Medical education has long relied on traditional didactic lectures as the primary mode of knowledge dissemination, particularly in foundational subjects like histology.[1] However, passive learning approaches often fail to engage students, leading to superficial understanding and poor long-term retention of complex concepts.[2] Histology, with its intricate microscopic structures and functional correlations, demands active learning strategies to bridge the gap between theoretical knowledge and clinical application.[3] In recent years, cooperative learning techniques have gained prominence in medical education for fostering critical thinking, teamwork, and deeper comprehension.[4] Among these, the Jigsaw method, developed by Aronson et al.,[5] stands out for its structured approach to collaborative learning. In this method, students are divided into small groups, where each member becomes an "expert" in a subtopic before teaching peers in their original "parent" group.[5] This dual-phase process not only reinforces individual mastery but also cultivates communication skills and collective accountability—attributes essential for future clinicians.[6] Despite its proven efficacy in disciplines like pharmacology and physiology,[7,8] the Jigsaw method remains underutilized in histology education, where visual and conceptual integration are paramount.[9] Existing studies on active learning in histology have focused largely on digital tools or problem-based learning,[10,11] with limited exploration of structured peer-teaching models like Jigsaw. Furthermore, while some institutions have adopted blended learning, the comparative effectiveness of Jigsaw as an adjunct to traditional lectures remains underexplored in resource-limited settings.[12] This study addresses these gaps by evaluating the Jigsaw method as an add-on intervention to traditional histology teaching for first-year MBBS students. Specifically, we aimed to: 1. Compare the academic performance of students taught via Jigsaw versus traditional lectures. 2. Assess student perceptions of the method’s impact on engagement and knowledge retention. 3. Validate outcomes through a crossover design to ensure reproducibility. By integrating quantitative performance metrics with qualitative feedback, this study provides actionable insights for curriculum designers seeking to enhance histology education through evidence-based, collaborative strategies.

Study Design A comparative interventional study with a crossover design was conducted to evaluate the effectiveness of the Jigsaw method as an adjunct to traditional lectures in histology education. The study was conducted in accordance with the Declaration of Helsinki and was approved by Institutional ethical Committee, Sri BM Patil Medical College and hospital, BLDE University, with Approval number -- BLDE (DU)/IEC/1169/2025-26 Institutional Ethical Clearance Certificate 17/6/2025. Participants Inclusion Criteria: First-year MBBS students (2024–25 batch) at Shri B. M. Patil Medical College, Vijayapura, who provided written informed consent. Exclusion Criteria: Students absent during the intervention or unwilling to participate. Sample Size: Out of 200 eligible students, 180 consented, and 139 completed the study (Group 1: *n* = 71; Group 2: *n* = 68). Randomization and Group Allocation Participants were randomly allocated into two groups using computer-generated random numbers: • Group 1 (Control): Received traditional didactic lectures. • Group 2 (Intervention): Underwent the Jigsaw method after an initial lecture. In Phase 2, the groups crossed over to ensure equitable exposure (Figure 1). Intervention 1. Traditional Lecture: Both groups attended a 45-minute lecture on histology topics (e.g., epithelial tissues, connective tissues). 2. Jigsaw Method (Group 2, Phase 1): • Step 1: Students formed parent groups (5 members each). Each member was assigned a subtopic (e.g., "Types of Epithelium"). • Step 2: Students regrouped into expert groups (all members assigned the same subtopic) for 40 minutes to discuss and master their topic using provided resources (textbooks, atlases).[5] • Step 3: Experts returned to parent groups to teach their subtopic (45 minutes). Faculty Role: Three facilitators guided discussions and clarified doubts. Data Collection Pre- and Post-Tests: • Multiple-choice questions (MCQs) and short-answer questions (SAQs) assessed knowledge retention. Tests were validated by subject experts (Cronbach’s α = 0.78). Student Feedback: • A 5-point Likert scale survey (1 = Strongly Disagree; 5 = Strongly Agree) evaluated perceptions of the Jigsaw method (Table 1). Statistical Analysis Data were analyzed using SPSS v26. • Within-group comparisons: Wilcoxon signed-rank test (non-parametric data). • Between-group comparisons: Mann-Whitney U test. • Qualitative data: Descriptive statistics (frequencies, percentages). A *p*-value < 0.05 was considered statistically significant.[13]

