Crossword puzzles versus Student-Led Objective Tutorials ( SLOT ) as innovative pedagogies in undergraduate medical education

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.

CONCLUSÃO: O presente estudo revelou que as sessões do SLOT se saíram melhor comparativamente àquelas com as palavras cruzadas em termos de melhorar as pontuações dos alunos nos testes, assim como promoveu o trabalho em equipe, habilidades de aprendizagem autodirigida e pensamento crítico. As palavras cruzadas tornam a sessão mais amigável ao aluno, pois é divertida e envolvente, mas um design cuidadoso é inevitável, pois pode falhar em testar o aprendizado em profundidade nos alunos.  (7). This method adds a friendly ambience to teaching, making learning fun and a constructively competitive arena enabling students to apply their knowledge and critical thinking skills (8). Studies have proved that crossword puzzle provides lexicon expansion, invigorates the intelligence, uplifts conviction, and hastens the capacity to learn mainly decreasing the excessive thrust heaped on rote learning (9). According to Dee Fink, providing an enabling learning environment is a significant cue for effective learning to take place (10). Integrating a variety of pedagogical tools rather than employing a single isolated classroom design definitely results in an intensifying and enriched learning experience (10). Hence, with this view, we designed the present study to assess and compare the effectiveness and perception of students on two different pedagogical methods:

PALAVRAS-CHAVE:
Crossword puzzles (CP) and SLOT as a teaching learning method in Pharmacology. Following this, one week later to assess the overall performance of students a written test on the same topics including MCQs and short answers was conducted for both the groups. The answer sheets were evaluated and the scores obtained by the students in the two methods were compared.

Statistical analysis:
To analyse the data, the methods of descriptive statistics (mean) and analytical statistics (independent t-tests) were used employing IBM SPSS Statistics 25. An independent t test was conducted to determine if a difference existed

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Scientia Medica Porto Alegre, v. 31, p. 1-7, jan.-dez. 2021 | e-37105 between the mean of the marks obtained by the students in the SLOT versus the CP.

RESULTS
Out of a total 244 students who were approached for the study, 203 students agreed to participate in the study and provided their informed consents.   The new type of tutorial was relevant to the topic.

4.3
2 The new type of tutorial stimulated interest in the topic.

4.1
3 The new type of tutorial assisted me in understanding of the content of the lectures. 4

4
The new type of tutorial provided guidance on how to learn effectively for this topic. 3.9

5
I learned more than I would have by participating in a traditional (old type) tutorial.

3.9
6 I received adequate feedback on my tutorial work.

7
The tutors were interested in helping me learn.

8
I enjoyed working with a team. 3.8

9
The group work increased my ability to learn independently.

3.6
10 My group succeeded working as a team. 3.8

11
The supervision by the lecturer was useful.

12
I am looking forward to more of this kind of innovative tutorial. 4 SLOT, Student Led Objective Tutorial. The supervision by the lecturer was useful. 3.8

10
I am looking forward to more of this kind of innovative tutorial.

11
Crossword puzzles promote active learning.

12
The material on the puzzles were pertinent to the topic.
Dr. Preethi J Shenoy • Dr. Rashmi R Rao Crossword puzzles versus Student-Led Objective Tutorials (SLOT)

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Feedback obtained through open-ended questions revealed that the students enjoyed the SLOT sessions as it was conducted with a competitive streak. They opined that it improved their in-depth understanding of the topic and made learning more active. They felt that framing MCQ enhances critical thinking which also led to a concept of ownership in learning. The students also appreciated that it improved teamwork, self-directed learning skills and improved peer-to-peer communication. According to the students the SLOT sessions were innovative, creative, interesting, and motivated them to study Pharmacology providing them with a healthy environment to learn from their peers.
On the other hand, the pitfalls of the session as opined by the students included a necessity for active engagement of the students within the team deemed to be a requirement for successful learning. Non-involvement of individuals was a strong deterrent for effective learning. They also felt that it was more time-consuming and prior allotment of subtopics within a group resulted in segmental learning.
The students in the crossword group appreciated the session as innovative, interactive and engaging, which made learning fun and nonmonotonous. It facilitated active participation in the tutorial and improved their creativity. It helped them to memorize the names of the drugs and motivated them towards active learning. However, they also felt that the time given was a limiting factor. Moreover, the questions did not facilitate in-depth understanding and explanation of the pharmacology of the drugs. They accepted that prior learning could have helped them better but did not offer any special advantages over the conventional tutorials held.

