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Effectiveness of the Jigsaw Method in Learning Anatomy among Phase I Medical Students: A Quasi-experimental Study |
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D Sreelekha, KV Sarala Devi, Rajeev Panwar 1. Associate Professor, Department of Anatomy, Sri Balaji Medical College and Hospital, Chennai, Tamil Nadu, India. 2. Professor and Head, Department of Anatomy, ESIC Medical College and Hospital, KK Nagar, Chennai, Tamil Nadu, India. 3. Assistant Professor, Department of Anatomy, ESIC Medical College and Hospital, KK Nagar, Chennai, Tamil Nadu, India. |
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Correspondence Address : D Sreelekha, No. 2/724C, 2nd Main Road, Kazura Garden, Neelankarai, Chennai, Tamil Nadu, India. E-mail: sreedorai@gmail.com |
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| ABSTRACT |  | |||||||||||||||||||||||||||||||||||||||||||||||||
: Introduction: The Didactic method of instruction has traditionally been the primary approach in Indian medical education. Over the past decade, there has been a notable transition in undergraduate medical education from pedagogy to heutagogy, emphasising attitude, ethics and communication. The Jigsaw method represents a relatively novel and innovative learning technique wherein the students are divided into parent groups, which are further divided into smaller subgroups. Aim: To evaluate the effectiveness of the Jigsaw method in comparison to the traditional Didactic approach in teaching Anatomy to first professional (Phase I) MBBS students. Materials and Methods: A quasi-experimental study was conducted in the Department of Anatomy at Employees’ State Insurance Corporation (ESIC) Medical College and Hospital, KK Nagar, Chennai, Tamil Nadu, India, from December 2024 to May 2025, on a study population of 152 Phase I MBBS students. The students were divided into two groups: Batch 1 engaged in the Jigsaw method, while Batch 2 participated in the Didactic method for the same specified topic. All the students underwent a Multiple Choice Questions (MCQ) based pretest and post-test before and after the teaching learning sessions, respectively. Additionally, feedback was collected from all participants using a Likert scale after the session. To know the difference in performance between pre- and post-test scores of each method, a paired t-test was used. Results: The mean difference (mean±SD) of pretest and post-test of the Jigsaw and the Didactic methods was calculated. The p-value arrived at was <0.001 for the Jigsaw method and 0.049 for the Didactic method. Further, the post-test scores of both methods were compared using the Independent t-test to understand the effectiveness of the methods. The p-value was less than 0.001, which was significant. The feedback scores were analysed using an Independent t-test. The mean±SD for the Jigsaw method was 25.98±4.17 and the Didactic method was 24.77±1.10. The p-value was 0.038, which showed a significant difference in the scores, with a higher score for the Jigsaw method. Conclusion: Students who participated in the Jigsaw method demonstrated improved post-test results, indicating enhanced retention and understanding of concepts compared to those who underwent the Didactic lecture methodology. | ||||||||||||||||||||||||||||||||||||||||||||||||||
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| Keywords : Innovative teaching, Interactive teaching, Jigsaw cooperative learning, Traditional teaching | ||||||||||||||||||||||||||||||||||||||||||||||||||
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DOI and Others :
DOI: 10.7860/IJARS/2026/81273.3072
Date of Submission: Jun 12, 2025 Date of Peer Review: Sep 23, 2025 Date of Acceptance: Dec 08, 2025 Date of Publishing: Jan 01, 2026 AUTHOR DECLARATION: • Financial or Other Competing Interests: None • Was Ethics Committee Approval obtained for this study? Yes • Was informed consent obtained from the subjects involved in the study? No • For any images presented appropriate consent has been obtained from the subjects. NA PLAGIARISM CHECKING METHODS: • Plagiarism X-checker: Jul 16, 2025 • Manual Googling: Nov 26, 2025 • iThenticate Software: Dec 06, 2025 (12%) ETYMOLOGY: Author Origin EMENDATIONS: 7 |
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| INTRODUCTION |
