This presentation is about managing time.

More specifically, it is about

managing time that is spent on learning.
Time spent on learning should emphasize long term memory in order to
reduce the need for inefficient, repetitive, comprehensive reviews before
exams.
With improved long term memory, exam prep becomes more integrative to
prepare for higher order questions.
When students truly learn how to learn, they learn how to integrate
knowledge through a process called the Experiential Learning Cycle.

This was covered in the video on the Neurobiology of Learning and is
also covered briefly in this video.

 Students enter professional education thinking that the medical school is

going to educate them.

Higher education provides courses that are structured and organized
around topics.

Completion of a course with a passing grade is supposed to indicate
that the student has been educated by the course.

This never happens the student only learns how to perform on the
next exam.

The student becomes familiar with facts and concepts but never uses
them to make decisions.

Courses taught by the case method are an exception, since the case
report is an application.
The only time education actually occurs is when the student connects new
facts with their application.

This is what medical school requires and what students dont expect.

Most medical schools excel in content organization and delivery, but
they suffer from inadequate application.

When medical schools require students to apply their knowledge, they
are helping the students educate themselves.

 Introduction provides some general reasons that concept mapping is both

needed and necessary.
Anatomy involves both structure and function of a concept map.
Construction shows how a map is orderly in a chaotic sort of way.
Examples illustrate how maps can vary for different topics and different
learning styles.
Barriers examines the most common reasons that students choose against
mapping
Recommendations provides a few tips for getting started successfully
more are available in the SuccessTypes book.

 Tool for organizing knowledge other tools are tables, lists,

cartoons/caricatures, and even highlighting.
Reading maps promote the deepest, most effective reading. Eliminates
need for re-reading since map becomes the reading.
Active learning active learning requires prefrontal decision making; maps
require constant decision making based on deep reading.

Gives students something to look for.
- Active: look for
- Passive: look at
Living maps grow with new learning; they should be saved for use
throughout medical training.
ADD/ADHD the requirement for inspection reading and deciding on where
concepts are entered into a map provides an ideal shifting of attention that
not only benefits big picture learners (easily distracted; low time-on-task) but
is ideal for the student who might be impaired by ADD/ADHD.
Visual representation - once a map is complete it represents the students
current understanding. Many linear learners, including faculty and residents,
actually find it clearer than text.
- Reveals gaps in understanding

 Deliberate Practice (DP) is a state-of-the-art concept that is used in several

areas of human performance, including medicine, with the purpose of
developing expert skills.
CM provides an opportunity for the basic elements of DP to be applied at the
beginning of medical training.
Mastery is hard to maintain and without deliberate practice skills deteriorate,
i.e. there is no standing still.
The sooner DP is understood and adopted, the better.

 One frequent comment is that, while it looks useful, its not for me.
This is an unconscious symptom indicating that the person is uncomfortable
when confronting their area of limitation in learning.

CMs reveal all stages in learning; thus, some stages are easier than
others.
They dont understand, yet, that expert learning is an acquired skill.
An acquired skill simply requires practice and expert skill requires
deliberate practice.

 Nodes, or bubbles that contain concepts.

Many nodes branch; creates a hierarchy

Some nodes are lists; integrates memorization within pattern
relationships

Connecting verbs or modifiers for clarity
Concept links create relationships; may contain descriptive text

Some links can converge on one node

Some links form cross-links between branches.
Hierarchical

Branch points represent levels in a hierarchy

Map hierarchy correlates with standard outline format
Alternate layouts

Top-down (preferred by linear learners)

Center-out

Sideways

1. The first step in mapping doesnt involve nodes or links, but rather a list.
It is critical to get a proper overview of the subject before starting
A map develops from its origin, generally entered at the top of the
map.
The initial list rarely includes only the terms for the first level, but is
rather a mixture of major topics
2. Scan the initial list and decide if some of the concepts belong within others
and note them with a checkmark or other indicator
The first level of concepts are added to the top node called the topic
node.
The first level concepts are the most general and they will include all
the remaining terms in the map linked in a branching pattern beneath
them.
3. Arrange the most general terms by attaching them to the topic node at the
top.
Try to estimate the spacing to allow the map to fill out the page evenly
After the major topics are entered, attach the remaining subtopics in
your list
 Important note! This may need to be redone as you complete the map and

discover better arrangements.

