Crossword Puzzles and Knowledge Retention.

Introduction: Medical education is a complex and demanding field, requiring students to learn and retain a vast amount of information in a short period. Medical students often face challenges in retaining information and applying it to real-world scenarios. To address this issue, various educational strategies have been employed to enhance knowledge retention and learning outcomes. One such strategy is the use of crossword puzzles as a tool for reinforcing medical concepts and terminology. Materials and Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to conduct this meta-analysis. We have searched electronic databases, including PubMed, Embase, and Scopus, for relevant studies published between 1990 and 2023. Fourteen studies were included with a total of 1,623 medical students. The majority of the studies were randomized controlled trials. The duration of the interventions ranged from 1 week to 6 months, with most studies employing a 2-week intervention period. Results and Analysis: Fourteen studies were included in the meta-analysis. The results of the meta-analysis indicated that the use of crossword puzzles in medical education was associated with a significant improvement in knowledge retention ( P < 0.001) and learning outcomes ( P < 0.001). Moderate heterogeneity was observed in the meta-analysis of knowledge retention ( P = 0.004) and low heterogeneity in the meta-analysis of learning outcomes ( P = 0.136). Sensitivity analysis revealed that the results were robust to the exclusion of individual studies, suggesting that the findings were not driven by a single study. Discussion: The results of this meta-analysis suggest that the use of crossword puzzles as an instructional tool in medical education was associated with a significant improvement in knowledge retention and learning outcomes among medical students across the world. The moderate heterogeneity observed in the meta-analysis of knowledge retention may be due to differences in study design, intervention duration, puzzle format, and participant characteristics. Conclusion: The use of crossword puzzles as an instructional tool in medical education shows promise for improving knowledge retention and learning outcomes among medical students.

AIMS: Small group teaching in Pharmacology offers an effective platform to encourage interaction amongst peers and self-directed learning. The present study is an attempt to assess and compare the effectiveness and perception of students on two different pedagogical methods: Crossword puzzles and Student Led Objective Tutorials (SLOT).METHODS: Second year undergraduate students who gave their informed consent were divided randomly into two groups: one which received crossword puzzle as a teaching learning method and the other had SLOT during which the students conducted an interactive quiz with multiple choice questions prepared by themselves. The students’ perceptions were recorded using a self-administered questionnaire. One week later, a unit test was conducted for both the groups and the performance of the students was compared. Statistical analysis was done using independent Student’s T test with SPSS version 15.0.RESULTS: Analyses revealed a statistical significant difference (P<0.001) between the mean marks obtained in the SLOT group (n= 74; 6.5±3.8) and the marks obtained in the crossword group (n= 87; 4.2±2.9), with the students in the tutorial group performing better. The students opined that SLOT sessions helped them to understand Pharmacology better whereas crossword sessions enabled them to memorize the names of the drugs.CONCLUSION: The present study revealed that SLOT sessions fared better compared to the crossword puzzles in terms of improving the students’ test scores. It fostered teamwork, self-directed learning skills and critical thinking. Crossword puzzles make the session more student friendly as it is fun and engaging but a careful design is inevitable as it may fail to test in-depth learning in students.

Background Conventional lectures in medical training may not always foster adequate comprehension and retention of complex physiological concepts. A modified flipped classroom integrating open-ended scenario-based questions (SBQs), multiple-choice questions (MCQs) assessments using an online response recording (ORR) system, and mind maps may enhance student comprehension, engagement, and knowledge retention. This study evaluates first-year Bachelor of Medicine and Bachelor of Surgery (MBBS) students' perceptions of an integrated instructional module on blood physiology. Methods This cross-sectional study was conducted at the All India Institute of Medical Sciences, Raebareli, India, from November 2024 to February 2025, involving 96 first-year MBBS students. The instructional module consisted of 21 structured lectures that utilized a modified flipped classroom approach with pre-class study materials and in-class PowerPoint-based teaching (Microsoft Corp., Redmond, WA). This approach was integrated with mind map navigations, SBQdiscussions, and MCQassessments via Google Forms (Google LLC, Mountain View, CA). Student perceptions were assessed using a validated 14-item questionnaire categorized into three domains: handout quality, comprehension and retention, and satisfaction and engagement. Additionally, two questions assessed the consistency of handout review before classes and the preferred method among SBQs, MCQs, and mind maps for enhancing understanding and retention. Responses were recorded on a five-point Likert scale. Data analysis included descriptive statistics, principal component factor analysis for construct validity, and Cronbach's alpha for reliability assessment. Results Students highly appreciated the quality of structured handouts (4.57 ± 0.42). Students believed that integrating SBQ discussions, MCQs with ORR, and mind maps helped improve knowledge retention and comprehension (4.28 ± 0.44) in a satisfactory and engaging environment (4.49 ± 0.41). Most students acknowledged the benefits of these methods: 91% agreed that MCQs reinforced key concepts, 96% reported an improved understanding through SBQ discussions, and 92% found mind maps helpful for knowledge retention. Additionally, 72% preferred the combined approach of SBQs, MCQs with ORR, and mind maps for comprehension and retention. However, only 26% consistently reviewed the handouts before classes. Conclusion The modified flipped classroom model integrating SBQs, MCQs with ORR, and mind maps helped students comprehend blood physiology while maintaining engagement in lectures. This structured instructional module offers a feasible and effective strategy for enhancing comprehension and engagement in medical education, even with limited resources.