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The introduction of Competency-based Medical Education (CBME) has created a significant shift in medical education, emphasising active learning. This approach enhances student engagement and develops critical thinking skills, leading to a rise in the importance of innovative practices involving cooperative learning, such as Jigsaw teaching (1). This method, initially developed by Elliot Aronson in 1978, aimed to create situations that involved cooperative interracial interactions. In these interactions, students were dependent on one another to learn, like assembling a jigsaw puzzle, with each member contributing an essential piece of learning (2). The Jigsaw teaching-learning methodology described by Elliot Aronson consists of four steps: 1) Students are divided into Jigsaw groups. These groups exhibit within-group heterogeneity (i.e., gender, students’ cognitive, social and motor levels) and between-group homogeneity and include three to eight students each; 2) Students join temporary “expert” groups consisting of students who have been assigned the same subset of material. This step provides less competent students with the opportunity to learn how to understand and teach materials from more competent peers; 3) Students return to their original Jigsaw groups, where they are responsible for teaching and explaining the skills they have learned to their group members to make them competent; 4) Home group students work together to produce final joint work through integration and evaluation. Among cooperative learning methods, the Jigsaw method is attractive for teachers, as it proposes a four-step teaching structure that is easy to follow (3). Several meta-analyses have been conducted on the effects of cooperative learning, focusing on three educational outcomes: achievement, social relations and self-esteem (4). In 2007, Johnson DW et al., analysed the impact of collaborative learning on interpersonal relationships and self-esteem, concluding that cooperative learning promotes greater affinity among students compared to competitive or individualistic approaches (5). Researchers have extensively studied innovative teaching methods like problem-based and team-based learning (6). The Jigsaw method is unique among innovative approaches, as the cooperation of every member is essential to achieve the team’s goals. However, in India, traditional methods are predominantly followed and there is a need for more studies to understand the efficacy, compatibility and feasibility of various innovative teaching methods at medical institutions and universities. Hence, the authors wanted to study the effectiveness of the Jigsaw method of innovative teaching and learning compared to traditional methods. The present study was conducted as part of the implementation of the CBME curriculum for phase I medical students. This Jigsaw method is being implemented and studied for the first time at the study Institute. | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Material and Methods |
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A quasi-experimental study was conducted in the Department of Anatomy at ESIC Medical College and Hospital, KK Nagar, Chennai, Tamil Nadu, India, between December 2024 and May 2025. The Institutional Ethical Committee (IEC) approval (IEC/2025/01/02) was obtained. A universal method of sampling was used. Inclusion criteria: All phase I MBBS students of batch 2024-25 were included. Exclusion criteria: Students who were absent on the day of the session and those who did not submit any pre-test or post-test responses. After excluding the absentees, a total of 146 students participated as batch 1 (72 students) and batch 2 (74 students) in the study. The students who did not submit any of the pre-test, post-test or feedback forms were also excluded from the study. Thus, the study was conducted on a sample population of 114 students who attended the session and underwent pre-test, post-test and submitted the feedback form. Study Procedure A clinically significant topic in the region of study, such as the Anatomy of the knee joint, a core competency with a ‘Show how’ level of knowledge and skill, was selected for the present study. After receiving 152 phase I MBBS students from the academic year 2024-25, the students were divided into batch 1 (roll no. 1 to 76) and batch 2 (roll no. 77 to 152). The first and second batches underwent the Jigsaw and the Didactic traditional teaching methods, respectively, on the same topic. The faculty was briefed about the lesson plan for the Jigsaw session a week prior, and their doubts were addressed to ensure the session was conducted in an organised manner. The pre-read material on the topic of the knee joint was shared with the students one week prior to the day of the session. Batch 1 A tutorial hour, consisting of at least 2.5 to 3 hours of continuous time, was allocated for the session. Seventy-six students from batch 1 were divided into five small parent groups, with 15 members selected from each group according to their roll no. order. The parent groups were designated as groups A, B, C, D, and E. Each parent group selected a leader