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Medical Education 2010: 44: 440448 Objectives As the medical profession continues to change, so do the educational methods by which medical students are taught. Various authors have acknowledged the need for alternative teaching and learning strategies that will enable medical students to retain vast amounts of information, integrate critical thinking skills and solve a range of complex clinical problems. Previous research has indicated that concept maps may be one such teaching and learning strategy. This article aims to: i! review the current research on concept maps as a potential pedagogical approach to medical student learning, and ii! discuss implications for medical student teaching and learning, as well as directions for future research. Methods The literature included in this review was obtained by searching library databases including A"A#$%&" '$A("), $(&", $*'"+)ost, Psych&,-+, PsychA(T&".$', Pub%ed/%$#.&,$, "&,A). and $%*A'$. This literature review is a summary of both conceptual and empirically published literature on the uses of concept mapping in medical education. Results The 01 studies reviewed here indicate that concept maps function in four main ways: i! by promoting meaningful learning2 ii! by providing an additional resource for learning2 iii! by enabling instructors to provide feedback to students, and iv! by conducting assessment of learning and performance. Conclusions This review provides ideas for medical school faculty staff on the use of concept maps in teaching and learning. 'trategies such as fostering critical thinking and clinical reasoning, incorporating concept mapping within problem3based learning, and using concept mapping in group and collaborative learning are identified. ,ew developments in medical education include the use of serial concept maps, concept maps as a methodology to assist learners with lower cognitive competence, and the combination of group concept maps with structured feedback. Professional #evelopment 4 ,ew )ori5ons 4 6ournals 4 'pring 7898 4 The *rain Targeted Teaching %odel The *rain Targeted Teaching %odel Dr. Mariale Hardiman, Ed.D. "hair, &nterdisciplinary 'tudies in $ducation and Assistant #ean, :rban 'chools Partnership 6ohns )opkins :niversity, *altimore, %#

#uring the past decade the neurological and cognitive sciences have produced a vast frontier of knowledge on how the brain processes, stores, and retrieves information. As educators have increasingly recogni5ed their role as consumers of this emerging knowledge, translating brain research into classroom instruction often becomes a challenge for the typical educational practitioner. &n an era of high3stakes accountability for student performance, many teachers feel pressured to prepare students to meet proficiency levels on standardi5ed tests. At the same time, they are often re;uired to implement a plethora of ever3changing educational initiatives and reforms handed to them by well3meaning school district supervisors. &n this climate, it would not be surprising for new teachers to feel overwhelmed and seasoned teachers to view any educational initiative, including perhaps research in the neurosciences, as merely a fad that soon will be replaced by yet another new initiative. Perhaps this thinking accounts for the fact that educational research is largely ignored by practitioners2 as a result little actual change has occurred in our nation<s classrooms during the last several decades. &n order for any research, especially current brain research, to become readily accessible to teachers, fragmented initiatives must be integrated into a cohesive model of instruction. The *rain3Targeted Teaching %odel is designed to meet this need. &t provides teachers with a format for using research in the neurosciences as well as research3based effective instructional practices to guide them in planning, implementing, and assessing a sound program of instruction. The model also assists administrators, supervisors, and professionals supporting instruction as they guide teachers in implementing research3based effective teaching strategies. -irst, it might be wise to address those critics who scoff at the term brain3based learning. 'ome, for example, might contend that the term has no meaning since all learning is brain3based. =After all,> they may say, =we don<t think with our feet?> @e know, of course, that all learning involves the brain. Aet we also know that not all teaching results in learning. Thus, while all learning is =brain3based,> all teaching is not. :nfortunately, many teaching practices that regularly occur in our schools defy what neuroscience tells us about the brain<s natural learning systems. The language of this model, therefore, does not refer to brain3based learning but rather to brain3targeted teaching. The *rain3Targeted Teaching %odel presents six stages, or =brain targets> of the teaching and learning process and describes brain research that supports each stage. @hile each brain target is presented separately, the components are interrelated. -or example, *rain3Target +ne describes the importance of establishing a positive emotional climate to foster high levels of learning2 these strategies are applied throughout the entire model. At the same time, evaluating leaning, *rain3Target 'ix, is an integral part of each component or target of the model.



