The City as Escape Room: Place, Participation, Meaning, and Affect

Little Patients, Big Tasks - A Pediatric Emergency Medicine Escape Room.

This study investigates the influence of the educational game design elements immersion, collaboration and debriefing, on fostering learning with educational escape rooms. We based the design of the escape room on an educational game design framework that aligns the learning goal and the game goal, that is, escaping from the room. One‐hundred‐and‐twenty‐six students, aged between 16 and 20 played the escape room. Measures for learning were pre‐and post‐tests. The game experience was measured through questionnaires, classroom observations and interviews with students and teachers. The results show a knowledge gain between pre‐and post‐test. Correlational analysis showed that all three design elements contributed to students' appreciation of the escape room, whereas only immersion had a direct contribution to knowledge gain. Based on the qualitative data it appeared that the used escape boxes contributed most to perceived immersion. Immersion helps students focus on each other and the tasks. Also, a narrative with distinct roles for each student helped to evoke immersion. Unexpectedly, these roles also scaffolded collaboration except for students in the school that engaged in a collaborative learning pedagogy. The study confirms the usability of the framework for game designs, based on theories for the design of physical and hybrid educational games. Practitioner notesWhat is already known about this topic The escape room as a learning environment appeals to teachers of different disciplines, ages, gender and teaching experiences. Teachers implement escape rooms to create active (hybrid) learning spaces, where learners need a combination of knowledge and skills to solve the subject‐based activities. Students and teachers perceive that while participating in escape rooms, students are more engaged, active and learn more compared to regular classes. The assumption is that escape rooms support collaboration and automatically collaborative learning. Review studies on educational escape rooms show that a systematic evaluation is usually absent, disputable or indicates no knowledge gain. Teachers design their educational escape rooms based on digital escape games and/or their experience as players of escape rooms. For digital educational games, important game design aspects are researched. Three main challenges in designing educational games are (1) the participants' transition from the real world to the game world, (2) the alignment of game design aspects and educational aspects and (3) the transfer from attained experiences and knowledge back into the real world. What this paper adds This paper evaluates an educational game design framework for escape rooms, focussing on the above‐mentioned main challenges in designing educational games. It investigates the influence of the educational game design elements immersion, collaboration and debriefing, on fostering learning with a hybrid educational escape room. It informs that all three design elements contributed to students' appreciation of the escape room, whereas only immersion had a direct contribution to knowledge gain. The used hybrid escape boxes contributed most to the immersion; scaffolding students to focus on each other and the tasks. Students' collaboration was successfully fostered. However, it scarcely led to collaborative learning during gameplay, due to lack of discussion and reflection needed for deeper understanding. Implications for practice and/or policy The educational escape game framework would help educators creating immersive games, which not only confront learners with meaningful contexts but also give learning gains. The educational escape game framework would help researchers focussing on important and difficult aspects of designing and implementing educational escape rooms to develop and research more effective escape rooms. In guidelines on creating immersion in educational escape games, the notion of physical objects is lacking. In this hybrid escape room, the physical objects such as escape boxes were the most powerful in creating immersion. In addition, the use of sound design in escape games in classrooms seems overrated. Debriefing after the gameplay is perceived necessary to discuss common misunderstandings, to make connections between the topics in various puzzles and to add more content to interest high‐achieving students.

