Role of “crossword puzzles” in retention of knowledge and learning outcomes among medical students: A meta-analysis

Introduction: Medical education is a complex and demanding field, requiring students to learn and retain a vast amount of information in a short period. Medical students often face challenges in retaining information and applying it to real-world scenarios. To address this issue, various educational strategies have been employed to enhance knowledge retention and learning outcomes. One such strategy is the use of crossword puzzles as a tool for reinforcing medical concepts and terminology. Materials and Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to conduct this meta-analysis. We have searched electronic databases, including PubMed, Embase, and Scopus, for relevant studies published between 1990 and 2023. Fourteen studies were included with a total of 1,623 medical students. The majority of the studies were randomized controlled trials. The duration of the interventions ranged from 1 week to 6 months, with most studies employing a 2-week intervention period. Results and Analysis: Fourteen studies were included in the meta-analysis. The results of the meta-analysis indicated that the use of crossword puzzles in medical education was associated with a significant improvement in knowledge retention ( P < 0.001) and learning outcomes ( P < 0.001). Moderate heterogeneity was observed in the meta-analysis of knowledge retention ( P = 0.004) and low heterogeneity in the meta-analysis of learning outcomes ( P = 0.136). Sensitivity analysis revealed that the results were robust to the exclusion of individual studies, suggesting that the findings were not driven by a single study. Discussion: The results of this meta-analysis suggest that the use of crossword puzzles as an instructional tool in medical education was associated with a significant improvement in knowledge retention and learning outcomes among medical students across the world. The moderate heterogeneity observed in the meta-analysis of knowledge retention may be due to differences in study design, intervention duration, puzzle format, and participant characteristics. Conclusion: The use of crossword puzzles as an instructional tool in medical education shows promise for improving knowledge retention and learning outcomes among medical students.