Abstract
Background and Objective
The study tested two active teaching methods Jigsaw and problem-based learning which were used to evaluate their impact on learning outcomes and student satisfaction of operating room students who attended the Gynecological Operating Room Technology course.
Materials and Methods
The study was a two-group quasi-experimental design conducted during the second semester of 2023–2024. A total of 32 sixth-semester operating room students participated through census sampling. Students were assigned to two groups of 16: the intervention group received instruction using the Jigsaw method, and the control group used the problem-based learning method. Both groups attended 8 identical educational sessions. Data were collected using a 20-item multiple-choice knowledge test and a researcher-developed 16-item satisfaction questionnaire with established validity and reliability. Statistical analyses were performed using SPSS version 24, including independent t-tests, paired t-tests, and analysis of covariance (ANCOVA).
Results
Both teaching methods significantly improved learning and satisfaction (p < 0.001). The Jigsaw group achieved higher post-test knowledge scores (Mean ± SD = 16.59 ± 2.36) compared with the problem-based group (15.14 ± 2.23; p < 0.01, ANCOVA), indicating a stronger effect of the Jigsaw method. Satisfaction scores increased from 18.31 ± 3.42 to 35.14 ± 4.12 in the Jigsaw group and from 20.62 ± 3.75 to 30.07 ± 4.85 in the problem-based group. No significant differences were observed between groups regarding demographic characteristics (p > 0.05).
Conclusion
Both Jigsaw and problem-based methods are effective for improving learning and satisfaction in operating room students. The Jigsaw method demonstrates superior performance in team-based practical courses and is recommended for teaching collaborative skills, whereas the problem-based method is suitable for courses requiring individual research and problem-solving.
Keywords
Introduction
Providing correct and scientifically aligned education is the only way to achieve desirable learning levels and enhance student satisfaction. 1 The goal of any education is learning, defined as relatively permanent changes in learners’ cognitive processes, affective performance, and behavior through experience. 2 Creating an effective learning environment ranks among the most critical duties of instructors. Teaching medical sciences holds added importance due to constant advancements in care practices, as students must analyze unforeseen issues in care settings, make timely decisions with the treatment team, and resolve them—demanding skills beyond traditional formal and logical learning.2,3
Numerous efforts have explored learning mechanisms, yielding diverse learning paradigms, with ongoing interest in identifying optimal methods.4,5 Contemporary focus has shifted to learner-centered approaches emphasizing interaction with content, peers, instructors, and knowledge construction, though one-way lecturing—centered solely on content transfer—retains advocates who view it as effective. 6 Advancing education requires understanding teaching processes and awareness of innovative implementation strategies, 7 particularly in medical sciences, whose primary mission is training competent individuals equipped with knowledge, attitudes, and skills to safeguard and promote community health. 8
Traditional, passive methods in medical education can lead to student fatigue, inattention, disengagement, lack of motivation, and reduced learning. 9 Recent emphasis has fallen on active learning and creative thinking, as it empowers students to identify their learning needs, engage actively in education, strengthen critical thinking, enhance decision-making in clinical scenarios, and bolster problem-solving skills.9,10
Over the past 50 years, various teaching methods have emerged, aiming to align instruction with learner-guided processes. Medical education worldwide employs a spectrum from instructor-centered to fully student-centered methods, with curricula evolving toward student focus and learner responsibility. 11 Studies comparing superior methods to lectures include one contrasting traditional and puzzle-based approaches, finding puzzle-based education more effective than lecture-based traditional teaching in boosting student performance on assessments. 12 Another compared problem-solving and lecturing, showing both effective but problem-solving superior in enhancing awareness and performance. 13 A study pitting lectures against flipped classrooms in operating room technology found greater satisfaction with flipped methods. 14 Thus, adopting these innovative approaches for operating room technology students is recommended. The Jigsaw method functions as a cooperative learning method which social psychologist Elliot Aronson and his team created during the early 1970s to help schools with racially diverse student bodies solve their intergroup conflicts and build positive relationships. 15 The method divides students into “home groups” which assign each student the duty to learn and explain a specific section of the study material. The participants start their work in “expert groups” which allow them to research their designated subtopic in depth before they return to their home groups to teach their classmates what they learned. The structure creates positive interdependence because each student needs to complete their work by receiving help from their classmates while the system demands students to take responsibility for their actions through face-to-face interaction and through developing their social and team working abilities which society considers essential for successful group work. 16 The Jigsaw (puzzle) method exemplifies active learning, using small-group strategies where learners collaborate toward shared goals to enhance their own and peers’ abilities. 