As the need for healthcare professionals continues to grow, different learning environments have been assessed to optimize knowledge while keeping the student engaged. Escape rooms, live action, team-based exercises, supplemented with TeamSTEPPS tools can assist in overall team performance, while keeping the participant engaged in a new learning environment. The goal of this quality improvement project was to enhance teamwork and collaboration through the integration of TeamSTEPPS concepts and escape room active learning. This concept was explored through the integration of TeamSTEPPS tools and strategies in an escape room setting. The purpose was to improve team dynamics and cohesiveness in a new dynamic way with a small cohort of nurse leaders in a large urban academic medical center, while exploring the engagement and depth of learning experience for the participant. Twelve nurse leaders completed two different escape rooms while observers completed the TeamSTEPPS observation tool assessing team dynamics and performance and participants assessed their perceptions before and after intervention. These nurses also were observed at staff meetings and completed a perceptions tool on teamwork pre- and postintervention. A postescape room survey was completed by participants to assess learning and interest in this interactive learning exercise. There was a significant statistical difference after TeamSTEPPS and escape room intervention (Mean 17.3 and p = 0.004 SD 5.9) when compared to before intervention as well as has a more positive sense of teamwork was noted. In addition, 75% of the nurses strongly agreed that the escape room was engaging and fun with 25% agreeing. Ninety-one percent agreed or strongly agreed that the escape room was an effective team-building exercise with 100% agreeing or strongly agreeing to recommend the escape room experience to others. This cohort validated the integration of TeamSTEPPS tools and strategies in an escape room setting as an enjoyable and engaging way to learn while providing an effective team-building activity. This small cohort demonstrates that new methods of learning such as an escape room should be explored further for engaging participants and improving communication and teamwork skills. Integrating TeamSTEPPS into an escape room offers this institution a way to continue this project while providing valuable team-building skills to its participants. While this was just a small sample in one intercity hospital, new methods for learning should be reviewed for successful teamwork in nursing and in healthcare as a whole, as there was some data to suggest that utilizing an escape room could have a positive impact on team cohesiveness as well as leadership skills for the individual.

ObjectivesEscape rooms are popular team-building activities used in both professional and commercial settings. The concept, where a team must work through multiple tasks to achieve a goal, has been incorporated...

Teamwork, a skill critical for quality patient care, is recognized as a core competency by the Accreditation Council for Graduate Medical Education (ACGME). To date, there is no consensus on how to effectively teach these skills in a forum that engages learners, immerses members in life-like activities, and builds both trust and rapport. Recreational ‘Escape Rooms’ have gained popularity in creating a life-like environment that rewards players for working together, solving puzzles, and completing successions of mind-bending tasks in order to effectively ‘escape the room’ in the time allotted. In this regard, escape rooms share many parallels with the multitasking and teamwork that is essential for a successful emergency department (ED) shift.A pilot group of nine emergency medicine (EM) residents and one senior EM faculty member underwent a commercial escape room as part of a team-building exercise in January 2018. The escape room required participants to practice teamwork, communication, task delegation, and critical thinking to tackle waves of increasingly complex puzzles, ranging from hidden objects, physical object assembly (i.e., jigsaw puzzles), and symbol matching. Activities required members to recognize and utilize the collective experiences, skills, knowledge base, and physical abilities of the group. After the game, players underwent a structured ‘game-master’ debriefing facilitated by an employee of the commercial escape room; this was followed by a post-event survey facilitated by a faculty member, which focused on participants’ feelings, experiences, and problem-solving techniques.Escape rooms afford learners the opportunity to engage in an activity that rewards teamwork and effective leadership through experiences that directly link to specific ACGME milestones and educational learning theories. EM participants were engaged in the activity and felt that the escape room reproduced an environment analogous to the ED. The debriefing that followed the activity provided a satisfactory conclusion to the experience; but learners preferred a more organized debriefing format that provided them with constructive and specific feedback on their performance.

Creating an Escape Room for Continuous Renal Replacement Therapy Validation

Although gamification is recognized for enhancing motivation and learning outcomes, there is a need for specific evidence on how innovative methods, such as educational escape rooms, affect learning experiences and teamwork. This study examined the effectiveness of using the educational escape room as an innovative approach for occupational therapy (OT) and occupational therapy assistant (OTA) students. One-group, preexperimental, pre- and poststudy. A simulation laboratory at a university. Seventy-six OT and 38 OTA students enrolled in clinical skills classes were randomly assigned to teams of OT and OTA students. An escape room incorporating associated topics covered in the clinical skills course. Students worked collaboratively and applied their combined knowledge and critical thinking skills to solve 10 puzzles to escape in 1 hr. The Readiness for Interprofessional Learning Scale, Self-Assessment Scale for Active Learning and Critical Thinking, and a researcher-developed knowledge assessment were administered 2 wk before and immediately after the escape room experience to evaluate the students' intraprofessional collaboration, activity learning, critical thinking skills, and knowledge levels. Students' readiness for teamwork, activity learning, and critical thinking skills increased after participating in the escape room experience. Students' knowledge levels also improved, with a moderate effect size. These results suggest the possible benefits of educational escape rooms. Escape rooms are an increasingly popular, innovative teaching modality in health care education. This study validated that escape rooms promote students' learning outcomes and intraprofessional teamwork. Plain-Language Summary: This study assessed the effectiveness of using an escape room as a teaching tool in a clinical skills class for occupational therapy (OT) and occupational therapy assistant (OTA) students. The findings revealed significant improvements in the students' teamwork, active learning, critical thinking skills, and knowledge levels after the escape room experience. These results suggest that incorporating escape rooms into OT education can enhance learning outcomes and should be further explored in future studies with more rigorous experimental designs. This innovative approach benefits students' academic development and can affect OT practice. Fostering collaboration and critical thinking better prepares students to provide comprehensive and effective care to their future clients. This study contributes to the growing body of research that supports active learning pedagogies in OT education, highlighting the importance of engaging and experiential learning methods in preparing students for real-world practice.

