The architecture of visual narrative comprehension: the interaction of narrative structure and page layout in understanding comics

Evaluating the Impact of Cartoon-Based Learning on Student Performance and Engagement in Medical Education: An Experimental Study

BACKGROUND

Pathology, a foundational yet challenging subject in medical education, is marked by its extensive content and intricate concepts. These complexities often pose a significant learning barrier for students, who must not only comprehend but also effectively apply this knowledge in their clinical practice.

OBJECTIVE

This study aimed to investigate the impact of utilizing cartoons as a supplementary educational tool in pathology. Specifically, it focused on assessing whether incorporating cartoons into the learning process would enhance students' understanding, memory retention, and ability to recall complex topics, thereby augmenting the effectiveness of traditional teaching methodologies.

MATERIALS AND METHODS

Conducted from June to September 2022, this experimental study involved 106 second-year MBBS (Bachelor of Medicine and Bachelor of Surgery) students. Participants were split into two groups: the "traditional group," which received standard interactive large-group teaching, and the "combination group," which benefited from both the standard teaching and additional cartoon-based instruction. The study focused on two selected chapters of the pathology curriculum. After completing the first chapter, the groups were crossed over for the second chapter. Evaluation of the students' learning was conducted through post-learning assessments using multiple-choice questions (MCQs).

RESULTS

The combination group, which received both traditional and cartoon-based teaching, showed a significant improvement in their assessment scores compared to the traditional group. This improvement was consistent in both assessments conducted (t(102) = 8.41, p < .001 and t(99) = 6.85, p < .001). Additionally, feedback from the students through a post-learning survey indicated a strong preference for the use of cartoons. The majority of students agreed that cartoons facilitated a better understanding and retention of complex pathology topics (χ² = 130.9, p < 0.001).

CONCLUSION

The incorporation of cartoons as a supplementary learning tool in pathology teaching shows promising results. This innovative approach not only complements but also enhances the traditional teaching methods, leading to improved comprehension, retention, and recollection of complex subjects among medical students. The study highlights the potential of cartoons in revolutionizing medical education, especially in teaching challenging subjects like pathology.

Modulation of Spectral Representation and Connectivity Patterns in Response to Visual Narrative in the Human Brain

The regional brain networks and the underlying neurophysiological mechanisms subserving the cognition of visual narrative in humans have largely been studied with non-invasive brain recording. In this study, we specifically investigated how regional and cross-regional cortical activities support visual narrative interpretation using intracranial stereotactic electroencephalograms recordings from thirteen human subjects (6 females, and 7 males). Widely distributed recording sites across the brain were sampled while subjects were explicitly instructed to observe images from fables presented in “sequential” order, and a set of images drawn from multiple fables presented in “scrambled” order. Broadband activity mainly within the frontal and temporal lobes were found to encode if a presented image is part of a visual narrative (sequential) or random image set (scrambled). Moreover, the temporal lobe exhibits strong activation in response to visual narratives while the frontal lobe is more engaged when contextually novel stimuli are presented. We also investigated the dynamics of interregional interactions between visual narratives and contextually novel series of images. Interestingly, the interregional connectivity is also altered between sequential and scrambled sequences. Together, these results suggest that both changes in regional neuronal activity and cross-regional interactions subserve visual narrative and contextual novelty processing.

A comic-based body image intervention for adolescents in semi-rural Indian schools: Study protocol for a randomized controlled trial

Adolescents in India experience body dissatisfaction, however, empirically supported interventions are lacking. This paper describes the protocol for the development, acceptability testing, and cluster randomized controlled trial (RCT) of a six-session comic-based intervention, which aims to improve body image and related outcomes among adolescents in semi-rural Indian schools. If found to be acceptable and effective, UNICEF will disseminate the intervention across schools in eight states of India. The acceptability study will be conducted with 24 students in Classes 6-8 (age 11-14) and nine teachers from Hindi-medium government schools using interviews and focus groups. The subsequent RCT will be conducted with 2400 students, with schools randomized to either the comic-based intervention or lessons-as-usual (control) groups. The primary outcome is body esteem, and secondary outcomes are disordered eating, appearance ideal internalization, body-image-related life disengagement, self-esteem, negative affect, and positive affect. Additional exploratory outcome measures are skin colour dissatisfaction, body hair dissatisfaction, appearance-based teasing, and endorsement of traditional gender roles. These outcomes will be examined at three timepoints: baseline (T1), 1 week-post-intervention (T2), and 12-weeks follow-up (T3). Analyses will compare outcomes in the intervention with the control group. This will be the first study to evaluate a body image intervention for adolescents in semi-rural Indian schools.

Comics as a body image intervention among adolescents in Indian Hindi medium schools: insights from an acceptability study

BACKGROUND

Indian adolescents experience body dissatisfaction. However, empirically supported interventions are lacking, particularly in lower socio-economic regions of India. This paper describes the acceptability testing of a six-session teacher-led comics-based intervention, aiming to improve body image and related outcomes among adolescents in Indian Hindi medium schools.