17 Also known as mosaic or Jigsaw, it involves instructors dividing lesson content into segments (typically five or six), assigning students to small groups, and distributing one segment per member; group members then teach their segment to peers. 18 Benefits include reduced student fatigue, increased participation, and deeper, more lasting learning. 19 Jigsaw particularly boosts learning and comprehension in operating room technology students through active engagement. 20
Problem-based learning (PBL) ranks among the most successful models from English-speaking countries, originating at Canada’s McMaster University in 1969 as a student-centered replacement for traditional lecturing. 21 In PBL, learners form the core, taking responsibility for their education and feeling accountable, which sustains learning. 22 Learning needs serve as content, with problem-solving reflection initiating the process; students define educational goals collaboratively, spanning basic and clinical knowledge to advance performance and knowledge integration. 23
PBL unfolds by presenting learners with a scientific-clinical scenario and problem, prompting resolution efforts. 24 It comprises stages: initial problem presentation for analysis using existing knowledge and hypotheses; self-directed research via lectures, sessions, or specialist resources (textbooks or experts); and follow-up where learners share findings, critique sources, and synthesize analyses for comprehensive conclusions. 25 PBL is an educational approach teaching students how to learn and collaborate in problem-solving groups. Unlike passive lecture-based information transfer, it stems from discovery learning.26,27This method fosters critical thinking and frameworks for self-directed learning, self-assessment, interpersonal communication, and information access/retrieval, eliminating passive teacher-to-student transfer. 28 Studies confirm PBL enhances verbal and nonverbal skills. 29 A meta-analysis on PBL effectiveness showed significant impacts across cognitive, skill, and attitudinal domains, even across educational levels (elementary, secondary, university), with greater efficacy at higher levels and superiority over traditional methods. 30 Given the Comprehensive Excellence and Productivity Program’s emphasis on innovative classroom methods, prior studies, and the complexities of operating room technology courses (encompassing physiology, anatomy, pathophysiology, and surgical procedures), this study implemented Jigsaw and PBL in the gynecological operating room technology course to compare their effects on learning and satisfaction among operating room technology students. Thus, the study aimed to compare the impact of Jigsaw and problem-based teaching methods on learning outcomes and satisfaction of operating room students in the Gynecological Operating Room Technology course.
Methods
Aims
The present study is a two-group quasi-experimental interventional study with a pre-test-post-test design, conducted to compare the effects of Jigsaw and problem-based methods on learning outcomes and satisfaction of students in the Gynecological Operating Room Technology course during the second semester of 2023-2024.
Study Design
The study population consisted of all 32 sixth-semester bachelor’s operating room students who were included via census sampling without randomization. Students were divided into two groups: experimental (16 students) and control (16 students). For ease of implementation, the groups were labeled: Group A (experimental) received instruction using the Jigsaw method, and Group B (control) using the problem-based method.
In this study, except for the teaching method—which differed—all other educational factors were identical for all students, including the instructor (one individual holding a master’s degree in operating room technology), teaching location, and timing for both methods. Before starting the classes, separate introductory sessions were held with each group, where teaching methods and study objectives were explained, student consent was obtained, and informed consent was secured from all participants. During the same session, a pre-test was administered to all students.
Inclusion criteria were student informed consent and completion of prerequisite units; exclusion criteria were lack of consent or absence from more than two sessions.
The course, a one-unit theoretical Gynecological Operating Room Technology class, required 8 mandatory sessions. Content was selected based on the course plan and blueprint, and identical material for all 8 sessions was delivered to both groups using Jigsaw and problem-based methods.
The study proceeded in three stages.
Pre-Intervention Stage
To assess baseline knowledge in specified topics, a pre-test (covering content from the 8 teaching sessions for both methods) was conducted one day before the first intervention session in both groups. The tool was a 20-item multiple-choice written test, designed based on the blueprint and adhering to Miller’s checklist standards.
