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Research Article
Use of picture puzzle in understanding pathology – A
comparative study
S. Padmaja, M. P. Brundha*
ABSTRACT
Aim: The aim of the study was to analyze the use of picture puzzle in understanding pathology. Introduction: These puzzles
help us in diagnostic thinking and clinical reasoning. They help us in creating an atmosphere of happiness, challenge which
creates a positive change in us and helps us to focus better on the subject. The puzzle game helps in stimulating the mind so
that there is an increase in vocabulary and better retention of the concepts in mind. Materials and Methods: Two batches
were selected and compared for analyzing the effect of the picture puzzle game. One batch involved conventional lecture and
the other batch involved picture puzzle also. They were compared based on the marks scored in the test. Results: Due to failed
normality, the Mann–Whitney U Statistic test was considered which mainly considered median value (center value). P-value
was found to be significant. P-value was found to be significant (P ≤ 0.001). The difference in average values between the
two batches was also found to be significant (4.46–3.58 = 0.88). The average was high in the study, which included a picture
puzzle in them. Discussion: According to another study, which involved Duran’s communicative adaptability scale which
depends on both cognitive and behavioral skills. This study concluded that games in learning had a positive effect on the
communication ability, adaptability, and resourcefulness in adult learners which also proved that they might have a role to
play in higher education. Wouters et al. detected in his study effective and significant change in learning and retention of
concepts due to the involvement of puzzles. Conclusion: Picture puzzles were found to be effective in understanding the
concepts of pathology.
KEY WORDS: Conventional lecture, Deeper understanding, Effective, Fun-filled way of learning, Picture puzzle
INTRODUCTION in technology, we need applying electronic tools to
our learning. We also include the use of the mobile
Pathology is the study of the causes and the effects phone during the lecture which some people may find
of injury or disease. They include a wide range of controversial.[4]
scope in research filed as well as medical practices.
Pathology as a field is mainly concerned with the The use of technology is necessary as students are
diagnosis, classification, and sub-classification of mostly connected to them in their everyday routine
diseases.[1] Pathology is very important as they help life. When we use multimedia in learning patterns,
in promoting the overall health and well-being of they are found to create a positive impact by increasing
our community. History of pathology has roots in the concentration and attention level of students in
all medical ties and took wing as a separate entity in the class. In the conventional method of teaching,
the past 15th century.[2] The conventional method of students were reiterating the information memorized
teaching is the chalk and board method which helps in exams. The conventional method also limits the
in improving the interaction of the students and the creative thinking skills of the students and also seldom
teachers. The success of the conventional method involves the individuals’ opinions.[5]
depends on the positive attitude and the dedication of
the teacher toward the subject.[3] With the advancement We consider cognitive and non-cognitive factors while
teaching a subject. Cognitive factors include attention
Access this article online and memory skills of the students. Non-cognitive
Website: jprsolutions.info ISSN: 0975-7619
factors were self-confidence and the anxiety level of
the student.[6] According to a previous study conducted
Department of Pathology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences,
Saveetha University, Chennai, Tamil Nadu, India
*Corresponding author: Dr. M. P. Brundha, Department of Pathology, Saveetha Dental College and Hospitals, Saveetha
Institute of Medical and Technical Sciences, Saveetha University, 162, Poonamallee High Road, Chennai - 600 077, Tamil Nadu,
India. Phone: +91-6379319094. E-mail: generalpath2015@gmail.com
Received on: 12-08-2019; Revised on: 14-09-2019; Accepted on: 19-10-2019
Drug Invention Today | Vol 14 • Issue 1 • 2020 197
S. Padmaja and M. P. Brundha
by Cariaga-Lo et al., the non-cognitive characteristics pathology concepts and the other was to help in better
were expressed when they experienced problem-based retainment in remembering and recalling the concepts.
learning.[6] In the conventional method of learning, the They help in mastering the core concepts. It can also
cognitive factors were compromised. There was less be used in the lecture to boost up the energy level of
interaction in class which leads to a loss of interest in students and lake them enthusiastic about the lecture.
