Application Value of Mind Mapping and Self-Drawing in the Residency Standardized Training Examination During the COVID-19 pandemic

doi:10.21203/rs.3.rs-2430462/v1

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Application Value of Mind Mapping and Self-Drawing in the Residency Standardized Training Examination During the COVID-19 pandemic

https://doi.org/10.21203/rs.3.rs-2430462/v1

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Purpose To explore the effect of mind mapping and self-drawing on medical residents preparing for the standardized national residency training examination.

Methods Eighteen residents (third year) in an ultrasound program were enrolled in this study. All residents used traditional methods plus mind mapping and self-drawing to study for the examination. The effect of the learning methods on residents was evaluated and analyzed by test scores and surveys.

Results The mean pretest score was 74.33 ± 11.08, compared to a mean posttest score of 89.54 ± 4.21. For each body system— urology, obstetrics/gynecology, cardiology and alimentary system— posttest scores were significantly higher than pretest scores (P < 0.01). The difference was not significant for the superficial and general principles of the ultrasound system (P = 0.94, 0.13). However, overall, residents obtained significantly higher practical posttest scores than those on the pretest (P < 0.01), and the level of satisfaction among residents was high(94.4%).

Conclusions Mind mapping and self-drawing can be applied to the review process for standardized residency training examinations and can help medical residents improve review efficiency and retain medical knowledge.

mind mapping

self-drawing

ultrasound

residents

COVID-19

Medical education has progressed significantly in recent decades, especially in the COVID-19 era. However, health professions educational institutions have been affected by the pandemic, significantly more than other educational institutions [1]. In response to the COVID-19 pandemic, many clinical and face-to-face teaching methods were suspended [2–4]. However, as an essential standard for the health care industry, the standardized national residency training examination is required to complete residency training in China. With a large number of questions and a wide range of knowledge, it is difficult for residents to understand and grasp the key points of the residency standardized training examination in the face of the massive clinical knowledge system. Mind mapping, as a scientific and effective learning tool invented in 2010, can help residents summarize their knowledge and better grasp clinical knowledge [5]. It uses the technique of focusing on both graphics and text to show the relationship between the topics at all levels with mutual affiliation and related hierarchical diagrams and to establish the memory link of the topic keywords with images and colors [5–7]. Mind mapping is based on the characteristics of brain radioactivity as expressed through graphs [8]. Self-drawing is based on the idea that pictures and drawings are effective tools for clinical teaching, especially when combined with the method of gradually solving clinical cases. Previous studies have shown that educational tools that offer explanations, drawings, illustrations, practice questions, and additional guidance provide additional practice in drawing the structures and pathways themselves [9–10]. However, no research on residents applying mind mapping and self-drawing has been conducted. Therefore, this study aims to explore the utility of mind mapping and self-drawing to introduce the learning process of the examination, to facilitate residents' interest in learning, to improve their learning initiative and learning efficiency, and thus to increase the passing rate of the national residency standardized training examination.

The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZJU) is an academic center that houses a 3-year residency program training and is also a tertiary care facility. Ultrasound (US) residents at our center in year 3 of the training program both before and during the pandemic from September 2019 to July 2022 were prospectively invited to participate in this study. All 18 residents were licensed and had more than 2 years of experience in our department. The committee on ethics and clinical investigations of SAHZJU approved this study (NO. 2021 − 1088). Verbal and written consent was obtained from each resident. Before the start of the study, each resident completed a theoretical and practical pretest to determine the baseline levels. The review lasted for 8 weeks and was divided into 8 parts, with one week for each of four systems (urology, obstetrics/ gynecology, superficial and general principles of ultrasound) and 2 weeks each for the cardiology and alimentary systems.

Lectures and talks on clinical topics (8 classes, 1 hour per class) were delivered online using the teleconferencing program Ding-talk (Ding-talk Communications, Alibaba, China). In this course, residents were introduced to the comparison of normal anatomy and physiology to pathological features and the differential diagnoses of such findings. As residents worked through the review, they were prompted to draw their own pictures depicting anatomy and mind mapping to guide their learning and understanding of the material. Premade pictures were also provided within the clinical thinking lectures for residents to reference after completing their own drawings.

There were exams at the beginning and end of each review, and at the end of the study, residents completed a written posttest. The questions were divided into three categories: knowledge-based (35 points), interpretation (25 points), and clinical decision-making (40 points) for both pre- and posttests. All residents underwent a proctored practical test in which they were graded on their ability to perform an ultrasound examination using a revised version of the Objective Structured Assessment of Ultrasound Skills (OSAUS), which is the assessment method we have always used [11]. The maximum score of the OSAUS assessment is 100, and a passing score is 80.

A survey in the regional language was used to evaluate satisfaction with teaching methods leading up to the examination. The questionnaire was designed by a qualified radiologist (ZM Lin) after consulting with a psychologist, but it was not validated. The content validation was used to determine whether the questionnaire measures what it was designed to measure. The degree of satisfaction with the teaching mode includes satisfaction (80–100 points), general (60–80 points) and dissatisfaction (less than 60 points). Then, the satisfaction degree was calculated according to the formula: satisfaction degree = satisfaction rate + general rate.

Statistical Processing

SPSS 23.0 software was used, and the Kolmogorov–Smirnov test was used to judge whether the data presented a normal distribution. Normally distributed continuous parameters are shown as the means ± standard deviations, and nonnormally distributed parameters are shown as medians (interquartile range). The t test was used to measure the data. Scores on pretests and posttests were compared using a Wilcoxon signed-rank test to assess individual differences (paired analysis). P < 0.05 was considered a statistically significant difference.

