Adv Physiol Educ 40: 223–228, 2016;
doi:10.1152/advan.00106.2015.
How We Teach: Classroom And Laboratory Research Projects
ClueConnect: a word array game to promote student comprehension of key
terminology in an introductory anatomy and physiology course
Kathryn M. Burleson1 and Jeffrey T. Olimpo2
1
Department of Biology, Hamline University, St. Paul, Minnesota; and 2Department of Biological Sciences, The University of
Texas at El Paso, El Paso, Texas
Submitted 17 July 2015; accepted in final form 26 February 2016
anatomy; physiology; terminology; game-based learning; active
learning
are dense with terminology,
structures, and processes to master. For this reason, novices
often experience difficulty in learning the vocabulary as well as
in linking structure and function, explaining concepts, and
making broader connections within the discipline (20). Research suggests that these challenges often emerge due to a
combination of inadequate student preparation, the pedagogical approaches adopted in the course, and the nature of the
discipline (13, 20). In courses with abundant content, in particular, there is a tendency for students to resort to memorization rather than develop deeper understanding of the material.
However, when students simply memorize information without
processing it, that knowledge is rapidly lost (21). Conversely,
when students move beyond memorization to test their mental
models of a concept through problem solving, inquiry, group
work, and application, higher levels of learning can be
achieved (3, 11, 14, 18). To help facilitate these deeper levels
of understanding, instructors often turn to classroom activities
that promote active learning (9, 10, 12).
Active learning strategies are diverse, but most focus on
asking students to reflect on what they know and to subsequently apply that knowledge through some form of activity.
The rise of flipped and active learning classrooms has resulted
in the development of a vast collection of tools to engage
students in the material, including case studies, clickers, con-
ANATOMY AND PHYSIOLOGY COURSES
Address for reprint requests and other correspondence: K. M. Burleson,
Dept. of Biology, Hamline Univ., 1536 Hewitt Ave., Box 182, St. Paul, MN
55104 (e-mail: [email protected]).
cept mapping, role plays, and simulations (2, 5, 12). One
approach to encourage active processing of information is
through the use of educational games. Games can be an ideal
supplement to traditional teaching approaches because they
often adopt a variety of novel and engaging methods to
reinforce and review concepts, resulting in improvements in
student learning and interest as it pertains to topics addressed
through gameplay (4, 10). To date, a number of games have
been successfully used to help students in introductory biology
and physiology classes, including those that model television
game shows, crosswords and word scrambles, word games,
and trivia-based board games (1, 8, 15, 16, 17). While these
games are useful for teaching students about singular concepts
(gastrointestinal physiology, scientific inquiry, or genetic pathways), they often do not allow students to practice and review
the course vocabulary that is necessary to master the concepts.
In an attempt to reinforce course concepts and make learning
more engaging in an anatomy and physiology class, we developed and evaluated a game focused on improving student
mastery of course terminology. The modified Funglish game
described here can easily be adapted for any classroom. Importantly, the game goes beyond memorization by requiring
students to work as a team to recall what they know about a
body part or process, describe it using an array of descriptive
tiles, and then locate it on a diagram. This allows students to
process and organize what they have learned and to be creative
in conveying information to one another.
METHODS
Participant recruitment procedures. Participants (n ⫽ 36) represented a convenience sample consisting of all students enrolled in one
section of Human Anatomy and Physiology 1 (A&P1) in the fall 2015
semester at a small, liberal arts college in the Midwest. Participants
did not receive course credit or compensation for their enrollment in
the research, and the research was classified as exempt after an
internal Institutional Review Board protocol review.
Activity description. In this activity, the game Funglish (Hasbro,
Pawtucket, RI) was adapted to the 3000-level A&P1 course. Funglish
consists of a game board with sections labeled “definitely,” “kind of,”
and “not,” color-coded descriptive tiles containing adjectives (for
example, “flexible,” “small,” or “historic”), and cards containing a list
of nouns (“light bulb,” “apple,” or “Dead Sea”). One team member is
selected to guess the terms on a noun card; the remaining teammates
have 3 min to use the descriptive tiles to create an array on the game
board to help their teammate guess each noun.