Redrawing maps decreases with experience, especially for sensing types
who tend to read linearly.
Be patient with yourself as you readjust to this new method of reading.
Feedback from many sensing type students indicates that this doesnt
just get faster, but it gets much faster than their original way of
reading!
Connecting verbs or modifiers added to the links can increase
understanding and benefit memory.

4. As you gain experience, you will begin to find ways of subdividing each topic
by branching.

You will begin to read paragraphs more thoroughly now and less by
scanning and inspection.

Many sensing types, at first, fill too many words in the nodes
reflecting their method of reading to memorize details.

Be patient with yourself for a while and fill in as much as you
want.

As you adjust to constructing maps, you will naturally begin to
find ways to subdivide.

You should take one thing at a time. First, inspection and
filling in nodes, then examining nodes to subdivide.

5. The identification of cross-links requires going back through the material to

find possible comparisons.

This is not a natural step for most sensing types who read linearly and
only going back to the beginning.

This step is important because it locates information that is on the

more difficult questions.

Finding cross-links also builds the analytic abilities of the brain that
are discussed later in this presentation.

6. The best overall pattern is the top-down

Top-down maps are preferred by most sensing types because they

reflect their linear reading pattern.

This is not a weakness, just a preference it is always best to work

through your preferences

Intuitive type students can use center-out or top-down, so why not use
what works for both types?

The examples that follow show how flexible a mapping system can be
The SuccessTypes book has many more examples.

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 This CM was produced by a first year resident physician on the topic of

seizures.

It illustrates several basic features of concept maps but lacks one very
important feature there are no cross-links.

The first level can be easily located from the main headings in a text
or lecture outline.

Note that not all nodes at the first level extend to equal lengths.

This reflects the content taught and reveals that not all of the material
in a lecture or reading assignment is covered in the same level of
detail.
It is not hard to imagine the map being extended and expanded as future
learning occurs.

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 This CM was produced by a third year resident physician on the topic of

seizures.

In comparison to the previous slide, it shows increased learning.

It is highly cross-linked and also has different entries in the level one
nodes.

This type of individualization of a map reflects the way this resident
has learned the subject.
Multiple versions of maps on the same subject can be equally correct.
Sensing types are uncomfortable with this aspect of mapping at first because
they need certainty that their map is correct

They dont trust any decision making that doesnt follow specific rules.

Their learning skills involving decision making (prefrontal) are greatly
strengthened by mapping.
Intuitive types generally benefit from an increase in time-on-task through the
back and forth process of constructing a map.

ADD/ADHD students also benefit for the same reason.

Intuitive types quickly adapt to organizing a map and they benefit from
having a place to organize the details that are their weakness.
Cross-links represent higher order learning: similarities, differences, cause-

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and-effect.

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 This CM is from the SuccessTypes book where it is described in more detail.

This is the first in a succession of maps where the mapping space is restricted
to one standard page.
This general overview helps students see the breadth of the topic where each
node represents an area to be mapped in more detail.
The expansion mode will specify where the map will continue.

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 As maps branch into subtopics, the students reading must involve decision
making and prioritization.
The amount of detail on any one page is an individual choice but a good
guideline is to leave white space for future notes.

This map on anatomy may be useful for recording notes on
musculoskeletal pathology
Maps help students think across disciplinary boundaries
Note that information on indexing a map helps keep organization for later
study.

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 While this map continues to subdivide the general topic of upper extremity
it is still not highly detailed at least not for a medical school gross anatomy
course.

This allows sensing types to discriminate between levels of complexity.

At first, sensing types view every concept level as a detail.

This is a result of their tendency to commit everything to memory.

Memorization bypasses decision making.

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 This map is approaching the final details.

Note that rotator cuff involves more than the muscle contributions
Each additional node attached to rotator cuff provides more complete
information that is related or grouped together
Each node requires a decision about organization.
Students report a feeling of satisfaction and control when completing a map
both of these emotions contribute to long term memory consolidation.

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 This map shows the final details of one of the muscles of the rotator cuff.
Any level of detail can be accommodated in a concept map.

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 Even complex structures such as the brachial plexus can be simplified with a
map.
Students often remark that when they look at their map the can understand it
better than reading the original text (and, faculty have made the same
comment!).

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 A map can organize and index concepts, but they cannot replace the hands-on
learning that occurs in the laboratory.
One reinforces the other.

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 This final level of detail could still be expanded with more nodes that add
clarity or integrate with another topic.
Note that any center-out concept map can easily be converted to top-down.
Most sensing types report that they prefer the top-down style intuitive types
dont care.

