{"id":"https://openalex.org/W7147345196","doi":"https://doi.org/10.3390/systems14040378","title":"Systems Thinking with Causal Loop Diagrams in Medical Education: An Exploratory Study","display_name":"Systems Thinking with Causal Loop Diagrams in Medical Education: An Exploratory Study","publication_year":2026,"publication_date":"2026-04-01","ids":{"openalex":"https://openalex.org/W7147345196","doi":"https://doi.org/10.3390/systems14040378"},"language":"en","primary_location":{"id":"doi:10.3390/systems14040378","is_oa":true,"landing_page_url":"https://doi.org/10.3390/systems14040378","pdf_url":"https://www.mdpi.com/2079-8954/14/4/378/pdf?version=1775031101","source":{"id":"https://openalex.org/S4210219410","display_name":"Systems","issn_l":"2079-8954","issn":["2079-8954"],"is_oa":true,"is_in_doaj":true,"is_core":true,"host_organization":"https://openalex.org/P4310310987","host_organization_name":"Multidisciplinary Digital Publishing Institute","host_organization_lineage":["https://openalex.org/P4310310987"],"host_organization_lineage_names":["Multidisciplinary Digital Publishing Institute"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Systems","raw_type":"journal-article"},"type":"article","indexed_in":["crossref","doaj"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://www.mdpi.com/2079-8954/14/4/378/pdf?version=1775031101","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5015723926","display_name":"David M. Rubin","orcid":"https://orcid.org/0000-0003-0316-9197"},"institutions":[{"id":"https://openalex.org/I192619145","display_name":"University of the Witwatersrand","ror":"https://ror.org/03rp50x72","country_code":"ZA","type":"education","lineage":["https://openalex.org/I192619145"]}],"countries":["ZA"],"is_corresponding":true,"raw_author_name":"David M. Rubin","raw_affiliation_strings":["Biomedical Engineering Research Group, School of Electrical & Information Engineering, University of the Witwatersrand, Johannesburg, 1 Jan Smuts Avenue, Braamfontein 2001, South Africa"],"raw_orcid":"https://orcid.org/0000-0003-0316-9197","affiliations":[{"raw_affiliation_string":"Biomedical Engineering Research Group, School of Electrical & Information Engineering, University of the Witwatersrand, Johannesburg, 1 Jan Smuts Avenue, Braamfontein 2001, South Africa","institution_ids":["https://openalex.org/I192619145"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5073554988","display_name":"Shamin Achari","orcid":"https://orcid.org/0000-0003-3914-4530"},"institutions":[{"id":"https://openalex.org/I192619145","display_name":"University of the Witwatersrand","ror":"https://ror.org/03rp50x72","country_code":"ZA","type":"education","lineage":["https://openalex.org/I192619145"]}],"countries":["ZA"],"is_corresponding":false,"raw_author_name":"Shamin Achari","raw_affiliation_strings":["Biomedical Engineering Research Group, School of Electrical & Information Engineering, University of the Witwatersrand, Johannesburg, 1 Jan Smuts Avenue, Braamfontein 2001, South Africa"],"raw_orcid":"https://orcid.org/0000-0003-3914-4530","affiliations":[{"raw_affiliation_string":"Biomedical Engineering Research Group, School of Electrical & Information Engineering, University of the Witwatersrand, Johannesburg, 1 Jan Smuts Avenue, Braamfontein 2001, South Africa","institution_ids":["https://openalex.org/I192619145"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5053806782","display_name":"Xriz L. Richards","orcid":null},"institutions":[{"id":"https://openalex.org/I192619145","display_name":"University of the Witwatersrand","ror":"https://ror.org/03rp50x72","country_code":"ZA","type":"education","lineage":["https://openalex.org/I192619145"]}],"countries":["ZA"],"is_corresponding":false,"raw_author_name":"Xriz L. Richards","raw_affiliation_strings":["Biomedical Engineering Research Group, School of Electrical & Information Engineering, University of the Witwatersrand, Johannesburg, 1 Jan Smuts Avenue, Braamfontein 2001, South Africa"],"raw_orcid":"https://orcid.org/0000-0001-6479-3757","affiliations":[{"raw_affiliation_string":"Biomedical Engineering Research Group, School of Electrical & Information Engineering, University of the Witwatersrand, Johannesburg, 1 Jan Smuts Avenue, Braamfontein 2001, South Africa","institution_ids":["https://openalex.org/I192619145"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5047837483","display_name":"Adam Pantanowitz","orcid":"https://orcid.org/0000-0002-4080-6389"},"institutions":[{"id":"https://openalex.org/I192619145","display_name":"University of the Witwatersrand","ror":"https://ror.org/03rp50x72","country_code":"ZA","type":"education","lineage":["https://openalex.org/I192619145"]}],"countries":["ZA"],"is_corresponding":false,"raw_author_name":"Adam Pantanowitz","raw_affiliation_strings":["Biomedical Engineering Research Group, School of Electrical & Information Engineering, University of the Witwatersrand, Johannesburg, 1 Jan Smuts Avenue, Braamfontein 2001, South Africa","Wits Innovation Centre, University of the Witwatersrand, Johannesburg, 1 Jan Smuts Avenue, Braamfontein 2001, South Africa"],"raw_orcid":"https://orcid.org/0000-0002-4080-6389","affiliations":[{"raw_affiliation_string":"Biomedical Engineering Research Group, School of Electrical & Information Engineering, University of the Witwatersrand, Johannesburg, 1 Jan Smuts Avenue, Braamfontein 2001, South Africa","institution_ids":["https://openalex.org/I192619145"]},{"raw_affiliation_string":"Wits Innovation Centre, University of the Witwatersrand, Johannesburg, 1 Jan Smuts Avenue, Braamfontein 2001, South Africa","institution_ids":["https://openalex.org/I192619145"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5035520618","display_name":"Ann George","orcid":"https://orcid.org/0000-0002-9042-2279"},"institutions":[{"id":"https://openalex.org/I192619145","display_name":"University of the Witwatersrand","ror":"https://ror.org/03rp50x72","country_code":"ZA","type":"education","lineage":["https://openalex.org/I192619145"]},{"id":"https://openalex.org/I40120149","display_name":"University of Oxford","ror":"https://ror.org/052gg0110","country_code":"GB","type":"education","lineage":["https://openalex.org/I40120149"]}],"countries":["GB","ZA"],"is_corresponding":false,"raw_author_name":"Ann George","raw_affiliation_strings":["Centre for Health Science Education, Phillip Tobias Building, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 29 Princess of Wales Terrace, Parktown 2193, South Africa","Department of Education, University of Oxford, 15 Norham Gardens, Oxford OX2 6PY, UK"],"raw_orcid":"https://orcid.org/0000-0002-9042-2279","affiliations":[{"raw_affiliation_string":"Centre for Health Science Education, Phillip Tobias Building, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 29 Princess of Wales Terrace, Parktown 2193, South Africa","institution_ids":["https://openalex.org/I192619145"]},{"raw_affiliation_string":"Department of Education, University of Oxford, 15 Norham Gardens, Oxford OX2 6PY, UK","institution_ids":["https://openalex.org/I40120149"]}]}],"institutions":[],"countries_distinct_count":2,"institutions_distinct_count":5,"corresponding_author_ids":["https://openalex.org/A5015723926"],"corresponding_institution_ids":["https://openalex.org/I192619145"],"apc_list":{"value":1600,"currency":"CHF","value_usd":1732},"apc_paid":{"value":1600,"currency":"CHF","value_usd":1732},"fwci":0.0,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":{"value":0.55591564,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"14","issue":"4","first_page":"378","last_page":"378"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11810","display_name":"Complex Systems and Decision Making","score":0.6093999743461609,"subfield":{"id":"https://openalex.org/subfields/1803","display_name":"Management Science and Operations Research"},"field":{"id":"https://openalex.org/fields/18","display_name":"Decision Sciences"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},"topics":[{"id":"https://openalex.org/T11810","display_name":"Complex Systems and Decision Making","score":0.6093999743461609,"subfield":{"id":"https://openalex.org/subfields/1803","display_name":"Management Science and Operations Research"},"field":{"id":"https://openalex.org/fields/18","display_name":"Decision