Escape into patient safety: bringing human factors to life for medical students

Patient safety education in undergraduate medical education through a global lens: a scoping review

BACKGROUND

Patient safety, an organizing framework to minimize risks and harm to patients in healthcare delivery, is broadly accepted as a crucial component of global undergraduate curricula. The incorporation of Patient Safety Education (PSE) into medical curricula, as suggested by the World Health Organization (WHO) can be challenging and has been partially and inconsistently applied. Factors such as densely packed curricula, gaps in the evidence-base, under-prepared faculty, and low levels of organizational support have influenced implementation. This review highlights teaching and learning evidence relevant for such integration of PSE into undergraduate medical education and considers variations in educational advancement across different regions referred to as WEIRD (Western, Educated, Industrialized, Rich and Democratic) and Non-WEIRD countries.

METHODS

We followed the JBI protocol for undertaking scoping reviews to identify evidence-based gaps and recommend further research supporting integration of PSE into undergraduate curricula. Using PubMed, Scopus, ERIC, CINAHL and Cochrane library, 720 papers, from 2013 to 2023, were identified. Screening of titles and abstracts of 61 studies of PSE in undergraduate medical programs, 28 articles met the inclusion criteria. Descriptive statistical and thematic analysis for data extraction about curriculum design, learning and teaching interventions was conducted.

RESULTS

Findings showed 39% of 28 papers reviewed originated in European region, and 36% from the Americas. Over half (57%) of the selected studies used quantitative methods of analysis, 37.4% were mixed methods, and only 3.5% used qualitative approaches. A variety of methods were used including interactive (21.4%), experiential (14.3%) and technology-enhanced (17.8%) pedagogic strategies. The WHO curriculum guides, and the Institute for Healthcare Improvement (IHI) were the common sources shaping the content of the interventions. Four themes were identified, cultural and contextual considerations; curriculum structure/session design; student engagement/ application; leadership support and faculty training.

CONCLUSIONS

Most publications and discourses emerged from WEIRD countries. Whilst outlining a range of pedagogical methods and curricular design, few explicitly referenced educational theories or addressed faculty development needs. Greater attention to cultural perspectives, local adaptation, efficacy of implementation strategies is needed globally. Research into longitudinal studies and impact on educational institutions will aid our understanding of how to promote, create and evaluate PSE across diverse countries.

CLINICAL TRIAL NUMBER

Not applicable.

Comparison of the escape room and storytelling methods in learning the stress response: A randomized controlled pilot study

AIM

The purpose of this study was to evaluate the effect of the Escape Room and Storytelling methods on nursing students' learning about the topic of stress response.

BACKGROUND

It is recommended that new generations be trained using innovative teaching methods that differ from traditional teaching methods. The Escape Room and Storytelling methods are among the techniques that have been used and recommended for this purpose.

DESIGN

The study was conducted with a randomized, controlled design.

METHODS

Thirty-five (n = 35) second-year undergraduate nursing students were randomly divided into two groups, one group was trained on stress response using the Escape Room method, while the other group was trained using the Storytelling method. Focus-group interviews were conducted with the students after the interventions.

RESULTS

There was a significant difference between the groups in terms of the median post-intervention knowledge assessment score. It was determined that the students in the Escape Room group scored significantly higher than those in the Storytelling group (p < 0.05) CONCLUSIONS: The use of these methods, which ensure the active participation of students and increase their motivation, effectively contributes to meeting the educational needs of students and increases their level of satisfaction.

Escaping the ordinary: a review of escape rooms in medical and veterinary education

BACKGROUND

Escape rooms (ERs), immersive role-playing games that require participants to solve a series of puzzles within a set time to achieve a specific goal, have gained popularity as innovative educational tools.

METHODS

A systematic review was conducted using the PRISMA guidelines, a comprehensive search of PubMed, Cochrane, Web of Science, and Scopus, for articles published between inception of journals to April 2024, focusing on the integration, outcomes, and participants' perceptions of ERs in medical and veterinary education.