to manage the team. The parent groups were facilitated by five faculty members, with one faculty member for each parent group. • Before beginning the session, a 10-mark MCQ pre-test on the topic was given to the students. After the students submitted the pre-test responses, the session began by forming parent groups, each group consisting of 15 students selected according to roll no. order as shown in (Table/Fig 1). • The selected topic was subdivided into five subtopics: a) Type of joint, articulating surfaces; b) Capsule and ligaments, Relations; c) Actions and muscles producing the movements; d) Blood supply, nerve supply; and e) Applied anatomy • Of the 15 members of each parent group, three members were selected and allotted one subtopic. Example: In group A, three members who were allotted the first subtopic “a)” are referred to as A1. Hence, the five subtopics were allotted to groups A1, A2, A3, A4, and A5 with three members in each subgroup. This was done in each parent group such that A1, B1, C1, D1, and E1 of each parent group were allotted to the same subtopic, as shown in (Table/Fig 1). • Each subtopic group was given study handouts of their subtopic and given 20 minutes to study and work on their subtopic individually. The three member subgroup of each parent group with the same subtopic then came together to form an expert group. Example: (A1-E1) Expert group 1, (A2-E2) Expert group 2, (A3-E3) Expert group 3, (A4-E4) Expert group 4 and (A5-E5) Expert group 5. • Five faculties, facilitated the expert groups 1, 2, 3, 4 and 5. The expert groups discussed their subtopics in detail for 30 minutes. At the end of 30 minutes, the expert groups returned to their parent groups and were guided by the facilitator to discuss all the subtopics in order. This session lasted for 30 minutes. • At the end of 30 minutes, each member of the parent group was well versed and an expert in the topic of the knee joint. One member from each parent group was asked to volunteer and present one subtopic to the entire class. After the presentation, doubts/add-on points were shared one at a time by the class and facilitators. A post-test was given to the students. Batch 2 Before beginning the session, a pre-test was given to the students on the same topic. A routine, 50 minutes Didactic session was conducted with a PowerPoint presentation. At the end of the lecture, a post-test was given. Feedback from the students was taken using the same structured feedback form used for batch 1. To maintain equality among the batches, the Jigsaw session was conducted for batch 2 after the Didactic lecture during the dissection hour, simultaneously by the same set of trained faculty. Statistical Analysis Data analysis was performed using the Statistical Package for Social Sciences (SPSS) 21.0. To know the difference between pre and post test scores of the two methods, a paired t-test was used. An Independent t-test was applied to test the significant difference between post-test scores and feedback scores of the two methods. A p-value <0.05 was considered statistically significant. The feedback scoring was based on Likert scale of 1 to 5 (1-Strongly disagree; 2-Disagree; 3-Neutral; 4-Agree; 5-Strongly agree). The feedback scores of both methods were also tabulated. | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Results |
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The total number of students who had submitted pre-test and post-test forms was taken as the sample population, which was 114, of which 56 students were in batch 1 and 58 students were in batch 2. Of the total 114 students, 51 students were males, and 63 were females, with a mean age of 18.05±0.51 years. Both methods individually showed significant improvement from pre-test to post-test scores (Table/Fig 2). The scores of both the methods were compared, which showed that the difference in the post-test scores of the two methods was statistically significant (Table/Fig 3). Most of the students who underwent the Jigsaw method felt that their specific learning objectives and their expected learning outcomes were met and the session was productive (Table/Fig 4). The feedback scores showed a statistically significant difference in the scores, with higher scores for the Jigsaw method (Table/Fig 5). | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Discussion |