In our adapted game, the descriptive tiles were replaced with clue
cards containing adjectives and verbs relevant to anatomy and physiology. Categories included anatomic directions (e.g., “superior” or
“distal”), tissue types (e.g., “epithelial” or “secretory”), qualities (e.g.,
“stretchy” or “hollow”), and actions (e.g., “communicates” or “articulates”). Throughout the semester, students created new clue cards as
1043-4046/16 Copyright © 2016 The American Physiological Society
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Burleson KM, Olimpo JT. ClueConnect: a word array game to
promote student comprehension of key terminology in an introductory
anatomy and physiology course. Adv Physiol Educ 40: 223–228,
2016; doi:10.1152/advan.00106.2015.—The sheer amount of terminology and conceptual knowledge required for anatomy and physiology can be overwhelming for students. Educational games are one
approach to reinforce such knowledge. In this activity, students
worked collaboratively to review anatomy and physiology concepts
by creating arrays of descriptive tiles to define a term. Once guessed,
students located the structure or process within diagrams of the body.
The game challenged students to think about course vocabulary in
novel ways and to use their collective knowledge to get their classmates to guess the terms. Comparison of pretest/posttest/delayed
posttest data revealed that students achieved statistically significant
learning gains for each unit after playing the game, and a survey of
student perceptions demonstrated that the game was helpful for
learning vocabulary as well as fun to play. The game is easily
adaptable for a variety of lower- and upper-division courses.
How We Teach: Classroom And Laboratory Research Projects
224
ANATOMY AND PHYSIOLOGY TERMINOLOGY REVIEW GAME
Table 1. ClueConnect rules
1
Supplemental Material for this article is available at the Advances in
Physiology Education website.
RESULTS
Card 2
Card 14
basement membrane
epiphysis
apocrine gland
osteoclast
epidermis
yellow bone marrow
adipose
osteoporosis
Card 17
Card 28
synapse
myelin
perimysium
astrocyte
hernia
ganglion
myosin
limbic system
Fig. 1. Sample term cards. Eight term cards consisting of four words each
were generated for each unit.
1. Array the clue cards face up on the table in front of your team.
2. Select one team member to guess the terms and place the game board in
front of them.
3. The remaining team members will give the clues. The clue givers draw
one term card and familiarize themselves with the terms before starting
the timer. Do not show the term card to the person guessing the terms.
4. For each term, start the timer and select clue cards to place onto the
game board. All clue givers may add cards to the board but should not
talk or gesture.
5. If clue givers find their choices for a term are lacking, they may write a
new clue on the blank slips provided.
6. The team member guessing the terms may call out guesses until they
correctly guess the term or their 2 min run out.
7. Once the term has been identified/revealed, the player guessing the term
must locate it anatomically on the diagram sheet provided.
8. The game board should be cleared and clue givers can move on to the
next clue on the card, continuing steps 4–6 until all four terms have been
guessed.
9. After all four terms on the card have been guessed, a new team member
is assigned to guess the terms from a newly drawn term card. This should
repeat until everyone has had a turn to guess the terms.
each unit exam. These surveys were identical across units and consisted of three Likert-item questions designed to assess if the game
helped students learn the terminology, prepared students for the exam,
and was fun to play. One additional open-ended item was presented
where students could provide general feedback on game structure and
gameplay. On the final course exam, the following two open-ended
items were presented to provide an overall evaluation of the game:
“Are there certain units or topics for which the game works better?”
and “Would you recommend continued use of the game in future
semesters?” Students were furthermore asked to rank the overall
helpfulness of ClueConnect in enhancing their understanding of
anatomy and physiology content relative to other course learning
activities using both a Likert-item scale and open-ended response
format.
Quantitative and qualitative analyses. Items on the pretest, posttest,
and delayed posttest for each unit were first scored as either correct (1)
or incorrect (0), and scores were entered into SPSS (version 22, IBM).
Repeated-measures ANOVA procedures with Bonferroni adjustment
were subsequently performed to identify within-group learning gains
for each unit. Descriptive statistics were tabulated for Likert-item
questions, with potential rankings ranging from 1 (not helpful/fun) to
5 (most helpful/fun), and the data were entered directly into SPSS
(version 22, IBM) for future analysis.
