Effectiveness of co-operative learning through the Jigsaw classroom technique for atraumatic restorative treatment: A quasi-experimental study

Effectiveness of co-operative learning through the Jigsaw classroom technique for atraumatic restorative treatment: A quasi-experimental study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effectiveness of co-operative learning through the Jigsaw classroom technique for atraumatic restorative treatment: A quasi-experimental study Sirjana Dahal, Anju Khapung, Samarika Dahal, Prakash Poudel This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7596280/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Co-operative learning like jigsaw technique consists of five basic elements namely positive interdependence, promotive interaction, individual accountability, teaching of social skills and quality of group processing. This study was conducted to evaluate the effectiveness of jigsaw classroom technique in improving dental students' knowledge and skills towards atraumatic restorative treatment (ART). Methods A quasi-experimental study was conducted among 25 dental students of Maharajgunj Medical Campus. Lecture on ART was delivered in the class followed by evaluation through a ten-point checklist for knowledge and ten-point checklist for skills. After one month, the students were divided into small, mixed-ability groups (5 in each group, total 5 groups) using jigsaw technique followed by content division, their assignment to expert groups, expert teaching, group activities and evaluation. Data was analyzed in SPSS version 24. Mean, standard deviation, median, interquartile range for quantitative data and frequency and percentage for qualitative data were calculated. Wilcoxon signed rank test was performed to determine the difference in median rating of knowledge and skill scores after lecture and jigsaw method. The significance level was set at P < 0.05. Results After lecture, 19 (76%) were able to answer questions on ART contraindications, whereas each participant answered correctly following jigsaw method. While all students were able to perform proper instrumentation, isolation of the operating area, caries removal, and cavity cleaning after using the jigsaw method of learning, the majority (21, 84%) were able to use only press finger technique followed by cavity cleaning (20, 80%) after lecture method. Some 9 (36%) students could correctly answer all ten knowledge questions and 3 (12%) could perform all steps of ART correctly after applying jigsaw method of learning but none of them could do so after lecture method. The jigsaw technique of learning resulted in significantly higher knowledge (P < 0.001) and skills scores (P < 0.001) than lecture method. Conclusions The study findings reveal that jigsaw method of learning is effective than traditional lecture method in enhancing both knowledge and practical skills of dental students. The jigsaw puzzle method can be integrated into the dental curriculum for dental students to effectively learn the many clinical procedures in dentistry. Atraumatic Restorative Treatment Co-operative Learning Jigsaw Lecture Figures Figure 1 Introduction The development of a supportive learning environment that may help students become informed and competent professionals is emphasized in modern medical education [ 1 ]. Dental students have traditionally received basic science knowledge through lecture-based teaching methods. This conventional method has many disadvantages, such as a lack of encouragement, communication, problem-solving skills, and group effort in solving problems [ 2 ]. Dental students acquire the necessary skills as outlined in their BDS curriculum in two phases: preclinical simulated clinical activities followed by subsequent clinical activities in patients. Because these simulated activities are expensive and resource intensive, improving teaching-learning strategies and ensuring that they are supported by evidence is crucial [ 3 ]. It is recommended that the number of verbal instructions be minimized and should not surpass the learner's attentional capacity to maximize learning outcomes. During the course of acquiring motor skills, instruction frequently includes explanations of how specific body parts, such as hands or fingers, move in relation to other body parts in both space and time [ 4 ]. Effective teaching practices should enhance students' memory, comprehension, communication, independence, and teamwork skills [ 5 ]. Cooperative learning (Cooperative-L) is one such teaching approach in which students aim to achieve outcomes that benefit themselves as well as other members of the group [ 6 ]. Cooperative-L has been accepted by educators as one of the most effective methods for assisting students in overcoming the difficulties involved in studying complex subjects [ 7 ]. Cooperative learning is a student-centered approach that has been shown to improve practical learning skills, communication abilities, and knowledge comprehension. It also fosters positive student attitudes toward their own learning [ 8 , 9 ]. It involves organizing students into small groups to help each other acquire academic topics [ 9 ]. Cooperative learning has five key elements: positive interdependence, promotive interaction, individual accountability, teaching of interpersonal and social skills, and quality of group processing. Arranging students in groups without positive interdependence does not promote cooperative learning environments [ 5 ]. Positive interdependence in cooperative learning requires students to collaborate as a group to attain common learning objectives [ 10 ]. The jigsaw approach, or Aronson’s puzzle, is one of the best known cooperative-L methods. Elliot Aronson developed the Jigsaw method at University of Texas in the early 1970s in an effort to address racial disparities in the classroom [ 11 , 12 ]. On the basis of the idea of collaborative learning, the jigsaw method of learning focuses on breaking down difficult subjects or issues into smaller, more manageable components to help students develop their critical thinking, leadership, social communication, and creative abilities [ 13 ]. In this active method of learning, every member's input is respected, encouraging teamwork and improving academic results [ 2 ]. In recent years, teachers and medical professionals have used their expertise and intuition to help students perform to the best of their abilities. Traditional teaching has shifted the educator's role from teacher to neutral observer [ 14 ]. Therefore, this study was conducted to evaluate the effectiveness