Abstract
Introduction
The coronavirus has hit the world and has led to substantial changes in all aspects of life. One of the important affected aspects is the teaching and learning process. Most of the learning authorities including King Abdulaziz University, Rabigh branch, have shifted to distant and online learning to avoid social contact and spreading the viral infection. Creating an interesting and interactive environment via online learning became necessary to attract the students’ attention and sharing in the online sessions was, therefore, crucial.
Methods
Crossword puzzles were created using an online tool. A questionnaire that assesses the satisfaction of the students regarding the application of the online puzzle was built and medical education experts did the content validity. Lectures were given online via the blackboard ultra-collaborate system followed by a brief session for solving the crossword puzzle. Students were given five minutes to think and prepare their answers and then they solved the puzzle via the chat window and the teacher corrected them. The questionnaire was sent to students in a Google form. Statistical analysis was followed using SPSS software.
Results
No major gender differences in students’ satisfaction levels. 75.7% strongly agreed that games are an interesting and enthusiastic method in physiology education. 78.4% strongly agreed that games are an effective tool of communication between the teacher and students. 70.3% strongly agreed: crossword puzzle is an interesting interactive online educational tool. 64.9% strongly agreed that puzzles helped them to memorize the definitions and terminologies in physiology. 78.4% strongly agreed that crossword puzzles are a good addition to the educational practice of physiology.
Conclusion
The crossword puzzle is considered a good tool for promoting an interesting, interactive online educational practice. The presence of no major gender difference in the students’ satisfaction regarding this tool casts light on the importance of interactive, enjoyable, and creative teaching practice particularly during the stigmata of epidemics.
Keywords: Crossword puzzle, Interactive online teaching, Medical physiology teaching, The gender difference in learning practice, Games in physiology teaching
Introduction
Physiology is considered an essential basic science in the medical curriculum. Students should understand how the body functions and the numerous mechanisms required to execute different tasks [1]. Nevertheless, most medical students perceive physiology as a difficult and complicated subject [2–4]. Physiology teaching relies upon different teaching methods varying between different curricula and schools, yet lectures are considered as the most valuable tool by both teachers and students [3]. However, lectures are a passive process where students are exposed to content and factual knowledge with limited time for learning and in-depth understanding [4–6].
Things got worse during the last pandemic of COVID-19 when most of the activities transformed to become distant and online learning [7]. In such an environment, interaction and communication between student and teachers is reduced. Additionally, less communication between the students themselves occurs [8].
Educators recommend minimizing factual information to encourage pupils to be more actively engaged in the learning process and problem-solving rather than passive learning [3, 9–11]. Various methods and techniques were introduced to transfer physiology teaching to be more interactive and interesting for the students [12, 13]. Utilizing games in teaching physiology is well established in the literature [11, 13, 14]. In fact, games require students to actively participate, solve challenges, and make judgments [15].
Crossword puzzles are an innovative and fun approach for students to revise and master learned concepts and knowledge, as well as develop their thinking skills [6, 15, 16, 17]. In addition, these puzzles offer students an opportunity to evaluate and assess their knowledge interactively [13, 16, 18]. For example, A previous study revealed the effectiveness of crossword puzzles in revising and memorizing cardiac cycle terms and events [19].
Nevertheless, utilizing cross puzzles during the pandemic as an online learning tool is not well documented in the literature. Our study aims to investigate the student perception of crossword puzzles and potential sex differences. To the best of our knowledge, this preliminary study is the first to explore this topic.
Methods
Subjects and Settings
This study involved the third-year medical student, at King Abdulaziz University, Rabigh branch at Rabigh Saudi Arabia in 2021. The staff announced to the students about the study and asked them to participate if they agree. The students were completely free to join, or quit, and to freely declare their opinion during the study without any negative consequences to them. Medical students at our university study systems physiology in year 3. The study protocol was approved by the ethical committee of Rabigh and King Abdulaziz University (reference no. 531–21).
Preparation Phase
The items (terms) used for generating the crossword puzzles were selected by staff members and were all related to the lectures on gastrointestinal physiology. Crossword puzzles were created using an online tool (www. crossword universe.com). An Arabic questionnaire that assessed students’ satisfaction regarding the application of online crossword puzzles was generated and experts in medical education evaluated the content validity. Additionally, to ensure its clarity and understandability, students who were not involved in the study tested the appropriateness and clarity of the questionnaire (Figs. 1 and 2).
Fig. 1.
A Graphical abstract represents the stages of the current study beginning from the preparation passing to application and ending in the results analysis phases
Fig. 2.
An example of the crossword puzzle used in the current study. The students were given time to answer based on the clues on the right side (across and down)
The questionnaire consisted of 21 statements (Table 1), which evaluate the general satisfaction of students regarding addition of game into the teaching practice, the addition of games into physiology in specific, the benefits of adding crossword puzzle games to the teaching practice, and the student’s opinions about the combination between multiple methods in teaching. The students’ responses consisted of five choices on the Likert scale (from strongly agree to strongly disagree). The questions were then entered into a Google form to allow the remote collection of the responses by the researchers.
