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REVIEW ARTICLE
Year : 2021  |  Volume : 10  |  Issue : 3  |  Page : 134-137

Encouraging the use of crosswords to facilitate deep conceptual learning in medical education


1 Medical Education Unit Coordinator and Member of the Institute Research Council, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India
2 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India

Date of Submission26-Apr-2021
Date of Decision20-May-2021
Date of Acceptance24-May-2021
Date of Web Publication17-Mar-2022

Correspondence Address:
Dr. Saurabh RamBihariLal Shrivastava
Professor, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV) – Deemed to be University, Thiruporur - Guduvancherry Main Road, Ammapettai, Nellikuppam, Chengalpet District - 603108, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdrntruhs.jdrntruhs_47_21

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  Abstract 


Medicine is a complex specialty, wherein a freshly enrolled student is expected to master the knowledge aspect of multiple subjects and even show proficiency in skills, attitude, values, etc. The present review was carried out to explore the role of crosswords in the field of medical education to enhance learning. An extensive search of all materials related to the topic was carried out in the PubMed search engine and a total of 15 articles were selected based upon the suitability with the current review objectives and analyzed. Active engagement of students can be achieved by promotion of small group teaching, and thus employment of games and puzzles as a part of medical training represents an active form of learning. Crossword puzzles have been used in the field of medical education, nursing education and also as one of the strategies for the development of staff members. The employment of crosswords as a tool for teaching-learning has been linked with multiple benefits, such as development of diagnostic thinking, clinical reasoning skills, expansion of vocabulary, and mind stimulation. It is a must that an evaluation strategy should be developed to identify the utility of crosswords as a learning tool. To conclude, crossword puzzles in the field of medical education delivery are an effective and feasible approach to ensure critical thinking and better learning, recall and understanding of the key concepts. Thus, its use in all the specialty should be encouraged for the benefit of medical students.

Keywords: Crosswords, medical education, small-group teaching


How to cite this article:
Shrivastava SR, Shrivastava PS. Encouraging the use of crosswords to facilitate deep conceptual learning in medical education. J NTR Univ Health Sci 2021;10:134-7

How to cite this URL:
Shrivastava SR, Shrivastava PS. Encouraging the use of crosswords to facilitate deep conceptual learning in medical education. J NTR Univ Health Sci [serial online] 2021 [cited 2022 Nov 30];10:134-7. Available from: https://www.jdrntruhs.org/text.asp?2021/10/3/134/339807




  Introduction Top


Medicine is a complex specialty, wherein a freshly enrolled student is expected to master the knowledge aspect of multiple subjects and even show proficiency in skills, attitude, professionalism, ethics, empathy, values, etc. Acknowledging the width and depth of knowledge that a student has to imbibe within a short period of time, it is a proven fact that better learning outcomes can be accomplished by employment of active teaching-learning methods that advocates student engagement instead of passive learning.[1] These active strategies play an important role in the acquisition and refinement of critical thinking, better communication skills, enabling motivation, development of good attitude and human values, etc. The present review was carried out to explore the role of crosswords in the field of medical education to enhance learning.


  Methods Top


An extensive search of all materials related to the topic was carried out in the PubMed search engine. Relevant research articles focusing on crosswords in medical education published in the period 2000 to 2021 were included in the review. A total of 18 studies similar to current study objectives were identified initially, of which, three were excluded due to the unavailability of the complete version of the articles. Overall, 15 articles were selected based upon the suitability with the current review objectives and analyzed. Keywords used in the search include crosswords and medical education in the title alone only. Only the articles published in the English language were included in the study. The collected information is presented under the following sub-headings, namely Small group teaching in medical education, Crosswords in Medical Education, Potential challenges and recommendations, Utility of crosswords in medicine, Additional considerations, Implications for practice, and Implications for research.

