# Improving learning outcomes of medical terminology course through classroom-based gamified crossword puzzle activities

## TL;DR

Using crossword puzzles in class helped students learn medical terms better, leading to improved test scores.

## Contribution

This study provides empirical evidence that crossword puzzles can enhance performance in medical terminology courses.

## Key findings

- Students using crossword puzzles scored higher on assessments compared to the control group.
- Regression analysis confirmed significant differences in total test scores between groups.
- Treatment effect analyses showed positive associations between crossword use and test performance.

## Abstract

Active learning strategies are widely promoted to enhance student engagement and knowledge retention in higher education. In health administration education, mastery of medical terminology is essential, yet students often experience difficulty with recall and application. Crossword puzzles have been proposed as a practical instructional tool to support terminology learning, but empirical evidence in this context remains limited.

This study examined the association between the use of crossword puzzles as learning aids and academic performance in a medical terminology course. A non-equivalent control group post-test-only design was employed. The sample comprised 211 s-year undergraduate health administration students enrolled in a 14-week course. Paper-based crossword puzzles were introduced in week 5 and implemented over 9 weeks. Independent t-tests were used to examine group differences, followed by multiple linear regression analysis to adjust for relevant covariates. Treatment effect analyses estimated the average treatment effect (ATE), average treatment effect on the treated (ATET), and average treatment effect on the non-treated (ATENT).

Students who used crossword puzzles demonstrated higher scores across individual assessment components and total test scores compared with the control group (p < 0.001). Regression-adjusted analyses confirmed statistically significant differences in total test scores between groups (p < 0.001). Treatment effect analyses yielded predominantly positive, statistically significant estimates for total scores, including ATE, ATET, and ATENT (p < 0.01), indicating consistent associations between crossword use and test performance.

The findings indicate that crossword puzzles are positively associated with higher performance in medical terminology assessments, supporting their role as a supplementary learning strategy. Students with weaker foundational knowledge may require additional instructional support. Given the observational study design, the findings should be interpreted as associative rather than causal.