Concept mapping is a graphical technique for organizing and representing knowledge, in which concepts are linked by labelled propositions to depict relationships within a domain.[1] The technique rests on the principle that meaningful learning occurs when new information is deliberately connected to a learner's existing cognitive framework, rather than acquired through rote memorisation.[1] Concept mapping has since been adopted across educational levels and disciplines, and quantitative synthesis has demonstrated its potential to improve knowledge organization and learning outcomes.[2] In medical education, concept maps have been proposed as a means of helping students integrate a rapidly expanding body of biomedical knowledge, connect basic science with clinical reasoning, and identify gaps or misconceptions that may not be readily apparent through conventional assessment.[3] Evidence suggests that concept mapping can contribute to knowledge organization, critical thinking, and learner engagement, although considerable heterogeneity exists across study designs, implementation methods, and outcome measures.[4] Within Indian undergraduate medical education, concept mapping has been evaluated in several settings, with studies during epidemiology teaching and in Community Medicine reporting improved performance and favourable student perceptions.[5,6] Community Medicine postings are particularly well suited to active, learner-centred teaching, since students encounter a wide range of interrelated concepts spanning epidemiology, disease prevention, risk factors, social determinants, and health systems — relationships that conventional topic-based teaching may not allow students to visualise systematically. At Madha Medical College and Research Institute (MMCRI), concept mapping was incorporated into small-group teaching during Community Medicine postings; however, its effectiveness in terms of knowledge gain, retention, concept-map quality, and student perception had not been formally evaluated in this setting. This study was therefore undertaken to evaluate the effectiveness of structured concept mapping among 2nd and 3rd year MBBS students during their Community Medicine postings, with the following objectives: (1) to compare knowledge scores before and immediately after a structured concept-mapping session; (2) to assess retention of knowledge at 4–6 weeks; (3) to assess the quality of student-constructed concept maps using a structured rubric; (4) to determine the relationship between concept-map quality and immediate post-test performance; and (5) to assess students' perception of concept mapping as a teaching–learning method.

Study design and setting. A quasi-experimental, single-group pre-test/post-test study was conducted in the Department of Community Medicine, MMCRI, Chennai, Tamil Nadu, India, among undergraduate medical students attending routine Community Medicine postings. Study population and sampling. The study included 2nd and 3rd year MBBS students posted during 10 consecutive posting batches (five batches per year; 30 students/batch; total N=300). Convenience sampling was used, with eligible students from each batch invited to participate. Students who participated in the scheduled session and consented were included; those who did not complete the required assessments were excluded from the corresponding analysis. Intervention. A structured concept-mapping session was conducted as part of routine small-group teaching. Students were introduced to the principles and construction of concept maps, then identified key concepts, organized them hierarchically, established labelled relationships, and incorporated cross-links and examples. Topics such as Fever and Hypertension were used for the activity. Students constructed their own maps, facilitated by faculty who clarified concepts as required. A representative example of a student-constructed concept map is shown in Figure 1. Outcome measurement. A 10-item multiple-choice question assessment was administered as a pre-test (immediately before the session), an immediate post-test (immediately after), and a retention test (4–6 weeks later), using the same assessment framework throughout. Concept maps were scored by two trained raters using a structured four-domain rubric (maximum total 28): propositions (10), hierarchy (8), cross-links (6), and examples (4).[1,7] Student perception was assessed using a 5-point Likert-scale questionnaire covering improvement in understanding, ability to relate new and prior knowledge, engagement relative to conventional lectures, willingness to attend further sessions, and ease of construction. Statistical analysis. Data were analysed using Jamovi. Continuous variables were summarized as mean ± SD; categorical variables as frequencies and percentages. Pre-test/post-test and post-test/retention scores were each compared using paired t-tests. Pearson's correlation coefficient assessed the relationship between total rubric score and immediate post-test score. A p-value <0.05 was considered statistically significant. Ethical considerations. Institutional Ethics Committee approval was obtained prior to commencement. Written informed consent was obtained from all participants; participation was voluntary and did not affect academic assessment