This study evaluated the effectiveness of the Jigsaw method compared to traditional lectures in histology education through pre- and post-test performance analysis and student feedback. Below are the detailed results presented with tables and descriptions. Comparison of Pre-Test and Post-Test Scores Table 1: Performance Comparison within Groups (Wilcoxon Signed-Rank Test) Group Test Phase Mean Score ± SD Z-value p-value Group 2 (Jigsaw, Phase 1) Pre-Test 13.87 ± 3.459 7.123 0.001* Post-Test 22.06 ± 2.952 Group 1 (Jigsaw, Phase 2) Pre-Test 8.60 ± 3.224 5.987 0.001* Post-Test 13.10 ± 2.632 Table 1: Presents the within-group comparisons of pre-test and post-test scores using the Wilcoxon signed-rank test. The data demonstrate that Group 2 (Jigsaw method in Phase 1) achieved a statistically significant improvement in mean post-test scores (22.06 ± 2.952) compared to their pre-test performance (13.87 ± 3.459), with a highly significant p-value of 0.001. This pattern was replicated during the crossover phase, where Group 1 showed similar significant gains (post-test: 13.10 ± 2.632 vs pre-test: 8.60 ± 3.224, p=0.001) when exposed to the Jigsaw intervention, confirming the consistent effectiveness of the method across different student cohorts. Table 2: Performance Comparison Between Groups (Mann-Whitney U Test) Comparison Mean Score ± SD U-value p-value Group 2 (Jigsaw) Post-Test 22.06 ± 2.952 1533.000 0.001* Group 1 (Control) Post-Test 15.91 ± 4.428 Group 1 (Jigsaw) Post-Test 13.10 ± 2.632 1060.000 0.001* Group 2 (Control) Post-Test 9.93 ± 3.567 Table 2: displays the between-group comparisons analyzed using the Mann-Whitney U test. The results reveal that the Jigsaw groups significantly outperformed their control counterparts in both phases of the study. In Phase 1, Group 2 (Jigsaw) post-test scores (22.06 ± 2.952) were markedly higher than Group 1 control scores (15.91 ± 4.428), with p=0.001. This performance advantage was maintained in Phase 2 after crossover, where the original control group (now receiving Jigsaw instruction) scored significantly higher (13.10 ± 2.632) than the new control group (9.93 ± 3.567), again with p=0.001. These findings provide robust evidence for the superior efficacy of the Jigsaw method over traditional lecture-based instruction. Student Feedback on Jigsaw Method Table 3: Student Perception Survey (n = 133) Statement Strongly Disagree (%) Disagree (%) Neutral (%) Agree (%) Strongly Agree (%) The objectives of the Jigsaw activity were clearly explained. 2.3 2.3 8.3 27.1 60.2 I understood my role and responsibility within my expert group. 2.3 0.8 5.3 21.1 70.7 I was able to learn my assigned sub-topic effectively. 2.3 1.5 5.3 31.6 59.4 Teaching my sub-topic to others helped reinforce my understanding. 3.0 0.0 7.5 28.6 60.9 My group members actively participated in the activity. 1.5 3.0 17.3 27.8 50.4 The method promoted teamwork and communication. 2.3 0.8 9.0 31.6 56.4 I felt more engaged using this method compared to traditional lectures. 3.0 0.8 13.5 29.3 53.4 The Jigsaw method helped me understand the overall topic better. 2.3 0.8 11.3 30.1 55.6 I would like more sessions using this method in the future. 2.3 3.0 9.8 29.3 55.6 Table 3: summarizes student perceptions of the Jigsaw learning experience through a 5-point Likert scale survey (n=133). The data show overwhelmingly positive responses, with particularly strong agreement (>85% combined agree/strongly agree) regarding clarity of objectives (87.3%), understanding of roles (91.8%), and learning reinforcement through teaching (89.5%). Notably, 60.9% of students strongly agreed that teaching their subtopic to peers enhanced their own understanding, while 56.4% strongly agreed the method promoted teamwork. The majority (55.6%) expressed a desire for more Jigsaw sessions in future coursework, indicating strong student acceptance of this pedagogical approach. A small but notable proportion of students (17.3%) remained neutral about their peers' level of participation, suggesting potential areas for improving group dynamics in future implementations. Knowledge Retention Analysis" "To evaluate long-term knowledge retention, delayed post-tests were administered after time interval. Wilcoxon signed-rank tests revealed statistically significant declines in scores for both cohorts: Table 4: Knowledge Retention Comparison Test Phase Part 1 (Initial Jigsaw) Part 2 (Crossover) Immediate Post 22.06 ± 2.952 13.10 ± 2.632 Delayed Post 18.68 ± 5.027 10.38 ± 3.829 *p*-value <0.001 <0.001 Table 4 compares knowledge retention between immediate and delayed post-tests across both study phases. For Part 1 (Initial Jigsaw Group), scores declined significantly from the immediate post-test (22.06 ± 2.952) to the delayed assessment (18.68 ± 5.027; *p* < 0.001), reflecting a 15.3% reduction in mean scores. Similarly, Part 2 (Crossover Group) showed a 20.8% decrease (13.10 ± 2.632 vs. 10.38 ± 3.829; *p* < 0.001). Despite this decay, three critical findings emerge: 1. Residual Retention: Delayed post-test scores remained substantially higher than baseline pre-test scores (Table 1), suggesting the Jigsaw method conferred lasting learning benefits despite expected attrition. 2. Consistency Across Groups: Both cohorts exhibited similar decay patterns (*p* < 0.001 for both), reinforcing the reproducibility of Jigsaw’s intermediate-term effects. 3. Variability Increase: The larger standard deviations in delayed tests (e.g., 5.027 vs. 2.952 in Part 1) indicate divergence in individual retention rates, possibly tied to self-study practices or baseline proficiency. These results align with cognitive load theory, where active learning methods like Jigsaw enhance encoding but require reinforcement to combat forgetting [14,15]. The retained knowledge (60–70% of immediate gains) surpasses typical lecture-based decay rates reported in prior studies[7,16].