Intervention Stage
The day after the pre-test, content delivery began as follows. Jigsaw method: Session content was prepared in five pages, and the class was randomly divided into 4 groups of 4. Groups were labeled A to D, with each member assigned numbers 1 to 4. Identical four-page content was distributed to groups for internal division (each member received a different page). Students had 10 minutes to study their page individually. Then, those with the same page (e.g., all with page 1 from the four groups) gathered for 10 minutes to discuss, clarify ambiguities with peers or the instructor. Afterward, members returned to home groups, selected a leader, and each presented their page content for 5 minutes. The leader managed timing and ensured all pages were covered, followed by 20 minutes of group exchange. Materials were then collected. Problem-based method: Students were divided into 4 groups of 4, each selecting a preferred name to foster group identity. The researcher presented a pre-designed scenario per session to engage students with the topic, introduced study resources, and clarified scenario text and objectives. Groups brainstormed collaboratively, then each member conducted 20 minutes of individual self-study on the scenario. Upon return, findings were shared, the group leader summarized responses, and the solution was presented orally.
Post-Intervention Stage
One week after the final session in both methods, a post-test using the same written test as the pre-test was administered to all students.
Participants
The procedure, objectives, and significance of the study were thoroughly explained to all participants. Questionnaires were completed with full consent by the participants, and all 31 ethical codes related to human research were adhered to. Following the approval of the ethics committee and obtaining informed consent from participants, this project was performed. Notably, this study was approved by the Ethics Committee of Mazandaran University of Medical Sciences [Ethics Code: IR.MAZUMS.REC.1403.017].
Measurement
Two instruments were used in this study.
1. Knowledge Test
A 20-item multiple-choice examination was developed based on the course blueprint and Miller’s framework. Content and face validity were confirmed by eight faculty members in operating room technology (31). Internal consistency reliability was assessed using Cronbach’s alpha coefficient (α = 0.82).
2. Satisfaction Questionnaire
Student satisfaction with the teaching method was assessed using a 16-item questionnaire rated on a three-point Likert scale (1 = dissatisfied, 2 = partially satisfied, 3 = completely satisfied). Total scores ranged from 16 to 48, with higher scores indicating greater satisfaction.
The questionnaire’s face and content validity were confirmed by 15 subject-matter experts. 31 Test–retest reliability demonstrated strong stability (r = 0.90).
Statistical Analysis
Data were analyzed using SPSS Statistics (IBM Corp., Armonk, NY, USA). Descriptive statistics were reported as mean ± standard deviation (SD) for continuous variables and frequency (percentage) for categorical variables. Statistical significance was set at p < 0.05 (two-tailed). Normality of continuous variables (knowledge/learning and satisfaction scores) was assessed using the Kolmogorov–Smirnov test. As data were normally distributed (p > 0.05), parametric tests were applied. Baseline comparisons between groups were performed using independent samples t-test for continuous variables (age, GPA, pre-test scores) and chi-square test for categorical variables (gender, residence status). Within-group pre- and post-intervention comparisons were conducted using paired samples t-test. Between-group differences in post-test scores were analyzed using independent samples t-test. To evaluate the effect of teaching method while controlling for baseline scores, analysis of covariance (ANCOVA) was performed with post-test knowledge/learning score as the dependent variable, group as the fixed factor, and pre-test score as the covariate. Homogeneity of variances was confirmed using Levene’s test. Effect size was reported as partial eta squared (η2).
We used the CONSORT reporting guideline 32 to draft this manuscript, and the CONSORT reporting checklist 33 when editing, included in supplement A.
Results
A total of 32 sixth-semester operating room students participated in this study, with 16 students allocated to each group.
Baseline Characteristics
Mean ± SD of Age in the Two Groups
Gender Distribution in the Two Groups
Residence Status Distribution in the Two Groups
Normality Assessment
Kolmogorov–Smirnov Test for Normality
Note. p > 0.05 indicates normal distribution.
Knowledge and Learning Outcomes
Baseline Comparison
Comparison of Pre-test Knowledge Scores Between Groups
Post-Intervention Comparison
Comparison of Post-test Knowledge Scores Between Groups
Within-group analysis using paired samples t-test showed significant improvement from pre-test to post-test in both groups (p < 0.001). However, the magnitude of improvement was greater in the Jigsaw group.
Satisfaction Outcomes
Jigsaw Group
Problem-Based Group
Comparison of Satisfaction Scores before and after Problem-Based Method (Paired t-Test)
Post-intervention comparison demonstrated significantly higher satisfaction in the Jigsaw group compared with the problem-based group (t 30 = 3.18, p = 0.003).