A total of 300 students were included in this cohort, drawn from 10 posting batches of 30 students each — five batches from 2nd year and five from 3rd year MBBS. Of these, 150 (50.0%) were from 2nd year and 150 (50.0%) from 3rd year. There were 168 females (56.0%) and 132 males (44.0%), with a mean age of 20.4 ± 1.1 years. Only 52 students (17.3%) reported prior exposure to concept mapping as a learning technique before this exercise (Table 1). Table 1. Baseline characteristics of participants Characteristic n % 2nd year — Batch 1 30 10.0 2nd year — Batch 2 30 10.0 2nd year — Batch 3 30 10.0 2nd year — Batch 4 30 10.0 2nd year — Batch 5 30 10.0 3rd year — Batch 1 30 10.0 3rd year — Batch 2 30 10.0 3rd year — Batch 3 30 10.0 3rd year — Batch 4 30 10.0 3rd year — Batch 5 30 10.0 Year of study — 2nd year MBBS (total) 150 50.0 Year of study — 3rd year MBBS (total) 150 50.0 Sex — Male 132 44.0 Sex — Female 168 56.0 Mean age (years), mean ± SD 20.4 ± 1.1 — Prior exposure to concept mapping 52 17.3 The mean pre-test knowledge score was 4.8 ± 1.4 out of 10. Following the concept-mapping session, the mean immediate post-test score rose to 7.9 ± 1.1, a mean improvement of 3.1 points (95% CI 2.9–3.3), which was statistically significant (p<0.001). This represents an increase of approximately 65% over the pre-test score, indicating a substantial immediate gain in knowledge attributable to the intervention (Table 2, Figure 3). Table 2. Comparison of pre-test and immediate post-test knowledge scores Time point Mean ± SD (/10) Mean difference (95% CI) p-value Pre-test 4.8 ± 1.4 — — Immediate post-test 7.9 ± 1.1 3.1 (2.9–3.3) <0.001* *Paired t-test; p < 0.05 considered statistically significant. At the delayed retention assessment conducted 4–6 weeks later, the mean score declined modestly from 7.9 ± 1.1 to 7.1 ± 1.3, a reduction of 0.8 points (95% CI −1.1 to −0.5, p=0.002). Despite this decline, the retention score remained well above the pre-test baseline, suggesting that a substantial proportion of the immediate knowledge gain was retained over the medium term (Table 3). Table 3. Comparison of immediate post-test and delayed retention scores Time point Mean ± SD (/10) Change from post-test p-value Immediate post-test 7.9 ± 1.1 — — Retention (4–6 weeks) 7.1 ± 1.3 −0.8 (−1.1 to −0.5) 0.002* *Paired t-test comparing immediate post-test with delayed retention scores. On rubric-based scoring of the student-constructed concept maps, the highest relative performance was seen in the Examples domain (77.5% of maximum score), followed by Propositions (76.0%) and Hierarchy (73.8%), while the Cross-links domain was comparatively weaker (56.7% of maximum). The mean total rubric score across all four domains was 20.0 ± 3.9 out of a maximum of 28 (71.4% of maximum), suggesting that students were generally more comfortable identifying individual concepts and relationships than integrating knowledge across different branches of the map (Table 4). Table 4. Concept map rubric scores by domain Rubric domain (max score) Mean ± SD % of maximum Range Propositions (10) 7.6 ± 1.5 76.0 4–10 Hierarchy (8) 5.9 ± 1.4 73.8 2–8 Cross-links (6) 3.4 ± 1.3 56.7 0–6 Examples (4) 3.1 ± 0.8 77.5 1–4 Total (28) 20.0 ± 3.9 71.4 10–27 A moderate, statistically significant positive correlation was observed between the total concept map rubric score and the immediate post-test score (r=0.52, R²=0.27, p<0.001), indicating that approximately 27% of the variance in post-test performance could be statistically accounted for by the quality of the concept map produced, consistent with the hypothesis that better-constructed maps reflect deeper understanding of the topic (Table 5, Figure 4). Table 5. Correlation between concept map rubric score and post-test score Variables r R² p-value Total rubric score vs. immediate post-test score 0.52 0.27 <0.001* *Pearson correlation coefficient. On the Likert-scale perception questionnaire, a majority of students responded favourably across all five statements. The strongest agreement was seen for the statement 'Would like more such sessions' (86.0% agreeing or strongly agreeing, median score 5), followed by 'Improved my understanding' (83.0%) and 'More engaging than lectures' (82.0%). The lowest, though still majority, agreement was for 'Easy to construct' (68.0% agreement, with 14.0% disagreeing), suggesting that while the technique was well received overall, a subset of students found the practical construction of concept maps comparatively more challenging (Table 6, Figure 5). Table 6. Summary of student perception (Likert-scale) responses Statement Agree/Strongly agree (%) Neutral (%) Disagree/Strongly disagree (%) Median Improved my understanding 83.0 10.0 7.0 4 Helped relate new & prior knowledge 77.0 14.0 9.0 4 More engaging than lectures 82.0 12.0 6.0 4 Would like more such sessions 86.0 9.0 5.0 5 Easy to construct 68.0 18.0 14.0 4