RESULTS

A total of 619 articles were retrieved, of which 12 articles met the inclusion criteria for final analysis. These studies focused on medical students and included medical education topics such as nephrology, human physiology, and dermatology. Notably, no ERs focused on the veterinary sector or directly addressed the One Health approach. ERs demonstrated a significant impact on students' self-reported knowledge, motivation, and collaboration skills gains. Participants reported improved confidence in clinical situations and a greater appreciation for interdisciplinary team dynamics. Most studies yield moderate MERSQI scores and impacts at Kirkpatrick Levels 1 and 2.

CONCLUSION

ERs increased immediate educational engagement and showed potential in improving an understanding of complex, interrelated health issues. This gap suggests a need for curricula that incorporates ERs to bridge human, animal, and environmental health sectors. The integration of ERs could be instrumental in equipping future prescribers with the interdisciplinary knowledge and skills needed to tackle complex health crises.

CLINICAL TRIAL NUMBER

Not applicable.

Educators' perceptions and learning needs regarding the implementation of escape rooms in health professions education

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.

Use of an Escape Room Experience in Emergency Veterinary Medicine Education

Escape room experiences have been used as an educational tool in several health professions, and to the authors' knowledge, it is not yet documented in veterinary medicine. They are an example of gamification in a simulated environment where course objectives guide puzzle development. Veterinary emergency medicine can be very stressful as veterinarians often have to make quick decisions. The element of a time limit adds stress to the experience as learners must complete the puzzles within a specified time to successfully escape the room. This article describes the development and delivery of an escape room experience in emergency veterinary medicine to third year students at the Western College of Veterinary Medicine at the University of Saskatchewan. In a survey following the experience, learners indicated they enjoyed participating in the learning activity. They felt it encouraged the use of communication, collaboration, and leadership skills which have been identified as core competencies in veterinary education. While on average learners would disagree with the experience being stressful, several commented that it was a "good stress". This indicates that the experience may have been considered challenging to learners, which in simulation, supports a positive way to achieving learning objectives that may not overstress participants.

Game design elements of serious games in the education of medical and healthcare professions: a mixed-methods systematic review of underlying theories and teaching effectiveness

Serious games, as a learning resource, enhance their game character by embedding game design elements that are typically used in entertainment games. Serious games in its entirety have already proven their teaching effectiveness in different educational contexts including medical education. The embedded game design elements play an essential role for a game's effectiveness and thus they should be selected based on evidence-based theories. For game design elements embedded in serious games used for the education of medical and healthcare professions, an overview of theories for the selection lacks. Additionally, it is still unclear whether and how single game design elements affect the learning effectiveness. Therefore, the main aim of this systematic review is threefold. Firstly, light will be shed on the single game design elements used in serious games in this area. Second, the game design elements' underlying theories will be worked out, and third, the game design elements' effectiveness on student learning outcome will be assessed. Two literature searches were conducted in November 2021 and May 2022 in six literature databases with keywords covering the fields of educational game design, serious game, and medical education. Out of 1006 initial records, 91 were included after applying predefined exclusion criteria. Data analysis revealed that the three most common game design elements were points, storyline, and feedback. Only four underlying theories were mentioned, and no study evaluated specific game design elements. Since game design elements should be based on theories to ensure meaningful evaluations, the conceptual GATE framework is introduced, which facilitates the selection of evidence-based game design elements for serious games.