<sec> <title>BACKGROUND</title> Despite global advocacy for its integration into medical curricula, disaster medicine (DM) education remains underdeveloped, especially in fragile settings where such training is urgently needed. In Lebanon, a country facing political and economic crises, students face significant barriers to in-person education. </sec> <sec> <title>OBJECTIVE</title> This study aims to evaluate the effectiveness of e-learning versus face-to-face (F2F) approaches in improving knowledge retention and provides insight into the practical considerations of implementing DM courses in such settings. </sec> <sec> <title>METHODS</title> This quasi-experimental study used a Solomon 4-group design to evaluate e-learning and F2F DM courses for second- to fifth-year medical students at the Lebanese University. A total of 205 participants, stratified by academic year, were divided between the 2 modalities. Knowledge was assessed before the course, after the course, and at 1-month follow-up. Confidence, competency, and satisfaction were evaluated after the course using validated tools. </sec> <sec> <title>RESULTS</title> Of 205 participants, 56.6% (n=116) favored e-learning. Both modalities improved knowledge and knowledge retention, with no significant difference between the 2 groups. Fifth-year students achieved the highest gains in knowledge, particularly in the e-learning group. Similarly, no significant difference in satisfaction was observed across modalities, although F2F was preferred overall, except among fifth-year students, who preferred e-learning. Confidence levels were also similar across both modalities, but F2F scored higher for skills like triaging. Feedback emphasized the relevance of the course and advocated for integration of DM into the medical curriculum, and adding practical sessions. </sec> <sec> <title>CONCLUSIONS</title> Integrating DM education into the fifth-year curriculum, prior to externship, can enhance preparedness and promote knowledge retention and application in real-world disaster settings. The study shows that e-learning is an effective modality for improving knowledge acquisition and retention in DM. Although feasibility and efficiency were not measured directly, the successful delivery of the course to geographically dispersed students suggests potential practical advantages. Combining F2F practical sessions for specific targeted topics in a blended curriculum is recommended to further enhance medical students’ confidence for future disaster response. These findings support broader policy efforts to institutionalize DM in medical curricula, particularly in fragile and resource-limited settings. </sec> <sec> <title>CLINICALTRIAL</title> <p/> </sec>

This study investigated the correlations between learning inquiry strategies and knowledge retention among Grade 6 learners in District 2 of Maramag, Bukidnon, for the 2024-2025 school year. Specifically, it evaluated the level of various learning inquiry strategies—questioning techniques, hands-on activities, scaffolding and guidance, authentic materials, and reflection—and their impact on learners' knowledge retention. A descriptive-correlational research design was used, with 256 learners selected through simple random sampling. Data were analyzed using mean, standard deviation, and Pearson product-moment correlation. Findings revealed that questioning techniques and hands-on activities were rated high, while scaffolding, authentic materials, and reflection were rated very high. This highlights the effectiveness of interactive, practical, and real-world learning experiences in fostering student engagement and understanding. Additionally, knowledge retention among learners was high, suggesting that diverse and active learning methods support effective retention. A significant correlation was found between inquiry strategies and knowledge retention, underscoring the value of combining questioning, hands-on activities, structured guidance, authentic materials, and reflective practices. These findings suggest that incorporating a variety of evidence-based instructional strategies can enhance student engagement and improve knowledge retention, making them valuable tools for teachers aiming to optimize learning outcomes.

