Unlocking Student Understanding: Analyzing Health Determinants and Health Systems Science Through Concept Maps in Pre-Clerkship Education – BMC Medical Education

Integrating the concepts of social determinants of health (DoH) and health systems science (HSS) early in medical education is crucial. It helps in training doctors who understand the bigger picture of healthcare. We believed that students would initially express these ideas well in their concept maps and improve as they went through the course. At first, their performance did increase, especially in early courses, but then it declined sharply. This drop could be due to factors related to students, faculty, and the tools we use.

Many students find concept mapping challenging. It’s a high-demand task that requires them to think critically and engage deeply. As they progress through their studies, students often focus more on clinical cases and less on the foundational knowledge of DoH and HSS, believing that this will prepare them better for their upcoming clerkships. They also have multiple assignments to manage each week, which can take their attention away from these essential topics. In the first course, students engaged well with the DoH content despite the heavy focus on basic sciences. However, as they moved into anatomy and beyond, the integration of health systems science lagged. By the time they reached the final courses, many students felt burnt out and less engaged, leading to lower scores.

Faculty development sessions have aimed to help teachers integrate DoH and HSS into their lessons. Yet, not all instructors consistently emphasize these topics in class discussions. Some faculty may not prioritize this content because they were trained in a time when it wasn’t as important. In small group settings, other pressing topics often take priority, causing students to miss out on essential learning connected to DoH and HSS. If faculty don’t encourage concept mapping in class, there can be a disconnection between students’ individual maps and the group’s overall understanding, leading to an incomplete representation of DoH.

We also received feedback that the technology used for concept mapping, Mindmup, can be a stumbling block. To help with this, we created template maps that students can easily modify, including the DoH icons. However, even with these resources, student engagement with DoH concepts remains low. Observations showed that when students did include DoH icons in their maps, they primarily linked them to patient history and rarely connected them to underlying scientific principles.

Our next steps include looking more closely at how basic sciences connect with DoH during class discussions. We plan to implement structured activities and provide more immediate feedback on concept maps to strengthen these links. Additionally, we will assess the interplay between cases discussed in class and HSS content to identify any barriers to achieving our educational goals.

Interestingly, the inclusion of HSS content in concept maps took a different pathway. It sharply decreased after the initial course, even during weeks designed for obvious connections. Improving the alignment between HSS examples and the core material could enhance their relevance and inclusion in students’ learning.

Our data collection has its limitations. With nearly 1,000 group maps over the course of the curriculum, we couldn’t analyze all of them thoroughly. Each of the roughly 167 students submits an individual map weekly, making it difficult to compare personal and group contributions. We still seek to understand the drop in HSS content after the first course, which differed from the trend seen with DoH.

Looking ahead, we aim to uncover why students struggle to incorporate DoH and HSS into their maps effectively. Assessing faculty comprehension of the significance of these topics may reveal challenges that need addressing. We also plan to examine concept maps created during mid-year and end-of-year assessments in clerkships to see how well students apply what they’ve learned in real clinical settings.