Open-ended responses were analyzed using a descriptive interpretive approach (19) with emergent themes identified after iterative
rounds of open and axial coding. Two researchers (K. M. Burleson
and J. T. Olimpo) with expertise in the fields of biology and bioeducation extensively discussed both the coding schema and those codes
assigned to participants, ultimately achieving 100% agreement between coders.
Engagement in the ClueConnect game increases students’
comprehension of core terminology related to the integumentary, skeletal, muscular, and nervous systems. The primary
purpose of creating the ClueConnect game was to assist students in learning anatomy and physiology vocabulary and to
make the learning experience fun. To address the first objective, student performance on the pretest/posttest/and delayed
posttest was analyzed using repeated-measures ANOVA procedures with Bonferroni adjustment to identify immediate
learning gains associated with the game as well as short-term
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they played the game, writing additional words on blank slips to add
to the deck. A total of 124 clue cards were generated over 2 semesters.
For each unit of the course, which included the integumentary,
skeletal, muscular, and nervous systems, eight four-word term cards
were created (Fig. 1). Term cards consisted of vocabulary from
A&P1, featuring structures and processes described throughout the
semester (see the Supplemental Material for the term cards, clue
cards, and game board).1 To be able to locate each structure or process
within the body, a page of diagrams accompanied the term cards for
each unit. For example, the skeletal system unit featured unlabeled
diagrams of the skeleton, a long bone, and an osteon.
Playing the game. After completing a pretest (methods described
below), students self-assembled into groups of three to four to play the
ClueConnect game (Table 1). Clue cards were spread across the table
top so that those students giving the clues could see all of their
options. One team member was selected for each round to guess all
four words on a term card. The remaining team members provided the
clues.
At the start of the game, the clue givers drew one term card and had
2 min to create an array for each of the four words listed on the card.
Clue givers were allowed to use their notebooks, textbooks, or
computers if they needed to look up the definition of a word.
Without speaking or gesturing, the team then assembled clue cards
on the game board to create an array of descriptors for the term
being guessed (Fig. 2). Throughout this process, the player attempting to identify the term could continue to call out guesses
until they provided a correct response or their time ran out.
Once the clue receiver successfully guessed the term, they used the
provided diagrams to locate the structure or process within the body.
After all four terms were identified and located, a new team member
would become the guesser, and the next round would begin. This
pattern continued until all members of the group had a turn guessing
two term cards each. Depending on how quickly students guessed the
terms, teams were able to get through all eight term cards within
60 –90 min. On average, rounds lasted ⬃10 min.
Measures of students’ conceptual understanding. To determine the
impact of the ClueConnect game on students’ comprehension of core
anatomy and physiology terminology as well as their short-term
retention of that knowledge, a pretest/posttest/delayed posttest study
design was used. Pre- and posttests were administered immediately
before and after each unit’s game, respectively, and consisted of 10
short-answer questions requiring students to identify various structures associated with the body system being investigated. Questions
on the pre- and posttests differed so as to reduce potential confounding due to item recall; expert evaluation of these items indicated that
they were of equal and appropriate difficulty for the course. Items on
the delayed posttest reflected a randomized compilation of questions
found on the pre- and posttests and were administered as part of the
in-class unit exams.
Student perceptions of ClueConnect. To examine the degree to
which students perceived the ClueConnect game to be engaging and
beneficial to their learning, a brief survey was administered as part of
How We Teach: Classroom And Laboratory Research Projects
ANATOMY AND PHYSIOLOGY TERMINOLOGY REVIEW GAME
225
Fig. 2. Clue cards arrayed on the game board by a
student group to describe “terminal hair.”
integumentary system received the highest score, with a median of 4.00 (Table 2). Students commented, specifically, that
the game facilitated their acquisition and understanding of
course vocabulary, with statements such as: “Yes, it works well
for both the clue givers and the guesser to assess their knowledge of the vocabulary” and “The game generally helps review
vocab words, so it is especially beneficial when a chapter has
a lot of new vocabulary.”
