PURPOSEPhysician assistant (PA) basic science coursework is fast-paced
and represents a significant increase in workload compared to undergraduate
studies. Students may rely on cramming, which can decrease long-term
retention and depth of understanding. Retrieval practice has been shown to
strengthen durable learning and improve integration of new information. This
project introduced word- and image-based puzzle activities into the lower
limb, vertebral column, and spinal cord (LVSC) anatomy block to enhance
recall, learning efficiency, and exam performance.
 
METHODSThe PA class (n = 28) receives anatomy lectures twice weekly. During
the two-week LVSC block, three optional 15-minute group retrieval-practice
sessions were added on instructional days 2, 3, and 4. In each session,
students collaboratively assembled puzzles requiring recall of concepts from
all previous lectures. Performance on the 2025 LVSC exam was compared to
class averages from 2021–2024. Student engagement and perceived usefulness
were assessed informally through direct feedback during sessions.
 
RESULTSStudents were highly engaged in the puzzle activities and reported
that they supported their understanding and recall of course material. The
2025 cohort outperformed all prior cohorts on the LVSC exam except the 2024
class. Additionally, the 2025 cohort achieved a higher average on the gross
anatomy comprehensive final exam than any cohort from 2021–2024.
 
CONCLUSIONThese preliminary findings suggest that puzzle-based retrieval
practice may support improved retention of gross anatomy content in PA
students. Limitations include small cohort sizes (n = 24–30) and a young
program (established 2021). Ongoing data collection across future cohorts
will help determine the long-term impact of this approach on retention and
performance.