Using an Abbreviation Puzzle as a Method to Familiarize Students with Infectious Diseases

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Co-Authored by Peyton Bellflower, Teighlor Livingston, Yalanda Gordon, Rachel Davis, Torien Beard, Matt Cowan, *Thomas Manning

*Chemistry department, Valdosta State University, Valdosta, Georgia, 31698

Puzzles used in an educational setting are primarily used for developing a student’s problem solving skills and, in some cases, to introduce content. Different types of puzzles are used in the field of medical education. For example, one study examined the use of crossword puzzles in teaching anatomy to medical school students. They were used as a student-oriented method to introduce and reinforce concepts and vocabulary.1-4 

Mohammed et al. incorporated an active learning exercise centered on the use of puzzles to learn anatomy with a group of 150 students.5 The students demonstrated the development of critical thinking skills that applied to human anatomy. In an end of course survey, students considered the crossword puzzles as an active learning exercise. Crossword puzzles have also been incorporated into a veterinarian school curriculum.6 The puzzle approach is used as a replacement method to simplify memorization of material by rote learning, a technique that the authors argued involve no strategy. This study measured an improvement in students that used a crossword puzzle compared to a group that had only memorization as a tool. The results of the study showed that the students that used a puzzle performed better than those that simply relied on memorization.7 Bryant used puzzles to reinforce lecture materials in a physiology course. The author found that the use of puzzles increased the interest level of the students and broke up what was described as “monotonous routine lectures.”.7 De Silva et al. developed and utilized word search puzzles as a teaching tool to increase students' interest in studying Diabetes Mellitus.8 The authors outlined how the puzzles have advantages such as increasing communication and cooperative skills, reflection on the content and providing students with an exercise that involves strategy. Yuriev et al. from Pharmacy and Pharmaceutical Sciences at Monash University outlined the use of puzzles in a chemistry curriculum.9 They also provide an excellent introduction and overview of the use of puzzles described in the literature ranging from the humanities to remembering drug names.


familiarity with infectious disease abbreviations & symptoms of each included malady

Time required: 

From creating a puzzle to determining possible answers and point values, can take as little as half an hour to to an hour, depending on the grid type.


In the history of humanity, infectious diseases have had a tremendous impact on both the quality of life and the life expectancy of the world’s population. While there are prominent ones that appear in the media (i.e. HIV and pneumonia), there are many that most people have never heard of. When students learn these diseases, whether as part of a health care curriculum or through general science education classes, familiarization with the infections’ name is the first step. 

This puzzle is developed by students and a faculty member of Valdosta State University during the Coronavirus pandemic that has brought the world to a standstill. It blends a novel approach to puzzles with an educational activity to serve as a learning tool for infectious diseases. While there is a strong strategic aspect to solving or completing the puzzle, it should also familiarize the participant with the names of infectious diseases and a few facts about each malady.


Table 1 can be found in the "Supporting Information". It provides a list of over 240 (alignment with the abstract) infectious diseases and abbreviations have been assigned to each malady. This is a unique type of puzzle that aims to combine the use of a strategic approach to maximize the score while providing strong educational aspects that familiarizes the participant with the name and general facts about the infections. The goal is to complete the puzzle using only the abbreviations provided.  We have broken the types down into two groups; the first is the smaller puzzles that must have all squares filled to be considered complete. In these puzzles, the number of abbreviations used is added up for a point total. The larger puzzle only has to have two or more letters connected. It does not require that all squares are filled. The ultimate goal with this style is to use all of the abbreviations. The instructions are as follows:


2 x 2 GRID

1. The participant can use a puzzle that has one of many geometries. For example, the puzzle can be empty (Figure 1A), give a random letter (Figure 1B), or provide the abbreviation of a disease (Figure 1C) as the starting point for the participants. In this preliminary demonstration a small (2x2) grid is utilized.

