Research article
Open Access

Retained mind mapping skills and learning outcomes in medical students: a mixed methods study [Version 2]

Tharin Phenwan[1][a], Weeratian Tawanwongsri[2]

Institution: 1. Walailak University School of Medicine, Thailand; School of Nursing and Health Science, University of Dundee, 2. Walailak University School of Medicine; Division of Dermatology, Faculty of Medicine, Ramathibodhi Hospital
Corresponding Author: Dr Tharin Phenwan ([email protected])
Categories: Assessment, Students/Trainees, Behavioural and Social Sciences, Undergraduate/Graduate
Published Date: 19/10/2018

Author Revision Notes

1) Added context section to describe the school of medicine and its curriculum
2) Added more explanation on methodology sections
3) Added more references

Abstract

Background: Mind maps (MM), is a learning method assisting learners in the visualisation of relationships between theoretical concepts. Studies showed the enhancement of data retention, overall comprehension, and creativity in MM users. Thus, MM has been implemented in many medical schools to facilitate medical students’ learning experiences. However, retained mind mapping skills and its effect on the learning outcomes in the long-term follow-up remain unknown.

Methods: A concurrent mixed-methods design with convenience sampling method. All (48) second-year medical students joined a three-day MM workshop in 2016. One year later, we surveyed the students who still use MM and those who did not. Mind Map Assessment Rubric (MMAR) and Grade Point Average (GPA) were compared between the two groups. Content analysis with data triangulation method was used to explore their preferences and MM skills.

Results: We achieved a 100% response rate. 39 (81.2%) of participants were female. The mean age of participants was 20.6 years (SD = 0.5). 37 students still use MM (77.1%). With MMAR, participants in the MM group scored 28.9 higher than participants in the MM-free group significantly (p = 0.01). There were no differences in the median GPAs to both groups. However, there was a significant correlation between using MM in learning and the second trimester (year1) (r=0.29, p<0.05). Majority of participants in the MM groups stated the advantages of using MM to help to organise data and their thought process. But the students in MM-free group saw the disadvantages of MM as a time-consuming process and the potential of missing information from lectures.

Conclusions: Without revision in MM, participants’ skills deteriorated immensely. There was a non-statistically significant trend toward increased learning outcomes with MM group. Further studies to examine whether more frequent MM use or workshop revision can boost their learning outcomes or not is recommended.

Keywords: Mind map; pre-clinic; mixed methods; assessment

Introduction

Medicine is a dynamic subject that changes constantly. The amount of new knowledge that we need to understand and memorise also increases immensely. Thus, learning tools or methods to help solidifying these memories is critical. One of those learning methods is Mind Map (MM) which is a visual diagram used to record and organise information in a way similar to how our brain processes memories. It was invented by Tony Buzan in the 1970s. The MM use a central theme in the middle of a page with categories and subcategories that radiate peripherally (D'Antoni et al., 2010). As for the facilitation and conversion of information into memory, it consists of spider diagrams, colour, pictures, keywords, association line, and highlighting key branches within a boundary known as ‘chunking’ (Howe, 1970; Bellezza, 1983; Day and Bellezza, 1983; Glass and Holyoak, 1986). This technique augments the visualisation of relationships and links between concepts, which aids in information acquisition, data retention, and comprehension (Spencer, Anderson and Ellis, 2013).

Numerous studies support the benefit of MM. One previous study in medical students found that the factual knowledge in students using the MM was greater by ten per cent (Spencer, Anderson and Ellis, 2013). The result was consistent with the other two Asian studies (Kalyanasundaram et al., 2017; Ying et al., 2017). Majority of medical students perceived that MM was helpful for organising and memorising the information (Wickramasinghe et al., 2011). Besides, it was among one of the potential factors influencing high academic achievement (Abdulghani et al., 2014). On the contrary, one study argued that the degree of visual imagery associated with the components of paired associate items was not indicative of the degree of visual imagery experienced during their learning or with the accuracy with which they were recalled (Day and Bellezza, 1983). It also may not have any benefit compared to the conventional note-taking method (D'Antoni et al., 2010).

