Does the mind map learning strategy facilitate information retrieval and critical thinking in medical students?

BACKGROUND: A learning strategy underutilized in medical education is mind mapping. Mind maps are multi-sensory tools that may help medical students organize, integrate, and retain information. Recent work suggests that using mind mapping as a note-taking strategy facilitates critical thinking. The purpose of this study was to investigate whether a relationship existed between mind mapping and critical thinking, as measured by the Health Sciences Reasoning Test (HSRT), and whether a relationship existed between mind mapping and recall of domain-based information. METHODS: In this quasi-experimental study, 131 first-year medical students were randomly assigned to a standard note-taking (SNT) group or mind map (MM) group during orientation. Subjects were given a demographic survey and pre-HSRT. They were then given an unfamiliar text passage, a pre-quiz based upon the passage, and a 30-minute break, during which time subjects in the MM group were given a presentation on mind mapping. After the break, subjects were given the same passage and wrote notes based on their group (SNT or MM) assignment. A post-quiz based upon the passage was administered, followed by a post-HSRT. Differences in mean pre- and post-quiz scores between groups were analyzed using independent samples t-tests, whereas differences in mean pre- and post-HSRT total scores and subscores between groups were analyzed using ANOVA. Mind map depth was assessed using the Mind Map Assessment Rubric (MMAR). RESULTS: There were no significant differences in mean scores on both the pre- and post-quizzes between note-taking groups. And, no significant differences were found between pre- and post-HSRT mean total scores and subscores. CONCLUSIONS: Although mind mapping was not found to increase short-term recall of domain-based information or critical thinking compared to SNT, a brief introduction to mind mapping allowed novice MM subjects to perform similarly to SNT subjects. This demonstrates that medical students using mind maps can successfully retrieve information in the short term, and does not put them at a disadvantage compared to SNT students. Future studies should explore longitudinal effects of mind-map proficiency training on both short- and long-term information retrieval and critical thinking.

Interrater reliability of the mind map assessment rubric in a cohort of medical students.

BACKGROUND: Learning strategies are thinking tools that students can use to actively acquire information. Examples of learning strategies include mnemonics, charts, and maps. One strategy that may help students master the tsunami of information presented in medical school is the mind map learning strategy. Currently, there is no valid and reliable rubric to grade mind maps and this may contribute to their underutilization in medicine. Because concept maps and mind maps engage learners similarly at a metacognitive level, a valid and reliable concept map assessment scoring system was adapted to form the mind map assessment rubric (MMAR). The MMAR can assess mind map depth based upon concept-links, cross-links, hierarchies, examples, pictures, and colors. The purpose of this study was to examine interrater reliability of the MMAR. METHODS: This exploratory study was conducted at a US medical school as part of a larger investigation on learning strategies. Sixty-six (N = 66) first-year medical students were given a 394-word text passage followed by a 30-minute presentation on mind mapping. After the presentation, subjects were again given the text passage and instructed to create mind maps based upon the passage. The mind maps were collected and independently scored using the MMAR by 3 examiners. Interrater reliability was measured using the intraclass correlation coefficient (ICC) statistic. Statistics were calculated using SPSS version 12.0 (Chicago, IL). RESULTS: Analysis of the mind maps revealed the following: concept-links ICC = .05 (95% CI, -.42 to .38), cross-links ICC = .58 (95% CI, .37 to .73), hierarchies ICC = .23 (95% CI, -.15 to .50), examples ICC = .53 (95% CI, .29 to .69), pictures ICC = .86 (95% CI, .79 to .91), colors ICC = .73 (95% CI, .59 to .82), and total score ICC = .86 (95% CI, .79 to .91). CONCLUSION: The high ICC value for total mind map score indicates strong MMAR interrater reliability. Pictures and colors demonstrated moderate to strong interrater reliability. We conclude that the MMAR may be a valid and reliable tool to assess mind maps in medicine. However, further research on the validity and reliability of the MMAR is necessary.

Role of cAMP response element-binding protein in the rat locus ceruleus: regulation of neuronal activity and opiate withdrawal behaviors.

The transcription factor cAMP response element-binding protein (CREB) is implicated in mediating the actions of chronic morphine in the locus ceruleus (LC), but direct evidence to support such a role is limited. Here, we investigated the influence of CREB on LC neuronal activity and opiate withdrawal behaviors by selectively manipulating CREB activity in the LC using viral vectors encoding genes for CREBGFP (wild-type CREB tagged with green fluorescent protein), caCREBGFP (a constitutively active CREB mutant), dnCREBGFP (a dominant-negative CREB mutant), or GFP alone as a control. Our results show that in vivo overexpression of CREBGFP in the LC significantly aggravated particular morphine withdrawal behaviors, whereas dnCREBGFP expression attenuated these behaviors. At the cellular level, CREBGFP expression in the LC in vivo and in vitro had no significant effect on neuronal firing at baseline but enhanced the excitatory effect of forskolin (an activator of adenylyl cyclase) on these neurons, which suggests that the cAMP signaling pathway in these neurons was sensitized after CREB expression. Moreover, in vitro studies showed that caCREBGFP-expressing LC neurons fired significantly faster and had a more depolarized resting membrane potential compared with GFP-expressing control cells. Conversely, LC neuronal activity was decreased by dnCREBGFP, and the neurons were hyperpolarized by this treatment. Together, these data provide direct evidence that CREB plays an important role in controlling the electrical excitability of LC neurons and that morphine-induced increases in CREB activity contribute to the behavioral and neural adaptations associated with opiate dependence and withdrawal.

