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The Paper Puzzle as an Active Learning Tool in the Teaching of Anatomy: A Qualitative Study of Perceptions in Students and Near-Peer Teachers

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Title: The Paper Puzzle as an Active Learning Tool in the Teaching of Anatomy: A Qualitative Study of Perceptions in Students and Near-Peer Teachers
Language: English
Authors: Ricardo Tello-Mendoza, Luis Adrian Alvarez-Lozada, Santos Guzman-Lopez (ORCID 0000-0003-4100-1360), Alejandro Quiroga-Garza (ORCID 0000-0002-5398-247X), Yolanda Salinas-Alvarez, Rodrigo Enrique Elizondo-Omana (ORCID 0000-0002-8017-2640), David A. Morton (ORCID 0000-0002-1455-3840)
Source: Anatomical Sciences Education. 2026 19(6):902-912.
Availability: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
Peer Reviewed: Y
Page Count: 11
Publication Date: 2026
Document Type: Journal Articles
Reports - Research
Education Level: Higher Education
Postsecondary Education
Descriptors: Active Learning, Puzzles, Anatomy, Program Effectiveness, Peer Teaching, Medical Students, College Freshmen, Student Attitudes, Student Motivation, Teamwork, Barriers, Foreign Countries
Geographic Terms: Mexico
DOI: 10.1002/ase.70112
ISSN: 1935-9772
1935-9780
Abstract: Active learning strategies enhance medical education by fostering self-directed learning, communication, and problem-solving skills. The paper puzzle, a game-based learning approach, provides an engaging way to reinforce anatomical knowledge and promote collaboration. This study assessed its impact on student performance and perceptions in clinical anatomy, comparing it to PowerPoint-based imaging reviews and evaluating the role of Near Peer Teachers (NPTs). A prospective, longitudinal, quasi-experimental study with a mixed-methods approach was conducted on first-year medical students enrolled in the Human Anatomy course. Surveys using a Likert scale assessed student and NPT perceptions, while focus groups and interviews provided qualitative insights. Thematic analysis identified key themes related to engagement, knowledge reinforcement, and effectiveness. A total of 907 medical students and 30 NPTs completed a survey, while 75 students and 10 NPTs participated in the qualitative phase. Students perceived the paper puzzle as an engaging and interactive review tool that reduced stress, increased involvement, and enhanced knowledge retrieval through collaboration and a structured gameplay loop. They also valued the emotional impact on learning. NPTs reported benefits for student motivation and teamwork but noted that time constraints limited content coverage. The activity's effectiveness was highly dependent on the NPT's facilitation, emphasizing the need for structured implementation. Findings suggested that game-based learning strategies like the paper puzzle can improve motivation, teamwork, and content retrieving in anatomy education when carefully designed and effectively executed by NPTs.
Abstractor: As Provided
Entry Date: 2026
Accession Number: EJ1507748
Database: ERIC
FullText Text:
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  Data: The Paper Puzzle as an Active Learning Tool in the Teaching of Anatomy: A Qualitative Study of Perceptions in Students and Near-Peer Teachers
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  Data: <searchLink fieldCode="AR" term="%22Ricardo+Tello-Mendoza%22">Ricardo Tello-Mendoza</searchLink><br /><searchLink fieldCode="AR" term="%22Luis+Adrian+Alvarez-Lozada%22">Luis Adrian Alvarez-Lozada</searchLink><br /><searchLink fieldCode="AR" term="%22Santos+Guzman-Lopez%22">Santos Guzman-Lopez</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-4100-1360">0000-0003-4100-1360</externalLink>)<br /><searchLink fieldCode="AR" term="%22Alejandro+Quiroga-Garza%22">Alejandro Quiroga-Garza</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-5398-247X">0000-0002-5398-247X</externalLink>)<br /><searchLink fieldCode="AR" term="%22Yolanda+Salinas-Alvarez%22">Yolanda Salinas-Alvarez</searchLink><br /><searchLink fieldCode="AR" term="%22Rodrigo+Enrique+Elizondo-Omana%22">Rodrigo Enrique Elizondo-Omana</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-8017-2640">0000-0002-8017-2640</externalLink>)<br /><searchLink fieldCode="AR" term="%22David+A%2E+Morton%22">David A. Morton</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-1455-3840">0000-0002-1455-3840</externalLink>)
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  Data: <searchLink fieldCode="SO" term="%22Anatomical+Sciences+Education%22"><i>Anatomical Sciences Education</i></searchLink>. 2026 19(6):902-912.
