Introduction

Incorporation of active-learning methods: 

• Allows facilitator to engage students.
• Makes the learning process interesting and interactive.
• Promotes acquisition of attitudes.
• For acquiring skills.
• Improves understanding and learning.

Crossword Puzzles:

• It is a novel tool for small group learning.
• A well-organized crossword puzzle is likely to test higher levels of cognition.

Rationale of the Study

• In the present scenario, the fundamental concepts of Anatomy are taught through didactic lectures, which results in:
• Passive learning by the students.
• Unable to exhibit the desired level of competency.
• Students often find it difficult to remember and recall the terminologies.
• This situation tempted us to think about an active learning tool which can help to reinforce the key concepts and better retention of the new terminologies.
• To improve vocabulary and encourage active learning crosswords were introduced as a teaching and learning tool.

AIM

• To evaluate the usefulness of crossword puzzles as a learning tool in the subject of anatomy at the level of undergraduate medical curriculum.

OBJECTIVES

• To evaluate and asses the students perception regarding the usefulness of crosswords as a quick and effective way in reinforcing the essential concepts and vocabulary.
• To design, implement, and evaluate the use of crossword puzzles as an educational tool to facilitate active learning of human anatomy.

Materials and Methods

• Study Design: Cross sectional study.
• Setting: Shadan Institute of Medical Sciences & Research Centre, Hyderabad, India.
• Study Period: September - 2015 to August - 2016.

Methodology:

• An ethical approval was obtained from institutional ethical committee of the college.
• 150 medical students of 1st MBBS of batch 2015-16 were included in the study.
• Set of 8 Crossword puzzles with 50 clues in each was prepared and given to the students.
• Crossword puzzles were constructed with the help of free online soft ware - eclipsecrossword.com.
• Students were randomly divided into groups of 5/6.
• Students were oriented and instructed as to mode of filling the grids.
• An informed verbal consent of the students was taken.
• Administered during the dissection sessions of different regions in the last 45 min.
• Answers were checked with key answers and results was declared.
• A feedback questionnaire was prepared.
• Responses from the students in the form of feedback questionnaire were statistically analysed.
• Program was evaluated using a 5 point Likerts Scale.

• Response rate - 97% (145 students out of 150).
• Score improved from 50% in first set to 84% in the eighth set.
• Average crossword completion index - 70.25%
• Major outcome evaluated - Student’s perception about the crossword puzzles as a learning tool.
• Few students reported “this activity to be a waste of time” (3%).

• Crossword puzzles were well perceived by the students - Challenging, effective & recreational learning tool which enhanced learning.
• Acceptability for this activity by the students was further strengthened by their suggestion of  providing  more puzzles for other topics & other subjects. 
• Facilitated active engagement of the students.
• Provided students with an opportunity to think critically, collaborate, compete, and recall and discuss salient concepts by using essential vocabulary associated with these concepts.
• Can be used as an active learning strategy to promote self-directed learning.

• Similar innovative exercises as crossword puzzle should be planned in other subjects by selecting tough topics perceived by the students
• Time slots for such exercises can be planned in all the blocks/modules which may give a scope of learning difficult  topics in an active form, rather than the sutdent becoming less motivated and completely omitting these topics from their studies.

• The authors would like to thank the Dean and management of SIMS for their continuous inspiration and support.
• The authors would like to thank the organizing committee of SIMEC – 2018, Riyadh for giving us this opportunity.
• The authors would like to thank all their colleagues, Head of the Department of Anatomy and  Students of 1st MBBS, Batch 2015-16 SIMS who have helped in this study.