Small group teaching in medical education

Active engagement of students can be achieved by promotion of small group teaching, which in turn provides scaffolding for improved student participation, deep understanding of the topic, promotes problem-solving, enhances students' accountability towards their learning, and development of interpersonal and social skills. [1,2] The employment of games and puzzles as a part of medical training represents an active form of learning that can be done as one of the small-group teaching approaches, and it becomes useful for the acquisition of the desired knowledge, skills, and attitudes. [2,3] These activities not only supplement the traditional teaching, but also aid in the quick review, summarization, identification of gaps in knowledge, and helps students to establish linkage between different concepts.[1],[2],[3]

Crosswords in medical education

Crossword puzzles have been used in the field of medical education, nursing education and also as one of the strategies for the development of staff members.[2],[3],[4] We must note that crosswords are frequently being used in newspapers, magazines, etc., and has been associated with the active engagement of the audience.[4] As crosswords are student-oriented activities, all the benefits of small-group teaching and active engagement can be accomplished.[5] The employment of crosswords as a tool for teaching-learning has been linked with multiple benefits, such as development of diagnostic thinking, clinical reasoning skills, understanding-learning-recall-retention of concepts, expansion of vocabulary, and mind stimulation.[3],[4],[5]

Further, merits have been observed in terms of the development of critical thinking, cooperative learning (via a discussion between members of the small group), and helps the student to identify the prevailing misconceptions. [5,6] The answers to the clue provide an immediate feedback to the students about their performance and thus aid in clarification of doubts. Moreover, we can even look for team building as the students learn via discussion in a competitive atmosphere.[4] From the feasibility perspective, it is easy to construct crosswords, and they are self-correcting. The findings of studies have revealed that the employment of crosswords in their own settings as a teaching-learning methodology delivered encouraging results in terms of improvement in vocabulary, highlighting the key concepts, as a medium to enhance collaboration, and making learning a joyful experience. [4,6]

Potential challenges and recommendations

Although crosswords are associated with multiple benefits, their use in teaching-learning has not been extensive. This could be because of the time required to construct the same, inability to address all types of learners' needs, competitive nature, does not fit within the traditional style of teaching-learning, and limited popularity among students. [4,5] At the same time, the designed crosswords should not be too easy or too difficult, as it will fail to attract the attention of students. [4,6] Most of these challenges can be sorted out by carrying out faculty development programs, wherein the staff can be sensitized about the scope, use and do's and don'ts while designing crosswords.

Utility of crosswords in medicine

Crosswords have been used in different medical specialties to enhance learning among the medical undergraduate and postgraduate students. For instance, an open-label randomized trial was conducted among the students of the second professional year with an aim to assess the utility of crossword in helping the students to remember the names of the drug, considering that it is difficult to recollect them.[7] The findings of the trial suggested that more than 71% of the students reported that crossword aided them to enhance their knowledge about antihypertensive and antiepileptic drugs, while 60% were of the opinion that it was a good problem-solving activity. Further, the students also revealed that crossword is a nice approach for recreation and at the same time enhance learning.[7] In another study done in India in the Pharmacology specialty amongst the students of second professional year, it was reported that crosswords played an important role in improving their attitude towards learning, which got subsequently reflected in terms of their better performance.[8]

The findings of another study that employed crossword as the teaching-learning and assessment method to improve the knowledge about anti-ulcer agents, it was observed that more than 90% of the participating students expressed that they are better oriented to the important topics in the subject and that it has augmented their learning significantly.[9] Further, we must note that crosswords have been widely employed in different specialty and super-specialty subjects, such as in the field of renal malignancies for making the students remember about the chemotherapeutic agents and the attributed renal toxicity.[10] In addition, crosswords have been used to get a better understanding about basic principles of obstetric anesthesiology, breast cancer, palliative care, genitourinary cancer and specific domains in pediatrics.[11],[12],[13],[14],[15]

Additional considerations

The Medical Education Unit of the institution has to play a significant role in terms of carrying out appropriate sensitization program. It is a must that an evaluation strategy should be developed to identify the utility of crosswords as a learning tool, with an aim to assess at least the reaction (Kirkpatrick level 1) and learning (Kirkpatrick level 2). [5,6] The next two higher levels are difficult to evaluate within the training period.[6] Moreover, we should be ready to bring about appropriate reforms in the crosswords based on the feedback received from the stakeholders.

Implications for practice

Introduction of crossword as a part of teaching-learning and assessment strategy is an effective approach to enhance learning. However, we have to plan about its systematic implementation and that has to start with orienting the faculty members about the merits of crossword and the ways in which crossword aids in establishing linkages. The orientation of the faculty members can be taken care by the Medical Education Unit of the institution, so as to empower them with the task. Subsequently, at the departmental level, the faculty members can discuss and come to conclusion about those topics that are difficult for the students to remember or understand. In addition, the departments can also select the topics that are very essential and basic, as adoption of crossword will be a nice approach to reinforce the important topics or concepts.

