Learning the concepts of clinical radiology, including lesion identification and formulation of differential diagnosis lists, can be challenging for veterinary students. A series of educational puzzles with an overarching narrative was developed to help students learn the fundamental concepts of urogenital, thoracic, and spine imaging. Third-year veterinary students had the opportunity to use as many of the puzzles as they wished as a part of their studies in a semester-long imaging course, and students completed surveys to indicate which puzzle sections they used and provide their opinions of the activities. Graded performance in the course was correlated with how many puzzle activities students used. A small but statistically significant correlation was found between the number of puzzle sections used and midterm exam score, final exam score, and overall course score. Although most students who used the puzzles as a part of their studies enjoyed the activities, there was a dramatic decrease in usage over the semester, from 74% of survey respondents using the initial topic to a low of 27% utilization of the sixth topic, followed by a small rebound to 37% for the eighth topic (the review for the final exam). Thus, while developing a puzzle series is achievable and beneficial to student learning, possibly because of improved student engagement through increased variety in learning opportunities, further steps are necessary to encourage continued student engagement throughout the semester.