Student Engagement in Patient Safety and Healthcare Quality Improvement: A Brief Educational Approach

Achieving optimal patient safety (PS) remains a challenge in healthcare. Effective educational methods are critical for improving PS. Innovative teaching tools, like case-based learning, augmented reality, and active learning, can help students better understand and apply PS and healthcare quality improvement (HQI) principles. This study aimed to assess activities and tools implemented to improve PS and HQI education, as well as student engagement, in medical schools. We designed a two-week course for fourth-year medical students at the Autonomous University of Guadalajara, incorporating Fink's taxonomy of significant learning to create engaging activities. The course featured daily synchronous and asynchronous learning, with reinforcement activities using tools, like augmented reality and artificial intelligence. A total of 394 students participated, with their performance in activities and final exam outcomes analyzed using non-parametric tests. Students who passed the final exam scored higher in activities focused on application and reasoning (p = 0.02 and p = 0.018, respectively). Activity 7B, involving problem-solving and decision-making, was perceived as the most impactful. Activity 8A, a case-based learning exercise on incident reporting, received the highest score for perception of exam preparation. This study demonstrates innovative teaching methods and technology to enhance student understanding of PS and HQI, contributing to improved care quality and patient safety. Further research on the long-term impact is needed.

A Human Factors and Systems-Thinking approach to Veterinary Patient Safety Education: Why, What, and How?

Preparing graduates to practice safely in today's increasingly complex veterinary workplaces is a key aim for veterinary educators. This requires embedding veterinary patient safety concepts into already full curricula. This teaching tip explores the benefits of incorporating human factors and systems-thinking principles into the design and delivery of veterinary patient safety education, showing how these can inform both what is taught and how. We explore what taking a human factors approach to veterinary patient safety education means, inviting educators to rethink not just curricular content but the whole approach to delivery. Advocating for the adoption of a systems-thinking-informed approach to curriculum design, we present a two-stage curriculum mapping process to support educators to embed core human factors principles as a way of thinking and doing for learners and faculty alike. Learning theories and educational design that align with human factors principles promote participatory methods and encourage collaborative experiential learning, critical thinking, and authentic application of knowledge and skills. Educators should explore opportunities presented by interprofessional education and workplace-based learning for practical application of these principles. Barriers to an integrated human factors-based patient safety curriculum include inconsistent terminology and understanding, significant faculty development requirements, and assessment challenges associated with existing regulatory and licensing requirements. Practical approaches to addressing these barriers are discussed. The recommendations outlined for the design and delivery of veterinary patient safety curricula will help ensure that institutions develop graduates that are effectively prepared for the complexity they will meet in the veterinary workplace, leading to improved patient safety and overall workplace well-being.

Systems-Based Practice in Graduate Medical Education: Evolving Toward an Ideal Future State

ABSTRACT

Systems-based practice (SBP) was first introduced as a core competency in graduate medical education (GME) in 2002 by the Accreditation Council for Graduate Medical Education as part of the Outcomes Project. While inclusion of SBP content in GME has become increasingly common, there have also been well-documented stumbling blocks, including perceptions that SBP has eroded the amount of curricular time available for more medically focused competencies, is not relevant for some practice contexts, and is not introduced early enough in training. As a result, SBP learning experiences often feel disconnected from medical trainees' practical reality. In this commentary, the authors provide guidance regarding potential changes that may facilitate the evolution of SBP toward an ideal future state where graduates bring a systems science mindset to all aspects of their work. Specific suggestions include the following: (1) expanding the SBP toolbox to reflect current-day health system needs, (2) evolve the teaching methodology, (3) broadening the scope of relevant SBP content areas, and (4) emphasizing SBP as an integrated responsibility for all health care team members. Levers to enact this transformation exist and must be used to influence change at the learner, faculty, program, and clinical learning environment levels.Physicians operate within an increasingly complex health care system that highlights the intersection of health care with complex social, environmental, and relational contexts. Consequently, the role of SBP in both physician work responsibilities and educational requirements continues to expand. To meet this growing demand, GME must adapt how it supports and trains the next generation of systems thinkers, ensuring they understand how levers in the health care system directly affect health outcomes for their patients, and integrate SBP into the foundation of GME curricula in an inclusive, holistic, and unrestrained way.