Crossword puzzles improve learning of Palestinian nursing students about pharmacology of epilepsy: Results of a randomized controlled study

Medical students have to process a large amount of information during the first years of their study, which has to be retained over long periods of nonuse. Therefore, it would be beneficial when knowledge is gained in a way that promotes long-term retention. Paper-and-pencil drawings for the uptake of form-function relationships of basic tissues has been a teaching tool for a long time, but now seems to be redundant with virtual microscopy on computer-screens and printers everywhere. Several studies claimed that, apart from learning from pictures, actual drawing of images significantly improved knowledge retention. However, these studies applied only immediate post-tests. We investigated the effects of actual drawing of histological images, using randomized cross-over design and different retention periods. The first part of the study concerned esophageal and tracheal epithelium, with 384 medical and biomedical sciences students randomly assigned to either the drawing or the nondrawing group. For the second part of the study, concerning heart muscle cells, students from the previous drawing group were now assigned to the nondrawing group and vice versa. One, four, and six weeks after the experimental intervention, the students were given a free recall test and a questionnaire or drawing exercise, to determine the amount of knowledge retention. The data from this study showed that knowledge retention was significantly improved in the drawing groups compared with the nondrawing groups, even after four or six weeks. This suggests that actual drawing of histological images can be used as a tool to improve long-term knowledge retention.

Background In the restorative dentistry module of the undergraduate dental program, dental students encounter many new terms and concepts in a short period of time. The provision of adequate learning support to reinforce key concepts can be challenging. Aim The purpose of this study is to determine student perceptions of how effective interactive crossword puzzles are as adjunctive tools to enhance the learning of restorative dentistry. Methods Students completed interactive crossword puzzles created by the authors, with a reward awarded to the first group of students who completed the puzzles successfully. The interactive crossword platform was programmed using the ReactJS framework and designed using Tailwind CSS. An evaluation of the student's perception of this educational method was conducted using textual feedback and Likert-scale questionnaires. Results Students found the crossword puzzles engaging, meaningful, and successful as indicated by their favorable Likert scores and feedback. Written comments revealed student enthusiasm for and a desire to be exposed to more of these exercises. Conclusions This work sheds light on the potential advantages of incorporating interactive crossword puzzles into the restorative dentistry course from a student's perspective. The crossword puzzles improved students' ability to review and reinforce concepts and terminology and proved to be meaningful and enjoyable. The web-based nature of the tool ensured good student responsiveness and engaged the entire class in an interactive, competitive setting. Application of the hint option, which offered a text of relevant reading material, helped students understand, retain more knowledge, and engage with course material more than they might have otherwise.

Despite anatomy and physiology being foundational courses in medical, nursing and allied ‐ health care programs, there is growing concern that the essential bioscience knowledge in these courses is not being retained by students over time. Numerous studies have demonstrated the difficulty of medical, nursing and allied health care students to retain and apply anatomical knowledge as they progress through their programs of study (Doomernik et al., 2017). However, physiological knowledge retention has not been studied as extensively as anatomical knowledge retention in health care disciplines, with very few studies focusing on nursing students (Aari et al., 2004). Of those studies most are carried out after graduation (Aari et al., 2004), or are focused on a single or limited number of organ systems (Pourshanazari et al., 2013). The present study aims to determine the level of physiological knowledge retained by nursing students in the four month time period between the completion of their physiology course in first‐year nursing and enrollment in the second‐year pathophysiology course. To answer this question, nursing students were quizzed on eight organ systems using the on‐line quizzing system Kahoot. Each Kahoot quiz included nine to eleven knowledge and comprehension level multiple‐choice questions. These scores were compared to first year quiz scores on the same content to determine overall knowledge retention over time. Data were statistically analyzed using SPSS II, and means were compared using 2‐sample t‐tests. The scores are described for each organ system by reporting the mean and standard deviation (SD). Statistical significance was set at P ≤ 0.05 for all tests. The mean score of questions from all organ systems in year one was 64.72 ± 9.3 (SD). Comparing that score to matched test items evaluated in the pathophysiology course, there is a decrease in the overall mean score from 64.72 ± 9.3 (SD) to 53.33 ± 25.8 (SD). This equates to an 86.6% retention rate, or 13.6% knowledge loss within four months. Organ‐specific knowledge retention was highest for renal physiology (99.0%), digestive physiology (97.8%), immunity (89.9%), vascular physiology (88.6%), and reproductive physiology (84.2%). Retention was comparatively lower for endocrine physiology (80.7%), inflammation (79.8%), and blood (79.4%). These results demonstrate a high level of knowledge retention overall with variations in retention being system specific. The level of knowledge retention in this study was significantly higher than previous rates reported in medical and allied‐health students (Pourshanazari et al., 2013) and is significantly higher than anatomical knowledge retention levels in the same population (Narnaware and Neumeier, 2019 a,b).Support or Funding InformationNone