Effect of Teaching Method on Knowledge (ANCOVA)
Levene’s Test for Homogeneity of Variances (Post-test Knowledge)
ANCOVA Results for Post-test Knowledge Scores (Controlling for Pre-test Scores)
Gender Differences
Comparison of Knowledge Scores by Gender (Independent t-Test)
Discussion
This study aimed to compare the effects of Jigsaw and problem-based teaching methods on learning outcomes and satisfaction among operating room students. Findings revealed that both methods significantly improved learning and satisfaction; however, the Jigsaw method demonstrated greater impact on learning (p<0.01), potentially fostering more meaningful student learning. No significant differences existed between groups regarding demographic variables (age, gender, GPA, residence).
These results align with multiple studies demonstrating the value of learner-centered, active approaches in health professions education. The superiority of Jigsaw in enhancing learning outcomes mirrors recent findings by Yazdankhahfard et al, where flipped classroom and Jigsaw methods improved nursing students’ knowledge of CPR in COVID-19 patients, with Jigsaw yielding higher knowledge gains. This suggests Jigsaw’s collaborative structure, individual accountability, and peer teaching promote deeper theoretical understanding, practical skills, and teamwork. 34 Similarly, Stetzik reported Jigsaw’s superiority over traditional lecture in undergraduate anatomy and physiology courses, attributing gains to improved performance, flexibility, and adaptability through puzzle-based interdependence. 35 In a directly relevant context, KALKAN found the puzzle (Jigsaw) method positively influenced operating room students’ motivation and study habits, supporting its utility in procedural, team-oriented training. 36
Additional evidence reinforces Jigsaw’s advantages in collaborative settings: one study showed it outperformed flipped and lecture methods by promoting interaction and learning responsibility, 37 while Fathy Amr confirmed its efficacy in boosting nursing students’ satisfaction and academic progress, 38 and Darabi highlighted increased knowledge, performance, satisfaction, and interest via heightened engagement. 39 These consistent similarities across studies indicate Jigsaw excels when content demands interdependent tasks, shared expertise, and peer accountability—features central to operating room environments.
However, not all literature supports Jigsaw’s superiority, and critical examination of divergences is essential. For instance, Kobayashi found electronic learning more effective than puzzle-based methods in certain contexts, underscoring respective limitations such as technology dependence versus group dynamics. 40 Possible explanations for this contrast include differences in course content (e.g., electronic methods may better suit self-paced, individualized digital content vs. Jigsaw’s strength in face-to-face interdependence for procedural skills), implementation variations (e.g., fidelity of group processes, facilitator training, or technology access/quality), cultural or institutional contexts (e.g., student familiarity with digital vs. collaborative formats in different educational systems), and outcome emphasis (e.g., immediate knowledge recall vs. long-term retention or team skills). Such factors highlight that method effectiveness is context-dependent rather than absolute, warranting careful consideration of local educational ecology when selecting strategies.
The positive impact of problem-based methods on satisfaction and engagement aligns with Wang and Nasution. Wang reported that problem-based clinical ophthalmology skills training enhances reasoning, motivation, and learning via real scenarios for novices. 41 Nasution noted problem-based gastrointestinal education significantly affects learning outcomes. 42 Additional studies showed problem-based methods improve knowledge scores, procedural/clinical skills, satisfaction, and interest—though potentially increasing study pressure while reducing time. 43 However, Zheng highlighted controversies in problem-based effectiveness and poor RCT reporting quality. 44 Relatively contrasting findings from another study demonstrated problem-based superiority in surgical training for clinical competency and satisfaction. 45 These divergences suggest PBL’s strengths lie in fostering self-directed inquiry, critical thinking, and application to complex, open-ended clinical problems—ideal for individual diagnostic or decision-making skills—while it may underperform in highly interdependent, team-procedural domains like gynecological operating room technology.
Broader pedagogical insights from systematic reviews in medical education further contextualize these findings. For example, a review of gamification interventions (which often incorporate interactive, motivational, and sometimes cooperative elements akin to Jigsaw) found that such techniques improved medical students’ performance in most cases, with a predominant cognitive focus and variations in psychomotor (more in electronic games) and affective (more in non-electronic) approaches; overall, 90% of included studies reported positive effects across Kirkpatrick levels. 46 This supports the general efficacy of innovative, active methods but underscores the need for high-quality evidence and alignment with specific learning domains—reinforcing that Jigsaw’s observed advantages here likely stem from its fit with the course’s emphasis on teamwork, task division, and practical integration in a sterile, collaborative OR setting.