This study evaluated structured concept mapping as a teaching–learning method among undergraduate medical students during Community Medicine postings. Knowledge scores improved significantly immediately after the intervention, with partial retention at 4–6 weeks. Concept-map quality showed a moderate positive correlation with immediate post-test performance, and student perception was predominantly favourable. The mean knowledge score increased from 4.8 ± 1.4 to 7.9 ± 1.1 immediately after the intervention, a gain of 3.1 points on a 10-point scale. This is consistent with prior literature indicating that concept mapping supports meaningful learning by encouraging learners to organize relationships between concepts rather than simply recall isolated facts.[2-4] Torre et al. emphasized the value of appropriate scaffolding when integrating concept maps into existing teaching activities;[8] the present study similarly embedded concept mapping within routine small-group teaching rather than as a separate academic exercise, demonstrating its feasibility within the existing posting structure. Comparable learning benefits have been reported among medical students elsewhere. A randomized pilot study among first-year medical students found that concept maps incorporated into problem-based learning were associated with improved examination performance and favourable perceptions,[9] consistent with the acceptance observed here. A systematic review of randomized controlled trials in preclinical medical education similarly reported that most included studies demonstrated improved academic performance with mind or concept mapping compared with conventional approaches, although the magnitude of benefit varied by context, topic, and implementation strategy.[10] The retention findings are noteworthy: although scores declined from 7.9 to 7.1 by 4–6 weeks, they remained substantially above baseline, suggesting that learning gained during the intervention was not entirely lost over the follow-up period, in keeping with earlier reports on mapping-based recall and retention.[16] The rubric findings further indicate that students performed relatively well on propositions, hierarchy, and examples, but comparatively poorly on cross-links — a domain that requires integrating relationships across different conceptual branches and may represent a more advanced skill requiring additional faculty guidance and repeated practice. The moderate correlation between rubric score and post-test performance (r=0.52, p<0.001) is consistent with similar associations reported elsewhere in medical education,[14,15] though it should be interpreted as an association rather than evidence of causation; roughly 27% of the variance in post-test scores was statistically linked to concept-map quality, with the remainder likely attributable to other learner and educational factors. Student perception was strongly favourable: more than four-fifths reported improved understanding and greater engagement than with lectures, and 86% wished to participate in further sessions, supporting the acceptability of the method. However, only 68% found the maps easy to construct, underscoring that concept mapping is not necessarily intuitive for first-time users and that structured orientation, exemplars, and guided practice with progressively reduced faculty support may be needed — particularly to strengthen cross-linking skills. These findings extend earlier Indian evidence from Physiology and Community Medicine settings,[5,6,13] and align with more recent work suggesting that concept mapping can usefully complement other active-learning approaches such as simulation and problem-based learning.[11,12] Overall, these findings suggest that concept mapping can be incorporated into routine undergraduate Community Medicine teaching with relatively limited additional resources, and may be particularly valuable for topics that integrate multiple epidemiological, clinical, environmental, and social concepts. Limitations This study has several limitations. First, the absence of a concurrent conventionally taught control group limits attribution of the observed improvement exclusively to concept mapping; repeated exposure, testing effects, or other concurrent learning activities may have contributed. Second, convenience sampling of posting batches may limit generalizability to other institutions or educational settings. Third, although two trained raters used a structured rubric, some subjectivity in scoring cannot be entirely excluded. Finally, the assessment focused on short-term knowledge outcomes and perception; longer-term outcomes and transfer to clinical or community-based problem-solving were not assessed. Future studies using controlled or randomized designs, larger multi-institutional samples, and objective assessment of higher-order learning outcomes could strengthen this evidence base.

Structured concept mapping was associated with a significant improvement in knowledge among 2nd and 3rd year MBBS students during Community Medicine postings. Although scores declined modestly by 4–6 weeks, performance remained substantially above baseline, indicating retention of a considerable proportion of the learning gained. Higher-quality concept maps were moderately associated with better immediate post-test performance, and students reported predominantly favourable perceptions of understanding, engagement, and willingness to participate in further sessions. Concept mapping therefore represents a feasible and acceptable active teaching–learning strategy for undergraduate Community Medicine postings, promoting organization and integration of knowledge. Acknowledgements The authors acknowledge the undergraduate medical students who participated in the study, and the faculty members of the Department of Community Medicine, Madha Medical College and Research Institute, for their support in conducting the teaching sessions and assessments.

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