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 This is a CM of RNA tumor viruses this map was donated by Kenneth D.

Somers, Ph.D, a sensing type microbiology professor.

The linear orientation of the sensing type is clearly visible along with
the lack of cross-links.

Dr. Somers nevertheless believed that the map simplified his lecture
and made it easier to understand.
Note that this map could be improved by placing the branches involving an
oncogene (third level) side by side instead of on the edges.
This map uses connecting modifiers on the links to clarify the nature of the
association.

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 The Recall Level of learning is nothing more than the memorization of

individual facts.
The utility of facts is that they can be associated with other facts.
Separate facts on a page are still correct and contain information at the
simplest level.

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 The Analysis Level of learning involves an understanding of which facts have

something in common and what that commonality is.
If grouping terms exist, then a hierarchy is formed and an indexing system has
begun.
Note that the factual relationships can be quite varied.

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 The Comparison Level of learning involves the identification or recognition of

features in common between branches in the map.
Comparisons can be similarities, differences, and cause-and-effect
relationships.
This map reveals only one of the crosslinking nodes that are possible.
Crosslinks can also simple connect the two branches, with or without a
modifier.
Even the effort to fill in the connecting node will be remembered because the
composition was actively decided.
Finding crosslinks is a characteristic of self-directed learners.

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 The mapping process can be reduced to a simple sequence: List, Group, and
Compare.
The listing component reminds the student to survey and avoid seeking details
until the major grouping terms are identified.
The map is initiated by organizing the grouping terms so that there is space
for expansion beneath (top-down maps).

This step breaks the unproductive habit of the sensing type to begin
reading and memorizing in linear order without stopping to identify
comparisons and contrasts.
The map continues its development as more subgroups are added.
The compare step requires the student to look around.

This is natural for intuitive types and in ordinary reading it slows them
down.

This benefits the sensing types because it is usually not a natural part
of their reading.

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 The Cmap Tools program is provided free of charge by IHMC (Institute for
Human and Machine Computing).

It is very easy to use and students can store their maps in electronic
form.
A hand-drawn map is difficult to store electronically, especially on media that
cannot be scanned or photographed

However, there may be important eye-hand feedback mechanisms that
aid consolidation of memory.

Sleep research has shown that the brain rehearses learning behaviors
from the previous day during each REM cycle and this produces
consolidation of memory.

Perhaps the first map should be done be hand and then, time
permitting, converted to electronic form

The repetition of the map construction is not a waste since it will
contribute to myelination and strenghtening of synapses.

Youre going to be doing a lot of rearranging at first

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 This is a view of the Cmap Tools program screen

All nodes and modifier fields can be moved around by dragging with the
mouse pointer and the links retain their connection.

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 CMs benefit either learning preference: sensing or intuitive

Sensing and Intuition are considered the MBTI preferences that make
up learning style
Construction of a CM requires a sensing type to read deeper and more
effectively.

Sensing types eventually begin thinking in terms of grouping categories
and relationships.
Intuitive types see connections more readily, but maps help them discover
even more leading to increased learning.

Intuitive types are able to get control of those hard to memorize
details by hanging them on the edges of their maps.
Because CMs require both patterns and details, both sensing and intuitive
types develop their blindspot.

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 This slide is illustrated with the type of concept maps that each would
construct

Linear (sensing) types like maps that are top-down; matches their
comfort zone for thinking

Integrative (intuitive) types dont need a special layout and can
easily visualize dispersed or center-out pattern; matches their
comfort zone for thinking.

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1. New information from lecture or reading is organized by the brain in

the sensory area.

The sensory area is influenced by the temporal area since it

processes long term memory.

What you already know or remember influences what you hear

or see when you are learning.

2. The temporal cortex integrates new information with what is already

known.

During sleep, the hippocampus (just medial to the temporal

cortex) records important memories from the previous day
through the process of rehearsal.

Rehearsal filters out information that is not emotionally

important.

Rehearsal occurs during each REM (rapid eye movement) cycle

of sleep.

The new memory is established through the growth of new

dendritic connections with other neurons.

Blocking dendritic growth blocks memory.

3. The prefrontal cortex uses the new information in the temporal

cortex to create (hence, creativity) new possibilities or meanings

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from the new learning.

New possibilities are posed as hypotheses or questions about what

might be true.