MM has been implemented in many medical schools to facilitate students' learning experience (Farrand, Hussain and Hennessy, 2002; Ghanbari, Javadnia and Abdolahi, 2010; Zhou, Shao and Xu, 2012). However, the retained MM skills and its effect on the learning outcomes in long-term follow-up is still unknown. This study aims to investigate the retained skills in medical students who use MM and its effect on learning outcome after a long-period introduction.

Methods

Context

Walailak University School of Medicine is a state-run medical school, located in Southern Thailand. All students are Thai. We offer a 6-year MD degree programme designed for 48 selected high school students in each academic year. To enhance our curriculum to the World Federation of Medical Education (WFME)’s framework, several subjects were adapted and improved to the WFME’s standard. The section B2.2.1 stated that “the medical school must teach the principles of scientific method, including analytical and critical thinking” (BME Standards, 2015). Hence, the encouragement of MM use. In each academic year, all students will join a three-day intensive camp to learn about the concept of MM taught by the expert after they finished their first year. But there is no long-term observation of the effectiveness of this camp yet.

Methods

From this context, we would like to know how much MM skills the students can retain after the intensive camp. We also would like to know the students’ perception regarding the use of MM and their study since we observed that some of them reverted to using conventional note-taking methods while the majority of them still use MM. The challenge for this observation was the data merging and integration of data. MM scores could not represent the students’ behaviour while the students’ response could not reveal any correlation between their use of MM and their performances. Hence we decided to opt for the mixed-methods design to explore in this issue comprehensively (Castro et al., 2010).

The qualitative part will provide more insights from the students that the quantitative part cannot. The quantitative aspect will show the objective correlations of their learning achievement which, semester Grade Point Average (GPA), overall Grade Point Average (GPAX), with their MMAR. Final results also came from the supplementation of findings that each other sole method could not demonstrate individually. In this study, we want to emphasise more on the student’s view and thus focusing more on the constructivist paradigm from their perspective. All students (48) in that academic year were recruited.

This study used a concurrent mixed-methods study with convenience sampling method. In October 2016, all second-year students joined the three-day intensive camp during the end of their first year to learn the concepts of mind mapping taught by an expert in the field. After the camp, we analysed their MMs and their written feedback forms after the course. One year later, one researcher (TP) surveyed if they continue using MM or not. TP also instructed students to draw one MM of the latest subject that they learnt and used the Mind Map Assessment Rubric (MMAR) to assess the quality of students’ MM.

MMAR is a validated instrument used to assess the quality of the MM (D'Antoni, Zipp and Olson, 2009). Its high intra-class correlation coefficient value indicates strong MMAR inter-rater reliability. Maps were scores in 6 categories with the following point assignments for each component as follows: concept-likes (2 point each), cross-links (10 point each), hierarchies (5 points each), examples (1 point each), invalid components (0 points), pictures (5 points each), and colours (5 points each)(West et al., 2002). Descriptive statistics were used for the demographic data.

We use concurrent triangulation design with more emphasis on qualitative aspect. Data was analysed simultaneously and merged during the analysis. In the qualitative part, we performed the content analysis from student’s written feedback forms. The constant comparative analysis was also used to compare the difference in MMs between students who continue using MM and those who have not. We also used Guba and Lincoln’s suggestion to increase our work’s rigour(Guba and Lincoln, 2005);

  • Credibility

   -Triangulation: we used investigator triangulation to increase the credibility by having two researchers independently analyse the data and constant discussion about the findings. Any discrepancies would be discussed with the third external auditor, the MM expert that taught the students. We had no unresolved discrepancies hence the third external auditor was not asked for their opinion.

   -Negative case analysis: we also have data from students who did not continue to use MM to compare those who did.