BackgroundThis study aims to investigate the characteristics of home cognitive stimulation activities for Thai patients with mild cognitive impairment (MCI) and mild dementia.MethodA cross‐sectional, questionnaire‐based study was conducted on Thai patients with the diagnosis of MCI and mild dementia. Patients’ characteristics, ability to use IT device or telecommunication technology, and home cognitive stimulation activities were collected. All activities were divided and calculated into sub‐scores of cognitive, religion‐related, and physical activities according to its frequency.ResultThere were 157 patients with a mean age of 76.2±7.9 years, 65.6% were female. 46.5% were diagnosed with MCI, and 53.5% with mild dementia. 47.1% had a graduate or higher degree. The mean MoCA score was 20.8±4.7. 51% of patients were able to use IT devices (smartphones, tablets, or computers). Patients with MCI were able to use IT devices more than patients with mild dementia (79.5% vs. 26.2%, p&lt;0.001). As many as 29.3% of them were able to use a teleconference technology such as video call or Zoom application. Among the 25 home cognitive stimulation activities collected (excluding watching television), only 7 activities that participants ≥30% rated as frequent (≥3 days per week) were doing chores (63.1%), working out (51.0%), listening to music (50.3%), praying (43.3%), reading (38.2%), cooking (33.1%), and texting via mobile (31.8%). The activities they engaged the least were playing cards, board games, doing crossword puzzles, and drawing (rated as frequent 0.6%). Compared with patients with mild dementia, patients with MCI exhibited higher scores in all sub‐scores (all p&lt;0.01). The cognitive activity sub‐score had an inverse correlation with the patient’s age and geriatric depression scale (r = ‐0.340 and ‐0.171, both p&lt;0.05). Patients who were able to use smart devices or video call/conference applications were found to be more likely to have higher scores in every activity sub‐scores (all p&lt;0.01).ConclusionIn this study, Thai patients had limited home activities, particularly those with dementia. However, about half of them were able to use IT devices, which may correlate with a higher cognitive activity score. Thai individuals with MCI or mild dementia may have room for improvement in the cognitive intervention delivered at home via teleconference.

The flipped classroom (FC) is an adult-centered learning strategy where educational materials are independently reviewed prior to case-based group discussion. FC is designed to engage higher level thinking skills, such as application and analysis, that are often not employed in traditional didactics (TD). FC is well-accepted and improves knowledge retention, but is not commonly used in graduate medical education. A respiratory physiology curriculum for neonatology training programs based on the American Board of Pediatrics board content specifications was created to standardize content and distribute the work of creating and peer reviewing …

The study focuses on exploring the effectiveness of various training modalities, including pictorial, video and virtual reality, in safety training for a multicultural workforce, specifically in the context of solar panel cleaning processes. Drawing on cognitive load theory and Kolb's learning cycle, the research aims to enhance self-efficacy and knowledge retention despite language barriers. The research questions center on learning modalities, working memory, information retention, self-efficacy, and real-world work performance, addressing the gap in safety training for multicultural workers in the building industry. By comparing the impact of different training modalities on learning outcomes, the study found that virtual reality training led to higher self-efficacy and task value scores, even with increased workload demand. However, no significant differences were observed in self-efficacy, task value and workload demand between the pictorial, video, and virtual reality training modalities. The research underscores the importance of addressing language barriers and different learning styles in safety training effectiveness, emphasizing the benefits of using pictorial aids, vide, and virtual reality technology. The research underscores Virtual Reality’s role in boosting training retention and engagement. The study's methodology involved six participants, randomly assigned to different training groups, with a focus on the solar panel cleaning process. The evaluation of training modalities was based on their effectiveness in improving knowledge retention and skill development. The findings suggest the need for further research to explore the long-term effects and scalability of virtual reality training in safety training across various industries, shedding light onto the role of cognitive load theory in information processing within safety training contexts.

Achieving learner engagement in the teaching and learning process is paramount towards ensuring knowledge retention in QBASIC programming. This study focuses on effects of b-learning and face-to-face (F2F) on college students’ engagement and retention in QBASIC programming. The study adopted quasi-experimental design with non-equivalent group research design. QBASIC Programming Achievement Test (QBPAT) and College Students’ Engagement Questionnaire (CSEQ) were instruments used for data collection. Results showed that the treatment groups’ retention mean score was significantly higher than the control group. Findings further showed that b-learning facilitated college students’ engagement and improved knowledge retention in QBASIC programming compared to their counterparts in the F2F group. It was recommended that faculty members should adopt innovative teaching pedagogies such as b-learning to promote students’ engagement and retention in the learning process.

