The Jigsaw teaching method compared to traditional teaching on anatomy and physiology knowledge in higher education – a randomised controlled trial

ERCT Criteria Breakdown

• Level 1 Criteria

  • C

    Class-level RCT

    • Randomisation was conducted at the individual student level (not by intact classes or schools) and no tutoring exception applies.
    • "Following the pre-test, participants were randomly assigned into two groups using Microsoft Excel for Microsoft 365." (p. 4)
    • Relevant Quotes: 1) "To answer these research questions, we conducted a randomised controlled trial. Students were randomly allocated to either teaching using JS or TT." (p. 3) 2) "Following the pre-test, participants were randomly assigned into two groups using Microsoft Excel for Microsoft 365. The randomisation procedure was carried out on site by one of the authors." (p. 4) 3) "Participants were assigned a random number using the = RAND( ) function, and the participant list was subsequently sorted from lowest to highest based on this random number." (p. 5) Detailed Analysis: ERCT Criterion C requires random assignment at the class level (or stronger), to reduce contamination from mixing treatment and control students within the same classroom context; student-level randomisation is only acceptable under the tutoring / personal-teaching exception. The paper clearly reports that "participants" / "students" were randomly assigned to the two groups using Excel on site, which indicates individual-level allocation rather than randomising intact classes. The intervention is a group-based teaching session (traditional lecture vs. Jigsaw), not a one-to-one tutoring program, so the criterion's exception does not apply. Criterion C is not met because allocation was at the individual student level rather than by class (or school).
  • E

    Exam-based Assessment

    • Learning was measured with a curriculum-based multiple- choice test developed by the authors, not a widely recognised standardized exam.
    • "A curriculum-based MCT was systematically developed by two of the authors in line with Kanzow et al. [22], Krathwohl [23] and Considine et al. [24]." (p. 3)
    • Relevant Quotes: 1) "A curriculum-based MCT was systematically developed by two of the authors in line with Kanzow et al. [22], Krathwohl [23] and Considine et al. [24]." (p. 3) 2) "The test consisted of 25 questions of medium difficulty, organised into five categories reflecting the curriculum sub-topics." (p. 3) 3) "To ensure face and content validity as described by Brenner et al. [25], the MCT was reviewed and evaluated independently by five anatomy and physiology lecturers at the Western Norway University of applied sciences." (p. 4) Detailed Analysis: ERCT Criterion E requires use of standardized exam-based assessments that are widely recognised (e.g., national / state exams or established standardized tests), rather than researcher-created instruments aligned to the intervention content. Here, the outcome measure is explicitly a "curriculum- based" multiple-choice test "developed by two of the authors." While the authors describe content review and face/content validity checks by lecturers, these steps do not transform the instrument into an external, widely recognized standardized exam. Criterion E is not met because the assessment was developed for this study rather than being a standardized external exam.
  • T

    Term Duration

    • Outcomes were measured again at a three-month follow-up, which is approximately one academic term after the intervention began.
    • "We assessed the students’ knowledge immediately before and after the teaching intervention and at a three-month follow-up." (p. 3)
    • Relevant Quotes: 1) "We assessed the students’ knowledge immediately before and after the teaching intervention and at a three-month follow-up." (p. 3) 2) "Three months later, the same MCT was repeated during a compulsory lecture at campus, within the normal teaching hours." (p. 5) Detailed Analysis: ERCT Criterion T requires that educational outcomes be measured at least one academic term after the intervention begins (commonly about 3–4 months). The paper states the intervention occurred on the day of the teaching activity (with immediate post-testing), and the follow-up measurement occurred "Three months later." A three-month follow-up is consistent with an approximately term-length interval from intervention start to the longer-term measurement, satisfying the minimum term-duration follow-up requirement. Criterion T is met because the study includes a follow-up assessment three months after the intervention started.
  • D

