Secondary Logo

Institutional members access full text with Ovid®

Assessing the Effectiveness of Using Mechanistic Concept Maps in Case-Based Collaborative Learning

Fischer, Krisztina, MD, PhD, MMSc; Sullivan, Amy M., EdD; Krupat, Edward, PhD; Schwartzstein, Richard M., MD

doi: 10.1097/ACM.0000000000002445
Innovation Reports

Problem Despite the advantages of using mechanistic concept maps (MCMs)—diagrams created individually or collaboratively by a team to foster inductive analysis of a clinical problem—in individual learning, very little is known about their benefits in collaborative learning.

Approach First-year medical and dental students (n = 170) were assigned to one of four learning groups in the Homeostasis I course, Harvard Medical School, February–March 2016. One group (n = 43) was randomly assigned to the MCM intervention; students in the remaining groups (n = 127) served as controls. Outcomes included pre- and postcourse surveys on, among other things, reasoning skills, attitudes toward teamwork, and tolerance of ambiguity; final exam scores; and qualitative responses to three open-ended questions on students’ perceptions of the effects of MCMs on their learning.

Outcomes Response rates for pre- and postcourse surveys were 87/170 (51%) and 91/170 (54%). Compared with students in the control groups, students in the MCM group reported better reasoning skills (P = .01) and attitudes toward teamwork (P = .02). There were no significant differences in final exam scores between the groups. Students in the intervention group found MCMs more helpful in conceptual learning than their own notes and flashcards (P = .0001) or the readiness assessment quizzes (P = .0009). Qualitative analysis indicated MCM students routinely overcame team-learning obstacles through strategies aimed at prioritizing collaborative inductive reasoning.

Next Steps Ongoing studies are evaluating the contextual elements and best practices for optimal employment of MCMs in promoting collaborative inductive reasoning.

K. Fischer is assistant professor of radiology, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts.

A.M. Sullivan is assistant professor of medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.

E. Krupat is associate professor of medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.

R.M. Schwartzstein is Ellen and Melvin Gordon Professor of Medical Education, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.

Funding/Support: This project was supported by the Spark Grant from HILT (2016).

Other disclosures: None reported.

Ethical approval: The protocol was deemed exempt by the Harvard Medical School institutional review board.

Previous presentations: A poster presentation about mechanistic concept mapping in case-based collaborative learning was presented at Medical Education Day, Harvard Medical School, Boston, Massachusetts, October 25, 2016. An oral presentation of part of the data was presented at Master’s Research Day, Harvard Medical School, Boston, Massachusetts, March 20, 2017.

Supplemental digital content for this article is available at,, and

Correspondence should be addressed to Krisztina Fischer, 221 Longwood Ave., Boston, MA 02115; telephone: (617) 525-7452; e-mail:

© 2019 by the Association of American Medical Colleges