A total of 1 resident with a Ph.D., 6 residents with master’s degrees, and 11 residents with bachelor’s degrees participated in this study. Among them, there were 4 male residents and 14 female residents, ages 25 to 33, with an average age of 28.1 ± 2.6 (Table 1).

All 18 residents completed the study. The mean pretest score was 74.33 ± 11.08, compared to a mean posttest score of 89.54 ± 4.21, P < 0.001. There was a significant increase in the scores from the pretest to the posttest. For the review of each system, all the posttest scores of urology, obstetrics and gynecology, and cardiology and alimentary system were significantly higher than that of the pretest score, except for the superficial and general principles of the ultrasound system (Table 2).

However, all residents’ scores on the practical posttest were significantly higher than those on the pretest.

Comparing the satisfaction level of the residents in the study, we found that the overall satisfaction level of the residents was high (Table 3).

Medical learning contains not only the basic elements of memory learning but also the essential foundation of systematic and comprehensive learning. However, most residents usually employ mechanical memorization and often expend great effort without any reward [12–13]. Resident education is one of the most important parts of medical education. As is well known, medicine involves many disciplines, such as human anatomy, physiology, psychology, pathology, biology, and chemistry, with a large number of difficult materials for residents, especially ultrasound residents.

The tree diagram is used to present the thinking process in mind mapping. Learners rely on this visual graphical tool to promote the structuring and integration of medicine knowledge, establish links between types of disease knowledge, and form medical networks [6–8]. Studies have shown that hand-drawn pictures are helpful in medical education [14–15]. We wanted to incorporate the idea of resident-generated visualizations as a tool to facilitate review for examination. A resulting significant increase in the scores from the pretest to the posttest showed that this method is effective. The longevity of changes due to the COVID-19 pandemic is indeterminate, which has affected conventional ultrasound education and training. The improvement of scores indicated that this method is useful for residents to review during the epidemic period.

The process of mind mapping is similar to the pattern of neural networks in the brain and is a method to realize radioactive thinking [5–7]. Mind mapping allows residents to draw different images and build their own brain maps vividly using lines, colors, pictures, arrows and multidimensional graphics, by which they can sort out knowledge from the overall level, build a knowledge structure and integrate it from the overall perspective. In this way, learning can achieve twice the result with half the effort and lay a solid foundation for the test and the future medical road [16]. It has been proven that in the medical school environment, self-drawing helps learners gradually learn anatomy, simplifies complex subjects, improves learners' confidence, and maintains overall learning satisfaction [17–18]. Our study showed that the posttest scores of urology, obstetrics and gynecology, and cardiology and alimentary system were significantly higher than those of the pretest scores; however, no significant differences in scores were found for the superficial and general principles of the ultrasound system.

The reasons may be as follows: 1) compared with other systems, the superficial system is relatively simple for residents; 2) the general principle of ultrasound is mainly related to acoustics and physics. Mind mapping and drawing might not be helpful in this field; 3) the initial performance of the residents was very good (top 2 prescores before review: 86.4 and 88) and does not leave much room for improvement.

The intention of resident standard education is not to obtain good examination scores but to train good clinicians. Although it is necessary to establish an appropriate mechanism to ensure the quality of our residents and to monitor the effectiveness of our education, as long as the examination properly reflects the nature of our education and training, good examination results should only be a byproduct of well-educated and trained residents [19]. Mind mapping and self-drawing are ideal learning strategies for residents preparing for the examination, as the activity requires residents to directly visualize the anatomy and the disease and to check their understanding at the same time [20–21]. Mind mapping and self-drawing may address any aspect of health care education and training, including but not limited to residency education. In addition, creating visual explanations has been shown to benefit students who have varying levels of spatial abilities [22]. The survey in our study showed that residents' satisfaction level was high, and most residents thought that mind mapping and self-drawing were effective in standardized residency training examinations.

There are several limitations to this study. The sample size was small, and the study was conducted in a single center.

Before and during the pandemic, all participants were residents in ultrasound in their third year of the center’s training program. Thus, the results may not be generalizable to students in other majors, and caution should be exercised when analyzing the results. Furthermore, the questionnaire was not validated. Additional studies involving students in other majors in multiple centers in other parts of the world would be valuable research opportunities in the future.

In summary, mind mapping and self-drawing can be applied to the review process of standardized medical residency training examinations to help residents improve review efficiency and retain medical knowledge.

Disclosure Statement: there are no relevant financial or nonfinancial competing interests to report.

Ethics approval and consent to participate

The ethics committee of our situation (The Second Affiliated Hospital Zhejiang University School of Medicine and The First Affiliated Hospital of Zhejiang Chinese Medical University) approved this study, and written informed consent was obtained from all patients before CEUS.

Consent for publication

Consent for publication was obtained from that person all patients.

Availability of data and materials

The datasets used during and/or analyzed during the current study are available from the supplementary materials and the corresponding author upon reasonable request.

Disclosure of interest

The authors declare that they have no competing interests.

Funding

This study received funding from the Medical Scientific Research Foundation of Zhejiang Province, China (Grant No. 2022480391).

Authors' contributions: All authors contributed to the conception and design of the study. The entire study was chaired and revised critically for intellectual content by PT Huang and YR Hong. ZM Lin contributed significantly to the analysis and manuscript preparation and wrote the manuscript. ZM Lin, C Zhang, HL Pan, W Xu, YR Hong, and PT Huang helped perform the analysis with constructive discussions. All authors read and approved the final manuscript, and all authors agree to be accountable for all aspects of the work.

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table 1 To 3 Are Available In The Supplementary Files Section.

No competing interests reported.

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Application Value of Mind Mapping and Self-Drawing in the Residency Standardized Training Examination During the COVID-19 pandemic

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