    Documented Control Group

    • The paper clearly defines the comparison groups (TT vs. JS), reports group sizes, and reports baseline and follow- up outcome data by group.
    • "After excluding the student who dropped out before completing the learning activity, a total of 47 participants were included, 23 in the TT group and 24 in the JS group." (p. 7)
    • Relevant Quotes: 1) "Forty-eight undergraduate social nursing students were randomised to either a TT or JS-based learning activity. One JS student dropped out before completing the activity and was excluded, resulting in 47 participants (23 TT, 24 JS)." (p. 2) 2) "After excluding the student who dropped out before completing the learning activity, a total of 47 participants were included, 23 in the TT group and 24 in the JS group." (p. 7) 3) "Table 2 Mean scores* for each teaching method at the three time points, and comparison of mean score between the two teaching methods (n = 47 students** and 135 scores)" (p. 8) Detailed Analysis: ERCT Criterion D requires that the control condition be well-documented, including who is in it, what they received, and baseline/outcome information enabling comparison. The study clearly identifies the two conditions (TT and JS), provides the final analysed sample sizes for each, and reports outcome data (including baseline and later timepoints) by group in a dedicated table summarising mean scores across timepoints. This provides sufficient documentation to understand the control group (TT) and compare it with the intervention group (JS). Criterion D is met because the control group is clearly described with group size and outcome data over time.

• Level 2 Criteria

  • S

    School-level RCT

    • The randomisation occurred among individual students, not among schools (or equivalent institutions/sites).
    • "Following the pre-test, participants were randomly assigned into two groups using Microsoft Excel for Microsoft 365." (p. 4)
    • Relevant Quotes: 1) "Following the pre-test, participants were randomly assigned into two groups using Microsoft Excel for Microsoft 365." (p. 4) 2) "A total of 95 ... undergraduate students in social nursing at the University of Western Norway were invited to participate in the study." (p. 3) Detailed Analysis: ERCT Criterion S requires school-level (or equivalent institution/site-level) randomisation, such as randomly assigning schools or campuses to intervention vs control. The paper describes a single-institution study at the University of Western Norway with individual participants randomised into TT vs JS. There is no indication that multiple schools/sites were randomised. Criterion S is not met because randomisation was not at the school (or site) level.
  • I

    Independent Conduct

    • The authors developed key study materials and conducted the randomisation on site, with no quoted evidence of an independent external evaluation team.
    • "The randomisation procedure was carried out on site by one of the authors." (p. 4)
    • Relevant Quotes: 1) "A curriculum-based MCT was systematically developed by two of the authors in line with Kanzow et al. [22], Krathwohl [23] and Considine et al. [24]." (p. 3) 2) "Following the pre-test, participants were randomly assigned into two groups using Microsoft Excel for Microsoft 365. The randomisation procedure was carried out on site by one of the authors." (p. 4) 3) "The test administration was overseen by one of the authors and standardised across the full-time and part time tracks." (p. 5) Detailed Analysis: ERCT Criterion I requires that the conduct of the study (implementation and/or evaluation) be independent from the intervention designers to reduce bias, typically via an external/third-party evaluation team. The paper explicitly states that two authors developed the primary knowledge test, that an author conducted the randomisation on site, and that an author oversaw test administration at follow-up. While some lecturers reviewed materials for validity, this is not the same as independent trial conduct or independent evaluation. Criterion I is not met because the study was conducted and evaluated by the author team without clear external independent oversight.
  • Y

    Year Duration

    • The study’s follow-up lasted three months, which is far short of 75% of an academic year.
    • "We assessed the students’ knowledge immediately before and after the teaching intervention and at a three-month follow-up." (p. 3)
    • Relevant Quotes: 1) "We assessed the students’ knowledge immediately before and after the teaching intervention and at a three-month follow-up." (p. 3) 2) "Three months later, the same MCT was repeated during a compulsory lecture at campus, within the normal teaching hours." (p. 5) Detailed Analysis: ERCT Criterion Y requires outcomes to be measured at least 75% of an academic year after the intervention begins. The longest stated follow-up in this study is "three months later," which corresponds to roughly one academic term, not most of a year. Criterion Y is not met because the tracking duration is three months rather than approximately a full academic year.
  • B