Regulation of drug reward by cAMP response element-binding protein: evidence for two functionally distinct subregions of the ventral tegmental area.

The transcription factor cAMP response element binding protein (CREB) is implicated in the actions of drugs of abuse in several brain areas, but little information is available about a role for CREB in the ventral tegmental area (VTA), one of the key reward regions of the brain. Here, we demonstrate that chronic exposure to drugs of abuse induces CREB activity throughout the VTA. Using viral-mediated gene transfer, we expressed green fluorescent protein (GFP)-tagged CREB or mCREB (a dominant-negative form of CREB) in the VTA and, using a conditioned place-preference paradigm, found that CREB activation within the rostral versus caudal subregions of the VTA produces opposite effects on drug reward. We identified VTA subregion-specific differences in the proportion of dopaminergic and GABAergic neurons and in the dopaminergic projections to the nucleus accumbens, another brain region implicated in drug reward, and suggest that this may contribute to behavioral differences in this study. We also measured expression levels of tyrosine hydroxylase and the AMPA glutamate receptor subunit GluR1, both of which are known to contribute to drug reward in the VTA, and found that both of these genes are upregulated following the expression of CREB-GFP and downregulated following expression of mCREB-GFP, raising the possibility that CREB may exert its effects on drug reward, in part, via regulation of these genes. These results suggest a novel role for CREB in mediating drug-induced plasticity in the VTA and establish two functionally distinct subregions of the VTA in which CREB differentially regulates drug reward.

Phospholipase Cgamma in distinct regions of the ventral tegmental area differentially modulates mood-related behaviors.

Neurotrophic factor signaling pathways modulate cellular and behavioral responses to drugs of abuse. In addition, chronic exposure to morphine increases expression of phospholipase Cgamma1 (PLCgamma1) (a protein involved in neurotrophic signaling) in the ventral tegmental area (VTA), a neural substrate for many drugs of abuse. Using viral-mediated gene transfer to locally alter the activity of PLCgamma1, we show that overexpression of PLCgamma1 in rostral portions of the VTA (R-VTA) results in increased morphine place preference, whereas PLCgamma1 overexpression in the caudal VTA (C-VTA) results in avoidance of morphine-paired compartments. In addition, overexpression of PLCgamma1 in R-VTA causes increased preference for sucrose and increased anxiety-like behavior but does not affect responses to stress or nociceptive stimuli. In contrast, overexpression of PLCgamma1 in C-VTA decreases preference for sucrose and increases sensitivity to stress and nociceptive stimuli, although there was a tendency for increased anxiety-like behavior as seen for the R-VTA. These results show that levels of PLCgamma1 in the VTA regulate responsiveness to drugs of abuse, natural rewards, and aversive stimuli and point to the possibility that distinct topographical regions within the VTA mediate generally positive versus negative responses to emotional stimuli. Moreover, these data also support a role for drug-induced elevations in PLCgamma1 expression in the VTA in mediating long-term adaptations to drugs of abuse and aversive stimuli.

Coping self-efficacy as a predictor of adherence to antiretroviral therapy in men and women living with HIV in Kenya.

The purpose of this study was to evaluate the relationship between the coping self-efficacy (CSE) scale and adherence to HIV medication in men and women enrolled in a large HIV treatment program in Kenya. Data were collected from a sample of 354 volunteers attending Nazareth Hospital's nine satellite clinics located in parts of Nairobi, and the central province of Kenya. A social demographic survey, Adult Clinical Trials Group adherence questionnaire, and CSE scale were used to obtain information. Descriptive statistics and logistic regressions were performed to analyze data and to test study hypotheses. Females were less likely to be nonadherent than males: the odds of adherence for females were 3.7 of the odds of adherence for males. Controlling for gender, CSE was significant. Adherence to antiretroviral therapy can be partially explained by CSE. Efforts aimed at building self-efficacy are likely to improve and maintain adherence to HIV and other medication. Implications, limitations, and future directions are discussed.

GLT-1 loss accelerates cognitive deficit onset in an Alzheimer's disease animal model.