   -Prolonged engagement: both researchers joined the MM camp and participated in the activity so that students would not feel uncomfortable around the researchers. After the camp, both of the researchers also taught the students on a regular basis hence the observation of their continuation/discontinuation of using the MM.

  • Transferability 

- By describing how we analysed the data and also the process in details.

  • Dependability 

   -We had an external audit; the MM expert to comment on our interpretation and preliminary findings regarding MM.

  • Confirmability

   -Audit trail: TP also made audit trail during the data collection and analysis process.

   -Triangulation: by investigator triangulation method.

For the quantitative part, we used a prospective cohort study for this prognostic research questions in order to evaluate participants’ retained MM skills using validated tool—MMAR. The statistical analysis was performed by SPSS software version 17 (SPSS Inc., Chicago, IL, USA). Mean and standard deviation (SD) or median and range were used to describe continuous data. Frequency and percentage were used for categorical data. Analyses of categorical data were performed using Mann-Whitney U test or student t-test depending on data distribution. And correlations between MMAR scores and GPA or GPAX were tested using Pearson’s Correlation. A p value of < 0.05 by two-tailed tests was considered statistically significant.

Results/Analysis

All (48) second-year students participated in the study with the response rate of 100%. 39 of them were females (81.2%). The mean age of participants was 20.6 years (SD = 0.5). Males had a mean GPA of 3.79 (SD=0.11), and females had a mean GPA of 3.73 (SD=0.15). There were no significant differences between males and females in terms of their GPA.

After the MM camp one year ago, 37 students (77.1%) declared that they still use MMs for their learning (MM group) while 11 of the students (22.9%) %) did not (MM-free group).

Using MMAR to assess the quality of MMs, the mean score of participants in MM group was 91.4 (SD = 34.9), and the mean score of the participant in MM-free group was 60.9 (SD = 26.8). Participants in the MM group scored 30.5 higher than participants in MM non-use group significantly (p = 0.01). (Figure 1)

Figure 1. Mindmap assessment rubric (MMAR) between two groups

MM variables each group were shown in Table 1. In MM group, median concept links, hierarchies, examples, pictures, and colours were 6.0 (IQR; 5.0-11.5), 4.0 (IQR; 3.0-5.5), 34.0 (IQR; 22.5-41.0), 0.0 (IQR; 0.0-1.5), and 3.0 (IQR; 1.0-5.5), respectively. In MM-free group, median concept links, hierarchies, examples, and colours were 5.0 (IQR; 4.0-6.0), 3.0 (IQR; 3.0-4.0), 28.0 (IQR; 10.0-33.0), and 1.0 (IQR; 1.0-7.0), respectively. Participants in the MM group gave more concept links and pictures in their MMs than did participants in the MM-free group significantly (p<0.05). Neither of these groups put cross-links on their MMs.

Table 1. Mind map variables between two groups

Variables

Median (IQR)

p-value

MM group

MM-free group

Concept links

6.0  (5.0-11.5)

5.0 (4.0-6.0)

<0.05

Cross links

0.0 (0.0-0.0)

0.0 (0.0-0.0)

-

Hierarchies

4.0 (3.0-5.5)

3.0 (3.0-4.0)

0.49

Examples

34.0 (22.5-41.0)

28.0 (10.0-33.0)

0.06

Pictures

0.0 (0.0-1.5)

0.0 (0.0-0.0)

<0.05

Colours

3.0 (1.0-5.5)

1.0 (1.0-7.0)

0.22

 

