This study demonstrates that the development of educational puzzles is readily feasible, and the use of a set of puzzles as an adjunct learning and studying tool can be useful for improving students’ understanding of radiographic interpretive principles. While students who used a given puzzle topic did not perform better on the associated quiz than students who did not use the puzzles, students who used at least two of the puzzle topics during the semester demonstrated longer-term improvements in terms of higher scores on the midterm exam and the course as a whole. The reason for the lack of differences in scores on the individual quizzes is unclear. However, it is suspected that the open-book nature of the quizzes and the relatively low number of questions limited variation in student scores and thus limited the power of the exercise to identify differences between groups.Of particular note is the declining utilization of the puzzle activities by students over the course of the semester, despite the vast majority of students stating that they found the activities both useful and entertaining. Usage of the sixth topic, near the end of the semester, was only approximately one-third the rate of usage of the first topic at the beginning of the semester. Although there was a slight rebound at the conclusion of the semester as students studied the final topic, which was specifically geared toward preparation for the final examination, the rate of utilization of this topic was still only half of the utilization of the first topic. This correlates with experiences in utilization of mobile game apps; for example, according to a 2019 benchmark report on the mobile gaming industry, the median 1-day user retention is approximately 25%, and median 7-day user retention is approximately 6%.10 User engagement drops rapidly with repetitive gameplay unless new content is introduced.10 Similar findings have been described in a gamified portion of an engineering course, where gameplay for learning dramatically decreased over the course of a semester.11 The use of different types of puzzles was intended in part to provide students greater variety and reduce repetitive activities; however, in light of the identified decline in student participation over the semester, it is unclear if the variation mitigated what could have been a more precipitous decline or if it had minimal or no effect on student participation.We could question if the puzzle activities should be required throughout the semester, especially if there is evidence that they may be beneficial to student learning. Answering such a question is certainly beyond the scope of this study, and a decision in either direction would require a consideration of the benefits of the puzzles and the additional time required of all students to complete the activities. It is also necessary to acknowledge that different students have different preferences in terms of learning styles (visual vs. verbal perception, sequential vs. global understanding)12—the variety of puzzles was intended to provide options to students regardless of their preferences, so to mandate puzzle use against a given student’s learning preferences could have negative consequences.The primary limitation of this study is that student participation was voluntary, so it is possible that any differences in scores between students who used the puzzles and those who did not are actually due to other factors. Students who had a stronger inclination toward imaging may have been more likely to use the puzzles, thus artifactually increasing scores in that group. Alternatively, students who found imaging more challenging could have been more likely to use the activities as an additional study guide, which would, in turn, depress the scores for the puzzle-use group. To better assess the effects of puzzle use on student outcomes, a randomized prospective study could be performed to compare puzzle use to conventional studying.

Of the 104 students in the class, 99 completed the first survey (administered at the time of the midterm examination), and 89 completed the second survey (administered at the time of the final examination). All completed surveys were used to classify students by the number of puzzle activities used for the purposes of comparative statistics and evaluations of correlations. For responses regarding the utility of puzzles and student enjoyment of the activities, only surveys from those students who used at least one of the activities were evaluated (n = 59 on the midterm survey, n = 50 on the final survey).When evaluating individual quiz scores, there were no significant differences in scores between those students who had used the respective puzzle activities prior to taking the quizzes and those who had not used the puzzles as a part of their studies (all p > .05).A small but statistically significant correlation was found between number of puzzle topics used and students’ midterm exam scores (R = .23, R2 = .051, p = .025), final exam scores (R = .22, R2 = .048, p = .038), and overall course scores (R = .23, R2 = .053, p = .030). Students who used 2 to 4 puzzle topics prior to taking the midterm examination performed better on the midterm exam than those who used one or no puzzle topics (52.8 vs. 49.9 points out of 60, p = .013). A specific cutoff value producing improved scores was not identified when evaluating students’ final examination scores. However, students who used two or more puzzle topics over the semester had higher overall course scores than those who used one or no puzzle topics (208.7 vs. 201.3 points out of 240 possible, p = .021).The overall use of activity topics by students decreased over the course of the semester. The first topic (i.e., the puzzles related to the material covered by the first quiz) was the most used topic, with 74% of survey respondents reporting that they used that topic. Use of topics dropped over the semester to a low of 27% utilization of the sixth topic before rebounding to 32% for the seventh topic and 37% for the final topic (Figure 4).Figure 4: Proportion of veterinary students reporting use of each topic (or chapter) in The Isle of ImaginingCh = chapter, F = finalOn the midterm survey, among respondents who used at least one of the puzzle activities, the majority of students (52.5%) found the activities to be somewhat useful (score of 4 out of 5), and 74.6% found the activities to be either somewhat useful or very useful (a score of 4 or 5, n = 44/59). Similar proportions were found on the final survey, where 82% of respondents (n = 41/50) found the activities to be somewhat useful or very useful.On the midterm survey, among respondents who used at least one of the puzzle activities, 80% of students either moderately enjoyed The Isle of Imagining (score of 5 out of 6, n = 20/60) or enjoyed The Isle of Imagining a lot (score of 6, n = 28/60). On the final survey, 98% of respondents (n = 46/47) reported at least a degree of enjoyment of the puzzles (scores 4–6), with 47% reporting that they enjoyed the puzzles a lot (score of 6, n = 22/47). When asked about the narrative components, proportions of enjoyment were similar, with 98% (n = 53/54) reporting at least some enjoyment, and 52% of respondents stating that they enjoyed the narrative a lot (score of 6, n = 28/54).In the free-response sections of the surveys, numerous students described the puzzles as being useful to their studies. Many of the positive comments centered around the general concepts of using the puzzles to organize students’ notes and thoughts as well as providing a novel means of studying. Many students also appreciated the different perspective provided by the puzzle activities as compared with conventional case-based studying. There was not a clear-cut favorite type of puzzle, although the Venn diagrams were the most commonly mentioned puzzles that students enjoyed and found useful. In terms of the narrative, there were generally two camps of students—one group of students read most, or all, of the narrative sections and found them to be enjoyable and funny; the other group did not read the narrative sections, as these students felt that time expenditure was not worth it, so these students focused solely on the puzzles themselves.