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The results of our study show that the improvement from pretest to post-test scores was greater for the Jigsaw method compared to the Didactic method. The feedback scoring shows that the Jigsaw method helped the students to understand the topic and its clinical correlation better and in acquiring skills such as collaboration, communication and critical thinking. Persky AM and Pollack GM in 2009 described a learning approach combining Problem-based Learning (PBL) with the Jigsaw technique. Although post-test scores of his study showed significant improvement, students expressed apprehension regarding group interaction and learning and expressed a preference for traditional lectures over interactive learning (7). Wilson JA et al., in 2017 and Chng HT et al., in 2024, studied the effectiveness of Jigsaw learning over Didactic lectures among undergraduate students. In the study done by Wilson JA et al., the improvement in post-test scores favoured the traditional method with a p-value of 0.001. In the study done by Chng HT et al., in a class of 192 students, the improvement in post-test scores was 22.2% and 14.3% in median percentage for the lecture and Jigsaw method, respectively. In both studies, the traditional method showed better post-test scores, signifying better academic performance. However, in both studies, students expressed a preference for the Jigsaw method, citing skill development and overall good and cooperative learning experience (8),(9). Bhandari B et al., in 2017 analysed the closed and open-ended feedback of 95 students following the Jigsaw method of learning and found that students were generally satisfied with this method as it facilitated better comprehension, communication and improved analytical abilities. However, not all students got an equal opportunity to present their sub-topic in this method (10). Oakes DJ et al., studied the Jigsaw method in 53 volunteers attending a workshop on abdominal Anatomy. There was a significant improvement in their post-test scores. The long-term retention, assessed by comparing the end-semester exam of workshop participants with non participants, was not significant. However, participants rated the Jigsaw method highly for both educational value and enjoyment and believed it would enhance their course performance (11). Chauhan A et al., compared the quantitative and qualitative data of two groups of Phase I MBBS students undergoing the Jigsaw and traditional methods. The post-test scores of the Jigsaw group were significantly higher. Students rated the Jigsaw method positively for enhancing peer interaction, promoting deeper learning of the subject, and improving communication skills (12). Suvarna P et al., investigated the efficacy of developing core competencies by conducting the Jigsaw method following a Didactic lecture. The post-test score showed a significant improvement and the study concluded that the Jigsaw method in combination with the traditional method was highly effective and beneficial to the students (13). Jeppu AK et al., examined the impact of Jigsaw learning on undergraduate medical students. The study assessed the method’s effectiveness. Quantitative data analysis showed a significant improvement in the students’ individual accountability, critical thinking, teamwork and skill development after Jigsaw learning sessions (14). In the present study, there was a significant improvement noted in the post-test scores of students who underwent the Jigsaw method compared to the Didactic lecture, which was similar to the studies done by Oakes DJ et al., and Chauhan A et al., (11),(12). The closed-ended feedback from the students showed that the retention was found to be better following the Jigsaw session and the students felt that the session was very interactive and were able to achieve their expected learning outcomes to their satisfaction. The Jigsaw method may be particularly effective for clinically significant topics, which require deliberation and demand in-depth understanding. Also, this method could ensure teamwork and thereby, encourage active and accountable participation by the students. Limitation(s) Despite its effectiveness, the Jigsaw method necessitates extensive preparation, trained faculty and considerable time to cover a topic adequately. In the present study, a 2-week prior preparation was required, and the topic that could be covered in a 1-hour Didactic lecture took around three hours through the Jigsaw method. | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Acknowledgement |
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Authors’ sincere thanks to all the faculty of the Department of Anatomy, ESIC Medical College, Chennai; Phase I MBBS students of the 2024-25 batch of ESIC Medical College, Chennai; Ms. Saranya, Statistician, Sree Balaji Medical College and Hospital, Chrompet, Chennai; Mr. S. Ramasubramanian, Senior consultant at Spideys, Chennai and Dr. Kokila, Senior Resident, Department of SPM, ESIC Medical College, for their valuable time and cooperation. | ||||||||||||||||||||||||||||||||||||||||||||||||||
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