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  Data: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
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  Data: Y
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  Data: 11
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  Data: 2026
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  Data: Journal Articles<br />Reports - Research
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  Data: <searchLink fieldCode="EL" term="%22Higher+Education%22">Higher Education</searchLink><br /><searchLink fieldCode="EL" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink>
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  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Active+Learning%22">Active Learning</searchLink><br /><searchLink fieldCode="DE" term="%22Puzzles%22">Puzzles</searchLink><br /><searchLink fieldCode="DE" term="%22Anatomy%22">Anatomy</searchLink><br /><searchLink fieldCode="DE" term="%22Program+Effectiveness%22">Program Effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22Peer+Teaching%22">Peer Teaching</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+Students%22">Medical Students</searchLink><br /><searchLink fieldCode="DE" term="%22College+Freshmen%22">College Freshmen</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Attitudes%22">Student Attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Motivation%22">Student Motivation</searchLink><br /><searchLink fieldCode="DE" term="%22Teamwork%22">Teamwork</searchLink><br /><searchLink fieldCode="DE" term="%22Barriers%22">Barriers</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink>
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  Label: Geographic Terms
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  Data: <searchLink fieldCode="DE" term="%22Mexico%22">Mexico</searchLink>
– Name: DOI
  Label: DOI
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  Data: 10.1002/ase.70112
– Name: ISSN
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  Data: 1935-9772<br />1935-9780
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Active learning strategies enhance medical education by fostering self-directed learning, communication, and problem-solving skills. The paper puzzle, a game-based learning approach, provides an engaging way to reinforce anatomical knowledge and promote collaboration. This study assessed its impact on student performance and perceptions in clinical anatomy, comparing it to PowerPoint-based imaging reviews and evaluating the role of Near Peer Teachers (NPTs). A prospective, longitudinal, quasi-experimental study with a mixed-methods approach was conducted on first-year medical students enrolled in the Human Anatomy course. Surveys using a Likert scale assessed student and NPT perceptions, while focus groups and interviews provided qualitative insights. Thematic analysis identified key themes related to engagement, knowledge reinforcement, and effectiveness. A total of 907 medical students and 30 NPTs completed a survey, while 75 students and 10 NPTs participated in the qualitative phase. Students perceived the paper puzzle as an engaging and interactive review tool that reduced stress, increased involvement, and enhanced knowledge retrieval through collaboration and a structured gameplay loop. They also valued the emotional impact on learning. NPTs reported benefits for student motivation and teamwork but noted that time constraints limited content coverage. The activity's effectiveness was highly dependent on the NPT's facilitation, emphasizing the need for structured implementation. Findings suggested that game-based learning strategies like the paper puzzle can improve motivation, teamwork, and content retrieving in anatomy education when carefully designed and effectively executed by NPTs.
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  Data: As Provided
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  Data: 2026
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  Data: EJ1507748
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1507748
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        Value: 10.1002/ase.70112
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      – Text: English
    PhysicalDescription:
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        PageCount: 11
        StartPage: 902
    Subjects:
      – SubjectFull: Active Learning
        Type: general
      – SubjectFull: Puzzles
        Type: general
      – SubjectFull: Anatomy
        Type: general
      – SubjectFull: Program Effectiveness
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      – SubjectFull: Peer Teaching
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      – SubjectFull: Medical Students
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      – SubjectFull: Student Attitudes
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      – SubjectFull: Student Motivation
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      – SubjectFull: Teamwork
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      – SubjectFull: Foreign Countries
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      – SubjectFull: Mexico
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      – TitleFull: The Paper Puzzle as an Active Learning Tool in the Teaching of Anatomy: A Qualitative Study of Perceptions in Students and Near-Peer Teachers
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              Y: 2026
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