Learning the concepts of clinical radiology, including lesion identification and formulation of differential diagnosis lists, can be challenging for veterinary students. A series of educational puzzles with an overarching narrative was developed to help students learn the fundamental concepts of urogenital, thoracic, and spine imaging. Third-year veterinary students had the opportunity to use as many of the puzzles as they wished as a part of their studies in a semester-long imaging course, and students completed surveys to indicate which puzzle sections they used and provide their opinions of the activities. Graded performance in the course was correlated with how many puzzle activities students used. A small but statistically significant correlation was found between the number of puzzle sections used and midterm exam score, final exam score, and overall course score. Although most students who used the puzzles as a part of their studies enjoyed the activities, there was a dramatic decrease in usage over the semester, from 74% of survey respondents using the initial topic to a low of 27% utilization of the sixth topic, followed by a small rebound to 37% for the eighth topic (the review for the final exam). Thus, while developing a puzzle series is achievable and beneficial to student learning, possibly because of improved student engagement through increased variety in learning opportunities, further steps are necessary to encourage continued student engagement throughout the semester.

How do puzzles help you?They help you learn numbersThey help exercise the brainThey are a time pass

A teacher regularly gives students brief quizzes of three to five questions covering material taught in the current or preceding lesson. Which of the following is likely to be the primary benefit of this practice?Question 1Answera.Minimising the amount of re-teaching required for students to master curricular content.b.Enhancing students' engagement in the learning process and recognition of key learning goals.c.Ensuring that the teacher has adequate performance data to assign students a fair grade for the classd.Helping improve instruction through ongoing feedback on teaching effectiveness.

In the realm of education, assessments play a pivotal role in gauging a student's understanding, progress, and overall performance. The three primary types of assessments utilized in this context are formative, summative, and diagnostic assessments. Each type serves a unique purpose and provides valuable insights into a student's learning journey. Formative assessments are integral during the learning process. They are designed to check a student's understanding of the material as they progress through it. These assessments are not necessarily about grading but rather about providing feedback. They allow educators to monitor the learning process in real-time and adjust their teaching strategies accordingly. For instance, if a student struggles with a particular concept, the teacher can identify this through a formative assessment and provide additional support or resources to aid understanding. Summative assessments, on the other hand, are conducted at the end of a learning period. Their primary purpose is to evaluate a student's overall performance and understanding of the subject matter. These assessments often take the form of final exams or end-of-term projects and contribute significantly to a student's final grade. They provide a comprehensive overview of a student's knowledge and skills, highlighting their proficiency in the subject. Lastly, diagnostic assessments are used at the beginning of a learning period. These assessments are designed to identify a student's strengths and weaknesses before instruction begins. They help educators tailor their teaching methods to meet the individual needs of each student. By understanding where a student excels and where they may need extra help, teachers can create a more effective and personalized learning plan. In conclusion, formative, summative, and diagnostic assessments are essential tools in education. They provide a roadmap for both teachers and students, guiding instruction and learning. By understanding where a student is at the beginning with diagnostic assessments, checking their understanding along the way with formative assessments, and evaluating their overall performance with summative assessments, educators can ensure that every student has the support they need to succeed.make this an extra long summary