Learning good manufacturing practices in an escape room: Validation of a new pedagogical tool

Game-based learning as training to use a chemotherapy preparation robot

INTRODUCTION

In 2015, our university hospital pharmacy acquired the PharmaHelp robot system to automate part of its chemotherapy production. Complex technical use, downtime periods, and insufficient training caused a drop in motivation and disparities in operators' knowledge. We created a short, playful, standardized, gamed-based training program to address this, and evaluated its impact.

METHODS

Operators were classified as trainers or trainees according to their knowledge about Information and Communication Technologies. Before, after the training, and at 6 months (6M), their robot knowledge was assessed on a 0-24-scale, motivation and self-efficacy in using it on 0-to-100 scales. Pairwise comparison t-test with Bonferroni adjustment was used (p < 0.05 considered significant). Satisfaction was measured using a six-point Likert scale. Trainer/trainee teams participated in 2-hour training sessions with three games and a debriefing. For "Knowing the manufacturing steps," cards with the steps were placed in the correct order. For "Knowing the criteria for using the robot," teams guessed whether certain compounds could be used with the robot. For "Knowing how to handle production errors," the answer to each error (taken from real-life issues) was selected from four options.

RESULTS

Participants (n  =  14) were very satisfied about sessions' interactivity and playfulness. Knowledge improved from 57% pretraining to 77% (p < 0.005) to 76.6% (6M) (p < 0.05 compared to pretraining). Motivation and self-efficacy, respectively, improved from 57.6% to 86.6% (p < 0.05) to 70.4% (6M) and from 48.5% to 75.6% (p < 0.05) to 60.2% (6M) (p > 0.1 compared to pretraining) (t-test).

CONCLUSIONS

This highly appreciated training program efficiently improved knowledge retention out to six months.

Using the Kirkpatrick model to evaluate a sepsis escape room for advanced pharmacy learners

BACKGROUND AND PURPOSE

The purpose of this study was to use the first three levels of the Kirkpatrick Model to evaluate the effectiveness of a simulation center-based escape room activity designed to positively influence student learning.

EDUCATIONAL ACTIVITY AND SETTING

In this simulation, learners solve puzzles related to care of a critically ill patient. This activity was assessed via an assessment questionnaire (Kirkpatrick level 1), a pre/post learner knowledge quiz and learner self-assessment of skills and attitudes (Kirkpatrick level 2), and unstructured observation of learners upon return to the clinical environment (Kirkpatrick level 3).

FINDINGS

Average learner knowledge assessment scores (Kirkpatrick level 2) improved from 80% (pre-) to 90.5% (post-) and learners identified an increased confidence in disease state diagnosis and expression of recommendations (Kirkpatrick level 2). Learner perception of the activity (Kirkpatrick level 1) was positive but also included areas for improvement. Anecdotal reporting supports learners transfer of the knowledge and skills reviewed in the session to practice (Kirkpatrick level 3), but no formal data collection or analysis was completed.

SUMMARY

This study provides quantitative and qualitative evidence to support effectiveness of the activity according to Kirkpatrick's Levels 1 and 2, and anecdotal evidence to support effectiveness according to Kirkpatrick's Level 3. Learners had positive perspectives of this activity and demonstrated evidence of increased knowledge and self-reported confidence in skills and attitudes, suggesting this activity has a positive impact on learners in the short-term; however, the data is not robust enough to support conclusions that this activity influences learner practice.

Creation and evaluation of an educational escape room for preclinical training on 3D printing in dentistry

INTRODUCTION

The benefit of pedagogical escape rooms for dental students' stimulation, interest and knowledge strengthening has been suggested by several studies. However, in previous studies, only a few students were evaluated. This study aims to confirm the purpose of this innovative pedagogical tool in terms of learning consolidation and team building from students' perceptions. We directly incorporated an educational escape game into the fundamental academic formation as a practical-work course for fifth-year dental students.