Table 1.
Questionnaire for the assessment of students’ satisfaction regarding the online crossword puzzles in physiology teaching
| Serial | Question | Strongly Agree | Agree | Do not know | Disagree | Strongly disagree |
|---|---|---|---|---|---|---|
| 1 | Games are generally an interesting and motivating way to retrieve information on the subject of physiology | |||||
| 2 | In general, educational games are a good way to create communication between the student and the teacher | |||||
| 3 | In my opinion, the crossword puzzle in particular is an interesting and fun way to communicate in virtual classes via the Internet | |||||
| 4 | The crossword puzzle helped me better remember what I had learned in Physiology | |||||
| 5 | The crossword puzzle helped me to connect the parts of what I studied better | |||||
| 6 | The crossword puzzle was very difficult | |||||
| 7 | The crossword puzzle was very easy | |||||
| 8 | The crossword puzzle is a waste of time and unnecessary | |||||
| 9 | The crossword puzzle increased my self-confidence in my ability to solve it | |||||
| 10 | Competition between peers is the main motive for solving the crossword puzzle | |||||
| 11 | The crossword puzzle game is a kind of creativity and innovation to facilitate communication between the student and the teacher | |||||
| 12 | I think that the addition of a crossword game to the ways of interaction between the student and the teacher via the Internet during virtual classes is beneficial | |||||
| 13 | I think that the addition of a crossword game to the ways of interaction between the student and the teacher in the classroom is beneficial | |||||
| 14 | liked the crossword puzzle regardless of the presence of the prizes | |||||
| 15 | I think that the crossword puzzle was a good addition to teaching physiology | |||||
| 16 | It is a need to include new, interesting ways of teaching that help attract students | |||||
| 17 | I prefer to keep only traditional methods of teaching such as lectures in the classroom or via virtual classes | |||||
| 18 | I prefer the combination of traditional methods and innovative creative methods in the educational process | |||||
| 19 | The crossword puzzle helped me understand the lecture by remembering and predicting the correct answer immediately after the lecture and before studying it | |||||
| 20 | The crossword puzzle helped me memorize the definitions of some terms and remember them better | |||||
| 21 | The crossword puzzle helped me remember and write letters of medical terms |
Application Phase
The lecture was given online via the blackboard ultra-collaborate system followed by a brief session for solving the crossword puzzle. The puzzle was viewed on the screen. Students were given five minutes to think and prepare their answers and then they solved the puzzle via the chat window and the teacher then corrected them via the microphone. The satisfaction assessment questionnaire was then sent to students in a Google form to collect their responses. Statistical analysis was followed using SPSS IBM-25 software. Results are presented as percentages.
Results
Demographic Data
From 64 students, 37 students (37.8% females and 62.8% males) volunteered to share in the current study. There was no significant gender difference in the student’s response to all statements, p > 0.05, except for three statements where the male satisfaction appeared to be greater than the female (they collectively ranged between strongly agree or agree). These statements were as follows: educational games are a good way to create communication between the student and the teacher, the crossword puzzle game is a kind of creativity and innovation to facilitate communication between the student and the teacher, and the crossword puzzle helped me understand the lecture by remembering and predicting the correct answer immediately after the lecture and before studying the material (p < 0.05).
Students Satisfaction Assessment
Gamification is an Addition to Physiology Teaching Practice
Of the whole study population, 75.7% strongly agreed that games are an engaging and enjoyable way to learn about physiology. 78.4% strongly agreed that games are an effective tool for communication between teachers and students. 70.3% strongly agreed that a crossword puzzle is an interesting interactive online educational tool. 78.4% strongly agreed that crossword puzzles were an excellent addition to the educational practice of physiology.
Gamification Boosts Memorization
64.9% strongly agreed that puzzles helped them memorize physiology definitions and terminologies. 70.3% strongly agreed that crossword puzzles helped them to connect the parts of the subject they have studied. 62.2% strongly agreed that the game helped them to memorize the letters of the medical terms. Finally, 64.9% strongly agreed that the puzzles helped them to remember the definitions of physiology.
Blended Teaching Practice is Necessary
40.5% strongly disagreed and 18.9% disagreed to keep only the traditional ways of learning physiology. 70.3% strongly agreed that they prefer the combination of traditional methods and innovative creative methods in the educational process.
Discussion
In the current study, we aimed to assess the students’ satisfaction regarding the incorporation of innovative interactive teaching methods into the educational process during the COVID-19 pandemic. Additionally, we aimed to assess the potential presence of sex differences regarding the level of satisfaction. We found that most of the students from both sexes showed a high level of satisfaction regarding the crossword puzzle. They found it an innovative, enjoyable, interactive tool that helped them to enjoy remote online education and overcome the absence of on-site learning and student–teacher interactions within the faculty. Moreover, this method helped them to study and to memorize medical terms and definitions. No significant gender difference in the response of students except for three questions related to creativity in using the puzzles, better communication between the two arms of the educational process, and the prediction of the right answer. For these three aforementioned items, the percentage of males who agreed was higher than that of females.