When asked if ClueConnect helped them prepare for exams,
students rated the game a median score of 3.00 (out of 5.00)
overall (Table 2). Interestingly, not all students recognized the
game as a learning tool: “The game is fun and temporarily
helps with explaining concepts and structures. I wouldn’t use it
as a way to study, the exams are far more in depth understanding than what the game covers.” Others felt the game revealed
gaps in knowledge: “It helped me realize what I needed to go
back and study based on my lack of knowledge on some of the
subjects during the game.” Yet another felt that the game
“helped with terminology and figuring out and connecting
words and ideas together. Playing that game allows me to then
learn and study what I couldn’t guess, and helped me with the
concept map and quiz games in class later on in the week.”
In determining if ClueConnect was fun to play, students
rated both the integumentary system and skeletal system units
the highest, with a median score of 4.00 (out of 5.00) for each
unit (Table 2). One student remarked “I thought the game was
fun and helped me learn what I needed to.” Others commented
on how it made reviewing the material more enjoyable: “Keep
doing it. Games like that make studying fun” and “It is a fun
way to know which vocabulary words you should know and
learn them!”
A Kruskal-Wallis test was subsequently used to examine
between-unit differences in student responses. The results
indicated a statistically significant difference in students’ perceptions of the utility of each unit’s game in regard to its
helpfulness in mastering terminology [␹2 (3) ⫽ 9.48, P ⫽
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retention of knowledge during the period between completion
of the activities and the respective unit exams.
Results indicated statistically significant pretest/posttest
learning gains for each unit as well as significant posttest/
delayed posttest gains for units related to the skeletal and
muscular systems. Student scores on the postgame tests increased by an average of three points immediately after gameplay, with an average posttest increase of 3.20 points for the
skeletal system unit and 3.08 points for the muscular system
(Fig. 3). Cohen’s d values for pretest/posttest comparisons
across units ranged from 1.35 to 1.82, indicating large effect
sizes (paired t-test; data not shown). Overall, student performance on the unit posttests demonstrated that playing the game
improved their immediate knowledge and recall of terms.
To further assess if playing the game increased students’
short-term retention of knowledge, a delayed posttest was
embedded in each unit’s exam. Results of the delayed posttests
revealed an average increase of 3.80 points compared with the
pretests, with students scoring, for instance, an average of 4.41
points higher in the skeletal system unit and 5.10 points higher
in the muscular system unit. Students gained an additional
point, on average, between the posttest and delayed posttest
(Fig. 3). These data suggest that the game helped students both
retain information and better prepare for the exam.
Student perceptions of the game. In addition to assessing the
impact of the ClueConnect exercises on students’ comprehension of course terminology, student perceptions about the game
were collected for each unit to determine if students perceived
the activity as fun and beneficial to their learning. Median
scores on Likert-item questions suggested that students found
ClueConnect to be moderately helpful in learning terminology
and preparing for unit exams as well as moderately enjoyable
(Table 2).
For instance, students rated the prompt “Did the game help
you learn the course terminology?” with median scores ranging
from 3.00 to 4.00 (out of 5.00) across the four units. The
How We Teach: Classroom And Laboratory Research Projects
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ANATOMY AND PHYSIOLOGY TERMINOLOGY REVIEW GAME
Fig. 3. Average student performance on the
pretest/posttest/and delayed posttest assessments stratified by unit. *P ⬍ 0.001.
student stated that “it helps me understand concepts better and
it helps me know if I understand it myself. If I can’t explain it,
I don’t know it.” This theme was evident throughout numerous
responses, suggesting an integral role of the ClueConnect game
in enhancing students’ ability to recognize key terminology
throughout the duration of the course. Students likewise reemphasized the value of the ClueConnect exercises as a study
mechanism to prepare for course exams. For instance, one
student asserted “I recommend the game because it’s a kind of
secret study component in which groups are having fun while
learning. [I] learn more because [I am] enjoying knowledge
rather than avoiding the drag of repetition and regurgitation to
remember vocabulary.”
