of mind mapping, thicker lines are used for main branches and they should get thinner as more levels are added.⁹ Text size can also be decreased as more levels are added. This approach creates categories inside a same concept, establishing boundaries and organizing groups with similarities. Categories give order and help the learner remember information easily.²⁵ They decrease cognitive load by reducing extraneous load and enhance intrinsic load—the information to be processed—by creating chunks of information easier to process in WM and consequently to be moved to LTM.
• Adding secondary branches: Try to limit the number of upcoming levels when creating secondary branches to four. Based on CLT, this limitation decreases overall cognitive load and forces you to analyze and select the most important concepts to add to the map. The process of selection creates a high-low yield classification that coincides with the process of how thinking schemata select relevant information and screen out unnecessary material to interpret it meaningfully.²⁶ Figure 3 shows central idea, primary branches, and secondary branches.

• Space limitation: Don´t forget that space is limited to a piece of paper, so try to imagine how the map will look at the end and try to make it as uncrowded as possible. As a suggestion to reduce space, the length of the branch should be equal to the length of the keyword.⁹

Once you are finished, you will notice that your mind map will likely look different than other mind maps about the same topic done by other students or faculty. This is expected as the mind map will reflect your unique understanding of the topic. It is important to remember that adding, exaggerating, distorting, and removing irrelevant details will enhance the process of learning.²⁵ As a next step, think of another topic that builds or overlaps from your first mind map. In this example, it could be acute right-lower quadrant abdominal pain. Overlapping maps exemplify constructivist theories of learning that emphasize the need to scaffold new information onto previously created thinking schemata in order to construct new knowledge.¹⁸ It is possible to compare thinking schemata to graphic organizers. Both of them chunk information; facilitate selection, organization and processing; and expand LTM.^25,27 Overlapping or consecutive mind maps between two subjects will allow you to more clearly see the association between both subjects.

Additional Steps for Consecutive Maps

Adding Diseases to the Mind Map

Notice that in Figure 4 the diseases are located at the end of each branch; everything else is practically the same as the first map. The map guides you from the structures towards their pathologies, instead of trying to make you memorize facts beginning from a disease as done by learning from linear textbooks.

Technology Resources

Mind maps can also be made electronically using a variety of paid and free resources as illustrated in Table 1. Depicted mind maps in this paper were created using the MindMeister web app. Directions on the use of all of these applications is beyond the scope of this paper, but we encourage you to experiment. Advantages of electronically created mind maps include the ability to share mind maps electronically and also allow students to build mind maps collaboratively.

The authors sincerely hope that this paper is helpful as one thinks about teaching and learning using mind maps in a manner consistent with CLT. Please do not hesitate to contact the authors through their email information below with any specific questions or concerns.

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We want to acknowledge Dr. Namirah Jamshed for her contribution to the initial manuscript.

Pablo Buitron de la Vega, MD, MSC, is an assistant professor at Boston University School of Medicine and Boston Medical Center, MA.

Maria Jose Sanchez, MD, is a graduate student at Milken School of Public Health, George Washington University, Washington, DC.

Roy Phitayakorn, MD, MHPE, is an associate surgeon at Massachusetts General Hospital, and an associate professor of surgery at Harvard Medical School, Boston, MA.

Lindsay Demers, MS, PhD, is an assistant professor, Boston University School of Medicine, MA.

Wazir Kudrath, MD, is chief executive officer, Kudrath Health Education and senior faculty, Kaplan Medical, League City, TX.