In MM group, the median GPAs of the first trimester (year1), the second trimester (year1), the third trimester (year1), the first trimester (year2), and GPAX were 3.83 (IQR; 3.83-3.88), 4.00 (IQR; 4.00-4.00), 3.63 (IQR; 3.40-3.72), 3.00 (IQR; 2.56-3.18), and 3.64 (IQR; 3.45-3.73), respectively. As for the MM-free group, the median GPAs of the first trimester (year1), the second trimester (year1), the third trimester (year1), the first trimester (year2), and GPAX were 3.88 (IQR; 3.83-3.88), 4.00 (IQR; 3.80-4.00), 3.59 (IQR; 3.40-3.72), 2.87 (IQR; 2.62-3.18), and 3.63 (IQR; 3.43-3.71), respectively (Figure 2). There were no differences in the median GPAs of the first trimester (year1), the second trimester (year1), the third trimester (year1), the first trimester (year2), and GPAX in both groups. There was also no correlation among MMAR scores, GPAs of the first trimester (year1), the second trimester (year1), the third trimester (year1), the first trimester (year2), and GPAX. Additionally, there was no correlation between using MM in learning and GPA or GPAX, excepting the correlation between using MM in learning and the second trimester (year1) (r=0.29, p<0.05).

Figure 2. Grade point average in the MM group and the MM-free group.

We analysed the reasons why participants still use MM or stop using them, as shown in Table 2. Majority of participants in MM groups stated the advantages of using MM as a tool helping those organising data and their thought process. On the contrary, students in MM-free group declared the disadvantages of MM as a time-consuming and missing data from the lectures.

Table 2. Categories and subcategories for mind map preferences

Currently using mind map

n (%)

Categories

Subcategories

(frequency)

Explanation

Yes

37 (77.1)

Content

 

- Content overview (28)

- Data organising (23)

- Safe time for review (3)

- See content outline easier

- Making notes easier

- Quicker than taking notes

Thought

 

 

- Thought organising (36)

- Better understanding (16)

-Quick for review (11)

- Reorganising thinking process

- Thinking in a sequence

- Easier to understand than taking notes

- Better for a review

No

11 (22.9)

Conventional methods

- Short notes (5)

- Others (6)

- Prefer conventional methods such as short notes, making tables

Inconvenient

- Take time (5)

- Not enough detail (2)

- Hassles (2)

- Take longer time than making notes

- Missing important details from lectures

- Unmotivated to make one

Discussion

While MM is still used as a tool for assisting in learning globally, retained skills of MM without any revision and its efficacy on learning outcomes particularly in the long-term period have not been well established in medical students. To our knowledge, this is the first study to investigate the retained skills in using MM and its effect on learning outcome after a long-period introduction. We found that the mean score of participants in the MM group was 91.4 (SD = 34.9) and the mean score of participants in the MM-free group was 60.9 (SD = 26.8). We also found significantly higher scores (30.5) in the MM group participants comparing to the MM-free group (p = 0.01). These findings suggested that those who did not use MM had lower skill levels on making high-quality MMs. All components in the MM-free group, particularly concept links and pictures, were also lower than those in the MM group significantly. 

Consistent with one previous study, retention of laparoscopic skills was assessed in the first and second-year medical students without prior experience in surgery. One year after the short training programme, their skill retention was 64.2-69.3% (p<0.05) compared with the immediate post-training evaluation (Sant'Ana et al., 2017).

These might imply that regular practice of MM is a cornerstone to keep the skills at a high level. The frequency of MM usage to maintain the skills and the cut-off period when the significant difference of MMAR scores was apparent are also noteworthy to investigate through future works.

For its efficacy on learning outcomes, we found a mild correlation between using MM and students’ learning on the second trimester’s GPA in year 1, i.e. four months after an intensive MM course. GPAs in the MM group was also higher than those in the MM-free group. However, the effects were not significant. Frequency of the MM usage and other learning achievement factors; for instance, regular exercise, time management, lesson reviews, family support, sleep deprivation and internal motivation may be other factors to determine students’ academic achievement (Abdulghani et al., 2014).

In the MM-free group, ‘time-consuming' was a major reason they rejected using MM in their learning. In this group of students, alternative learning techniques that help them learn and memorise the learning materials may be more favourable. 

Overall, MMAR scores in the MM group was lower than we expected. We thus plan to follow-up whether the course revision or encouraging student to use MM more frequent will enhance their MMAR scores and GPA in the longer period or not.