The prefrontal cortex also eliminates unlikely possibilities and makes

decisions.

In other words, the prefrontal cortex is the part of your brain that
takes tests.

2. Prefrontal decisions are tested by motor activity.

Motor activity can be through speaking or drawing (writing)

Both speaking and drawing can be conducted with an emotional

connection

e.g. dialogue, map construction both have emotional components

Long term memory is impossible without an emotional connection.

3. The results of the motor activity are experienced as new concrete

experience.

And, the cycle continues

4. Thus, we think from back (temporal) to front (prefrontal), past to future.

The sensing preference would reflect preferred use of both sensory and
temporal processing.

Facts and simple concepts would correlate with the linear left
side of the temporal area.

Pattern memory would correlate with the integrative right side of
the temporal area.
The intuitive preference would reflect preferred use of right
(integrative) prefrontal processing.
The thinking preference would reflect preferred use of left (linear
logical algorithms) prefrontal processing.
The feeling preference would reflect preferred use of limbic
(emotional; hippocampus is limbic) and prefrontal processing.
 Note: I always refer to processing instead of contains or is found since the
actual location of memory or information is not known with certainty.

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Each step in the Experiential Learning Cycle can be a limitation.

1. Concrete experience

You may find that you are impatient and dont read everything.

You may find that when you read everything you dont know what to
look for so you wait for something to happen.

Other perceptual problems may involve physical reading problems

such as dyslexia or the Irlen syndrome (irlen.com)

2. Reflective observation

You may find that you have trouble recognizing patterns or

relationships in new material.

You may find that you are impatient with details.

You may find that you get distracted by interesting new information
and have difficulty staying on task.

3. Abstract hypothesis

You may find that you arent comfortable posing questions; you would
rather be told the questions by a teacher.

You may find that you need more certainty in wondering what patterns
exist.

You may think that your big picture is wrong.

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4. Active testing

You may find that you have never developed the habit of acting on
what you are learning

Many students enter medical school believing that continuing to sit and
read is all that is required.

You may find that you have never learned how to study with others.

You may find that you have never taken much time to represent what
you know in writing.

CMs address all of these limitations and correct them or lead to other corrective
actions.

Information learned in a study group using the question analysis method in

Chapter 8 of SuccessTypes helps with construction of CMs

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 Before a student will use concept mapping as an effective time management

and reading method, there are several barriers that must be surmounted.

The perception of time needed is a major barrier.

CM is a skill that must be learned before it is efficient.

Skill development takes time.

Without proof of the outcome, many students see it as a risk.
CM doesnt take any more time than any other method that actively organizes
material - the problem is that students are used to a receiver role and not a
producer role

The producer role is the only route to expert thinking
Sensing types have the greatest difficulty in giving up their ineffective linear
reading, but they become the strongest advocates once they are adapted to
it.
CM requires decisions and this produces fatigue.
CM construction also reveals limitations in the learning cycle and is
discouraging, at first.

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 Leave lots of white space. Maps grow. New information, new insights.
Students cant develop their learning if they dont make their own maps.
It wont help them to use someone elses map to study, but someone elses
map can help them refine their own.
I hope you are seeing the difference in reading someone elses thinking and
using someone elses thinking.

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 Maps grow because the curriculum is progressive, sometimes called

scaffolding.

Each step of the curriculum progresses through topics that serve as a
prerequisite to the next stage.

Anatomy of the heart precedes how the heart functions (physiology).
The decisions that go into producing a map can involve excluding some
information that is deemed low priority.
When students refine their maps over the weekend through dialogue and
selective reading, they never look at the course notes or the textbook again.

They only use CMs when reviewing for exams.
If two students construct their own maps, they can view them together and
compare their thinking.

Then both can enhance their own maps to reflect increased
understanding.

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 The magic is not in the map, it is in making the map.

Concept maps not only reflect understanding, they produce understanding.
Map creation is a discovery process. Discovery of relationships.
Understanding involves an awareness of relationships.
Discovery is a prefrontal function.

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 Introduction provided some general reasons that concept mapping is both

needed and necessary.
Anatomy involved both structure and function of a concept map.
Construction showed how a map is orderly in a chaotic sort of way.
Examples illustrated how maps can vary for different topics and different
learning styles.
Barriers examined the most common reasons that students choose against
mapping
Recommendations provided a few tips for getting started successfully
more are available in the SuccessTypes book.

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