Analysis of different gamification-based teaching resources for physiotherapy students: a comparative study

BACKGROUND

For health professionals, gamification is a new teaching method that has achieved an important role in recent years, with excellent results in learning and knowledge acquisition. Thus, the objective of this study was to analyze the gaming experience through different gamification resources in the classroom with physiotherapy students.

METHODS

A comparative study on gamification-based teaching resources was carried out during the first semester of the 2021-2022 academic year. A total of 33 physiotherapy students participated in this study. After the theoretical topics were taught, the participants were invited to participate in different gamification resources such as Kahoot!, Physiotherapy Party and Escape Room. The gaming experience with the different gamification resources was measured with the GAMEX scale.

RESULTS

The Physiotherapy Party showed a higher score in relation to the enjoyment dimension compared to the Kahoot! and Escape Room (p = 0.004). The Escape Room presented higher scores in absorption, creative thinking, activation and dominance compared to Kahoot! and Physiotherapy Party (p < 0.005).

CONCLUSIONS

Gamification resources promote enjoyment and creativity in the students in the classroom. The use of new teaching methods based on gamification, such as Escape Room as Physiotherapy Party should be considered as first choice in the use of gamification resources due to the benefits they bring to students.

Implementation of a hepatitis-themed virtual escape room in pharmacy education: A pilot study

As we enter a world of blended learning in higher education, an increased need for adaptation of teaching strategies to enhance engagement has been recognised to amplify learning outcomes online. Gamification has been identified as a creative tool to engage the current cohort of learners who are also characteristically tech-savvy. To this end, escape room games have gained considerable traction in medical and pharmacy education to promote learning, critical thinking and teamwork. In this pilot study we describe the implementation of a 60-minute, web-based hepatitis-themed escape room game within a Year 3 Pharmacotherapy unit at Monash University. A total of 418 students participated in this activity. Students' knowledge gain on the topic was assessed through a pre- and post-intervention assessment, whereby a statistically significant improvement was seen in the knowledge score following implementation of the gaming activity (58.66% pre-intervention vs. 72.05% post-intervention, p < 0.05). The innovative learning activity was also well perceived by the students. Virtual escape room game is a viable pedagogical approach to teach and reinforce clinical concepts among pharmacy students. With the evolving landscape of education and learner demographics, investment in technology- enhanced game-based learning is a promising trajectory to support students' growth in a learner-centered environment. A comparison between virtual escape room game and traditional teaching will further inform effectiveness of the gamification on long term knowledge retention.

Design and evaluation of a new consolidation exercise for students studying cardiac physiology: a digital escape room

The current student body will, by and large, seek online resources to supplement their learning. However, resources that are freely available online vary in accuracy and quality, and the vast majority rely on passive learning. Therefore, there is a need for interactive physiology teaching resources that facilitate application of knowledge, that can be accessed by students in their own time. The aim of this study was to design a digital escape room on the topic of cardiac arrhythmias and to evaluate this resource as a consolidation exercise to support learning and enjoyment of physiology. The digital escape room was designed as a series of interactive puzzles and created with a website page builder on a freely accessible WordPress site. To facilitate engagement, the escape room incorporated a countdown timer. Second-year medical students were invited to play the digital escape room remotely as a group exercise after delivery of the relevant teaching. Evaluation of the resource took place quantitatively with Google Analytics and Tag Manager software and qualitatively with a questionnaire (Microsoft Forms). Quantitative evaluation suggested that the puzzles were created across a range of difficulties but that most groups were able to complete the exercise and remained engaged throughout. Student feedback suggests that the format of the resource was rated positively, and most participants felt that the game helped to consolidate and apply their knowledge of cardiovascular physiology. Future studies will focus on examining whether the cardiovascular-themed digital escape room improves knowledge attainment among students studying physiology in higher education.NEW & NOTEWORTHY This article describes the design and development of a new, freely accessible cardiovascular-themed digital escape room. This web-based resource promotes active learning by facilitating problem-solving and application of physiology knowledge while working against a clock.