attending the class. It was also difficult for the teachers When they boost up the energy level, the output was
to analyze the student’s level of understanding of the found to be increased among the students. It increased
concepts. They were also unable to control the level of better productivity among students. They were found
daydreamers and sleeping people in the class. to be helpful in also making students face problems in
real life by their way of viewing life from a different
In line with the moving world, when everything
perspective.
changes, our education system is alone not an
exception. Hence, we have tried to engage students There are many websites in Google available to use
in active learning and make learning more interactive and study. Some of them include purposegames.com
and interesting.[7] and puzzlegames.com. They mostly are free websites
When a picture puzzle was introduced to the class, the that can be used to analyze our level of understanding
main motive of them was to motivate the students in of the concepts. We can also find some websites which
learning the subject. We wanted to convert the passive allow us to create puzzles so that they can improve our
way of learning into an active way.[8] They not only creativity as well as try to increase our level of interest
improve the way of learning but they also increase in understanding the concepts. Some researchers may
the problem-solving ability as well as the general find it to be controversial to use mobile and technology
knowledge of people. These games are a method in the learning process. The main aim of this study is
that is valuable for us to acquire effective cognitive to analyze the effect of puzzle game in understanding
skills. These puzzles help us in diagnostic thinking the concepts of pathology.
and clinical reasoning. They help us in creating an
atmosphere of happiness, challenge which creates a MATERIALS AND METHODS
positive change in us and helps us to focus better on
the subject.[9] The puzzle game helps in stimulating the A picture puzzle is an active way of gaining
mind so that there is an increase in vocabulary and knowledge, which makes learning very interesting.
better retention of the concepts in mind. They act as a They also improve our critical thinking.
self-learning tool that stimulates our critical thinking
Study Design
and practical application of our knowledge acquired.[10]
These puzzles were aimed to evoke interest in the We include cross over study in this article. There were
student regarding the subject.[11] The puzzle helps in two batches analyzed. One batch was exposed to the
highlighting the main concepts. conventional method of learning and the other batch
to the conventional method with the addition of a
These games are used as a complementary aid to the picture puzzle. After a given period, both the batches
conventional method of teaching. They were used were analyzed for results.
to also increase the academic performances of the
students, along with providing student satisfaction.[7] Inclusion Criteria
The games were used to mainly analyze the level Students from Saveetha Institute of Medical and
of understanding the concepts of pathology, which Technical sciences were selected in this study. The
were difficult to remember in the conventional 2nd-year undergraduate syllabus consists of pathology,
method. They not only help in making learning a so they were selected for this study.
fun-filled manner but they also help in increasing
our logic skills and problem-solving skills. When Exclusion Criteria
they see the pictures, it increases their visual spatial
Students from the 1st year, 3rd year, and final year
awareness and helps in better grasping and deeper
undergraduate were not selected as their syllabus does
understanding of concepts. They improve our
not include pathology.
reasoning skills. They help in better hand and eye
coordination. Selection of Sample
When they finish solving the puzzle, it gives them A total of 100 students from the 2nd-year medical and
a sense of pride and achievement feeling which can dental undergraduates were analyzed in this study.
improve their self-esteem level. In this way, they not Batch A consisted of 50 students and batch B another 50
only improve cognitive factors, but they also improve students. One batch was exposed to only conventional
the non-cognitive skills. The two main outcomes lectures and the other batch to conventional lectures
expected from the picture puzzle were understanding and picture puzzles.
198 Drug Invention Today | Vol 14 • Issue 1 • 2020
S. Padmaja and M. P. Brundha
Preparation of Game taken. If they consume 1–2 min, the grades were 10,
The game was created using a website called 3–4 min it was 9, 4–5 min they were graded as 8,
“purposegames.com.” We have to register ourselves 5–6 min, it was 7, 6–7 min, it was 6, 7–8 min, and
and create a login ID [Figure 1]. The puzzle was to above it was 5.
be created on the topic pathology. Since its vast area
Preparation
to cover, we chose “necrosis” to create a puzzle.
