In my September Volunteer Voice article, ˙Experience Is King,Ó I presented the idea of using concept mapping as a competency maintenance tool. This month, I'll take you through how to create an effective concept map of calls or continuing education (CE) issues and use them to document competency and provide an alternative training method. To illustrate this point, I'll reference and create a concept map for this month's CE article on depression, ˙The Great Depression,Ó on p. 62 of November JEMS.
Evolution of Mapping
Originated by Joseph Novak atCornellUniversity inIthaca,N.Y., in the 1970s, concept mapping evolved from research to understand the ways children think while learning.This tool can also be used to understand our thinking about the treatment of patients. Although the method of concept mapping in this article may vary slightly from Novak's original method, the result is similar; the goal is to provide a graphical representation of your thought process to identify the discrete concepts that make up our patients' conditions and the links between those concepts.
Concept mapping has many related forms, such as patient mapping, treatment mapping and a simple form called mind mapping. Unfortunately, many of these mapping tools focus on concepts or patient conditions rather than the connections between the concepts, which may be more important than the concepts themselves. It's the difference between knowing how to use your skills and knowing when. A monkey may be able to mimic some of your skills, but knowing when and when not to use them makes a significant difference between just going through the motions and actually saving our patients' lives.
Our training often focuses on mastering skills and individual topics, such as cardiology. Although this type of initial training is needed, we gain experience from analyzing connections between our skills and our patients, which have become increasingly important. Ask your members to create a concept map of their experiences to help identify and clarify the connections, and have them actively reflect on their calls.
As discussed in the September Volunteer Voice, documentation of your experiential learning process not only helps you grow as a provider, but it can also be used to prove competency in your skills and your ability to diagnose and treat patients. Collecting these concept maps into a portfolio can show your competency and identify areas of weakness. If this sounds like an intense, continuous quality improvement (QI) plan, that's because it is.
Creating the Concepts
Concept maps can take many forms, and creating them can be as challenging as you want to make them. The simplest form starts with six boxes, each representing a concept or part of the patient's condition. These concepts, or components, are often seen as signs and symptoms, general impressions, pertinent negatives and other clues as to what's bothering the patient.
At this point, it's not as important which concepts you place on the map but that you start focusing on what makes up the patient's condition. You may end up adding, deleting, combining or rearranging the concepts as you move along, so don't worry about ˙getting it rightÓ on the first try. Some people start writing their maps by hand (I prefer using PowerPoint). I've even seen some people use sticky notes on a white board. Flexibility is good. These changes will represent your learning process.
Once you have the concepts, the next step is to start connecting them and figuring out the relationships between them. To do this, we start by connecting any two boxes, shown by a line with arrows pointing in the direction where the boxes are connected. For example, my first connection was between ˙feeling hopelessÓ and ˙stopped taking her medications,Ó putting arrows on both ends of the line to represent a two-way relationship between the concepts.
As stated earlier, because the connections are significant, we need to clarify the connection by labeling exactly how they are associated. The easiest way to think of this is to make the two concepts into a sentence by labeling the relationship above the arrow, such as ˙feeling hopelessÓ may have caused her to ˙stop taking medications,Ó and the inverse may be that ˙stopping the patient's medicationsÓ have caused the patient to ˙feel hopeless.Ó
The end result of this mapping shows your findings, with connections that represent your thoughts about those findings. I recently used this method with a paramedic student and found it helps identify the missing links between classroom knowledge and experience. Identifying patterns and quickly making connections between the patterns enable providers to make decisions and develop true expertise. Concept mapping helps you visualize the patterns in ˙black and whiteÓ and interpret what you've missed or your subconscious thoughts on the findings. As your map develops, you'll find yourself connecting more concepts while you add or group items together. Some people use colors to denote different sections of the map or draw circles around items to group them together.
Using The Connections
True learning happens through the creation of concept maps and comparing the maps with others. You can compare your map to your partner's to recognize the differences in perception and decision-making, or compare it with other calls to see how patients differ. It may seem a daunting task at first, but once you get the hang of it, you can create a decent concept map in minutes.
Further, your training or QI officer can demonstrate growth and proficiency of the provider by placing these maps (either electronically or physically) into a portfolio. Because the concept maps are based on experience, what's learned throughout this process will result in improved patient care. The documentation of competency and learning can then be used to meet your local regulations, therefore lessening the burden on the member.
Doing precedes understanding, and the only way you're going to get by is to actually do it. I challenge every service to try this method for one month in place of your regular training. Use your next training session to describe the process, give your members a month to try it, and then debrief the results the following month. Encourage members to openly share their concept maps without fear, and you'll be amazed by the amount of informal learning that goes on.
- Novak JD, Caœas AJ: ˙The Theory Underlying Concept Maps and How to Construct Them.ÓTechnical Report IHMC CmapTools 2006-01. Florida Institute for Human and Machine Cognition, 2006.