Joyful Learning is Necessary During Outbreaks
Previous studies in different medical and paramedical faculties have utilized crossword puzzles in the educational process. Many of them found it a useful and a fun tool that strengthens the student–teacher relationship and helps the students to be engaged in the educational process [20–22]. Even though games cannot substitute traditional methods of acquiring theoretical knowledge, they can help to reinforce data acquisition while still promoting thinking skills. Games foster a challenging, constructively competitive setting that promotes students’ engagement in a friendly and enjoyable setting [16].
During the COVID-19 pandemic stigmata, the students became depressed as a result of the prolonged homestay as well as social, emotional, and financial challenges [23, 24]. Emotionally enjoyable learning is necessary during pandemic. With using E-learning technologies, some aspects may be considered obstacles in students’ learning processes, like demotivation of students and slow feedback or assistance because educators are not constantly accessible when students require assistance while learning or feelings of isolation because of the physical absence of peers. Nevertheless, these challenges can be overcome with the assistance of teachers who must modify their teaching strategies to students’ requirements [25]. Therefore, the academic authorities encouraged the teachers to do their utmost to encourage the students to attend and to incorporate a useful and enjoyable tool properly into the educational process [26].
Crossword Puzzles Can Promote the Different Learning Styles of the Students
Piaget (1990) highlighted that knowledge is acquired via four sensory perceptions: visual (by observing pictures, symbols, or diagrams), auditory (by listening, discussing instructional material), visual iconic (by reading and writing), and kinesthetic (by moving, using tactile sensory abilities) [27]. Every individual possesses his learning style. Knowing one’s learning style can lead to improved learning and help the learner focus on weaker points. Learning styles analysis can also be used to improve achievement and inclusion by informing the teaching and learning process [28]. This could be difficult during online practice. Therefore, the teaching practice should incorporate many challenging, constructive, and competitive methods that can promote the students’ learning styles.
By incorporating crossword puzzles into the educational process during online practice, many sensory modalities are actively integrated as follows: students first visualize the puzzles via the screen and then think and recall the information, followed by writing down their answers into the chat window while listening to the educator’s confirmation and correction of their answers via the microphone. Adding to the aforementioned, the active memorization process includes recalling and writing down the information. All these factors can contribute to a better learning outcome.
The Role of Sex on Students’ Responses
Every student possesses his/her own unique learning style. An earlier study by Nuzhat et al. [27], on Saudi Arabia University students reported that students preferred multimodal learning styles the most [27]. Males and females preferred auditory and kinesthetic preferences among students who preferred unimodal preference. Furthermore, female students had more diverse preferences than male students did. When compared to unimodal learners, multimodal learners have higher cumulative grade point average GPAs [27]. In the current study, the percentage of male students who agreed to participate in this study was greater than the percentage of females. This can be attributed either to the larger numbers of males in this class of medical students. However, we did not find a significant difference in the response of males and females to the questionnaire except for three items. The items on which there was a sex difference could reflect the suitability of this educational methods for both sexes and the different learning styles among male and female students. The items, on which there was a sex difference for the sake of the male of students, could be related to presence of sex-related differences in the cognitive processing between males and females. It has been reported that sex differences in visuospatial skills are widely acknowledged, with men outperforming women on mental rotation tests and tests of spatial perception and orientation, whereas women perform better than men on object location memory tests. The root of these sex differences is not completely understood, and various studies point to different causes [29].
Conclusion and Future Prospective
The current study concludes the utility of the crossword puzzle game in physiology teaching via online practice. Remote online learning, which can be boring and unsuitable for some students, especially in a practical college, like medicine, can be mitigated, at least partially, by introducing such enjoyable and interactive methods. Furthermore, the lack of sex differences inter/within in students’ satisfaction with the game may reflect the success of this educational method in dealing with the different learning styles of the students as well as their need for fun and interaction during the epidemic.
Successful education requires interaction and communication between teachers and students. Consequently, staff must be constantly upgraded by developing new methods to overcome unexpected challenges such as epidemics. Attempts to create completely computerized versions of games could aid in improved interaction.
Acknowledgements
We would like to acknowledge Dr. Marwa EL-Naggar, Assistant professor of Medical Education, Al-Jauf University, Saudi Arabia. Additionally, we provide our thanks to Prof. Fatma Albeladi, the vice dean of the female campus, Faculty of Medicine in Rabigh, and to Prof. Badra Saeed Alghamedi, the former Head of the Physiology Department, Faculty of Medicine in Rabigh, for their support and advice to go through this research.
Author Contribution
ShY.: principal investigator, idea generation, generation of crossword puzzles, questionnaire preparation, study implementation, editing the paper and discussing the results, figure generation. LK.: sharing in questionnaire preparation, sharing in editing the paper. MZ.: implementation phase and statistical analysis. All authors revised the manuscript in its final form.
Funding
This research is not funded by any funding agency.
Declarations
Conflict of Interest
The authors declare no competing interests.
Footnotes
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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