METHODS

Thirty-five students (50% girls; M _{age, girls} = 12.3 years; M _{age, boys} = 13 years) and nine teachers (11% women) from Hindi medium schools in Rajasthan, India, completed a quantitative acceptability questionnaire regarding comics that target body dissatisfaction and associated risk factors. They also participated in online or telephone semi-structured interviews to share in-depth feedback, with teachers providing additional feedback on an accompanying teacher guide. The quantitative data were analysed descriptively, with the interviews analysed using qualitative codebook thematic analysis.

RESULTS

Quantitative analyses revealed that 73% of students felt the comics made them feel good about themselves. Qualitative analyses revealed four themes: (1) body dissatisfaction is a concern; (2) the comics are powerful; (3) increasing ease of understanding; (4) a teacher guide to aid delivery.

CONCLUSION

This study demonstrates acceptability of a novel teacher-led comics-based body image intervention for adolescents in Indian Hindi medium schools from lower socio-economic settings. These findings are currently informing intervention optimizations, which will be evaluated in a randomized controlled effectiveness trial. If found to be effective, this intervention will be disseminated across eight Indian states by UNICEF. Trial registration. This trial has been registered with ClinicalTrials.gov; a database of privately and publicly funded studies conducted around the world. Registration date: 2nd May 2020; Registration ID: (NCT04317755). https://clinicaltrials.gov/ct2/show/NCT04317755?term=NCT04317755&draw=2&rank=1.

Cartoon versus traditional self-study handouts for medical students: CARTOON randomized controlled trial

OBJECTIVE

The objective of this study is to compare the effectiveness of a "cartoon-style" handout with a "traditional-style" handout in a self-study assignment for preclinical medical students.

METHODS

Third-year medical students (n = 93) at the Faculty of Medicine Ramathibodi Hospital, Mahidol University, took a pre-learning assessment of their knowledge of intercostal chest drainage. They were then randomly allocated to receive either a "cartoon-style" or a "traditional-style" handout on the same topic. After studying these over a 2-week period, students completed a post-learning assessment and estimated their levels of reading completion.

RESULTS

Of the 79 participants completing the post-learning test, those in the cartoon-style group achieved a score 13.8% higher than the traditional-style group (p = 0.018). A higher proportion of students in the cartoon-style group reported reading ≥75% of the handout content (70.7% versus 42.1%). In post-hoc analyses, students whose cumulative grade point averages (GPA) from previous academic assessments were in the middle and lower range achieved higher scores with the cartoon-style handout than with the traditional one. In the lower-GPA group, the use of a cartoon-style handout was independently associated with a higher score.

CONCLUSIONS

Students given a cartoon-style handout reported reading more of the material and achieved higher post-learning test scores than students given a traditional handout.

What is your neural function, visual narrative conjunction? Grammar, meaning, and fluency in sequential image processing

Visual narratives sometimes depict successive images with different characters in the same physical space; corpus analysis has revealed that this occurs more often in Japanese manga than American comics. We used event-related brain potentials to determine whether comprehension of "visual narrative conjunctions" invokes not only incremental mental updating as traditionally assumed, but also, as we propose, "grammatical" combinatoric processing. We thus crossed (non)/conjunction sequences with character (in)/congruity. Conjunctions elicited a larger anterior negativity (300-500 ms) than nonconjunctions, regardless of congruity, implicating "grammatical" processes. Conjunction and incongruity both elicited larger P600s (500-700 ms), indexing updating. Both conjunction effects were modulated by participants' frequency of reading manga while growing up. Greater anterior negativity in frequent manga readers suggests more reliance on combinatoric processing; larger P600 effects in infrequent manga readers suggest more resources devoted to mental updating. As in language comprehension, it seems that processing conjunctions in visual narratives is not just mental updating but also partly grammatical, conditioned by comic readers' experience with specific visual narrative structures.

Drawing the line between constituent structure and coherence relations in visual narratives

Theories of visual narrative understanding have often focused on the changes in meaning across a sequence, like shifts in characters, spatial location, and causation, as cues for breaks in the structure of a discourse. In contrast, the theory of visual narrative grammar posits that hierarchic "grammatical" structures operate at the discourse level using categorical roles for images, which may or may not co-occur with shifts in coherence. We therefore examined the relationship between narrative structure and coherence shifts in the segmentation of visual narrative sequences using a "segmentation task" where participants drew lines between images in order to divide them into subepisodes. We used regressions to analyze the influence of the expected constituent structure boundary, narrative categories, and semantic coherence relationships on the segmentation of visual narrative sequences. Narrative categories were a stronger predictor of segmentation than linear coherence relationships between panels, though both influenced participants' divisions. Altogether, these results support the theory that meaningful sequential images use a narrative grammar that extends above and beyond linear semantic shifts between discourse units. (PsycINFO Database Record