ObjectiveTo evaluate whether “Script Killing” immersive teaching improves job competency among resident physicians rotating through the emergency department across departments.MethodsWe conducted a cohort-allocated controlled educational study at Zhengzhou People’s Hospital (November 2024 to March 2025). Thirty-six rotating residents were allocated by cohort to an intervention group (n = 18; “Script Killing” immersive role-play, also referred to as a murder-mystery game–based scenario teaching) or a control group (n = 18; traditional teaching). Outcomes included written theoretical assessment, objective structured clinical examination (OSCE), teaching satisfaction, recognition of the teaching process, clinical decision-making indicators (e.g., triage accuracy and reasonableness of emergency management plans), and 3-month knowledge retention.ResultsAfter 3 months, the intervention group scored higher than controls in theoretical knowledge (86.82 ± 2.85 vs. 72.45 ± 3.25) and OSCE performance (92.47 ± 3.22 vs. 75.18 ± 4.08) (both p < 0.001). Triage accuracy was higher in the intervention group (94.44% vs. 66.67%, p = 0.034). The reasonableness of management plans was numerically higher but did not reach statistical significance (88.89% vs. 61.11%, p = 0.054). At 3-month follow-up, the intervention group showed better knowledge retention, with smaller declines in theoretical and OSCE scores from baseline (p < 0.001).Conclusion“Script Killing” immersive teaching was associated with improved examination performance, OSCE skills, and key decision-making behaviors, with higher learner satisfaction and improved knowledge retention among cross-department rotating residents in the emergency department.

Today’s learners are immersed in engaging virtual activities such as video games, social media, and streaming services. These platforms set high expectations for user engagement, providing experiences that are user-centred and intrinsically motivating. Online learning must now compete with these digital environments for learners' attention, necessitating a transformation in its approach to increase retention and satisfaction. The Learning Wave is a novel Learning Experience Design framework that addresses this challenge by two key psychological theories: Self-Determination Theory (SDT) and Flow Theory. SDT, developed by Deci and Ryan (2000), posits that intrinsic motivation is driven by three psychological needs: autonomy, competence, and relatedness. Flow Theory, introduced by Csikszentmihalyi (1990), is a highly functional state helping learners boost their academic performance through immersion in the activity and provides incentives for personal growth (Rodriguez-Ardura &amp; Meseguer-Artola 2016). By applying these theories, The Learning Wave generates learning experiences that positively impact learning behaviour through enhanced engagement and motivation. The framework applies strategies from digital and serious games, combining them with storytelling techniques and instructional design models to create a modern pedagogical approach to the design of online courses. At its core, The Learning Wave utilises a three-phase pattern: learn, reflect, and challenge. This structure enables learners to progressively build understanding, review and reflect on their learning, and apply their knowledge and skills to real-world scenarios. The framework employs Semantic Waves (Maton, 2013) as a construction methodology, ensuring a thoughtful progression of the learner from basic understanding to advanced application of concepts, and facilitating the creation of Flow states by gradually increasing complexity to match learner skill development. Complementing the learner experience is the use of storytelling. By incorporating narrative elements, the learning experience is enriched with contextual depth, diverse perspectives, and emotional engagement, factors known to enhance retention and application of knowledge (Landrum et al., 2019). This approach also supports the relatedness aspect of SDT, fostering a sense of connection to the learning material. As a visual tool, The Learning Wave allows instructional designers to map out the entire learning experience, illustrating how learners progress through different phases. It incorporates a series of learning moments, points of reflection, and challenge events, charting the learner's journey from novice to competent problem-solver. The framework's flexibility accommodates both high-level designs and intricate, complex experiences. The Learning Wave has been incorporated as the foundational pedagogy in the development of twelve postgraduate microcredentials at Western Sydney University, with qualitative and quantitative feedback showing learners are motivated and more confident with the knowledge and skills they are developing. Further analytics, articles, case studies, and publications are forthcoming. This poster presentation demonstrates how The Learning Wave framework transforms online learning. It showcases the 3-stage pattern, alignment with storytelling techniques, and process of gaining strategic knowledge through information deconstruction and reconstruction. It highlights how this approach, grounded in educational theories and modern engagement techniques, can enhance learner motivation, improve knowledge retention, and lead to more effective online educational experiences in our digital world.