,euroscientists have recently described the intricate interactions between the emotional and cognitive brain systems. (esearch has shown that the brain<s limbic system, located Bust above the brain stem at the base of the brain, is responsible for our emotional responses. ,euroscientists tell us that information that comes to the brain is processed first in this emotional center before being processed in the cognitive or =thinking> center, located in the frontal lobe of the cerebrum. @ith information processing short3circuited first to the emotional center, chronic stress may impair long3term memory and deep learning. The effects of stress and threat on learning have clear implications for educators. @hile we may be unable to control all the factors of stress in the lives of our students, the adept teacher can minimi5e threat3causing practices within the classroom. At the same time, the teacher should maximi5e strategies that promote positive emotion. (esearch has shown that while threats impede learning, positive emotional experiences, during which the brain produces certain chemicals or neurotransmitters, can contribute to long3term memory. &n the *rain3Targeted Teaching %odel, teachers are encouraged to deliberately plan for positive emotional connections within the framework of a specific unit of study, referred to as a learning unit. 'uch connections include specific activities that will connect the students emotionally to the content. The infusion of the visual and performing arts is an effective way to tap into children<s emotional response systems to enhance learning and should be included within the activities of every learning unit.



@hile *rain3Targeted +ne focuses on establishing a positive emotional climate, *rain3 Target Two fosters the careful planning of the physical learning environment. @e know that our eyes register about 0C,888 visual images per hour, with about ninety percent of

the brain<s sensory input coming from visual stimuli. @ith this vast visual capacity, the active brain constantly scans the environment seeking stimuli. (esearchers tell us that the brain<s visual attending mechanism is strongly influenced by novelty in the environment. 'tudies compared the effects of bland, unchanging environments with classrooms that provided students with stimulation through fre;uently adBusting and changing classroom displays. -indings revealed that children were off task more often in settings that lacked novelty. 'ound, lighting, and scent also appear to have an effect on learning. 'oft background music can help to relax students and provide a comfortable learning environment. )owever, while performing tasks that demand high levels of concentration, a ;uiet setting appears to be most effective. &n studying the effects of lighting, researchers have shown increases in achievement of students who were taught in classrooms with the most natural and full spectrum lighting compared to dark classrooms or those with cool3white fluorescent lights Dosik E )eschong, 7888!. 'cent can also be used to enhance memory, as olfactory input moves directly to the limbic system or emotional center. This accounts for the vivid recollection that an encounter with a familiar scent may invoke. &n the *rain3Targeted Teaching %odel, teachers carefully plan the physical learning environment by deliberately planning for novelty, order, and beauty within each learning unit.

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*rain3Target Three encourages teachers to design the learning experience in a way that is compatible with the brain<s natural learning systems. @hile it may seem natural for teachers to write lesson plans that present information to students in se;uential order until all of the content has been covered, this approach may in fact impede learning. ,euroscientists tell us that the brain categori5es new stimuli into concepts that are either familiar or novel, then combines these concepts to create new patterns of thinking and understandingHa concept referred to as patterning. The brain filters new information through the lens of prior experience and prior knowledge in order to create new meaning. ,ew information, then, becomes integrated into a holistic pattern of cognition. &magine completing a Big3saw pu55le without ever having seen the overall image that the pu55le displays. @ithout giving students =big picture concepts> of the content that they will learn in a unit of study, students are often learning disconnected bits of information

that too often never come together into an overarching concept or pattern. .ack of conceptual understanding typically results in loss of retention of the disBointed facts and details. &n The *rain3Targeted Teaching %odel, teachers are encouraged to use content standards and curriculum guidelines to design overarching goals and concepts, then to display these learning goals in non3linguistic representations such as concept maps or graphic organi5ers. Activities are then designed to allow students to understand how the obBectives they will learn during the unit relate to the big picture concept. As they continue through the content, students are referred back to the concept map to reinforce the relevance of each learning activity.


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The next stage of The *rain3Targeted Teaching %odel is to engage students in activities that will enable them to demonstrate mastery of skills, content, and concepts. *rain3 Target -our promotes mastery of learning goals and obBectives by planning multiple activities to activate the brain<s memory systems. &n teaching for mastery, teachers must provide students with learning activities to create and sustain new engrams, or memory patterns. "ognitive scientists have identified three types of memory systems: short3term, working, and long3term memory. 'hort3term and working memory systems provide a form of temporary storage2 short term memory allows us to retain information for a few seconds or minutes, while working memory serves as a =desk top> for retrieval of information when it is in immediate use. +nce the brain determines that the information in our working memories is no longer needed, it is partially or totally forgotten. :nfortunately, too often what is presented in our classrooms is designed for students< working memoriesHstudents learn information so they can retrieve it on a test or ;ui5 then ;uickly forget much of it as they move on to the next topic. "learly the goal of teaching and learning is for students to ac;uire knowledge, processes, and skills that they can use to build new knowledge, a process that re;uires the use of long3term memory systems. .eading researcher on memory, .arry ';uire 7887!, tells us that the most important factor in determining how well we remember information is the degree to which we rehearse and repeat that information. *ased on the method and fre;uency of presentation, memories consolidate as the brain reorgani5es, modifies, and strengthens synaptic connections among neurons. #uring tasks that involve only working memory, the brain uses proteins that currently exist in brain synapses (atey, 7889!.