of the jigsaw classroom technique in improving dental students' knowledge of and skills in atraumatic restorative treatment. Methods Study design A quasi-experimental study design was used to evaluate the effectiveness of cooperative learning through the jigsaw classroom technique in teaching atraumatic restorative treatment, a minimally invasive procedure that uses hand instruments and glass ionomer cement for the restoration of cavities. Study participants This study was performed among 25 fourth year Bachelor of Dental Surgery (BDS) students at the Maharajgunj Medical Campus (3rd batch BDS) from January-June 2025. They had no prior formal training in atraumatic restorative treatment. However, those who were absent during any single day of data collection were excluded. This study compared knowledge and clinical skills between the traditional lecture method and the jigsaw method. Ethical considerations Ethical approval was received from the Institutional Review Committee of the Institute of Medicine [Ref. no 358 (6–11) E2]. Informed consent was obtained from the study participants before data collection. Data collection Lectures on ART were delivered to students in the classroom where other regular classes were conducted. They were assessed for knowledge via a 10-point scale. The participants were subsequently asked to perform ART on extracted teeth that were mounted in plaster of Paris. Their ability to perform ART was also assessed with the help of a 10-point scale. The criteria for assessment were set by preparing 10 questions each for knowledge and skills by two community dentistry experts working in the same institution. After one month, the same students were divided into five home groups, each of which had five members. Each member was assigned a specific ART subtopic: definition and principles, indications and contraindications, the ART process, GIC manipulation, defective restorations and management. Students with the same subtopic from different groups formed "expert groups", where they studied and discussed their assigned topic in depth. It was followed by a teaching phase where expert group members returned to their home groups and taught their peers in their respective subtopics. Collaborative learning was performed with the help of home groups that synthesized a complete understanding of the ART procedures. Finally, an assessment of knowledge and skills was performed, which was similar to that conducted after the lecture method. Data analysis The data collected were entered into a Microsoft Excel Sheet and transferred to SPSS version 24 for statistical analysis. The means, standard deviations, medians and interquartile ranges were computed for descriptive statistics. Shapiro‒Wilk test was used to check the normality of the data. Owing to the skewed nature of the data, a nonparametric test was used for further analysis. Wilcoxon signed-rank test was performed to determine the median difference in knowledge and skills scores regarding ART after lecture and the jigsaw method. The significance level was set at p < 0.05. Results The mean age of the study participants was 23.56 ± 1.07 years (minimum age = 22 years, maximum age 26 years). The sex distribution of the study participants is presented in Fig. 1 . Most of the study participants correctly answered questions concerning contraindications to ART (19, 76%) after the lecture method was delivered, and all of them (25, 100%) could answer this question after jigsaw method was implemented. For the assessment of skills, most of them (21, 84%) could use the press finger technique followed by cleaning the cavity (20, 80%) after the lecture method, whereas all the students (25, 100%) could perform proper instrumentation, isolation of the operating area, caries removal, and cleaning of the cavity after the jigsaw method of learning. In the overall assessment, most of them could answer questions regarding the knowledge and skills of the ART after the jigsaw method of learning (Table 1 ). Table 1 Distribution of study participants according to their knowledge and skills regarding Atraumatic Restorative Treatment (n = 25) Items Lecture method Jigsaw method No (0) n (%) Yes (1) n (%) No (0) n (%) Yes (1) n (%) Knowledge Definition 15 (60) 10 (40) 5 (20) 20 (80) Principles 9 (36) 16 (64) 2 (8) 23 (92) Indications 7 (28) 18 (72) 1 (4) 24 (96) Contraindications 6 (24) 19 (76) - 25 (100) Properties of GIC 11 (44) 14 (56) 1 (4) 24 (96) GIC manipulation 19 (76) 6 (24) 6 (24) 19 (76) Procedure of ART 11 (44) 14 (56) 6 (24) 19 (76) Post restoration instructions 10 (40) 15 (60) 3 (12) 22 (88) Failure of ART 19 (76) 6 (24) - 25 (100) Management of failure in ART 7 (28) 18 (72) 1 (4) 24 (96) Skills Instrumentation 23 (92) 2 (8) - 25 (100) Isolation of the operating area 23 (92) 2 (8) - 25 (100) Caries removal 8 (32) 17 (68) - 25(100) Cleaning the cavity 5 (20) 20 (80) - 25 (100) Conditioning of the cavity 13 (52) 12 (48) 2 (8) 23 (92) Mixing of cement 21 (84) 4 (16) 12 (48) 13 (52) Restoring the cavity 12 (48) 13 (52) 9 (36) 16 (64) Use of press finger technique 4 (16) 21 (84) 2 (8) 23 (92) Carving 17 (68) 8 (32) 8 (32) 17 (68) Maintenance of restorative area 24 (96) 1 (4) 2 (8) 23 (92) The distribution of study participants based on all correct responses regarding knowledge and skills is presented in Table 2 . None of the students could answer all the questions regarding knowledge correctly or perform all the steps of ART in extracted teeth correctly after the lecture method. However, 9 (36%) students could correctly answer knowledge questions, and 2 (12%) could perform all steps of the ART correctly (Table 2 ). Table 2 Distribution of study participants on the basis of all correct responses on knowledge and skills (n = 25) Items (Total 10 items) Correct responses to all ten items Lecture method n (%) Jigsaw method n (%) No (0) Yes (1) No (0) Yes (1) Knowledge scores 25 (100) - 16 (64) 9 (36) Skill scores 25 (100) - 22 (88) 3 (12) A comparison of knowledge and skills scores regarding atraumatic restorative treatment is presented in Table 3 . Significantly higher knowledge (P < 0.001) and skills scores (P < 0.001) were obtained after the jigsaw method was used for learning than after the lecture method. Table 3 Comparison of knowledge and skills scores regarding atraumatic restorative treatment (n = 25) Items Category Mean ± SD Median (IQR) P value* Knowledge scores (10 items) Lecture 5.96 ± 2.42 7 (5–8) < 0.001 Jigsaw 9 ± 1.04 9 (8.50–10) Skill scores (10 items) Lecture 4 ± 1.35 4 (3–5) < 0.001 Jigsaw 8.32 ± 0.99 8 (8–9) *Wilcoxon signed rank test Discussion Students