Figure 1A: A blank puzzle grid


Figure 1B: A random letter, I in this case, is provided


Figure 1C: The abbreviation for one of the diseases (Table 1) is provided as a starting point


2. Add letters to make the most infectious diseases abbreviation initials possible. There are a few regulations to this:

a. An infectious disease abbreviation can only count once toward the point total.

b. Every square must contain a letter for the puzzle to be considered complete.

c. The initials from the table are the only ones that can be used.

d. The goal is to finish the puzzle (all squares filled) and to maximize your point total!

e. Abbreviations can be added forward, backward, horizontal, vertical, or diagonal.

f. The participant can NOT add random letters to fill blank spaces. When a letter is added it must result in at least one new abbreviation. It does NOT have to result in new initials in all directions/connections.

g. Each abbreviation added counts as one point toward the total score. When given in a classroom setting, a competitive environment adds an extra dimension to the learning atmosphere. Also, the exercises can be timed events.

The participant completes Figures 1 A, B, or C above. The completed puzzle does not have to include an abbreviation in every direction. Figure 2A is one example of a completed puzzle that started with all squares blank.

Figure 2A: The blank puzzle completed (See Figure 1A)


Figure 2B: The puzzle with the random letter completed (See Figure 1B)


Figure 2C: The puzzle with the abbreviation completed (See Figure 1C)


The two 2x2 puzzles, (Fig. 1, 2), which are used to demonstrate the rules, will only accommodate a small number of abbreviations and the 3 letter abbreviations cannot be used. Below is a 5x5 puzzle that also draws on Table 1. This puzzle combines the need of a strategic approach to maximize the score and strong educational aspects that familiarizes the participant with the name and a few general facts. It assumes no prior knowledge on the topic. The goal is to complete the puzzle by connecting the letters using only the abbreviations provided.

The instructions are;

1. Any number of letters in any arrangement can be used to start the puzzle. In this case, two letters, R and C, are randomly selected. This is provided to the participant (Fig. 2D).


Figure 2D: The letters used and their position can be changed


The abbreviations in Table 1 are used to complete the puzzle. The puzzle is considered completed when the letters are connected— specifically boxes containing letters are touching horizontally, vertically and/or diagonally. Below the puzzle the participant keeps track of the abbreviations utilized (Fig. 2E).


Figure 2E: RB, BR, BO, GO, CG, GE, GA, AG, AE (9 points)


5 x 5 GRID

The Rules summarized are:

2. Add letters to generate the most infectious diseases abbreviation initials. Regulations to this:

a. The letters given in the grid are connected using the abbreviations provided in Table 1.

b. An infectious disease abbreviation can only count once toward the point total. A completed puzzle may have the same abbreviation in multiple locations but the disease can only count once.

c. One abbreviation can count twice if both the forward and reverse (i.e. BR, RB) are in the table.

d. The initials from the table are the only ones that can be used.

e. The goal is to finish the puzzle and to maximize your point total!

f. Abbreviations can be added forward, backward, horizontal, vertical, or diagonal.

g. The participant can NOT add random letters to fill blank spaces. When a letter is added it must result in at least one new abbreviation. It does NOT have to result in new initials in all directions.

h. Three letter abbreviations may be considered a bonus in some cases. For example, CLM also contains the abbreviations CL and LC, so it would count as three points.

i. Each abbreviation added counts as one point toward the total score.


Figure 2F: Adding one letter increased the point total


While Puzzle 1 is considered complete, the score is low. Additional abbreviations can be added to increase the score until the table is full. For example, adding the letter I (above) forms RI, BI, GI, or three additional points; or 9 points total (Fig. 2F).


4 x 4 GRID, LARGER GRIDS & Adding Variations

Figure 3A, B, C, D, and E are larger grids with different shapes. Variations can be used with participants if the activity is used multiple times. For example, in Table 1 there is a brief description of each infectious disease. In order to have students read the description, there can be a puzzle that only uses abbreviations for diseases that mention bacterial diseases, another for viral and a third for parasites. Others can require you only use diseases that begins with a specific letter (only use letters H and C), or all diseases are eligible except ones that mention an antibiotic. By changing geometries and using starting letters in different locations, different strategies apply, and the same puzzle is not reused.