@hen information moves, however, from working to long3term memory systems, new proteins are created. $ffective teaching can result in biochemical changes in the brain? *rain Target -our of The *rain3Targeted Teaching %odel encourages teachers to plan for repeated rehearsals of content, skills, and concepts so that the information becomes part of students< long3term memory systems. 'uch repetition would be terribly boring for students and teachers too! if the same activities were presented multiple times in the same way. &nstead, teachers are encouraged to plan varied experiences so that students can manipulate information within a variety of modalities. The best way to accomplish this is through the integration of artful teaching into content instruction. &ntegration of the arts encourages meaningful connection to concepts, encouraging teachers to pair visual, kinesthetic, and musical thinking with linguistic learning tasks. As )oward Fardner 9IJ0! states, =The abilities involved with the visual arts, with sculpture or painting, with drama, mime, use of the body, with music, all represent separate sets of cognitive skills.> "ognitive learning and higher3order thinking can be enhanced with meaningful connection to the arts through such activities as musical performance, role3 playing, visual representations, creative movement, drama, poetry, and creative writing. *y providing students with multiple ways to manipulate content, skills, and concepts, teachers are not only promoting long3term memory but are providing the opportunity to differentiate instruction based on students< emotional needs, academic goals, and cognitive learning styles.

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The ac;uisition of knowledge is only the beginning of a sound instructional program. *rain research supports what educators know to be the hallmark of effective instruction Hlife3long learning best occurs when students are able to apply content, skills, and processes to tasks that re;uire them to engage in higher3order thinking and problem3 solving skills. :sing knowledge meaningfully re;uires students to extend thinking by examining concepts in deeper, more analytical ways, thus re;uiring the brain to use multiple and complex systems of retrieval and integration. *rain researchers have used the concept of the modular brain to describe differentiated functions of brain regions. %odules from one part of the brain connect to other modules when we perform complex tasks. (esearch has demonstrated, for example, that the motor cortex, originally thought only to control motor functions, becomes activated when the brain engages in problem3 solving that includes such cognitive components as memory, language, emotion, and active learning.

*rain3Target -ive promotes the use of performance3based instructional activities within each learning unit. 'uch activities re;uire students to engage in inductive and deductive thinking, analysis, and problem3solving skills. &t allows students to apply what they have learned in tasks that have real3world application. @ithin the *rain3Targeted Teaching learning unit, *rain3Target -ive activities include conducting investigations, designing experiments, creating metaphors and analogies, examining cause and effect patterns, analy5ing perspective, and engaging in creative thinking through the visual and performing arts.



@hile *rain3Target 'ix is the last stage of the *rain3Targeted Teaching %odel, each stage of the model includes evaluation activities. The goal of evaluation is to provide students with relevant feedback about their performance so that the student can adBust learning habits and the teacher can make sound instructional decisions. "ognitive science supports what teachers know by experience: &mmediate feedback strengthens learning and memory patterns. The *rain3Targeted Teaching %odel supports the use of an evaluation measure for each obBective and activity. &n addition to traditional grading methods ;ui55es, tests, essays, etc! evaluation measures should also employ a combination of tools including scoring rubrics, grading keys, and self3grading tools, student3generated reflections.

!HE BRAIN !AR"E!ED !EACHIN" $EARNIN" +NI! *y using the following format of the *rain3Targeted Teaching .earning :nit, teachers can be assured that they are implementing research3based effective teaching strategies as well as implementing what the neurological and cognitive sciences tell us about how the brain thinks and learns. Teachers who have implemented this model are ;uick to say that, while it re;uires more =front3loaded> planning than a traditional planning format, once completed they can focus on lesson implementation rather than planning for the two or three week learning unit time segment. They have also related that the model re;uires them to think more deeply about instructional implementation, fostering more creative and innovative lessons. *y using the *rain3Targeted Teaching %odel, teaching and learning not only becomes more effective, it becomes more fun? Please visit #r. )ardimanKs site on her *rain3Targeted Teaching %odel for 'ample :nits and a .earning :nit Template to help you plan your own units using this model.