New Resident Training Strategy Based on Gamification Techniques: An Escape Room on Sepsis in Children

AIM

Adapting "escape rooms" for educational purposes is an innovative teaching method. The aim of this study was to ascertain the degree of learning of the residents. A secondary objective was to determine their degree of satisfaction.

METHODS

A prospective, observational study took place in October 2019. A sepsis-based escape room was designed and carried out. A mix of paediatric medical residents and paediatric nursing residents were enrolled. A prior knowledge test was carried out, which was repeated right at the end of the escape room and then again three months later. Furthermore, all participants completed an anonymous post-study survey.

RESULTS

We enrolled 48 residents, 79.2% of whom were women. The mean score for the pre-escape room exam was 7.85/9 (SD 1.65), that for the post-escape room exam was 8.75/9 (SD 0.53), and for the exam three months later, it was 8.30/9 (SD 0.94). Among the participants, 18.8% did not manage to leave before the established 60 min time limit. The results of the satisfaction survey showed high participant satisfaction.

CONCLUSIONS

The escape room proved to be a valuable educational game that increased students' knowledge of sepsis management and showed a positive overall perceived value among the participants.

Le débriefing par revue après action pour la simulation en santé : applications à la médecine d’urgence

Introduction : Le débriefing est une analyse postévénementielle qui est une partie fondamentale du processus d’apprentissage par simulation. Il est une évaluation formative permettant d’explorer les raisons des déficits de performance dans un objectif d’amélioration des performances. La revue après action (RAA) est une technique du débriefing développée par l’armée américaine et qui explore en équipe les intentions derrière les actions. L’objectif de ce travail a été de décrire les principes de la revue après action en tant que technique et d’en déterminer l’intérêt, les avantages et les inconvénients en simulation en santé, notamment en médecine d’urgence.

Méthodes : Revue narrative de la littérature traitant du débriefing en simulation par revue après action. Après analyse de la littérature dans les bases Medline, Web of Science, ScienceDirect, Pascal & Francis et Defense Technical Information Center, les articles ont été inclus s’ils répondaient aux critères suivants : apprentissage par simulation, revue après action comme méthode de débriefing.

Résultats : Quinze manuscrits ont été inclus. La revue après action permet une analyse non punitive et objective de la simulation. Ses principales forces sont d’analyser collectivement les performances d’équipe et de proposer des mesures correctives. Ses principales limites sont l’absence de débriefing individuel et son inefficacité en cas d’insuffisance de formation du débriefeur.

Conclusion: La revue après action est un format de débriefing favorisant les apprentissages et l’amélioration des performances d’équipe, mais explore peu les performances individuelles.

An Escape Room to Orient Preclinical Medical Students to the Simulated Medical Environment

INTRODUCTION

Simulation is increasingly being used in the preclinical years of US medical school curricula to provide experiential learning opportunities for students. However, preclinical medical students may not be able to access the full benefits of immersive simulation scenarios without an in-depth introduction to the simulation environment and manikin. An escape room may be an effective way to orient students in an interactive manner to overcome this barrier.

METHODS

We designed and implemented a 90-minute escape room orientation activity to address student discomfort in the simulation environment by providing a team-based, hands-on exploration of identified critical features of the room and manikin in the guise of a routine clinic visit for a patient. We surveyed learners on their confidence immediately following the escape room and on their perceptions of the session effectiveness following their first simulation.

RESULTS

A total of 148 preclinical medical students participated in the escape room activity in 30 groups of four to five persons. Of those students, 130 participated in a simulated patient case within 1 month of the escape room activity, and 89 filled out a follow-up survey. Of responding students, 80% reported that the escape room activity was highly effective or very effective in preparing them for participation in a simulated patient case.

DISCUSSION

Implementing an escape room orientation activity for preclinical medical students was effective in preparing students to participate in their first immersive simulation scenario.

