251 Effects of Escape Room Simulation on Trainee Confidence

Abstract

Simulation-based learning revolutionized medical education and enabled safe clinical teaching. Although high-fidelity simulations mimic clinical situations, they mostly lack the emotional extremes of the authentic workplace. However, particularly in the emergency department, emotions like urgency, anxiety and fear are shown to alter physicians clinical reasoning and teamwork skills. Escape room games have recently been applied to medical education to fill this gap. Holding gamification elements, escape rooms adapt to reflect the clinical atmosphere; therefore, can be used to teach and assess both clinical and soft skills under emotional and time pressure in a feasible way. This study aims to evaluate the effects of escape room use as a simulation environment on clinical success and trainee confidence. This observational pilot study was performed to evaluate the self-assessed confidence levels regarding teamwork, leadership, clinical and communication skills, and tutor-assessed clinical skills of emergency medicine (EM) residents, in an escape room environment simulating realistic EM cases (Table). Two standardized patients and 2 mannequins were used to simulate the cases. Each team is required to have at least one PGY-1 and PGY-3 EM resident and had a maximum of 60 minutes to complete the course. Each participant completed a 5-point Likert scale type pre- and post-game confidence questionnaire (Table). Independent EM faculties assessed video-recordings of performances to decide team competency according to pre-determined criteria and scoring system. Assessment data were analyzed using means and standard deviation. Wilcoxon rank sum and Spearman correlation tests were used to compare pre- and post-game confidence scores, analyze the correlation between pre- and post-game confidence scores and team success, respectively. The primary study outcome was to evaluate the effects of escape rooms as a simulation environment on trainee confidence. The secondary outcome was to analyze the relationship between trainee-assessed individual confidence levels and tutor-assessed team success. All 4 teams (T), including a total of 18 EM residents (T1: n= 4, T2: n=5, T3: n=5, T4: n=4), were able to complete all the 4 stations including 8 measured tasks. There was no significant difference between team demographics (age, sex, PGY). There was no statistically significant correlation between the mean pre- and post-game confidence scores and team success. The post-game confidence score of questions focusing on the leadership (Question 9 and 10) were significantly higher than the pre-game scores. (p=0.02 and p=0.046, respectively) Our study showed that escape room simulations improved leadership confidence in EM residents. Escape room simulations can be implemented into simulation-based training sessions to facilitate leadership.