can effectively participate in their education, share knowledge with other groups, and take personal responsibility for their learning by using the Jigsaw cooperative learning technique. This cooperative learning method increases interaction and creates an environment of respect and collaboration because each group depends on its members doing well and actively participating in the group to succeed [ 14 ]. Compared with other active learning approaches, there is a paucity of published research evaluating the effectiveness of the jigsaw technique as a teaching strategy for dental students in Nepal. Therefore, this study was conducted to determine the effectiveness of co-operative learning through the jigsaw classroom technique for atraumatic restorative treatment. The findings of this study demonstrate a significant improvement in both knowledge and practical skills regarding atraumatic restorative treatment (ART) among dental students using the jigsaw cooperative learning method compared with the traditional lecture-based approach. The participants showed a markedly better understanding of ART concepts after the jigsaw method. After the lecture method of instruction, 19 (76%) students correctly answered question on the contraindications of ART, whereas all the students (25, 100%) correctly answered this question following the jigsaw method. Similarly, key theoretical components, such as the definition, principles, indications of ART, and properties of glass ionomer cement (GIC), also yielded higher correct response rates after jigsaw-based learning than the traditional lecture method. These results are consistent with those of prior studies indicating that cooperative learning fosters deeper understanding by promoting peer discussion, active engagement, and individual accountability [ 15 – 18 ]. Skill-based assessments revealed even more noticeable differences between the two teaching methods. While certain practical skills, such as instrumentation, isolation, and caries removal and cavity cleaning, could not be adequately performed after lectures by all the students, all of them (100%) successfully executed these procedures following the jigsaw method. This may be attributed to the interactive nature of the jigsaw technique, which not only encourages better cognitive assimilation but also increases procedural confidence through collaborative practice and peer feedback [ 18 , 19 ]. Notably, none of the students could answer all the knowledge questions or perform all the ART steps correctly after the lecture method in the present study. In contrast, 9 (36%) demonstrated complete knowledge, and 3 (12%) demonstrated full skill competency after the jigsaw puzzle technique of collaborative learning. This suggests that even if traditional lectures are instructive, they might not be enough to help students master clinical domains that need both conceptual knowledge and manual skill. In accordance with these findings, a study conducted in Saudi Arabia reported significantly higher test scores after applying the jigsaw puzzle method of learning for cavity preparation than the traditional method [ 20 ]. A study by Bhandary et al reported the effectiveness of the jigsaw technique in promoting active engagement, analytical reasoning, and collaborative learning, which are pivotal in dental education [ 13 ]. Accordingly, Haider et al., through their preliminary study, reported the effectiveness of the jigsaw technique in fostering motivation and improving academic achievement among undergraduate dental students [ 21 ]. In the present study, there was a significant increase in both knowledge (P < 0.001) and skill scores (P < 0.001) after the jigsaw method of learning was introduced compared with the traditional lecture method. The knowledge score improved from 7 to 9 (median scores), whereas the skill score increased from 4 to 8 (median scores). These findings align with the educational literature emphasizing the effectiveness of student-centered strategies, such as cooperative learning, in enhancing academic performance [ 22 , 23 ]. One possible reason for the superior outcomes with the jigsaw method is its structure, which requires students to teach each other and thus engage with the material at a deeper level. This peer-teaching model likely reinforces learning and fosters better retention, critical thinking, and problem-solving skills. Clinical readiness in health profession education is related to medical students' professional identities, teamwork experience, and objective clinical rotation endpoints [ 24 , 25 ]. This study has some limitations. The sample size was relatively small (n = 25), and the study was conducted in a single institution only, which may limit the generalizability of the findings. Additionally, the short follow-up period precludes conclusions about the long-term retention of knowledge and skills. Furthermore, both the traditional and jigsaw methods of learning were introduced to the same study participants after one month gap. The knowledge and skills acquired through lecture instructions might not have been completely eliminated within a one-month period. Therefore, some form of retention might have occurred, which could have added assessment scores after the jigsaw method. However, the findings of this study support the integration of cooperative methods such as the jigsaw technique into dental curricula to improve both theoretical knowledge and practical competence in dental procedures. Conclusion The findings of this study revealed that the jigsaw puzzle method, which is a cooperative learning technique, is an effective tool for improving both knowledge and practical skills related to atraumatic restorative treatment (ART) among dental students. The jigsaw puzzle method can be incorporated into the dental curriculum for the effective learning of various clinical procedures carried out in dentistry by dental students. It can enhance both knowledge and clinical skills through teamwork. Future research should focus on the impact of cooperative learning over longer durations, across diverse student populations, and with the incorporation of objective clinical assessments for better assessment of results. Abbreviations ART Atraumatic Restorative Treatment BDS Bachelor of Dental Surgery Cooperative L Cooperative Learning SD Standard deviation SPSS Statistical Package for Social Sciences T.U. Tribhuvan University Declarations Acknowledgements The authors would like to thank the fourth-year dental students, third batch studying at Maharajgunj Medical Campus for their voluntary participation in this