Finally, compared with other course learning activities (lecture, animations, concept mapping, Venn diagrams, Jeopardy,
laboratories, and process-oriented guided-inquiry learning
exercises), students ranked ClueConnect identically in its
effectiveness at promoting understanding of course content,
including course terminology, with a median score of 4.00
of 5.00 for all activities (data not shown). One student
commented that “the game’s greatest value is the discussion
Table 2. Median scores for Likert-item questions regarding
the degree to which students perceived the ClueConnect
game as fun and beneficial to their learning
Unit
Unit
Unit
Unit
1:
2:
3:
4:
integumentary system
skeletal system
muscular system
nervous system
Learning
Terminology
Prepares for the
Unit Exam
Fun to
Play
4.00
3.00
3.50
3.00
3.00
3.00
3.00
3.00
4.00
4.00
3.00
3.00
Results were evaluated by Likert-item rankings ranging from 1 (not helpful/
fun) to 5 (most helpful/fun).
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0.024] and preparing for the unit exam [␹2 (3) ⫽ 10.99, P ⫽
0.012] as well as the degree to which each unit’s game was fun
to play relative to one another [␹2 (3) ⫽ 14.71, P ⫽ 0.002].
Planned Mann-Whitney U-comparisons with Bonferroni correction revealed that the ClueConnect game was perceived to
be more beneficial for the integumentary system unit than any
of the other units (Table 3). No statistically significant differences between unit 2, 3, and 4 exercises was observed (P ⱖ
0.103 for all comparisons).
Students expressed that the game might be more suitable for
some units than for others when presented with the following
prompt: “Think about the game overall across the semester.
Are there certain units or topics for which the game works
better?” Many students (n ⫽ 15) indicated that they did not
find the exercise helpful or enjoyable for unit four (the
nervous system), although they found it beneficial for previous units. This perception, as one student stated, was
likely due to the fact that “it works better for smaller units;
for the nervous system, we had so much thrown at us, it was
impossible to remember” and that “With the nervous system, there were so many more terms to know but the terms
also related to so many different things it was hard to keep
track of them all.” Importantly, however, analysis of qualitative data collected at the end of the semester largely
revealed that ClueConnect was perceived as beneficial
across most units of the course.
When asked if ClueConnect should be continued in future
semesters of the course, student responses indicated a continued need for the game. Students’ overall assessment of the
ClueConnect game was positive. More than 86% of participants (n ⫽ 31) indicated that the game should be used in future
semesters, citing, for example, that “it keeps us aware of what
we need to know and don’t know, and that can help us
determine what we need to work on in the future.” Another
How We Teach: Classroom And Laboratory Research Projects
ANATOMY AND PHYSIOLOGY TERMINOLOGY REVIEW GAME
Table 3. Planned Mann-Whitney U-comparisons for
ClueConnect Likert-item questions
Comparison
Unit
Unit
Unit
Unit
Unit
Unit
1–unit
1–unit
1–unit
2–unit
2–unit
3–unit
2
3
4
3
4
4
Learning
Terminology
Prepares for the
Unit Exam
Fun to
Play
357.50*
465.00
387.50
484.00
552.00
509.00
354.00*
483.00
371.50*
453.00
555.50
475.00
385.50
364.50*
306.00†
550.00
464.00
483.50
Results are reported as U-values. *P ⬍ 0.008; †P ⫽ 0.001.
DISCUSSION
The ClueConnect game provides a versatile and fun way for
students to review and reinforce their knowledge of anatomy
and physiology terminology. Furthermore, the results demonstrated statistically significant improvement in students’
knowledge of course vocabulary after gameplay, with learning
gains apparent both immediately after each game as well as 1
wk later.
Student perceptions regarding the usefulness of the game for
learning course terminology and preparing them for exams
varied across each unit, with the majority of students rating the
game as most helpful for the integumentary system and as least
helpful for the nervous system. Critical analysis of the collected survey data coupled with informal classroom observations suggest that median scores on Likert-item questions may
have been moderate because not all students were cognizant of
their own learning. For instance, when students struggled with
the terminology during gameplay, they often spent time looking up the information in their textbooks or notes and discussing the concepts with one another. Despite this informal study
time, students often considered the game unsuccessful if their
peers could not guess the terms. Importantly, while students
did not always recognize this process as a significant part of
their learning, their performance on subsequent posttests argued otherwise, with students scoring an average of three
points higher after the game. Thus, ClueConnect worked successfully as a review tool even if the students themselves did
not perceive that they were learning as a result of engaging in
the game. Furthermore, students’ written feedback at the end of
the semester indicated that the game was considered valuable
for reinforcing course terminology and encouraging them to
study, with 86% of students recommending the game for future
semesters of A&P1.