Figure 3A: A larger grid


Figure 3B: Slight variations in geometries can force a change in strategy


Figure 3C: As the number of squares increases, the number of possible solutions increases and the strategy becomes more important to maximize the score.


Figure 3D: The spiral puzzle makes most selections one dimensional



Figure 3E: The ladder puzzle format can be completed fairly quickly and can be used as a warm up for the larger puzzle (below) or a quick exercise at the beginning of a class that uses a subset of Table 1. For example, students can only use diseases that begin with the letters A, C and M.


15 x 15 GRID

Figure 4 is a 15 x 15 grid that can be completed using all of the abbreviations in Table 1. All of the grids in the puzzle do not have to be filled for it to be considered complete. In this approach, using all of the abbreviations coupled with a higher number of unused grids results in a higher score.


Figure 4: The ultimate grid for infectious diseases can be used several ways.


There can be two types of grids given:

a. An empty grid that is considered completed when all of the abbreviations are used.

Calculate your score using: # Points = (# of Disease Abbreviations) / (# of squares occupied by a letter)    (Equation1)

This puzzle rewards maximizing abbreviations in all directions.

b. Two or more letters are provided in the puzzle and must be connected for the puzzle to be complete. Once the first approach is used, there is a blueprint available. Inserting letters in different locations of the grid for different groups of participants can assure that a unique solution is required.

All other rules used for the smaller puzzles outlined above apply.



This puzzle is designed to familiarize students with the names and a few facts of over 230 infectious diseases that plague humanity at different levels and in different forms. The activity involves strategy and allows students to adsorb the names and a few facts about each disease. The last eight diseases are Coronaviruses, which is currently in the news around the clock and resulted in our university closing (as well as many others worldwide). This puzzle is not limited to students in healthcare or science curriculums, but can be used by any person, from middle school to old age, that might be interested in learning more about infectious diseases.


Compile puzzle options and either print table 1 or upload for students to access virtually.

We would like to thank the NSF Noyce Program for sponsoring the original development of his puzzle logic by Noyce interns during the summer of 2019.
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  2. Manning, T., Monetti, D. M., (2013) Nano and Molecular Cryptology: Hiding Information in Molecules and Nanostructures, Journal of Nano Education, 5 (2), 93-108(16).
  3. Slater, M.S., Moss, H., Cowger, J.J., Nichols, L., Robinson, A., Spradley, A., Vinson, J., Change, J., Hathaway, D., Manning, T., (2018) Word Strings and Famous Quotes: Blending a Strategic and Familiarity Exercise for STEM Education, The Chemical Educator, 23, 159-164.
  4. Tanner, J., (2010) International Chemistry Competition Winners Announced, April 27, 10-082.
  5. Nazeer Mohammed, Sultana Razia, Ahmed Mohammad Muzammil, Asad Mohammad Rehan, Sami Waqas, Hattiwale Haroon Rasheed, Sreekanth T, International Journal of Medical Research & Health Sciences,  2018, 7(10), p. 12-19.
  6. Angel Abuelo, Cristina Castillo, Stephen A. May, Journal of Veterinary Medical Education, Volume 43 Issue 3, Fall 2016, pp. 255-262.
  7. Bryant, J.D., Crossword Puzzles - Entertaining tool to reinforce lecture content in undergraduate physiology teachingInternational Journal of Biomedical Research, Vol. 7 NO.6 (2016)
  8. da Silva E, Toledo MM, Lopes PH (2017) Word Searches Puzzles as a Tool to Motivate Learning about Diabetes Mellitus. J Dia Res Ther 3(1).
  9. Elizabeth Yuriev, Ben Capuano and Jennifer L. Short, Chem. Educ. Res. Pract., 2016, 17, 532.

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