Escape rooms are increasingly popular all around the world. Due to their popularity, we are also seeing more variations in concept, form, and aim. For example, nowadays we can engage with physical, digital or mixed escape rooms. Escape rooms are also developed for a range of purposes beyond entertainment, including to broadcast a message, train, and/or exchange data. However, past research on escape rooms has focused mostly on analysing physical versions or on investigating if and how escape rooms can educate players. This paper aims to overcome these gaps by exploring how escape rooms (digital, physical or mixed) can be designed for a variety of purposes beyond entertainment. Hence, this paper offers two main contributions: a definition of escape rooms with a purpose and a framework that can be used to both design and analyse escape rooms with a purpose. The framework is initially implemented based on a literature review in the fields of serious games, escape rooms and puzzle design. Its efficacy is then tested through the analysis of three escape rooms with a purpose. Following this analysis, the framework is finalised to include the following key design elements: concept/idea; stakeholders (target players and others); purpose; goal/winning condition; equipment; theme; narrative (puzzle organisation and storytelling methods); puzzle design; and evaluation.

Medical escape rooms have risen in popularity for their ability to teach various skills to medical students in a gamified context [1]. We designed two simulation-based medical escape rooms in which students could enhance their clinical and non-clinical skills, and learn about human factors. The escape room mimicked the complexity of a real patient with multiple pathologies, unlike traditional simulation, which usually focuses on one. This created a fun, realistic approach to experiential learning whilst enhancing psychological safety, collaboration, teamwork and communication. Learning outcomes for the escape room incorporated clinical reasoning, prescribing, data interpretation, synthesis of management plans, practicing effective communication, teamworking, leadership and situational awareness skills. These were mapped to the General Medical Council’s outcomes for graduates. The aim of creating the escape room was to create a realistic complex scenario, incorporate teamworking and clinical and non-clinical aspects of patient care, whilst maximizing engagement and easing the stress of traditional simulation. The escape room simulations were themed for Christmas and Valentine’s day with an underlying non-medical mission. The simulation was designed to ensure students practiced their A-E assessments. When students made the correct assessments and requested the correct investigations and management, clues would reveal answers to complete a puzzle or unlock a box that would slowly allow them to solve their non-medical mission. Feedback was collected from all 40 students who participated in the two escape rooms, using Likert scales and open answer text. 97% of students agreed or strongly agreed that the Escape Room enhanced their clinical reasoning skills. 98% agreed or strongly agreed that the session addressed nonclinical skills e.g. leadership, communication and teamworking and that the session will benefit patient care in future clinical practice. 95% agreed or strongly agreed that the debrief enhanced their clinical knowledge. Students enjoyed treating realistic multiple pathologies and completing several tasks, allowing for prolonged, in depth simulated practice. Students appreciated the teamworking opportunities, quizzes, puzzles and lateral thinking opportunities. They found the Escape Room simulation more fun and relaxing than traditional simulation, yet just as relevant. The positive feedback validates the potential of medical escape rooms as a unique teaching modality, and the scope to promote teamworking within a complex simulation scenario beyond that of traditional simulation. There is the potential to diversify and use escape rooms to promote interprofessional learning. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