study. Additionally, the authors would like to thank Maharajgunj Medical Campus for supporting this study by providing the necessary funds. Author contributions S.D.1 and A.K. both designed the study, making substantial intellectual contributions. S.D.1 analysed the data and drafted the manuscript. S.D.2 and P.P. revised the manuscript. S.D. and A.K. contributed to the data collection. S.D.2 and P.P. contributed to data interpretation. All the authors read and approved the final manuscript. Funding The study was funded by the Research Management Cell, Maharajgunj Medical Campus, Maharajgunj, Kathmandu, Nepal, under a Departmental grant. Availability of data and other materials The data and related materials will be provided by the corresponding investigator upon reasonable request. Ethics approval and consent to participate This study was performed following the principles of the Declaration of Helsinki. Ethical approval was obtained from the Institutional Review Committee of the Institute of Medicine, Kathmandu, Nepal [Ref. no 358 (6-11) E2]. Written informed consent was obtained from all fourth-year dental students included as study participants in this study. Consent for publication Not applicable Competing interests The authors declare that they have no competing interests. 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16:40:49","extension":"xml","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":90968,"visible":true,"origin":"","legend":"","description":"","filename":"b72c5f5c83c744ddb92bb88a20bdfda71structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7596280/v1/396ad967d1d04a8ebfa68fdb.xml"},{"id":95664649,"identity":"9d5f1e0d-93e9-42da-9380-2a83a4a28804","added_by":"auto","created_at":"2025-11-11 16:40:49","extension":"html","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":99323,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7596280/v1/49cc3e8c917aa3c8069a2881.html"},{"id":95664641,"identity":"1f400ca5-9281-4bbc-9f95-04eef67e93a9","added_by":"auto","created_at":"2025-11-11 16:40:49","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":20398,"visible":true,"origin":"","legend":"\u003cp\u003eSex distribution of the study participants (n=25)\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7596280/v1/5cb622f1bfb5aee1666eb114.png"},{"id":96877838,"identity":"78bf1289-0632-4052-8429-27b7814507a3","added_by":"auto","created_at":"2025-11-27 06:08:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":667918,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7596280/v1/f3b180df-9330-4d7a-b7e8-5eb0445d4844.pdf"},{"id":95797162,"identity":"be5a173b-4692-43da-a3c7-7a03dd9919c0","added_by":"auto","created_at":"2025-11-13 08:01:31","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":15627,"visible":true,"origin":"","legend":"","description":"","filename":"supplementarydocument.docx","url":"https://assets-eu.researchsquare.com/files/rs-7596280/v1/cf2643396735faa59e29d564.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effectiveness of co-operative learning through the Jigsaw classroom technique for atraumatic restorative treatment: A quasi-experimental study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe development of a supportive learning environment that may help students become informed and competent professionals is emphasized in modern medical education [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Dental students have traditionally received basic science knowledge through lecture-based teaching methods. This conventional method has many disadvantages, such as a lack of encouragement, communication, problem-solving skills, and group effort in solving problems [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDental students acquire the necessary skills as outlined in their BDS curriculum in two phases: preclinical simulated clinical activities followed by subsequent clinical activities in patients. Because these simulated activities are expensive and resource intensive, improving teaching-learning strategies and ensuring that they are supported by evidence is crucial [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. It is recommended that the number of verbal instructions be minimized and should not surpass the learner's attentional capacity to maximize learning outcomes. During the course of acquiring motor skills, instruction frequently includes explanations of how specific body parts, such as hands or fingers, move in relation to other body parts in both space and time [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eEffective teaching practices should enhance students' memory, comprehension, communication, independence, and teamwork skills [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Cooperative learning (Cooperative-L) is one such teaching approach in which students aim to achieve outcomes that benefit themselves as well as other members of the group [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Cooperative-L has been accepted by educators as one of the most effective methods for assisting students in overcoming the difficulties involved in studying complex subjects [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eCooperative learning is a student-centered approach that has been shown to improve practical learning skills, communication abilities, and knowledge comprehension. It also fosters positive student attitudes toward their own learning [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. It involves organizing students into small groups to help each other acquire academic topics [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Cooperative learning has five key elements: positive interdependence, promotive interaction, individual accountability, teaching of interpersonal and social skills, and quality of group processing. Arranging students in groups without positive interdependence does not promote cooperative learning environments [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Positive interdependence in cooperative learning requires students to collaborate as a group to attain common learning objectives [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe jigsaw approach, or Aronson\u0026rsquo;s puzzle, is one of the best known cooperative-L methods. Elliot Aronson developed the Jigsaw method at University of Texas in the early 1970s in an effort to address racial disparities in the classroom [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. On the basis of the idea of collaborative learning, the jigsaw method of learning focuses on breaking down difficult subjects or issues into smaller, more manageable components to help students develop their critical thinking, leadership, social communication, and creative abilities [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In this active method of learning, every member's input is respected, encouraging teamwork and improving academic results [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn recent years, teachers and medical professionals have used their expertise and intuition to help students perform to the best of their abilities. Traditional teaching has shifted the educator's role from teacher to neutral observer [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Therefore, this study was conducted to evaluate the effectiveness of the jigsaw classroom technique in improving dental students' knowledge of and skills in atraumatic restorative treatment.