Escape-cardio: Gamification in cardiovascular physiotherapy. An observational study

INTRODUCTION

In recent years, innovative educational strategies of learning have appeared, to generate greater motivation in the students. Gamification has become popular in the educational area, including Escape Rooms. The primary aim of the study was to evaluate if this gamification activity led to better knowledge acquisition by the students, improving performance in their final exam. As a secondary objective, we surveyed the satisfaction of the students participating in the Educational Escape Room.

MATERIAL AND METHODS

An observational study of cases and controls was carried out. We designed an escape room based on the cardiovascular area of physiotherapy, titled Escape-Cardio. We provided scaffolded learning activities through the activity. Primary outcomes corresponded to the students' qualifications and the number of correct answers in the final exam. Qualitative questionnaire results of students of both courses were collected using a self-created survey, which was completed after the activity.

RESULTS

58 students participated in the Escape-Cardio. We observed better performance in the intervention group, improving their average mark and number of correct answers in the exam, with a statistically significant difference compared to the control group (p-value<0.05). In the qualitative assessment, students answered the survey, and all of them scored unanimously each item with the maximum score, aiming for 100% satisfaction.

CONCLUSION

Escape-Cardio students improved their professional knowledge application in the cardiovascular physiotherapy area in a statistically significant way. An excellent qualitative evaluation was achieved by them.

Ready Patient One: How to Turn an In-Person Critical Care Simulation Scenario Into an Online Serious Game

Introduction

Serious gaming has become popular in healthcare education as an engaging way to train learners. When coronavirus disease 2019 (COVID-19) forced the cancellation of in-person simulation sessions, we designed a serious game to deliver content in an interactive format with no out-of-pocket expense. We describe the design process and game reception so that others may replicate it.

Methods

We designed an online game using Choose-Your-Own-Adventure (CYOA) and Escape Room concepts. Using online survey software, we presented an interactive story based on an existing simulation scenario and included interactive puzzles as roadblocks to scenario progression. Each puzzle represented a critical care concept, and many contained hyperlinks to prior basic science lecture material to reinforce learning. A post-game survey assessed students’ experience.

Results

All (N=88) students enrolled in a scheduled simulation session participated in the game, and 75% (66/88) responded to a post-participation survey. All respondents (100%) were able to complete the game. The majority (57.6%) completed the game in 30 minutes to 1 hour. Most students strongly agreed or agreed that the game enhanced their understanding of critical care concepts (93.9-97.0%), and that they were interested in doing more CYOA games (90.9%).

Conclusion

The game was well-received, delivered critical care content, and challenged students to apply basic science principles to medical decision-making from the safety of their own homes. The game was self-guided, requiring minimal active facilitator involvement. We plan to expand the use of the game to other settings and explore its use in formative/summative assessment and remediation.

Engaging Students with Patient Safety in an Online Escape Room

BACKGROUND

Creating innovative online instruction was essential during the COVID-19 pandemic. This article highlights an engaging, online escape room (OER) educational innovation used to teach patient safety to first-semester nursing students.

METHOD

Utilizing constructivist and adult learning theories, the OER, developed using Google Forms, consisted of gamification. Students completed puzzles related to a patient safety scenario presented via text, photograph, audio, and video to promote critical thinking and decision making.

RESULTS

Review of student reflections, test scores, and survey results determined the OER was effective to develop the student's understanding of the nurse's role in patient safety to include identification of safety concerns and appropriate interventions.

CONCLUSION

Using Google forms, educators can create an OER for various topics to enhance student engagement and critical thinking skills. The OER can be supplemental instruction or an alternative for clinical and simulation instruction when online learning is mandated. [J Nurs Educ. 2021;60(8):466-469.].