Appropriate pictures were browsed and used. After The picture puzzle, along with conventional lectures,
selecting the pictures, we disoriented them and was tested for results. The total hour of pathology
removed the names. Once they were fixed, the timings class was for an hour. Batch A underwent only
were set for the game along with a score [Figure 2] conventional lecture for 1 h. The other batch had
Finally, the link was saved and distributed among a class for 45 min and the last 15 min they were
students through the mail and WhatsApp. They were exposed to picture puzzles and were asked to solve
graded and ranked according to the timings of the it. The students’ consent was approved first, and
game. then only the picture puzzle was distributed to them.
After solving the puzzle, they were asked to take
Criteria for Picture Puzzle a screenshot and send it to the teacher for further
Four pictures were taken to create the puzzle. Once analysis. The marks obtained from both the batches in
they start [Figure 3] the puzzle, the timings also start their internal assessment by an unbiased faculty were
getting recorded. Once the puzzle is completed the analyzed statistically.
time taken to complete the puzzle was displayed on
Test Performed
the screen. Grading was done according to the time
For the statistical comparison between the two batches,
we have considered the “Mann–Whitney U Statistic”
test. t-test was conducted among the two groups. The
normality had failed in the test so, the Mann–Whitney
U Statistic test. We had considered the median value
in this test (center value). From the formation of
collage till the statistical comparison, they were under
the guidance of pathology department faculty.
RESULTS AND DISCUSSION
The effect of the picture puzzle was compared between
the two batches. The results of the two batches were
analyzed statistically, as shown in Table 1.
Figure 1: Account created on the website
Figure 2: Timings recorded Figure 3: Before the puzzle started
Drug Invention Today | Vol 14 • Issue 1 • 2020 199S. Padmaja and M. P. Brundha
Table 1 depicts the number of people in each batch on both cognitive and behavioral skills. This study
(50 each). There were no missing values. Due to failed concluded that games in learning had a positive
normality, the Mann–Whitney U Statistic test was effect on the communication ability, adaptability,
considered which mainly considered median value and resourcefulness in adult learners, which also
(center value). P-value was found to be significant. proved that they might have a role to play in higher
P-value was found to be significant (P ≤ 0.001). The education.[19] Wouters et al. detected in his study
difference in average values between the two batches effective and significant change in learning and
was also found to be significant (4.46–3.58 = 0.88). retention of concepts due to the involvement of
The average was high in the batch which was exposed puzzles.[20] According to another study by Sitzmann,
to picture puzzle games in them. they were found to be focused and effective on certain
aspects such as knowledge (procedural and declarative)
As a clinician, we need to develop a systemic method and retention of them.[21] In 2006, the Federation of
to face an unknown situation. We require more American Scientists issued a widely publicized report
skills to analyze the slides, which can be gained by stating that games are a powerful resource that can aid
exposing ourselves to a lot of visual slides.[5] The in education. Studies have also been done to depict
main use of the picture puzzle game is to use them that digital games especially puzzles do help us to
as an additional resource for teaching pathology for a visualize as well as support learning especially in
better understanding of concepts. They were also seen conceptual understanding.[22]
to increase the academic performance of the students
(above-mentioned results). They help in achieving CONCLUSION
a fun-filled, non-threatening environment for study
purposes.[12] Learning through puzzles increases our We can conclude from this study that the involvement
practical knowledge related to the environment so that of the picture puzzle games has led to the betterment of
they are more effective. Puzzle improves our visual the academic progress in students. They have enabled
processing, response, and automaticity.[13] The present a deeper understanding of the concepts leading to
technology helps us to create hypothetical situations also better time management, cognitive skills. Thus,
using these puzzles which can help us to imagine and try picture puzzle with conventional lectures together is
to bring out our creativity. This also helps us to build up effective in learning for the students.
our confidence level while treating the patients.[14]
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Source of support: Nil; Conflicts of interest: None Declared
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