Glutamate transporters regulate normal synaptic network interactions and prevent neurotoxicity by rapidly clearing extracellular glutamate. GLT-1, the dominant glutamate transporter in the cerebral cortex and hippocampus, is significantly reduced in Alzheimer's disease (AD). However, the role GLT-1 loss plays in the cognitive dysfunction and pathology of AD is unknown. To determine the significance of GLT-1 dysfunction on AD-related pathological processes, mice lacking one allele for GLT-1(+/-) were crossed with transgenic mice expressing mutations of the amyloid-ß protein precursor and presenilin-1 (AßPPswe/PS1ΔE9) and investigated at 6 or 9 months of age. Partial loss of GLT-1 unmasked spatial memory deficits in 6-month-old mice expressing AßPPswe/PS1ΔE9, with these mice also exhibiting an increase in the ratio of detergent-insoluble Aß42/Aß40. At 9 months both behavioral performance and insoluble Aß42/Aß40 ratios among GLT-1(+/+)/AßPPswe/PS1ΔE9 and GLT-1(+/-)/AßPPswe/PS1ΔE9 mice were comparable. These results suggest that deficits in glutamate transporter function compound the effects of familial AD AßPP/PS1 mutant transgenes in younger animals and thus may contribute to early occurring pathogenic processes associated with AD.

The role of norepinephrine in differential response to stress in an animal model of posttraumatic stress disorder.

BACKGROUND: Posttraumatic stress disorder (PTSD) is a prevalent psychiatric disorder precipitated by exposure to extreme traumatic stress. Yet, most individuals exposed to traumatic stress do not develop PTSD and may be considered psychologically resilient. The neural circuits involved in susceptibility or resiliency to PTSD remain unclear, but clinical evidence implicates changes in the noradrenergic system. METHODS: An animal model of PTSD called Traumatic Experience with Reminders of Stress (TERS) was developed by exposing C57BL/6 mice to a single shock (2 mA, 10 sec) followed by exposure to six contextual 1-minute reminders of the shock over a 25-day period. Acoustic startle response (ASR) testing before the shock and after the last reminder allowed experimenters to separate the shocked mice into two cohorts: mice that developed a greatly increased ASR (TERS-susceptible mice) and mice that did not (TERS-resilient mice). RESULTS: Aggressive and social behavioral correlates of PTSD increased in TERS-susceptible mice but not in TERS-resilient mice or control mice. Characterization of c-Fos expression in stress-related brain regions revealed that TERS-susceptible and TERS-resilient mice displayed divergent brain activation following swim stress compared with control mice. Pharmacological activation of noradrenergic inhibitory autoreceptors or blockade of postsynaptic α(1)-adrenoreceptors normalized ASR, aggression, and social interaction in TERS-susceptible mice. The TERS-resilient, but not TERS-susceptible, mice showed a trend toward decreased behavioral responsiveness to noradrenergic autoreceptor blockade compared with control mice. CONCLUSIONS: These data implicate the noradrenergic system as a possible site of pathological and perhaps also adaptive plasticity in response to traumatic stress.

Topographical organization of GABAergic neurons within the ventral tegmental area of the rat.

The ventral tegmental area (VTA), the origin of dopaminergic cell bodies that comprise the mesocorticolimibic DA system, is widely implicated in drug and natural reward, cognition, and several psychiatric disorders. In addition to dopaminergic neurons, this region is populated by GABAergic neurons, which both regulate the firing of their dopaminergic counterparts and send projections throughout the brain. Although the dopaminergic neurons of the VTA have been extensively characterized neuroanatomically, much less is known about the GABAergic neurons in this region. Recent data suggest that the rostro-caudal topographic organization of these GABAergic neurons may correspond to their ability to regulate drug reward. In the present study, we used immunohistochemical techniques to examine the frequency and topography of GABAergic neurons throughout the rostro-caudal axis of the VTA and the extent to which they coexpress other proteins, including tyrosine hydroxylase (a marker of DA neurons), cholecystokinin, parvalbumin, calretinin, and calbindin d 28k.

Lack of neuropeptide Y attenuates the somatic signs of opiate withdrawal.

Recent evidence suggests that neuropeptide Y (NPY) may be involved in the neurobiological responses to drugs of abuse. This study was designed to assess the possible contribution of NPY to opiate withdrawal behaviors. Here we report that mice lacking the NPY gene show normal conditioned place aversion to opiate withdrawal, but show attenuated opiate withdrawal somatic signs.

Role of noradrenergic signaling by the nucleus tractus solitarius in mediating opiate reward.

Norepinephrine (NE) is widely implicated in opiate withdrawal, but much less is known about its role in opiate-induced locomotion and reward. In mice lacking dopamine beta-hydroxylase (DBH), an enzyme critical for NE synthesis, we found that NE was necessary for morphine-induced conditioned place preference (CPP; a measure of reward) and locomotion. These deficits were rescued by systemic NE restoration. Viral restoration of DBH expression in the nucleus tractus solitarius, but not in the locus coeruleus, restored CPP for morphine. Morphine-induced locomotion was partially restored by DBH expression in either brain region. These data suggest that NE signaling by the nucleus tractus solitarius is necessary for morphine reward.