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design\u003c/h2\u003e\u003cp\u003eA quasi-experimental study design was used to evaluate the effectiveness of cooperative learning through the jigsaw classroom technique in teaching atraumatic restorative treatment, a minimally invasive procedure that uses hand instruments and glass ionomer cement for the restoration of cavities.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy participants\u003c/h3\u003e\n\u003cp\u003eThis study was performed among 25 fourth year Bachelor of Dental Surgery (BDS) students at the Maharajgunj Medical Campus (3rd batch BDS) from January-June 2025. They had no prior formal training in atraumatic restorative treatment. However, those who were absent during any single day of data collection were excluded. This study compared knowledge and clinical skills between the traditional lecture method and the jigsaw method.\u003c/p\u003e\n\u003ch3\u003eEthical considerations\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003cp\u003e was received from the Institutional Review Committee of the Institute of Medicine [Ref. no 358 (6\u0026ndash;11) E2]. Informed consent was obtained from the study participants before data collection.\u003c/p\u003e\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eLectures on ART were delivered to students in the classroom where other regular classes were conducted. They were assessed for knowledge via a 10-point scale. The participants were subsequently asked to perform ART on extracted teeth that were mounted in plaster of Paris. Their ability to perform ART was also assessed with the help of a 10-point scale. The criteria for assessment were set by preparing 10 questions each for knowledge and skills by two community dentistry experts working in the same institution.\u003c/p\u003e\u003cp\u003eAfter one month, the same students were divided into five home groups, each of which had five members. Each member was assigned a specific ART subtopic: definition and principles, indications and contraindications, the ART process, GIC manipulation, defective restorations and management. Students with the same subtopic from different groups formed \"expert groups\", where they studied and discussed their assigned topic in depth. It was followed by a teaching phase where expert group members returned to their home groups and taught their peers in their respective subtopics. Collaborative learning was performed with the help of home groups that synthesized a complete understanding of the ART procedures. Finally, an assessment of knowledge and skills was performed, which was similar to that conducted after the lecture method.\u003c/p\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eThe data collected were entered into a Microsoft Excel Sheet and transferred to SPSS version 24 for statistical analysis. The means, standard deviations, medians and interquartile ranges were computed for descriptive statistics. Shapiro‒Wilk test was used to check the normality of the data. Owing to the skewed nature of the data, a nonparametric test was used for further analysis. Wilcoxon signed-rank test was performed to determine the median difference in knowledge and skills scores regarding ART after lecture and the jigsaw method. The significance level was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe mean age of the study participants was 23.56\u0026thinsp;\u0026plusmn;\u0026thinsp;1.07 years (minimum age\u0026thinsp;=\u0026thinsp;22 years, maximum age 26 years). The sex distribution of the study participants is presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eMost of the study participants correctly answered questions concerning contraindications to ART (19, 76%) after the lecture method was delivered, and all of them (25, 100%) could answer this question after jigsaw method was implemented. For the assessment of skills, most of them (21, 84%) could use the press finger technique followed by cleaning the cavity (20, 80%) after the lecture method, whereas all the students (25, 100%) could perform proper instrumentation, isolation of the operating area, caries removal, and cleaning of the cavity after the jigsaw method of learning. In the overall assessment, most of them could answer questions regarding the knowledge and skills of the ART after the jigsaw method of learning (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDistribution of study participants according to their knowledge and skills regarding Atraumatic Restorative Treatment (n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eItems\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eLecture method\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eJigsaw method\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo (0)\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes (1)\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo (0)\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes (1)\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eKnowledge\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDefinition\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15 (60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e20 (80)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrinciples\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16 (64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e23 (92)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18 (72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e24 (96)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eContraindications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19 (76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e25 (100)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProperties of GIC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11 (44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14 (56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e24 (96)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGIC manipulation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19 (76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e19 (76)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProcedure of ART\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11 (44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14 (56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e19 (76)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePost restoration instructions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15 (60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e22 (88)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFailure of ART\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19 (76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e25 (100)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eManagement of failure in ART\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18 (72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e24 (96)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSkills\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInstrumentation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23 (92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e25 (100)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIsolation of the operating area\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23 (92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e25 (100)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCaries removal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8 (32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17 (68)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e25(100)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCleaning the cavity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20 (80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e25 (100)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConditioning of the cavity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13 (52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12 (48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e23 (92)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMixing of cement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21 (84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12 (48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13 (52)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRestoring the cavity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9 (36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e16 (64)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUse of press finger technique\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21 (84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e23 (92)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCarving\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17 (68)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 (32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e17 (68)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaintenance of restorative area\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24 (96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e23 (92)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe distribution of study participants based on all correct responses regarding knowledge and skills is presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. None of the students could answer all the questions regarding knowledge correctly or perform all the steps of ART in extracted teeth correctly after the lecture method. However, 9 (36%) students could correctly answer knowledge questions, and 2 (12%) could perform all steps of the ART correctly (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDistribution of study participants on the basis of all correct responses on knowledge and skills (n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eItems (Total 10 items)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003eCorrect responses to all ten items\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eLecture method n (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eJigsaw method n (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo (0)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes (1)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo (0)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes (1)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKnowledge scores\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16 (64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9 (36)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSkill scores\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22 (88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3 (12)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eA comparison of knowledge and skills scores regarding atraumatic restorative treatment is presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Significantly higher knowledge (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and skills scores (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were obtained after the jigsaw method was used for learning than after the lecture method.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of knowledge and skills scores regarding atraumatic restorative treatment (n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eItems\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMedian (IQR)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP value*\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eKnowledge scores (10 items)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLecture\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e5.96\u0026thinsp;\u0026plusmn;\u0026thinsp;2.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7 (5\u0026ndash;8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJigsaw\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9 (8.50\u0026ndash;10)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSkill scores\u003c/p\u003e\u003cp\u003e(10 items)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLecture\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (3\u0026ndash;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJigsaw\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e8.32\u0026thinsp;\u0026plusmn;\u0026thinsp;0.