Sciences"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T12574","display_name":"Clinical Reasoning and Diagnostic Skills","score":0.0575999990105629,"subfield":{"id":"https://openalex.org/subfields/2714","display_name":"Family Practice"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11238","display_name":"Simulation-Based Education in Healthcare","score":0.056299999356269836,"subfield":{"id":"https://openalex.org/subfields/2737","display_name":"Physiology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/exploratory-research","display_name":"Exploratory research","score":0.6359000205993652},{"id":"https://openalex.org/keywords/causal-loop-diagram","display_name":"Causal loop diagram","score":0.5418000221252441},{"id":"https://openalex.org/keywords/diagrammatic-reasoning","display_name":"Diagrammatic reasoning","score":0.539900004863739},{"id":"https://openalex.org/keywords/set","display_name":"Set (abstract data type)","score":0.5209000110626221},{"id":"https://openalex.org/keywords/heuristic","display_name":"Heuristic","score":0.4187999963760376},{"id":"https://openalex.org/keywords/test","display_name":"Test (biology)","score":0.3765000104904175},{"id":"https://openalex.org/keywords/diagram","display_name":"Diagram","score":0.3605000078678131},{"id":"https://openalex.org/keywords/causality","display_name":"Causality (physics)","score":0.3458000123500824},{"id":"https://openalex.org/keywords/systems-thinking","display_name":"Systems thinking","score":0.33149999380111694}],"concepts":[{"id":"https://openalex.org/C85973986","wikidata":"https://www.wikidata.org/wiki/Q1091731","display_name":"Exploratory research","level":2,"score":0.6359000205993652},{"id":"https://openalex.org/C144400606","wikidata":"https://www.wikidata.org/wiki/Q2412982","display_name":"Causal loop diagram","level":3,"score":0.5418000221252441},{"id":"https://openalex.org/C106624574","wikidata":"https://www.wikidata.org/wiki/Q5270387","display_name":"Diagrammatic reasoning","level":2,"score":0.539900004863739},{"id":"https://openalex.org/C177264268","wikidata":"https://www.wikidata.org/wiki/Q1514741","display_name":"Set (abstract data type)","level":2,"score":0.5209000110626221},{"id":"https://openalex.org/C41008148","wikidata":"https://www.wikidata.org/wiki/Q21198","display_name":"Computer science","level":0,"score":0.49779999256134033},{"id":"https://openalex.org/C173801870","wikidata":"https://www.wikidata.org/wiki/Q201413","display_name":"Heuristic","level":2,"score":0.4187999963760376},{"id":"https://openalex.org/C2777267654","wikidata":"https://www.wikidata.org/wiki/Q3519023","display_name":"Test (biology)","level":2,"score":0.3765000104904175},{"id":"https://openalex.org/C186399060","wikidata":"https://www.wikidata.org/wiki/Q959962","display_name":"Diagram","level":2,"score":0.3605000078678131},{"id":"https://openalex.org/C154945302","wikidata":"https://www.wikidata.org/wiki/Q11660","display_name":"Artificial intelligence","level":1,"score":0.34950000047683716},{"id":"https://openalex.org/C64357122","wikidata":"https://www.wikidata.org/wiki/Q1149766","display_name":"Causality (physics)","level":2,"score":0.3458000123500824},{"id":"https://openalex.org/C27177047","wikidata":"https://www.wikidata.org/wiki/Q269699","display_name":"Systems thinking","level":2,"score":0.33149999380111694},{"id":"https://openalex.org/C15744967","wikidata":"https://www.wikidata.org/wiki/Q9418","display_name":"Psychology","level":0,"score":0.3257000148296356},{"id":"https://openalex.org/C161584116","wikidata":"https://www.wikidata.org/wiki/Q1952580","display_name":"Multivariate statistics","level":2,"score":0.3222000002861023},{"id":"https://openalex.org/C77405623","wikidata":"https://www.wikidata.org/wiki/Q598451","display_name":"System dynamics","level":2,"score":0.32190001010894775},{"id":"https://openalex.org/C38180746","wikidata":"https://www.wikidata.org/wiki/Q1952580","display_name":"Multivariate analysis","level":2,"score":0.3070000112056732},{"id":"https://openalex.org/C198531522","wikidata":"https://www.wikidata.org/wiki/Q485146","display_name":"Sample (material)","level":2,"score":0.29490000009536743},{"id":"https://openalex.org/C184670325","wikidata":"https://www.wikidata.org/wiki/Q512604","display_name":"Loop (graph theory)","level":2,"score":0.2840000092983246},{"id":"https://openalex.org/C80444323","wikidata":"https://www.wikidata.org/wiki/Q2878974","display_name":"Theoretical computer science","level":1,"score":0.2797999978065491},{"id":"https://openalex.org/C11671645","wikidata":"https://www.wikidata.org/wiki/Q5054567","display_name":"Causal model","level":2,"score":0.2768000066280365},{"id":"https://openalex.org/C119857082","wikidata":"https://www.wikidata.org/wiki/Q2539","display_name":"Machine learning","level":1,"score":0.26829999685287476},{"id":"https://openalex.org/C18762648","wikidata":"https://www.wikidata.org/wiki/Q42213","display_name":"Work (physics)","level":2,"score":0.2653999924659729},{"id":"https://openalex.org/C25343380","wikidata":"https://www.wikidata.org/wiki/Q277521","display_name":"Relation (database)","level":2,"score":0.26170000433921814},{"id":"https://openalex.org/C169903167","wikidata":"https://www.wikidata.org/wiki/Q3985153","display_name":"Test set","level":2,"score":0.2612999975681305},{"id":"https://openalex.org/C33923547","wikidata":"https://www.wikidata.org/wiki/Q395","display_name":"Mathematics","level":0,"score":0.2578999996185303},{"id":"https://openalex.org/C180747234","wikidata":"https://www.wikidata.org/wiki/Q23373","display_name":"Cognitive psychology","level":1,"score":0.257099986076355},{"id":"https://openalex.org/C2776359362","wikidata":"https://www.wikidata.org/wiki/Q2145286","display_name":"Representation (politics)","level":3,"score":0.25589999556541443},{"id":"https://openalex.org/C3018260909","wikidata":"https://www.wikidata.org/wiki/Q1322871","display_name":"Exploratory analysis","level":2,"score":0.25279998779296875},{"id":"https://openalex.org/C180198813","wikidata":"https://www.wikidata.org/wiki/Q121182","display_name":"Information system","level":2,"score":0.251800000667572},{"id":"https://openalex.org/C2522767166","wikidata":"https://www.wikidata.org/wiki/Q2374463","display_name":"Data science","level":1,"score":0.2515999972820282}],"mesh":[],"locations_count":2,"locations":[{"id":"doi:10.3390/systems14040378","is_oa":true,"landing_page_url":"https://doi.org/10.3390/systems14040378","pdf_url":"https://www.mdpi.com/2079-8954/14/4/378/pdf?version=1775031101","source":{"id":"https://openalex.org/S4210219410","display_name":"Systems","issn_l":"2079-8954","issn":["2079-8954"],"is_oa":true,"is_in_doaj":true,"is_core":true,"host_organization":"https://openalex.org/P4310310987","host_organization_name":"Multidisciplinary Digital Publishing Institute","host_organization_lineage":["https://openalex.org/P4310310987"],"host_organization_lineage_names":["Multidisciplinary Digital Publishing Institute"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Systems","raw_type":"journal-article"},{"id":"pmh:oai:doaj.org/article:d34223b9bb1b4cc29c6c7e6b018b3da8","is_oa":true,"landing_page_url":"https://doaj.org/article/d34223b9bb1b4cc29c6c7e6b018b3da8","pdf_url":null,"source":{"id":"https://openalex.org/S4306401280","display_name":"DOAJ (DOAJ: Directory of Open Access Journals)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by-sa","license_id":"https://openalex.org/licenses/cc-by-sa","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"Systems, Vol 14, Iss 4, p 378 (2026)","raw_type":"article"}],"best_oa_location":{"id":"doi:10.3390/systems14040378","is_oa":true,"landing_page_url":"https://doi.org/10.3390/systems14040378","pdf_url":"https://www.mdpi.com/2079-8954/14/4/378/pdf?version=1775031101","source":{"id":"https://openalex.org/S4210219410","display_name":"Systems","issn_l":"2079-8954","issn":["2079-8954"],"is_oa":true,"is_in_doaj":true,"is_core":true,"host_organization":"https://openalex.org/P4310310987","host_organization_name":"Multidisciplinary Digital Publishing Institute","host_organization_lineage":["https://openalex.org/P4310310987"],"host_organization_lineage_names":["Multidisciplinary Digital Publishing