Once these topics are finalized, the next task is to design the crossword puzzle that can be either done by the interested faculty members or using free programs available on the Internet. The final crosswords can be looked for correctness before it is administered to the students. The administration of crosswords can happen either during a didactic lecture or in a small group activity or in the learning management system or as an assignment after the college hours, with an intention to augment self-directed learning. The keys to the crosswords can be shared with the students after they have submitted and that act as instant feedback about their overall performance.

Implications for research

Qualitative studies or mixed-methods study designs can be carried out to explore the perception of the students about crosswords, the pros and the cons, and their overall satisfaction after they have participated in a crossword. We can even carry out randomized control trial with crossover to compare the outcomes of two different leaching-learning methods (viz. crosswords and didactic lecture) in terms of the performance of the students in each of the arms. There is always a scope for improvement based on the results of the research, with a single intention to enhance learning and benefit students.


  Conclusion Top


To conclude, crossword puzzles in the field of medical education delivery are an effective and feasible approach to ensure critical thinking and better learning, recall, and understanding of the key concepts. Thus, its use in all the specialty should be encouraged for the benefit of medical students.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Shrivastava SR, Shrivastava PS. Encouraging medical students to become self-directed learners through conduction of small-group learning sessions. J Nat Sci Med 2021;4:90-1.  Back to cited text no. 1
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Ballon B, Silver I. Context is key: An interactive experiential and content frame game. Med Teach 2004;26:625-8.  Back to cited text no. 2
    
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Raines D. A fun way to learn terminology: The crossword puzzle. Nurs Womens Health 2007;11:29-31.  Back to cited text no. 3
    
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Htwe TT, Sabaridah I, Rajyaguru KM, Mazidah AM. Pathology crossword competition: An active and easy way of learning pathology in undergraduate medical education. Singapore Med J 2012;53:121-3.  Back to cited text no. 4
    
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Manzar S, Al-Khusaiby SM. Crossword puzzle. A new paradigm for interactive teaching. Saudi Med J 2004;25:1746-7.  Back to cited text no. 5
    
6.
Saxena A, Nesbitt R, Pahwa P, Mills S. Crossword puzzles: Active learning in undergraduate pathology and medical education. Arch Pathol Lab Med 2009;133:1457-62.  Back to cited text no. 6
    
7.
Gaikwad N, Tankhiwale S. Crossword puzzles: Self-learning tool in pharmacology. Perspect Med Educ 2012;1:237-48.  Back to cited text no. 7
    
8.
Patrick S, Vishwakarma K, Giri VP, Datta D, Kumawat P, Singh P, et al. The usefulness of crossword puzzle as a self-learning tool in pharmacology. J Adv Med Educ Prof 2018;6:181-5.  Back to cited text no. 8
    
9.
Shah S, Lynch LM, Macias-Moriarity LZ. Crossword puzzles as a tool to enhance learning about anti-ulcer agents. Am J Pharm Educ 2010;74:117.  Back to cited text no. 9
    
10.
Jhaveri KD, Fishbane S. Nephrology crossword: Onco-nephrology--chemotherapy agents and nephrotoxicity. Kidney Int 2013;84:421-2.  Back to cited text no. 10
    
11.
Wright J, Simpao AF, Viswanath O. Basic principles of obstetric anesthesiology: A crossword puzzle. J Clin Diagn Res 2017;11:UO01-2. doi: 10.7860/JCDR/2017/27981.10209.  Back to cited text no. 11
    
12.
McClelland S 3rd, Rhome RM, Zellars RC. Radiation oncology crossword: Breast cancer. Breast Cancer Res Treat 2019;177:225-30.  Back to cited text no. 12
    
13.
Fleser L. Palliative crossword puzzle. J Palliat Med 2020;23:727-8.  Back to cited text no. 13
    
14.
McClelland S 3rd, Mitin T, Thomas CR Jr. Radiation oncology crossword: Genitourinary cancer. Rep Pract Oncol Radiother 2019;24:281-3.  Back to cited text no. 14
    
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Calleja T. A safari through pediatrics: A crossword. Clin Pediatr (Phila) 2020;59:725-6.  Back to cited text no. 15
    




 

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