    Balanced Control Group

    • The JS condition received substantially more total time and broader learning resources than TT, and this resource difference was not framed as the treatment variable nor matched in the control condition.
    • "Limitations include ... the JS group was allocated more total time (165 min) for the teaching procedure than the TT group (105 min), possibly influencing the comparability of the two approaches." (p. 11)
    • Relevant Quotes: 1) "The lecture lasted for 105 min, including a 15-minute break between two 45-minute sessions (Table 1)." (p. 6) 2) "The students had unrestricted access to learning resources in both digital and print formats, including the course textbook and printed materials, a subscription-based online anatomy learning platform and all other publicly accessible online content." (p. 6) 3) "Limitations include ... the JS group was allocated more total time (165 min) for the teaching procedure than the TT group (105 min), possibly influencing the comparability of the two approaches." (p. 11) Detailed Analysis: ERCT Criterion B requires balancing time and resources between intervention and control unless (a) differences are negligible, (b) the extra resources are explicitly the treatment variable being tested, or (c) the control is otherwise matched with comparable educational inputs. Here, the paper explicitly acknowledges a non-negligible time imbalance: 165 minutes allocated for JS procedures versus 105 minutes for TT. In addition, the JS group is described as having "unrestricted access" to extensive digital and print resources, including a subscription- based online learning platform; the TT description does not indicate an equivalent resource provision. Importantly, the study’s stated comparison is between teaching methods (JS vs TT), not an explicit test of "more time/resources" as the intended treatment variable. The authors treat the time difference as a limitation affecting comparability, which supports the interpretation that the added time is a confound rather than the target of evaluation. The control condition is not described as receiving matched time or alternative activities of equivalent duration/resource intensity. Criterion B is not met because the intervention group received additional time/resources without a matched control and without framing extra resources as the treatment variable.

• Level 3 Criteria

  • R

    Reproduced

    • No evidence is provided that an independent research team has replicated this specific RCT in another context.
    • "As with all pedagogical research, challenges remain with reproducibility of real-world teaching environments." (p. 11)
    • Relevant Quotes: 1) "As with all pedagogical research, challenges remain with reproducibility of real-world teaching environments." (p. 11) Detailed Analysis: ERCT Criterion R requires independent replication of the same study (or a clearly equivalent replication) by a different research team in a different context, published in a peer-reviewed journal. The paper does not report that it is itself a replication of a prior identical RCT, nor does it cite an external study that independently replicated this specific trial’s design and findings. Given the paper’s very recent 2026 publication, no independent replication of this specific RCT could be identified during this ERCT check. Criterion R is not met because there is no quoted or otherwise identifiable evidence of an independent replication of this specific RCT.
  • A

    All-subject Exams

    • Criterion E is not met (the outcome test is not a standardized exam), therefore All-subject Exams cannot be met.
    • Relevant Quotes: 1) "A curriculum-based MCT was systematically developed by two of the authors in line with Kanzow et al. [22], Krathwohl [23] and Considine et al. [24]." (p. 3) Detailed Analysis: ERCT Criterion A requires standardized exam-based assessment across all main subjects, and it explicitly depends on Criterion E being satisfied (standardized exams). This study uses a researcher-developed curriculum-based multiple-choice test focused on a specific anatomy and physiology topic, rather than standardized all-subject exams. Since Criterion E is not met, Criterion A is not met by definition. Criterion A is not met because the study does not use standardized exam-based assessments (Criterion E fails).
  • G

    Graduation Tracking

    • The study only follows students for three months and does not track outcomes through graduation; additionally, Criterion Y is not met, so G cannot be met.
    • "We assessed the students’ knowledge immediately before and after the teaching intervention and at a three-month follow-up." (p. 3)
    • Relevant Quotes: 1) "We assessed the students’ knowledge immediately before and after the teaching intervention and at a three-month follow-up." (p. 3) 2) "Three months later, the same MCT was repeated during a compulsory lecture at campus, within the normal teaching hours." (p. 5) Detailed Analysis: ERCT Criterion G requires tracking participants until graduation at the relevant educational stage. This study includes only an immediate post-test and a three-month follow-up, with no indication of longer tracking. Additionally, ERCT rules specify that if Criterion Y (Year Duration) is not met, Criterion G cannot be met. Since the study lasts only three months (and Y is not met), G necessarily fails as well. Criterion G is not met because the study does not track students through graduation and has only a three-month follow-up.
  • P

    Pre-Registered

    • The paper explicitly states that trial registration is not applicable, providing no pre-registered protocol or registry identifier.
    • "Trial registration Clinical trial number not applicable." (p. 3)
    • Relevant Quotes: 1) "Trial registration Clinical trial number not applicable." (p. 3) Detailed Analysis: ERCT Criterion P requires a publicly accessible pre-registered protocol (with registry/link and evidence that registration occurred before data collection). The paper explicitly states that trial registration is "not applicable" and provides no registration platform, identifier, or date. This indicates there was no pre-registration consistent with the ERCT requirement. Criterion P is not met because no pre-registered protocol is provided and trial registration is stated as not applicable.