1. Kneebone R., Kidd J., Nestel  D., Asvall  S., Paraskeva  P. and Darzi  A. An innovative model for teaching and learning clinical procedures. Medical Education (2002), 36: 628–634. doi:10.1046/j.1365-2923.2002.01261.
2. Wilkes MS, Hoffman JR. An Innovative Approach to Educating Medical Students about Pharmaceutical Promotion. Academic Medicine. 2001; 76(12). 1271-1277.
3. Blouin RA, Joyner PU, and Pollack GM. Preparing for a renaissance in pharmacy education: the need, opportunity, and capacity for change. Am J Pharm Educ 2008; 72 (2) Article 42.
4. Di Piro JT. Why do we still lecture? Am J Pharm Educ. 2009; 73(8) Article 137.
5. Joan Bryant,   Crossword Puzzles – Entertaining tool to reinforce lecture content in undergraduate physiology teaching,  International Journal of Biomedical Research 2016; 7(6): 346-349.
6. Bligh D. What’s the Point in Discussion?. In: Bligh D, Ian McNay, Harold Thomas, eds. What’s the Point in Discussion?. 2^nd ed. England: Intellect Books, 2000 pp
7. Svinicki M. Learning and Motivation in the Postsecondary Classroom. In: Svinicki M. eds. Learning and Motivation in the Postsecondary Classroom 1^st ed. Bolton, Jossey-Bass, Anker Publishing; 2004.
8. Bransford J, Brown A, Cocking R, eds. How People Learn: Brain, Mind, Experience, and School. Washington, DC: National Research Council, National Academy Press; 2000.
9. Augarde T. The Oxford Guide to Word Games. New York, NY: Oxford University Press; 1984.
10. Saxena A, Nesbitt R, Pahwa P, Mills S. Crossword puzzles: active learning in undergraduate pathology and medical education. Arch Pathol Lab Med. 2009; 133(9):1457–1462.
11. Raines, D.A. (2010). An innovation to facilitate student engagement and learning: Crossword puzzles in the classroom. Teaching and Learning in Nursing, 5, 85-90.
12. Crossman, E.K. and S.M. Crossman (1983). The Crossword puzzle as a teaching tool. Teaching of Psychology, 10(2), 98-99.
13. Franklin, S., M. Peat and A. Lewis (2003). Non-traditional interventions to stimulate discussion: The use of games and puzzles. Journal of Biological Education, 37(2), 79-84.
14. Childers CD. Using crossword puzzles as an aid to studying sociological concepts. Teach Sociology. 1996; 24(2):231–235.
15. O’Leary S, Diepenhorst L, Churley-Strom R, Magrane D. Educational games in an obstetrics and gynecology core curriculum. Am J Obstet Gynecol. 2005; 193:1848–1851.
16. Odenweller CM, Hsu CT, Di Carlo SE. Educational card games for understanding gastrointestinal physiology. Am J Physiol. 1998; 275:78S–84S.
17. Ballon B, Silver I. Context is key: an interactive experiential and content frame game. Med Teach. 2004; 26:525–528.
18. Eckert GU, Da Rosa AC, Busnello RG, Melchior R, Masiero PR, Scroferneker ML. Learning from panel boards: T-lymphocyte and B-lymphocyte self-tolerance game. Med Teach. 2004; 26: 521–524.
19. Bailey CM, Hsu CT, Di Carlo SE. Educational puzzles for understanding gastrointestinal physiology. Am J Physiol. 1999; 276:1S–18S.
20. Kuhn MA. Gaming: a technique that adds spice to learning? J Contin Educ Nurs 1995 Jan-Feb; 26 (1):35-9.
21. Bunce, D.M., Flens, E.A., and Neiles, K.Y. (2010). How long can students pay attention in class? A study of student attention decline using clickers. Journal of Chemical Education, 87 (12), 1438-1443.
22. Weisskirch, R. S. (2006). An Analysis of Instructor-Created Crossword Puzzles or Student Review. College Teaching, 54(1), 198-202.
23. Ritzko, J.M., Robinson, S. (2006). Using games to increase active learning. Journal of College Teaching& Learning, 3(6), 45–50.
24. Runki Saran, Saurabh Kumar, Use of crossword puzzle as a teaching aid to facilitate active learning in dental materials INDIAN JOURNAL OF APPLIED RESEARCH Volume : 5 | Issue : 4 | April 2015 | ISSN - 2249-555X.
25. Crossword Puzzles as a Tool to Enhance Learning About Anti-Ulcer Agents, Samit Shah, PhD, Launa M. J. Lynch, PhD, and Lilia Z. Macias-Moriarity, PhD   Am J Pharm Educ. 2010 Sep 10; 74(7): 117.
26. Tufts MA, Higgins-Opitz SB. What makes the learning of physiology in a PBL medical curriculum challenging? Student perceptions. Adv Physiol Educ 33: 187–195, 2009.
27. Kalyani P. Crosswords as a learning tool in Anatomy and Physiology teaching. Med Teach. 2007; 29 (5): 513.
28. Nitin Gaikwad, Suresh Tankhiwale; Crossword puzzles: self-learning tool in Pharmacology; Perspect Med Educ. 2012; 1: 237-248. 
29. Barclay SM, Jeffres MN, Bhakta R. Educational card games to teach pharmacotherapeutics in an advanced pharmacy practice experience. Am J Pharm Educ 75: 1–7, 2011.
30. Fernanda K. Marcondes, Maria J. C. S. Moura, Andrea Sanches et al. A puzzle used to teach the cardiac cycle. Adv Physiol Educ 2015; 39: 27–31.
31. Middendorf J, Kalish A. The change-up in lectures. Natl Teach Learn Forum 1996; 5(2):1-7.
32. Rodenbaugh HR, Lujan HL, Rodenbaugh DW and DiCarlo SE Having fun and accepting challenges are natural instincts: jigsaw puzzles to challenge students and test their abilities while having fun. Adv Physiol Educ 2014.38: 185–186.
33. Davis TM, Shepherd B and Zwiefelhofer T. Reviewing for exams: do crossword puzzles help in the success of student learning? The Journal of Effective Teaching 2009; 9 (3): 4-10.
34. Massey AP, Brown SA, Johnston JD. It’s all fun and games until students learn. J Inf Syst Educ. 2005; 16:9–14.