Delivering a Novel Medical Education "Escape Room" at a National Scientific Conference: First Live, Then Pivoting to Remote Learning Because of COVID-19

Escape Rooms are gaining prominence as education modalities; the use of principles of game design have been shown to augment knowledge acquisition in a fun, team-based learning experience ("edutainment"). In this report, we outline some of the medical literature and then provide our step-by-step approach and lessons learned when building what was, to our knowledge, the first continuing medical education Escape Room at a national scientific meeting. We then comment on how this innovative educational offering was reimagined the following year for remote (virtual) learning because of the COVID-19 pandemic.

Advancing team cohesion: Using an escape room as a novel approach

Objective

An escape room was used to study teamwork and its determinants, which have been found to relate to the quality and safety of patient care delivery. This pilot study aimed to explore the value of an escape room as a mechanism for improving cohesion among interdisciplinary healthcare teams.

Methods

This research was conducted at a nonprofit medical center in Southern California. All participants who work on a team were invited to participate. Authors employed an interrupted within-subjects design, with two pre- and post-escape room questionnaires related to two facets of group cohesion: (belonging – (PGC-B) and morale (PGC-M)). Participants rated their perceptions of group cohesion before, after, and one-month after the escape room. The main outcome measures included PGC-B/M.

Results

Sixty-two teams participated (n = 280 participants) of which 31 teams (50%) successfully “escaped” in the allotted 45 minutes. There was a statistically significant difference in PGC between the three time periods, F(4, 254) = 24.10, p < .001; Wilks’ Λ = .725; partial η2 = .275. Results indicated significantly higher scores for PGC immediately after the escape room and at the one-month follow-up compared to baseline.

Conclusions

This work offers insights into the utility of using an escape room as a team building intervention in interprofessional healthcare teams. Considering the modifiability of escape rooms, they may function as valuable team building mechanisms in healthcare. More work is needed to determine how escape rooms compare to more traditional team building curriculums.

[Room of horrors: A low-fidelity simulation practice for patient safety-relevant hazards of hospitalization]

INTRODUCTION

Even in well-developed healthcare systems, raising awareness for undesirable dangers and risks of modern healthcare services among the clinical staff is a continuous and methodical challenge. The concept of the so-called "Room of Horrors" is both an innovative and a low-fidelity simulation approach for team-based training of patient safety-relevant hazards. The purpose of this evaluation study is to report on practicability and acceptance of such a low-threshold simulation training.

METHOD

A fictitious patient room including a patient manikin (lying in bed) was set up in the hospital to simulate the Room of Horrors. Additional artifacts such as a side table, medication and the medical record completed the simulation, in which 12 typical errors or latent risks related to patient safety were hidden. After a short briefing, individuals or groups (2-5 participants) should enter the room and try to find as many errors as possible. The error detection rate was evaluated immediately followed by a debriefing. The participants were then asked to answer a short structured questionnaire to provide content-related feedback about the patient safety simulation.

RESULTS

Within three days, the Room of Horrors was visited by a total of 89 participants (27 teams and 6 individuals). Average error detection rate was 8.54 out of 12 hidden errors (71%), whereby the teams showed a slightly better result. All the surveyed participants found the simulation to be educational and beneficial. The importance of team discussion was particularly emphasized by a majority of participants. 91% of the participants found the wrong patient identification wristband and in spite of a documented lactose intolerance a yogurt on the side table. 88% of the participants recognized the bell which was out of the patients reach. Few participants found the missing indication of a permanent catheter (24%) and a doubled prescription of paracetamol (42%).

DISCUSSION

A comparison of several international studies about so-called Rooms of Horrors shows that the present study has a relatively high average detection rate (71%), although a significant percentage of the participants are not engaged in medical or nursing services. Not surprisingly, the average detection of errors of the teams were higher than individuals. This strengthens the theory that a discursive discussion and exchange of dialogue among the clinical staff in a patient's room increases patient safety or at least strengthens situational awareness for clinical risks. The consistently positive feedback coincides with the evaluation results of other clinics and thus demonstrates the acceptance of simulation-based on-site training. The organizational and financial effort to execute the simulation training remained very low (apart from the resulting costs incurred due to the participants missing from their regular hospital duties). Hence, the evaluation study proves practicability and acceptance of this simulation method.