Conclusion

We found that after a one-year period, participants who did not continue using MMs made lower-quality MMs when compared to those who continue using it. Students in the MM-free group declared the disadvantages of MM as a time-consuming process and missing practical knowledge from lectures. There was a trend toward increased learning outcomes with the MM group. However, the result was not significant. Further study should be done to examine whether more frequent MM usage or MM skills revision can boost their learning outcome or not. 

Take Home Messages

  1. Mind map (MM) has been known as a visual think tool enhancing data retention, overall comprehension, and creativity.
  2. Regular practice is mandatory to retain the MM skills.
  3. There was a trend toward increased learning outcomes in the MM users.

Notes On Contributors

Dr Tharin Phenwan is a Family Medicine lecturer at Walailak University School of Medicine and is now a research student at School of Nursing and Health Science, University of Dundee. His research focuses on palliative care, qualitative research, interprofessional, and medical students assessment. ORCID:https://orcid.org/0000-0003-0120-952X

Dr Weeratian Tawanwongsri is also a lecturer at Walailak University School of Medicine. His research focuses on assessment, pre-clinical medical students, and student admission. ORCID: https://orcid.org/0000-0002-1949-7323

Acknowledgements

We would like to express our gratitude to all students who participated in this study and also to Mr. David Stanton for his help with English language editing.

Bibliography/References

Abdulghani, H. M., Al-Drees, A. A., Khalil, M. S., Ahmad, F., et al. (2014) 'What factors determine academic achievement in high achieving undergraduate medical students? A qualitative study', Med Teach, 36 Suppl 1, pp. S43-8. https://doi.org/10.3109/0142159X.2014.886011

Bellezza, F. S. (1983) 'The spatial-arrangement mnemonic', Journal of Educational Psychology, 75(6), p. 830. https://doi.org/10.1037/0022-0663.75.6.830

BME Standards (2015) The World Federation for Medical Education. Available at: http://wfme.org/standards/bme/ (Accessed: October 12, 2018).

D'Antoni, A. V., Zipp, G. P., Olson, V. G. and Cahill, T. F. (2010) 'Does the mind map learning strategy facilitate information retrieval and critical thinking in medical students?', BMC Med Educ, 10, p. 61. https://doi.org/10.1186/1472-6920-10-61

Day, J. and Bellezza, F. (1983) 'The relation between visual imagery mediators and recall', Memory & Cognition, 11(3), pp. 251-257. https://doi.org/10.3758/BF03196971

Farrand, P., Hussain, F. and Hennessy, E. (2002) 'The efficacy of the 'mind map' study technique', Med Educ, 36(5), pp. 426-31. https://doi.org/10.1046/j.1365-2923.2002.01205.x

Ghanbari, A., Javadnia, F. and Abdolahi, M. (2010) 'Teaching of gross anatomy for students of medicine by mind map-based power point slides', Med Teach, 32(3), p. 272.

Glass, A. and Holyoak, K. (1986) 'Cognition. NY'. Random House.

Howe, M. J. A. (1970) 'Using Students' Notes to Examine the Role of the Individual Learner in Acquiring Meaningful Subject Matter', The Journal of Educational Research, 64(2), pp. 61-63. https://doi.org/10.1080/00220671.1970.10884094

Kalyanasundaram, M., Abraham, S. B., Ramachandran, D., Jayaseelan, V., et al. (2017) 'Effectiveness of Mind Mapping Technique in Information Retrieval Among Medical College Students in Puducherry-A Pilot Study', Indian J Community Med, 42(1), pp. 19-23. https://doi.org/10.4103/0970-0218.199793

Sant'Ana, G. M., Cavalini, W., Negrello, B., Bonin, E. A., et al. (2017) 'Retention of laparoscopic skills in naive medical students who underwent short training', Surg Endosc, 31(2), pp. 937-944. https://doi.org/10.1007/s00464-016-5063-y