Institute"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Systems","raw_type":"journal-article"},"sustainable_development_goals":[{"id":"https://metadata.un.org/sdg/4","display_name":"Quality Education","score":0.6611317992210388}],"awards":[],"funders":[],"has_content":{"pdf":true,"grobid_xml":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7147345196.pdf","grobid_xml":"https://content.openalex.org/works/W7147345196.grobid-xml"},"referenced_works_count":27,"referenced_works":["https://openalex.org/W1963996086","https://openalex.org/W2046036800","https://openalex.org/W2067304913","https://openalex.org/W2069157810","https://openalex.org/W2077546866","https://openalex.org/W2114570931","https://openalex.org/W2125497117","https://openalex.org/W2157800154","https://openalex.org/W2334735300","https://openalex.org/W2600919681","https://openalex.org/W2784754594","https://openalex.org/W2891493353","https://openalex.org/W2907898442","https://openalex.org/W2954441014","https://openalex.org/W2967205483","https://openalex.org/W3001032057","https://openalex.org/W3011979743","https://openalex.org/W3012964541","https://openalex.org/W3114986069","https://openalex.org/W3115451525","https://openalex.org/W4225291024","https://openalex.org/W4254431624","https://openalex.org/W4282966254","https://openalex.org/W4400524442","https://openalex.org/W4401990114","https://openalex.org/W4410440237","https://openalex.org/W4414800369"],"related_works":[],"abstract_inverted_index":{"Medical":[0],"literature":[1],"is":[2,190],"replete":[3],"with":[4,49,141],"diagrammatic":[5],"representations":[6],"of":[7,63,166,180,201,209],"systems,":[8],"yet":[9],"lacks":[10],"standardised":[11],"nomenclature":[12],"and":[13,83,97,106,129,149,205],"consistent":[14],"symbolic":[15],"conventions.":[16],"In":[17],"an":[18],"introductory":[19],"system":[20,96],"dynamics":[21],"course":[22,59],"for":[23,45,94,100,143],"health":[24],"science":[25],"students,":[26],"causal":[27],"loop":[28],"diagrams":[29],"(CLDs)":[30],"are":[31],"used":[32],"to":[33,60,184,192],"support":[34],"systems":[35,48,64,74,182],"thinking.":[36],"Notwithstanding":[37],"recognised":[38],"limitations,":[39],"CLDs":[40,67,142,176],"provide":[41],"a":[42,98,120,163,202,206],"coherent":[43],"heuristic":[44],"representing":[46],"multivariate":[47],"feedback.":[50],"We":[51],"studied":[52],"55":[53],"first-year":[54],"volunteers":[55],"enrolled":[56],"in":[57,175],"the":[58,90,101,196],"compare":[61],"understanding":[62,179],"presented":[65],"as":[66],"versus":[68],"typical":[69],"journal":[70,92,127,186],"diagrams.":[71,187,210],"Two":[72],"endocrine":[73],"were":[75,87],"selected":[76],"from":[77],"open-access,":[78],"peer-reviewed":[79],"literature:":[80],"calcium":[81],"homeostasis":[82],"glucose":[84],"homeostasis.":[85],"Participants":[86],"shown":[88],"either":[89],"original":[91],"diagram":[93],"one":[95],"CLD":[99],"other,":[102],"or":[103],"vice":[104],"versa,":[105],"answered":[107],"twelve":[108],"true/false":[109],"questions\u2014six":[110],"per":[111],"system.":[112],"A":[113,157],"mixed-model,":[114],"two-way":[115],"repeated":[116],"measures":[117],"ANOVA":[118],"revealed":[119],"significant":[121],"interaction":[122],"between":[123],"Diagram":[124],"(CLD":[125],"vs.":[126,132,147,152],"diagram)":[128],"System":[130],"(Calcium":[131],"Glucose).":[133],"Post":[134],"hoc":[135],"comparisons":[136],"showed":[137],"significantly":[138],"higher":[139,164],"performance":[140],"both":[144],"Calcium":[145],"(0.84":[146],"0.38)":[148],"Glucose":[150],"(0.83":[151],"0.63),":[153],"p":[154],"<":[155],"0.001.":[156],"Fisher\u2019s":[158],"Exact":[159],"Test":[160],"also":[161],"indicated":[162],"proportion":[165],"questions":[167],"favouring":[168],"CLDs.":[169],"These":[170],"findings":[171],"suggest":[172],"that":[173],"training":[174],"may":[177],"enhance":[178],"complex":[181],"compared":[183],"standard":[185],"Further":[188],"work":[189],"needed":[191],"address":[193],"limitations":[194],"including":[195],"small":[197],"sample":[198],"size,":[199],"use":[200],"single":[203],"cohort,":[204],"restricted":[207],"set":[208]},"counts_by_year":[],"updated_date":"2026-05-21T06:26:12.895304","created_date":"2026-04-02T00:00:00"}