An escape room is a cooperative game that has been adapted into medical education and major academic conferences. We describe the design, development, and implementation of an educational ID-themed escape room activity entitled "Out-BREAK!" at an international conference, IDWeek 2023. An anonymous survey was conducted to collect demographic data, assess participant satisfaction with the escape room puzzles, and gauge participant interest in game-based learning. Thirty escape room sessions were held over 3 days and included 201 participants. Escape room survey respondents (n = 132) were younger and more likely to be trainees compared with in-person IDWeek attendants. Among 131 responses, all respondents enjoyed the experience and would recommend the escape room activity to friends. Survey respondents enjoyed the puzzle solving (93%), medical content (92%), and team building (79%) components. Only 35% of the respondents had ever previously participated in game-based learning; 95% thought the escape room was a valuable teaching method. Among the 72 survey respondents involved in medical education, almost all (90%) said they were interested in incorporating escape rooms into medical education. The Out-BREAK! escape room at IDWeek 2023 was successfully implemented and well received. Despite only a third of participants having prior experience with game-based learning, almost all respondents perceived the escape room to be an effective teaching method.

The full paper describes secondary students’ experience in a summer STEM camp in which they puzzled through and then designed escape rooms. The theoretical framework used is experiential learning as explained by John Dewey (1938). In this methodology, students learn from being immersed in situations that at least mimic real life, if not fully real-life. Educators are challenged to find materials for students to learn within some experience. As successive experiences are integrated, the learning progresses. If the learning is within the capability of the student, curiosity to learn more may be aroused, and the learning continues. First, the students were told how escape rooms work and were put into teams for the escape room activities. The instructors set up escape rooms for the students to try their hand at escaping, and competing in teams to see which team had the shortest escape time. After the students all had the opportunity to try out an escape room, they worked in teams to create their own escape room. Another camp session involved basic cryptograph with ciphers, primarily shift ciphers. A requirement of their designs was to include a cipher somewhere in the design. Students were given lock boxes, numerical, alphabetic, and emoji locks of various kinds to use. They worked through a process of 1) deciding on a theme, 2) creating various challenges and clues, 3) sequencing the clues, 4) creating hints, 5) and setting up the escape room. Finally, the four teams each had the opportunity to escape the other teams’ rooms. The paper will describe more fully the students’ engagement and reaction to the escape rooms as well as the collaborative discussions and learning. Informal learning experiences are an important part of the pre-college learning that engages students and increases their interest in STEM. Escape rooms are a great way to immerse students in collaborative learning and boost their desire to learn more.

Objective: To engage students in a flipped classroom activity utilizing an escape room to teach the importance of systemic inflammatory response syndrome criteria recognition, sepsis diagnostics, the anticipation of medical doctor orders, and the implementation of nursing interventions for the care of a sepsis patient. To escape the room, students must work together to answer a series of questions to solve all of the puzzles and open the locks. Methods: A total of 32 fourth-semester students over three semesters participated in the sepsis escape room. Groups were randomly assigned as students came into the simulation room. Students were oriented to the room, given the objectives of the activity, and provided a patient scenario to start the escape room. During the activity, students completed a variety of math equations, puzzles, and advanced nursing skills to progress through the room. Students were timed while completing these activities; the goal, to escape the room in less than an hour. Results: Students were actively engaged and involved in the escape room learning activity. All groups completed the sepsis escape room under one hour. After the escape room, a debrief was conducted, and a survey was given to all the students. Survey results and discussion revealed that the escape room was a more meaningful and engaging learning activtity for new material versus traditional lecture. Conclusion: The escape room is a valuable learning activity to teach sepsis diagnosis and treatment for fourth-semester nursing students. The application of an escape room could be modified and used for any level of nursing student or any disease process.

