The effectiveness of Symptom-Oriented Mind Mapping Combined with Problem-Based Learning in Critical Care Clerkships: A Randomized Controlled Trial

Tian Gao^1,2Xuewei Zhao^1,2heng Bo Wang¹Ling Wang³Yuan Mao^1,2Dan Wang^1,2Yao Zheng Han^1,2Ping Xue Xu^1,2Li Qian^1,2Can Yang^1,2Jie Yin^1,2Wei Wang^1,2*Xilan Yang^1,2*

• ¹Nanjing Medical University, Nanjing, China
• ²The Fourth Affiliated Hospital of Nanjing Medical University, 南京市, China
• ³The Fourth Affiliated Hospital of Nanjing Medical University, Nanjing, China

Objective: This study evaluated the efficacy of Symptom-Oriented Mind Mapping combined with Problem-Based Learning (SOM-PBL) in intensive care unit (ICU) clinical clerkships, assessing its impact on medical students' knowledge integration, clinical decision-making efficiency, and procedural skills, thereby providing theoretical and practical insights for optimizing critical care medical education. Methods: A prospective randomized controlled trial enrolled 160 fifth-year medical students during ICU clerkships at the Fourth Affiliated Hospital of Nanjing Medical University (January 2023–December 2024). Participants were randomly assigned to the SOM-PBL group (n = 80) or the control group (n = 80) using stratified randomization based on academic major and pre-clerkship academic performance. All students subsequently completed a four-week ICU clerkship using their assigned instructional method (SOM-PBL or traditional teaching), after which they underwent comprehensive assessments in theoretical knowledge, procedural skills, clinical reasoning, and educational satisfaction. Results: The SOM-PBL group achieved significantly higher median knowledge theoretical scores [median (IQR): 77 (73, 80) vs. 74 (72, 77); P < 0.05] and superior clinical reasoning performance [median (IQR): 88 (85, 93) vs. 87 (84, 89.75); P < 0.05]. No significant intergroup difference was observed in procedural skills performance [median (IQR): 92 (90, 94) for both groups; P = 0.938).SOM-PBL showed significant strengths in monitoring technology/device application, pathophysiology/disease recognition, and diagnostic cognitive rigor (all P < 0.05). Over 80% of SOM-PBL students rated ≥90% of survey items as 4 or 5 on a 5-point Likert scale, indicating high satisfaction with learning efficiency, engagement, clinical reasoning enhancement, and course quality. Conclusion: The study demonstrated that the SOM-PBL approach significantly enhanced medical students' knowledge integration and clinical decision-making efficiency during ICU clerkships. However, no significant improvement was observed in procedural skills. These findings offer both theoretical and practical value for innovating critical care medical education by effectively addressing knowledge fragmentation and bridging the theory-practice gaps.