CONCLUSION

The study provides no information about the extent to which the simulation actually influences the behavior and situational awareness of the participants. At least the awareness of the participants for real risks, hazards and errors of modern patient care was raised temporarily. The Room of Horrors can be easily adapted to different learning goals and settings. It is a flexible and practical learning arrangement. In comparison to the organizational and financial efforts involved, the implementation can be recommended without exception.

The great escape? The rise of the escape room in medical education

Medical education has changed focus to a more learner-centred model, placing learners at the centre of innovations in training. The escape room is one such innovative learner-focused activity, in which a team of players cooperatively discover clues, solve puzzles and complete tasks in order to progress through the challenge to achieve a specific goal. Escape rooms can be used in medical education as a tool for team building, an entertaining way of delivering technical and non-technical skills, to read and acquire or refresh knowledge, as well as for educational research. Despite appearing to be a superficial form of entertainment, escape rooms can be grounded in sound educational theory and, when used effectively, act as a low-cost, high-impact resource for a variety of learners. While escape rooms may well be an example of yet another educational 'fad' demonstrating the rising influence of 'Millennial MedEd', it signals a promising shift to more learner-centred, team-based methods which are essential to the practice of safe modern healthcare during the current COVID-19 pandemic and beyond.

Student pharmacist perceptions of learning after strengths-based leadership skills lab and escape room in pharmacy practice skills laboratory

BACKGROUND AND PURPOSE

Leadership is a required component of doctor of pharmacy programs. There is opportunity for students to receive instructional education on leadership concepts through serious games.

EDUCATIONAL ACTIVITY AND SETTING

First-year pharmacy students (n = 146) participated in a required skills-based leadership lab including a team-based escape room activity.

FINDINGS

Students reported a statistically significant increase in understanding of leadership concepts and application at the end of the global lab activities (p < 0.01) and a majority of the students found the escape room activity "very useful" (56%).

SUMMARY

Escape rooms present a unique opportunity to engage students in active learning and problem solving. A majority of the students found the escape room activity useful and enjoyed the interactive application of leadership concepts. Potential challenges to implementing escape rooms such as time to develop, physical space requirements, supplies, and volunteers to facilitate the experience should be considered prior to implementation. Serious gaming is an emerging pedagogy, and this data supplements existing literature to support use in pharmacy education.

Feasibility of a paediatric radiology escape room for undergraduate education

OBJECTIVES

To develop a paediatric radiology themed escape room session for undergraduate education and secondly, to determine participant satisfaction and improvement in knowledge.

METHODS

A paediatric radiology escape room with accompanying tutorial was developed around key learning objectives set within the RCR and ESR undergraduate curriculum. Students were recruited from two different universities and undertook the escape room themed teaching. An 8-question single best answer (SBA) test was completed before, immediately after and at 2 weeks post-teaching to determine participant improvement and retention of knowledge. The general feedback was also collected.

RESULTS

The escape room sessions were held three times, for 19 students (6-7 students per session). All groups completed the escape room in ≤ 20 min. Students enjoyed the experience, assigning an average satisfaction score of 9.4/10 (range 7-10). The majority (17/19, 89.5%) preferred this method of teaching to a lecture-based tutorial alone, although all said they found the tutorial component useful. For the SBA test, there was an average increase in 3.6 marks (range 1-6 marks) per participant between before and after the escape room. This improved knowledge was mostly sustained after 2 weeks, with an average increase of 3.4 marks difference (range 1 to 6) per participant compared to before the teaching.

CONCLUSIONS

A paediatric radiology themed escape room is a feasible teaching method, enjoyed by participants and associated with an increase in radiological knowledge. Further work with larger sample size and direct comparison with other traditional teaching methods is required.