Spencer, J. R., Anderson, K. M. and Ellis, K. K. (2013) 'Radiant thinking and the use of the mind map in nurse practitioner education', J Nurs Educ, 52(5), pp. 291-3. https://doi.org/10.3928/01484834-20130328-03

West, D. C., Park, J. K., Pomeroy, J. R. and Sandoval, J. (2002) 'Concept mapping assessment in medical education: a comparison of two scoring systems', Med Educ, 36(9), pp. 820-6. https://doi.org/10.1046/j.1365-2923.2002.01292.x

Wickramasinghe, A., Widanapathirana, N., Kuruppu, O., Liyanage, I., et al. (2011) 'Effectiveness of mind maps as a learning tool for medical students', South East Asian Journal of Medical Education.

Ying, G., Jianping, X., Haiyun, L., Xia, L., et al. (2017) 'Using Mind Maps to Improve Medical Student Performance in a Pharmacology Course at Kunming Medical University', J Coll Physicians Surg Pak, 27(7), pp. 404-408.

Zhou, H. C., Shao, S. W. and Xu, B. Y. (2012) 'Application of mind map in teaching of medical parasitology', Zhongguo Ji Sheng Chong Xue Yu Ji Sheng Chong Bing Za Zhi, 30(6), pp. 477-9.

Appendices

None.

Declarations

There are no conflicts of interest.
This has been published under Creative Commons "CC BY-SA 4.0" (https://creativecommons.org/licenses/by-sa/4.0/)

Ethics Statement

The Human Research Ethics Committee of Walailak University approved this study (WUEC-18-021-01). Informed consent was obtained from all volunteers prior to participation in the study.

External Funding

This paper has not had any External Funding

Reviews

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Barbara Jennings - (08/06/2019) Panel Member Icon
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This paper made me think about a need for evidence-based support for undergraduate students regarding study skills. Our learners arrive at medical school with high levels of academic achievement and we may assume optimal study skills.
The analysis of mind-mapping (MM) use in this paper suggests that these study skills need continual use or development; or they will deteriorate.
The authors use a pre-validated tool to appraise the MM skills in a cohort 48 medical students and noted a significant drop in skills between groups that do, or do not, identify as MM users. The medical school now provides significant training (MM camps) for their students after their first year of study.
The usefulness of MM to learning outcomes (including grade point averages) and the students’ perception of MM were also analysed.
The rationale for the study and its organisation and governance are strengths for this paper. The results are presented clearly in tables and charts, but some sub-headings could have been used to identify linked sections of the Methods and Results – which could have improved clarity. The statistical analysis and any limitations could have been explored in more detail and some of the narrative presentation of GPA results are hard to follow. There are also typos, problems with punctuation and other small errors noted throughout this revised manuscript (e.g. a paper is cited (Guba and Lincoln, 2005) but I could not locate it in the reference list.
I will recommend this paper to my colleagues who support students in their revision periods, and to PBL tutors and students too.



Possible Conflict of Interest:

For Transparency: I am an Associate Editor of MedEdPublish.

Ken Masters - (05/06/2019) Panel Member Icon
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The paper reports on a mixed methods study examining the retained mind-mapping skills of medical students.

While the authors and some readers may find themselves a little disappointed with the results, which show little of major significance, this is exactly the kind of paper that needs to be published and read. There is no doubt that MM does benefit many students. Like all other learning tools, however, it does not benefit everybody, and, too often, because of publishing bias, we see only the studies in which MM has had an observable and significant impact. This study shows reasonably, that, yes, it might have an impact, and those students who create high-quality MMs generally like to continue using them, and find benefit from them. The benefit appears to be from the quality of the MM, not whether or not the students work hard or perform better. So, by all means, use MMs, and those students who like them, and create high-quality MMs will probably continue to do so, and those who don’t, wont. But not everybody will do so. This is not a failure. It simply means that, as valuable as MMs are, they are not a panacea for everything, and not everybody likes, or uses them, and not everybody needs to like them or use them.