#r. )ardimanKs latest book, Connecting Brain Research with Effective Teaching: The Brain Targeted Teaching Model! is available at the ,ew )ori5ons for .earning 'tore. Re.erences *arber, 6., *arrett, D., *eals, D., *ergman, .., E #iamond, %. 9IIC!. .earning About .earning. *erkeley: .)' F$%'. "aine, F. E "aine, (. 7889!. The *rain, $ducation, and the "ompetitive $dge. .anham, %#: (owman E .ittlefield $ducation #amasio, A. 7880!. .ooking for 'pino5a: 6oy, 'orrow, and the -eeling *rain. ,ew Aork: )arcourt. #iamond, %. E )opson, 6. 9III!. %agic Trees of the %ind. ,ew Aork: Penguin Froup. Fa55aniga, %. 7881!. The $thical *rain. ,ew Aork: #ana Press. Foleman, #. 9IIL!. $motional &ntelligence: @hy &t "an %atter %ore than &M. ,ew Aork: *antam *ooks. )ardiman, %. 7889!. "onnecting brain research with dimensions of learning. $ducational .eadership, 1I 0!, 17311. )ardiman, %. 7880!. "onnecting brain research with effective teaching: The *rain3 Targeted Teaching %odel. .andam, %#: (owman E .ittlefield $ducation. )ibbard, D. %. 9IIC!. Performance3*ased .earning and Assessment. Alexandria, VA: A'"#. )oward, P.6. 7888!. The +wner<s %anual for The *rain. Atlanta: *ard Press. 6ensen, $. 7888!. #ifferent *rains, #ifferent .earners: )ow to (each the )ard to (each. 'an #iego: The *rain 'tore. Dosik, D. '. E )eschong, .. 7888!. #aylight makes a difference: #aylight in the classroom can boost standardi5ed test scores and learning. $(&" #ocument: $# N19CJ Dandel, $. 788C!. &n 'earch of %emory: The $mergence of a ,ew 'cience of %ind. ,ew Aork: @.@. ,orton E "ompany. Daufeldt, %. 9III!. *egin with the *rain: +rchestrating the .eaner3"entered "lassroom. "hicago: Oephyr Press. .e#oux, 6. 9IIC!. The emotional brain: The mysterious underpinnings of emotional life. ,ew Aork: Touchtone *ooks.

%ar5ano, (. 6. 9II7!. A #ifferent Dind of "lassroom: Teaching with #imensions of .earning. Alexandria, VA: A'"#. %ar5ano, (.6., Pickering, #.6., Pollock, 6. $. 7889!. "lassroom &nstruction that @orks: (esearch3*ased 'trategies for &ncreasing 'tudent Achievement. Alexandria, VA: A'"#. (atey, 6.6. 7887!. A :ser<s Fuide to the *rain: Perception, Attention, and the -our Theaters of the *rain. ,ew Aork: Vintage *ooks. (ose, '. 7881!. The -uture of the *rain: The Promise and Perils of Tomorrow<s ,euroscience. +xford: :niversity Press. 'ilver, ). -., 'trong, (.@., E Perini, %. 6. 7888!. 'o $ach %ay .earn: &ntegrating .earning 'tyles and %ultiple &ntelligences. Alexandria, VA: A'"#. 'prenger, %. 9III!. .earning E %emory: The *rain in Action. Alexandria, VA: A'"#. ';uire, .. (. 7887!. %emory systems of the brain. .earning *rain $xpo: The *rain 'tore. Available: Tate, %. .. 7880!. @orksheets #on<t Frow #endrites. Thousand +aks, "A: "orwin Press, &nc. Tomlinson, A. A., E %cTighe, 6. 788C!. &ntegrating #ifferentiated &nstruction and :nderstanding by #esign: "onnecting "ontent and Dids. Alexandria, VA: A'"#. @iggins, F. E %cTighe, 6. 9IIJ! :nderstanding by #esign. Alexandria, VA: A'"#. @olfe, P. 7889!. *rain %atters: Translating (esearch into "lassroom Practice. Alexandria, VA: A'"#. Oentall, '. '. 9IJ0!. .earning environments: A review of physical and temporal factors.$xceptional $ducation Muarterly, N 7!, I8391. P%ay 7898 The 6ohns )opkins :niversity ,ew )ori5ons for .earning