Notably, course content nature appears pivotal in explaining method-specific outcomes. This study’s focus on practical “Gynecological Operating Room Technology”—requiring teamwork, task division, sterile collaboration, and integration of procedural components—aligns particularly well with Jigsaw’s pedagogical strengths (responsibility distribution, positive interdependence, and peer expertise sharing, and structured group processing). In contrast, PBL may excel in scenarios emphasizing autonomous problem-solving and theoretical depth without heavy reliance on immediate peer interdependence. Thus, rather than one method being universally superior, alignment between teaching strategy and course demands (e.g., collaborative vs. individualistic elements), along with contextual factors like implementation quality and student characteristics, likely drives differential effectiveness. This interpretation is consistent with broader literature showing context-specific advantages in nursing and surgical education, where Jigsaw often yields better outcomes in team-based, skill-integrated courses, while PBL supports deeper individual reasoning in case-driven contexts. Future research could explore hybrid approaches, long-term skill retention, or moderated effects of cultural/implementation variables to further clarify these mechanisms.
Limitations
Main limitations include the single-center, small-sample design and its impact on generalizability, selection of Sample size via census sampling without randomization, the lack of long-term follow-up to assess knowledge retention, the potential for instructor bias, as the same instructor taught both groups using different methods (despite being a strength in control, it may introduce performance bias), the possibility of cross-contamination between groups, as students from different groups likely interact outside class.
Conclusion
This study compared two innovative teaching methods to optimize learning in the critical, procedure-oriented field of operating room technology. Both Jigsaw and problem-based learning significantly improved student learning and satisfaction compared to traditional approaches. However, the Jigsaw method showed statistically superior performance in enhancing knowledge acquisition, highlighting the importance of aligning teaching strategies with course characteristics. Given the collaborative and interactive nature of the “Gynecological Operating Room Technology” course, Jigsaw is particularly well-suited. Educators and curriculum planners should select teaching methods based on course requirements, and greater integration of Jigsaw techniques into practical courses is recommended.
Supplemental Material
Supplemental Material - Comparing the Effect of Jigsaw and Problem-Based Teaching Methods on Learning and Satisfaction of Operating Room Students in the Gynecological Operating Room Technology Course
Supplemental Material for Comparing the Effect of Jigsaw and Problem-Based Teaching Methods on Learning and Satisfaction of Operating Room Students in the Gynecological Operating Room Technology Course by Maliheh Shirzad, Neda Rashidi, Amirhossein Jamali, Ali Asghar Ghorbani, Sahar Keshvari, Hodeise Asadpour Sorkhkolaee, Fatemeh Imani, Ehsan Memarbashi, and Elham Ramezanpou in Journal of Medical Education and Curricular Development.
Footnotes
Acknowledgments
The authors would like to express their sincere gratitude to the School of Allied Medical Sciences and anyone who help us with this article.
Author Contributions
Conceptualization: MS, NR, AG, ER. Methodology: MS, HA, AG, ER. Data collection: SK, HA, FI, AJ. Data analysis: FI, EM. Writing: MS, NR, AJ. Review and editing: AJ. Supervision: ER, AJ.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests
The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The authors of the study titled “Comparing the Effect of Jigsaw and Problem-Based Teaching Methods on Learning and Satisfaction of Operating Room Students in the Gynecological Operating Room Technology Course “declare that there are no conflicts of interest related to this study. All authors have disclosed any financial relationships or affiliations that could be perceived as influencing the research. This includes any employment, advisory roles, stock ownership, or other financial interests in entities. The integrity of this research is maintained by adhering to ethical guidelines and ensuring that the health and safety of participants were prioritized throughout the study. In accordance with the principles outlined by the International Conference on Harmonization (ICH) and relevant ethical standards, all efforts were made to identify and mitigate potential conflicts. The authors affirm that no external funding sources influenced the design, conduct, or reporting of this study, and all findings are presented objectively without bias. This statement ensures transparency regarding potential conflicts and reinforces the commitment to ethical research practices.
Supplemental Material
Supplemental material for this article is available online.
References
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