The findings of this study demonstrate that the Jigsaw method significantly enhances histology learning outcomes and fosters collaborative skills among first-year MBBS students. Our results align with existing evidence supporting cooperative learning strategies in medical education while providing new insights into its application in histology. Academic Performance Improvements The Jigsaw group showed a 55% increase in post-test scores compared to pre-tests (*p* < 0.001), with similar gains observed during the crossover phase. These results corroborate studies by Sanaie et al. (2019), who reported a 32% improvement in nursing students' performance using Jigsaw over traditional lectures.[7] The consistency of outcomes across both phases of our study reinforces the reliability of this method. Notably, the Jigsaw group's post-test scores (22.06 ± 2.95) surpassed those of the control group (15.91 ± 4.43), mirroring findings by Sharma et al. (2021) in histology education.[17] This suggests that peer teaching and segmented learning—core features of the Jigsaw technique—are particularly effective for mastering visually complex subjects like histology. Despite the Jigsaw method’s immediate effectiveness, our findings align with Ebbinghaus’ forgetting curve, showing significant knowledge decay in delayed assessments[14]. However, the retained scores (18.68/30 in Part 1; 10.38/15 in Part 2) still surpassed pre-test baselines, suggesting Jigsaw may mitigate typical attrition rates compared to passive learning[15]. This parallels studies by Sanaie et al.[7], where active learning methods showed slower decay than lectures. Future iterations could integrate spaced repetition to bolster retention. Unlike problem-based learning (PBL), which requires extensive faculty facilitation,[10] the Jigsaw method achieved comparable outcomes with minimal instructor input. This scalability makes it a practical alternative for resource-constrained institutions. Additionally, while digital tools (e.g., virtual microscopy) improve visual literacy,[10] our study highlights Jigsaw's added advantage of fostering teamwork and communication—skills critical for clinical practice.[6] Student Engagement and Perceptions Student feedback revealed strong approval for the Jigsaw method, with 87.3% agreeing that it clarified learning objectives and 91.8% reporting improved teamwork. These findings align with Aronson’s original Jigsaw experiments (1978), where students exhibited higher motivation and accountability in collaborative settings.[5] The emphasis on peer teaching likely contributed to these outcomes, as explaining concepts to others reinforces understanding—a phenomenon supported by Bloom’s taxonomy of active recall.[18] Interestingly, 55.6% of students preferred Jigsaw over traditional lectures for future sessions, a trend also observed by Freeman et al. (2014) in STEM disciplines.[2] This preference may stem from the method's interactive nature, which mitigates the passivity associated with didactic teaching. However, a minority (17.3%) expressed neutrality about peer participation, suggesting that group dynamics warrant careful management to ensure uniform engagement.[4] Practical Implications The Jigsaw method’s time efficiency (85 minutes/session) and low faculty dependency make it adaptable to diverse medical curricula. Its success in histology—a subject demanding visual and conceptual integration—supports its potential application in other disciplines, such as pathology or radiology.[3] Furthermore, the crossover design’s reproducibility (Phase 2 results: *p* < 0.001) underscores its utility in longitudinal educational research.[19] Limitations and Future Directions This study has limitations. First, its single-institution design may limit generalizability. Second, long-term retention was not assessed; follow-up studies could evaluate knowledge decay over time. Finally, while the Jigsaw method reduced faculty workload compared to PBL,[10] its success depends on clear instructions and balanced group participation—factors that require standardization in future implementations. Future research should: 1. Compare Jigsaw with flipped classrooms in histology. 2. Assess its impact on clinical problem-solving (e.g., histopathology diagnostics). 3. Explore hybrid models (e.g., Jigsaw + digital microscopy) to optimize visual learning.

This study affirms the Jigsaw method as a highly effective, student-approved strategy for histology education. Its dual benefits—improved academic performance and enhanced collaborative skills—make it a valuable addition to medical curricula, particularly in settings seeking scalable, interactive alternatives to traditional lectures.

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