Although the small number of participants does limit the generalisability somewhat, the paper still has value. Repeated studies would be useful.

Some issues with the paper

• There is no real information about the course. To be fair to advocates and teachers of MM, it would be necessary for the authors to supply information about the course. There way the paper is written, it appears that a full three days was devoted to mind-mapping which is certainly intensive, and it is important to know more about this course.
• The listing of the GPA scores should have been placed in a table for easier reading.
• While most people are familiar with the concept of GPA, the GPAX is not widely known, so this should be explained.
• The paper needs a closer proof-reading to remove some language errors.


So, while there are some issues with the paper, it does have value to people who are working with Mind-Maps. I look forward to seeing repeats of the study.
Possible Conflict of Interest:

For Transparency: I am an Associate Editor of MedEdPublish

Felix Silwimba - (19/10/2018)
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This is a good medical education paper, applicable to learners and educators in low- and middle-income countries. The abstract is well done. its adequate and contains all the relevant information. The method is clearly explained. All learners had received training in MM skills, a follow up study conducted to assess their utilisation of the skill. The methodology is clear as a concurrent mixed methods study. The findings of the study are clear, and the conclusion correctly drawn, including areas for further study.
However, I seek clarity from the authors on the order of the concurrent mixed study. What is it that was done first, the quantitative or qualitative study. If so I would like to see in the study the hypothesis that should have been subjected to a statistical test for it to be falsified. Then for the qualitative part, I would like to see the research questions, the qualitative method used and the analysis of the qualitative data. I see components of grounded theory method mentioned in the study (Bryant, 2017). Then the hypothesis generated from the data.
Reference.
Bryant, A., 2017. Grounded theory and grounded theorizing: Pragmatism in research practice. Oxford University Press.
Raquel CORREIA - (19/10/2018)
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Thank you for sharing your hard work and reviewing the first version of the article.

The subject of mind mapping is a fascinating one, and the technique might indeed suit some medical students. Many thanks indeed for bringing it to the Medical Education “table”.

I have many reservations regarding the article though. Please bear with me as I try to explain from my humble point of view, what could be improved.

From my reading, you are trying to compare and prove different things:

The question needs to be clear. What is it that you want to bring to the table with this article? Is it the efficacy of a mind mapping course (and posterior usage) or is it about learning outcomes? Is it about mind mapping being an efficient note taking tool? Or is it about the pros and cons of using mind maps in medical school?

Once you’ve answered this question, in my opinion, your article will become clearer and possibly give way to two or three different articles. Here you’re trying to answer different things at the same time, and they do not seem to be related.

2. It would be wonderful to get some editing done, both in terms of cutting unnecessary words and language. The results part is really difficult to follow and I’d suggest trying to either speak of mind mapping or usage of mind maps on the whole.

3. It would be great to know more about the intensive three-day course that you have on mind mapping skills.

4. You’ve used the Mind Map Assessment Rubric (MMAR)to assess the quality of students mind maps one year later. It seems to me that, as expected, students who don’t use mind maps will score lower than the ones who use them regularly on a quality scale. Which question are you trying to answer with these results?

5. The GPA paragraph is really hard to understand. It could perhaps use a table for better understanding. And, regarding the GPA, how do you prove the relation between retained skills in using MM and its effect on learning outcomes?

6. The following paragraph seems to be an extrapolation. Why have you chosen to bring this study up? What is the relation between mind mapping skills and surgical skills? “Consistent with one previous study, retention of laparoscopic skills was assessed in first and second-year medical students without prior experience in surgery. One year after the short training programme, skill retention was 64.2-69.3% (p<0.05) compared with immediate post-training evaluation (Sant'Ana et al., 2017).
These might imply that regular practice of MM is a cornerstone to keep the skills at a high level.”

7. The conclusion could be developed.

I do thank you for the hard work that I believe you’ve put in this article. MM is an interesting and important learning tool that should indeed be more studied.