Escape rooms include the same experiential learning methods that make traditional simulation practices effective while adding gamification which improves learner engagement. Our existing simulation curriculum lacked active experimentation, an essential component of Kolb's experiential learning cycle. The goal of this curriculum innovation was to determine the feasibility of adding an escape room immediately following the simulation to provide an effective independent learning experience for learners. We created a 40-min escape room activity using principles of self-determination theory. All students in the paediatric clerkship participated once over one academic year. Students were presented with an unstable child with seizures and worked in teams of 3-5 to open locks and solve puzzles as they applied nine clinical skills learned from the preceding simulation session. Students (N = 66) reported increases in knowledge after both the simulation and the escape room and an increase in confidence after completing the escape room, indicating we were successful in adding active experimentation to our curriculum. They also commented on the value of applying and practising new skills and of engaging in teamwork, which reinforced the utilization of self-determination theory as a guiding principle for escape room design. Our escape room is novel in that it takes place in a paediatric clerkship setting and builds upon existing curricular elements to provide students with independent practice of clinical skills in a gamified and fun approach early in their clinical training years. Escape rooms are a feasible and an effective method to provide hands-on experience to clinical learning.

Purpose of the article Despite the rising popularity of escape rooms as an experiential learning method, the literature lacks an in-depth understanding of educators’ challenges and requirements when implementing this approach. To address this gap, this research explores health professions educators’ perceptions and learning needs concerning the integration of escape rooms into health professions education. Materials and methods This qualitative descriptive study recruited 18 health professions educators, who participated in an escape room educational activity comprising a standardised introduction, briefing, escape room and debriefing. Data was collected using focus group interviews, conducted immediately after the escape room experience. Data was analysed using thematic analysis. Results Thematic analysis revealed five themes and eleven subthemes, encompassing participants’ perceptions and learning needs regarding escape rooms, and wider aspects regarding their application and implementation. Participants generally responded positively to escape rooms, recognising their potential for providing personlised learning experiences. Participants’ learning needs included deeper knowledge of the escape room approach, as well as assistance in designing and facilitating escape rooms. Conclusions This study contributes valuable insights into educators’ perspectives on escape rooms, informing the development of targeted faculty development programs. While educators demonstrated enthusiasm, providing support for designing and facilitating escape rooms is crucial.

BackgroundActive learning approaches that promote participation, critical thinking, and practical competency are becoming more and more necessary in medical and nursing education. Virtual reality (VR) and gamification, especially in the context of escape rooms, have become popular instructional technology in response to these issues. The interactive, scenario-based learning environments provided by these tools encourage motivation, teamwork, and decision-making. The impact and transformative possibilities of incorporating virtual reality and gamified escape rooms into medical and nursing education are examined in this paper.MethodsThe use of virtual reality (VR), gamification, and escape rooms in medical and nursing education was investigated using a thorough narrative literature review. In order to give a comprehensive and holistic overview of new subjects, this method was selected. Keywords like “escape room,” “digital escape room,” “online escape room,” “gamification,” “game-based education,” “virtual reality in medical education,” “medical student,” “nursing education,” “nursing student,” and “nursing staff” were used in the January 10, 2025, search across Web of Science, PubMed, ERIC, and Scopus. English-language publications from the past ten years that addressed virtual reality, gamification, or escape rooms in medical or nursing education were included in the inclusion criteria. Non-relevant papers, non-peer-reviewed literature, and research with unclear methodology or no empirical data were among the exclusion criteria. 25 studies were chosen for a thorough assessment after a rigorous screening process based on methodological rigor and relevance.ResultsThe total number of retrieved articles in Google Scholar, PubMed, Scopus, and Web of Science on January 10, 2025, was 172. After removing 64 duplicate articles, 108 papers were screened by experts. After this investigation, 25 articles were extensively reviewed for the results section. The findings from the selected studies can be categorized into four main areas: enhancing clinical decision-making, improving teamwork and collaboration, increasing knowledge retention and engagement, and reducing stress in high-pressure scenarios. These studies, summarized in Table 1, highlight the effectiveness of escape rooms and VR-based training in medical and nursing education, particularly in emergency medicine, pharmacy, radiology, internal medicine, and psychiatry.ConclusionThe integration of VR and gamified escape rooms in healthcare education presents a promising approach to improving clinical training and competency development among medical students, nursing students, and healthcare professionals. The findings underscore the need for further research and implementation of these tools to enhance experiential learning and optimize medical education outcomes. By leveraging gamification and VR simulations, medical training programs can bridge educational gaps and improve patient care delivery in both traditional and remote learning environments.Clinical trial numberNot applicable.