While students’ learning cannot be definitively attributed to
the game itself rather than simply time spent with the material,
it is clear that the game is an effective learning strategy to
master course content. The game carries additional benefits
to students over studying on their own as it allows students to
consider the perspectives of their peers and reinforces teamwork skills. To make their review sessions more fruitful, some
students admitted to modifying the game throughout the semester, adding their own verbal clues along with the clue cards
or creating stories to link the terms together as they played.
Others would use the provided diagrams to help their peer
guess the terms. Their adaptation of the game allowed students
to review course terminology, determine which concepts they
did not fully grasp, and then discuss it with their peers, yielding
marked and statistically significant improvement on postgame
assessments. At the same time, the game provides faculty
members who teach in flipped or active learning classrooms a
novel method for students to review material. Indeed, in
written feedback, several students commented that the novelty
of the ClueConnect game aided in their learning. Current
research in science, technology, engineering, and mathematics
education shows improved outcomes for students in classes
that incorporate active learning. Adding activities like ClueConnect allows students to practice and apply their knowledge,
which increases their success. ClueConnect is an effective
supplement to existing instructor resources to enhance students’ learning (6, 7).
There are a few limitations to the game in its current format.
For instance, when students were allowed to form their own
groups, they tended to gravitate towards peers who performed
at a similar level, and this made the game problematic if no one
in the group was prepared. In some cases, students had not
studied before the game, so it was difficult for them to recall
terms, and this led to frustration for some of the groups.
Possible solutions to these issues include mixing up the groups
or assigning students randomly so that groups are composed of
individuals with a range of abilities and preparation levels.
Providing a list of vocabulary terms at the start of the unit and
allowing students to refer to the sheet during the game may
also make the game more effective by narrowing their choices.
This approach also allows the students to review the unit’s
terms before playing the game, which may make the activity
more enjoyable.
Several students commented that they felt concepts from the
game were not covered on the unit exams or that they wanted
to have their pre- and posttests back so that they could see what
they were getting wrong. After this feedback, the instructor
made it a practice to briefly review concepts that consistently
were wrong on the posttests and to circle the embedded posttest
questions when scoring the unit exams to allow the students to
track their performance. This practice appeared to motivate
students in subsequent iterations of the game to work to learn
the terms, as they knew they would appear on the exams.
The majority of students felt positive about the game, and
several had suggestions for improving ClueConnect in future
semesters. These suggestions include allowing the use of
verbal cues/discussion in addition to game tiles, the addition of
topic headers to narrow the focus for each round of the game,
using pictures as clues in addition to words, and writing the
definition of the terms on the back of the cards to aid clue
givers and to allow them to verify they are giving valid
clues. Additional ideas for gameplay include having student
groups compete with one another to see who can guess or
locate a term first. Game kits can be loaned out to those
students who want to play on their own to review before
exams. Finally, the game presented here was printed on
cardstock. Modifications to make the game more durable
include using laminated pieces or printing on magnetic
sheets or using a whiteboard to write clues to reduce
preparation time and printing costs.
In conclusion, the ClueConnect game is a low-cost, fun, and
effective way for students to review anatomy and physiology
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it starts.” Another felt that all active learning exercises in
the course aided their learning, indicating that it was important to “keep doing it all.”
227
How We Teach: Classroom And Laboratory Research Projects
228
ANATOMY AND PHYSIOLOGY TERMINOLOGY REVIEW GAME
vocabulary and is easily adaptable to a variety of courses at
both the introductory and advanced level.
ACKNOWLEDGEMENTS
The authors thank the Human Anatomy and Physiology Society (HAPS)
members who added clue cards to the deck at the HAPS Annual Conference
workshop in San Antonio, TX.
DISCLOSURES
No conflicts of interest, financial or otherwise, are declared by the author(s).
AUTHOR CONTRIBUTIONS
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