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BMC Med Educ. 2016 Aug 22;16(1):216. doi: 10.1186/s12909-016-0734-x.

Visualizing complex processes using a cognitive-mapping tool to support the learning of clinical reasoning.

Author information

Department of Educational Information Technology, East China Normal University, KM&EL Lab, The University of Hong Kong, Hong Kong SAR, Hong Kong.
KM&EL Lab, Faculty of Education, The University of Hong Kong, Hong Kong SAR, Hong Kong.
Harvard Graduate School of Education, Harvard School of Public Health, Boston, MA, USA.
Department of Nephrology, Shanghai Jiao Tong University Affiliated First People's Hospital, Shanghai, China.
School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, Hong Kong.



Practical experience with clinical cases has played an important role in supporting the learning of clinical reasoning. However, learning through practical experience involves complex processes difficult to be captured by students. This study aimed to examine the effects of a computer-based cognitive-mapping approach that helps students to externalize the reasoning process and the knowledge underlying the reasoning process when they work with clinical cases. A comparison between the cognitive-mapping approach and the verbal-text approach was made by analyzing their effects on learning outcomes.


Fifty-two third-year or higher students from two medical schools participated in the study. Students in the experimental group used the computer-base cognitive-mapping approach, while the control group used the verbal-text approach, to make sense of their thinking and actions when they worked with four simulated cases over 4 weeks. For each case, students in both groups reported their reasoning process (involving data capture, hypotheses formulation, and reasoning with justifications) and the underlying knowledge (involving identified concepts and the relationships between the concepts) using the given approach.


The learning products (cognitive maps or verbal text) revealed that students in the cognitive-mapping group outperformed those in the verbal-text group in the reasoning process, but not in making sense of the knowledge underlying the reasoning process. No significant differences were found in a knowledge posttest between the two groups.


The computer-based cognitive-mapping approach has shown a promising advantage over the verbal-text approach in improving students' reasoning performance. Further studies are needed to examine the effects of the cognitive-mapping approach in improving the construction of subject-matter knowledge on the basis of practical experience.


Clinical reasoning; Cognitive mapping; Computers; Technology

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