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 (8\u0026ndash;9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e*Wilcoxon signed rank test\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eStudents can effectively participate in their education, share knowledge with other groups, and take personal responsibility for their learning by using the Jigsaw cooperative learning technique. This cooperative learning method increases interaction and creates an environment of respect and collaboration because each group depends on its members doing well and actively participating in the group to succeed [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Compared with other active learning approaches, there is a paucity of published research evaluating the effectiveness of the jigsaw technique as a teaching strategy for dental students in Nepal. Therefore, this study was conducted to determine the effectiveness of co-operative learning through the jigsaw classroom technique for atraumatic restorative treatment.\u003c/p\u003e\u003cp\u003eThe findings of this study demonstrate a significant improvement in both knowledge and practical skills regarding atraumatic restorative treatment (ART) among dental students using the jigsaw cooperative learning method compared with the traditional lecture-based approach. The participants showed a markedly better understanding of ART concepts after the jigsaw method. After the lecture method of instruction, 19 (76%) students correctly answered question on the contraindications of ART, whereas all the students (25, 100%) correctly answered this question following the jigsaw method. Similarly, key theoretical components, such as the definition, principles, indications of ART, and properties of glass ionomer cement (GIC), also yielded higher correct response rates after jigsaw-based learning than the traditional lecture method. These results are consistent with those of prior studies indicating that cooperative learning fosters deeper understanding by promoting peer discussion, active engagement, and individual accountability [\u003cspan additionalcitationids=\"CR16 CR17\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSkill-based assessments revealed even more noticeable differences between the two teaching methods. While certain practical skills, such as instrumentation, isolation, and caries removal and cavity cleaning, could not be adequately performed after lectures by all the students, all of them (100%) successfully executed these procedures following the jigsaw method. This may be attributed to the interactive nature of the jigsaw technique, which not only encourages better cognitive assimilation but also increases procedural confidence through collaborative practice and peer feedback [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eNotably, none of the students could answer all the knowledge questions or perform all the ART steps correctly after the lecture method in the present study. In contrast, 9 (36%) demonstrated complete knowledge, and 3 (12%) demonstrated full skill competency after the jigsaw puzzle technique of collaborative learning. This suggests that even if traditional lectures are instructive, they might not be enough to help students master clinical domains that need both conceptual knowledge and manual skill. In accordance with these findings, a study conducted in Saudi Arabia reported significantly higher test scores after applying the jigsaw puzzle method of learning for cavity preparation than the traditional method [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. A study by Bhandary et al reported the effectiveness of the jigsaw technique in promoting active engagement, analytical reasoning, and collaborative learning, which are pivotal in dental education [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Accordingly, Haider et al., through their preliminary study, reported the effectiveness of the jigsaw technique in fostering motivation and improving academic achievement among undergraduate dental students [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn the present study, there was a significant increase in both knowledge (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and skill scores (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) after the jigsaw method of learning was introduced compared with the traditional lecture method. The knowledge score improved from 7 to 9 (median scores), whereas the skill score increased from 4 to 8 (median scores). These findings align with the educational literature emphasizing the effectiveness of student-centered strategies, such as cooperative learning, in enhancing academic performance [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. One possible reason for the superior outcomes with the jigsaw method is its structure, which requires students to teach each other and thus engage with the material at a deeper level. This peer-teaching model likely reinforces learning and fosters better retention, critical thinking, and problem-solving skills. Clinical readiness in health profession education is related to medical students' professional identities, teamwork experience, and objective clinical rotation endpoints [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis study has some limitations. The sample size was relatively small (n\u0026thinsp;=\u0026thinsp;25), and the study was conducted in a single institution only, which may limit the generalizability of the findings. Additionally, the short follow-up period precludes conclusions about the long-term retention of knowledge and skills. Furthermore, both the traditional and jigsaw methods of learning were introduced to the same study participants after one month gap. The knowledge and skills acquired through lecture instructions might not have been completely eliminated within a one-month period. Therefore, some form of retention might have occurred, which could have added assessment scores after the jigsaw method. However, the findings of this study support the integration of cooperative methods such as the jigsaw technique into dental curricula to improve both theoretical knowledge and practical competence in dental procedures.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe findings of this study revealed that the jigsaw puzzle method, which is a cooperative learning technique, is an effective tool for improving both knowledge and practical skills related to atraumatic restorative treatment (ART) among dental students. The jigsaw puzzle method can be incorporated into the dental curriculum for the effective learning of various clinical procedures carried out in dentistry by dental students. It can enhance both knowledge and clinical skills through teamwork. Future research should focus on the impact of cooperative learning over longer durations, across diverse student populations, and with the incorporation of objective clinical assessments for better assessment of results.