DISCUSSION
The present study was an attempt to compare the effectiveness of two innovative teaching modalities employed as small group pedagogies in Pharmacology. The results of the scores obtained by the students in the SLOT group showed a significant increase when compared to the scores obtained by the students in the Crossword group.
The questionnaire also revealed that the students appreciated the SLOT sessions better in improving an in-depth understanding of the subject as suggested in earlier studies (11) whereas the crossword merely facilitated memorization of the names of the drugs and failed to increase critical thinking and problem-solving skills.
SLOT has been deemed to be an innovative pedagogical tool to inculcate increased interest amongst learners providing ample opportunities for peer learning and self-directed learning (4).
Literature survey revealed earlier studies which have proved its supremacy over the conventional tutorials and a method to propagate active learning.
The students have also opined that the design of the tutorial helps the students to score better in MCQ examinations (4). The results of the present study are in concordance with a previous study that found peer tutoring engaging and encouraging to stimulate the students' academic development (12).
SLOT could prove to be a welcome addition to innovative pedagogical tools as it relies on student involvement and promotes a sense of ownership in learning amongst them. The students have to develop an in-depth understanding of the subjects to help them frame the MCQs thereby improving their analytical skills and promotes critical thinking.
It improves their reasoning skills as they discuss with their peers on framing the wrong alternatives for the MCQ. Presenting the MCQ also helps them to improvise on their communication skills and instils confidence in them (4). This further on helps them to apply the pharmacological concepts taught to real-life scenarios, which they might face during their clinical sojourn (4).
One of the pitfalls as mentioned by the students was non-involvement of all the students, which could reflect on their performance as a group. This has also been reported in an earlier study in which 39% of the students felt that there was a lack of co-operation amongst some of the members of the team who failed to actively contribute in framing MCQ (13). Factors like differing personalities, lack of peer-to-peer interaction can minimize the success of groups (14). It has been proved that utilizing group dynamics principles and concepts of reflection enables the groups to inspect and introspect (15).
A previous study incorporating crossword puzzles in Pharmacology has elaborated that it increased the learning abilities of the students by improving their ability to recall the names of the drug and diseases (16). It has also been deemed to improve the cognitive skills of the students and inculcate interest in learning. The results of our study is also consistent with earlier reports reporting such sessions as fun and efficient means of review for examinations (16). Saxena et al. in an earlier study has reported that crossword puzzles were instrumental to the overall learning of 61 out of 80 students while implementing it in the subject of undergraduate Pathology (16).

Yet another study by Crossman and Crossman
has reported that higher test scores were obtained by students in the subject of History of Psychology after incorporating crossword puzzles as a pedagogical study tool (17). The utility of crossword puzzle lies in the fact that it stimulates the learner to recall previous contents learned and enjoys the act of learning. However, in our study the scores obtained by the students were less when compared to the SLOT session and the student acceptability also leaned more towards the SLOT sessions when compared to the CP.
SLOT and crossword puzzles could prove to be novel tutorial methods that can counterbalance shortage in teaching faculty with increased utility in inculcating interest amongst both students and facilitators, uniformity in dissemination of content, provide an arena for group learning, and optimum usage of audio-visual aids in teaching and learning. SLOT might also elucidate the students' prospects of peer tutoring in and out the classroom. However, a crucial design of crosswords is essential to increase its utility as a pedagogical tool in enhancing higher order reasoning abilities and improve learning in students.

Funding
This study did not receive financial support from external sources

Conflicts of interest disclosure
The authors declare no competing interests relevant to the content of this study.