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Puzzle-based pedagogic activity to address rote learning of antibiotic classes in clinical pharmacology course for undergraduate nursing students

Constanza Morén, Emi Ruiz Mariscal, Mónica Negredo, Maria Preciado and 6 more

BMC Medical Education | May 28, 2026

Abstract

Abstract

OBJECTIVE: We aimed to evaluate the impact of an active learning strategy, the Puzzle technique, on nursing students' knowledge acquisition and engagement in Clinical Pharmacology, focusing on antibiotics. BACKGROUND: Absenteeism and low motivation among university students pose significant challenges in higher education. Traditional rote learning methods often lead to disengagement, particularly in content-heavy subjects such as Clinical Pharmacology. Within this field, learning antibiotic classes requires extensive memorization, which may hinder students' performance and retention of knowledge. Given the increasing role of nurses in antibiotic prescription, enhancing their pharmacological training is essential. DESIGN: Educational intervention study with three intervention groups and two control groups, including within-group pre-post assessments. METHODS: A total of 330 s-year nursing students from the University of Barcelona participated. Three groups (A, B, and C) engaged in the Puzzle intervention, while two groups (D and E) served as controls, thereby receiving only the standard theoretical instruction without any additional activity. The intervention consisted of a peer-to-peer collaborative activity where students were assigned specific antibiotic topics to teach their peers. Learning outcomes were assessed through a quiz, midterm, and final exams. RESULTS: Intervention groups demonstrated significantly higher accuracy in quiz (p < 0.001) and exam accuracy percentages (p < 0.001) compared to controls. Among the intervention groups, students who participated in the activity outperformed their intra-group controls. Additionally, students reported high satisfaction and perceived applicability in learning consolidation. CONCLUSIONS: Our findings specifically pertain to undergraduate nursing students and undergraduate nursing education. The Puzzle technique effectively enhanced knowledge retention of antibiotic drug classes within Clinical Pharmacology. This peer-to-peer approach may serve as a valuable pedagogical tool for improving learning outcomes in nursing education, particularly in complex pharmacological subjects.

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Authors

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Constanza Morén

first | Bellvitge University Hospital | ORCID 0000-0001-6848-7407

Emi Ruiz Mariscal

middle | Generalitat de Catalunya

Mónica Negredo

middle | Institut Municipal d'Assistència Sanitària | ORCID 0000-0002-4263-6408

Maria Preciado

middle | Universitat de Barcelona

Gemma Martínez

middle | Hospital Clínic de Barcelona | ORCID 0000-0002-7613-609X

Mireia Llauradó‐Serra

middle | Universitat de Barcelona | ORCID 0000-0002-5123-0581

Antonio Rosa

middle | Universitat de Barcelona | ORCID 0000-0002-0914-9413

Melinda González

middle | Universitat de Barcelona

Natalia Rodríguez

middle | Consorci Institut D'Investigacions Biomediques August Pi I Sunyer

Laura Martínez

last | Universitat de Barcelona | ORCID 0000-0002-1300-249X

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Citation

BibTeX

@article{Morn2026Puzzle,
  title = {Puzzle-based pedagogic activity to address rote learning of antibiotic classes in clinical pharmacology course for undergraduate nursing students},
  author = {Constanza Morén and Emi Ruiz Mariscal and Mónica Negredo and Maria Preciado and Gemma Martínez and Mireia Llauradó‐Serra and Antonio Rosa and Melinda González and Natalia Rodríguez and Laura Martínez},
  journal = {BMC Medical Education},
  year = {2026},
  doi = {10.1186/s12909-026-09484-1},
  url = {https://doi.org/10.1186/s12909-026-09484-1}
}

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