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eART\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Atraumatic Restorative Treatment\u003c/p\u003e\n\u003cp\u003eBDS\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Bachelor of Dental Surgery\u003c/p\u003e\n\u003cp\u003eCooperative L\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Cooperative Learning\u003c/p\u003e\n\u003cp\u003eSD\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Standard deviation\u003c/p\u003e\n\u003cp\u003eSPSS\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Statistical Package for Social Sciences\u003c/p\u003e\n\u003cp\u003eT.U. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Tribhuvan University\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank the fourth-year dental students, third batch studying at Maharajgunj Medical Campus for their voluntary participation in this study. Additionally, the authors would like to thank Maharajgunj Medical Campus for supporting this study by providing the necessary funds.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eS.D.1 and A.K. both designed the study, making substantial intellectual contributions. S.D.1 analysed the data and drafted the manuscript. S.D.2 and P.P. revised the manuscript. S.D. and A.K. contributed to the data collection. S.D.2 and P.P. contributed to data interpretation. All the authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was funded by the Research Management Cell, Maharajgunj Medical Campus, Maharajgunj, Kathmandu, Nepal, under a Departmental grant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and other materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data and related materials will be provided by the corresponding investigator upon reasonable request.\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThis study was performed following the principles of the Declaration of Helsinki. Ethical approval was obtained from the Institutional Review Committee of the Institute of Medicine, Kathmandu, Nepal\u0026nbsp;[Ref. no 358 (6-11) E2]. Written informed consent was obtained from all fourth-year dental students included as study participants in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKarimi Moonaghi H, Bagheri M, Jigsaw. A good student-centered method in medical education. Future of Medical Education Journal [Internet]. 2017 Mar 1 [cited 2025 Aug 6];7(1):35\u0026ndash;40. 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Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11583157\u003c/span\u003e\u003cspan address=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11583157\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Atraumatic Restorative Treatment, Co-operative Learning, Jigsaw, Lecture","lastPublishedDoi":"10.21203/rs.3.rs-7596280/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7596280/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eCo-operative learning like jigsaw technique consists of five basic elements namely positive interdependence, promotive interaction, individual accountability, teaching of social skills and quality of group processing. This study was conducted to evaluate the effectiveness of jigsaw classroom technique in improving dental students' knowledge and skills towards atraumatic restorative treatment (ART).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA quasi-experimental study was conducted among 25 dental students of Maharajgunj Medical Campus. Lecture on ART was delivered in the class followed by evaluation through a ten-point checklist for knowledge and ten-point checklist for skills. After one month, the students were divided into small, mixed-ability groups (5 in each group, total 5 groups) using jigsaw technique followed by content division, their assignment to expert groups, expert teaching, group activities and evaluation. Data was analyzed in SPSS version 24. Mean, standard deviation, median, interquartile range for quantitative data and frequency and percentage for qualitative data were calculated. Wilcoxon signed rank test was performed to determine the difference in median rating of knowledge and skill scores after lecture and jigsaw method. The significance level was set at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eAfter lecture, 19 (76%) were able to answer questions on ART contraindications, whereas each participant answered correctly following jigsaw method. While all students were able to perform proper instrumentation, isolation of the operating area, caries removal, and cavity cleaning after using the jigsaw method of learning, the majority (21, 84%) were able to use only press finger technique followed by cavity cleaning (20, 80%) after lecture method. Some 9 (36%) students could correctly answer all ten knowledge questions and 3 (12%) could perform all steps of ART correctly after applying jigsaw method of learning but none of them could do so after lecture method. The jigsaw technique of learning resulted in significantly higher knowledge (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and skills scores (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) than lecture method.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThe study findings reveal that jigsaw method of learning is effective than traditional lecture method in enhancing both knowledge and practical skills of dental students. The jigsaw puzzle method can be integrated into the dental curriculum for dental students to effectively learn the many clinical procedures in dentistry.\u003c/p\u003e","manuscriptTitle":"Effectiveness of co-operative learning through the Jigsaw classroom technique for atraumatic restorative treatment: A quasi-experimental study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-11 16:40:44","doi":"10.21203/rs.3.rs-7596280/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3bbe98d7-147c-4873-af30-5172f46fbd84","owner":[],"postedDate":"November 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-27T06:08:21+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-11 16:40:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7596280","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7596280","identity":"rs-7596280","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}