MATERIALS AND METHODS

The present escape game focused on 3D printing, whose implementation fit the different steps of an escape game well. This study was conducted in March 2022. All fifth-year dental students (n = 212) were divided into 5-6 student groups to match the conditions of an escape game. Before entering the room, each student had to complete a cross-sectional knowledge true/false test of 8 questions to assess their general level. Additionally, an 18-question appreciation survey was completed when leaving the room.

RESULTS

The students perceived the 3D-printing escape game to be relevant and especially expressed the benefit of being part of a team to exchange and build knowledge. These results suggest knowledge strengthening. The instructional benefit of this process seemed to exceed its mere fun and appealing aspect.

CONCLUSION

Our results with a large number of students showed that, from the students' perception, the educational escape game significantly improved knowledge and team-building. It created a supportive learning environment and increased students' motivation. It can provide a fun and effective way to diversify instruction.

The effect of an escape room game on college nursing students' learning attitude and game flow experiences in teaching safe medication care for the elderly: an intervention educational study

BACKGROUND

In the context of an aging population, the Gerontological Nursing course is becoming more and more important. Escape room games have been shown to have a positive effect on nursing education, but they have not been applied in the Gerontological Nursing course. The purpose of this study was to investigate the effects of adding an escape room game-based learning activity at the end of classroom teaching in a Gerontological Nursing course on nursing students' learning attitude and game flow experience.

METHODS

In April 2023, a total of 84 nursing students from two classes at a medical school in Northeast China were selected for the study, and the classes were divided into a test group (n = 41) and a control group (n = 43). Both groups received regular classroom teaching on "Safe Medication Care for the Elderly", and the test group participated in an escape room game at the end of the classroom teaching. General information about the nursing students in both groups was collected prior to participation; learning attitude were measured before and after participation; and game flow experience was measured before and after participation in the test group. Data were analyzed using independent samples t-tests and paired samples t-tests.

RESULTS

There was no statistically significant difference in the general information and learning attitude of nursing students between the two groups before participation. After participation, the total learning attitude score of nursing students in the test group was (73.17 ± 1.67) and that of the control group was (61.63 ± 2.66), and the difference was statistically significant (p < 0.001, Cohen's d = 5.196). The game flow experience of nursing students in the test group before and after participation was (63.27 ± 2.48) and (81.29 ± 2.49), respectively, and the difference between before and after was statistically significant (p < 0.001, Cohen's d = 5.253).

CONCLUSIONS

During the teaching process of the Gerontological Nursing course, an escape room game added at the end of classroom teaching can improve nursing students' learning attitude and also help them to have a good game flow experience. These findings suggest that teaching activities based on the escape room game have considerable practical application value.

A room of errors simulation to improve pharmacy operators' knowledge of cytotoxic drug production

INTRODUCTION

We used an educational healthcare simulation tool called room of errors (ROE) to raise pharmacy operators' awareness of potential errors in a chemotherapy production process and assessed its impact on their knowledge and satisfaction.

METHODS

Twenty-five errors (compiled from internal procedures, literature and our hospital's reported incidents) were categorised as static (n = 7, visible by the participant anytime) and dynamic (n = 18, made by a pseudooperator in front of the participant). Our simulated cytotoxic production unit (CPU) hosted the 1 h-simulation. Two pharmacists (supervisor/pseudo-operator) welcomed the trainee for a 10-min briefing. During the 20-min simulation, participants watched the pseudo-operator's gestures in a simulated chemotherapy production process. Participants called out each error observed (recorded by the supervisor). A 20-min debriefing followed. ROE's impact on knowledge was measured through participants' answers to a before-and after 18-item questionnaire about CPU's procedures and certainty about answers on a scale (0%-100%). Participants evaluated the training using a satisfaction questionnaire (Likert scale, 1-6).

RESULTS

The 14 participants detected 70.4% ± 11.4% of errors. Least-detected errors were "using non-disinfected vials" (42.9%) and "touching syringe plunger" (0%). Critical errors (expired leftovers or glucose instead of sodium chloride) were detected at 57.1%. Knowledge improved from 60.3% to 94.1% (p < 0.001) and certainty from 75.3% to 98.8% (p < 0.001). Participants appreciated this non-judgmental, informative, and original training (satisfaction 95.7%). Some pointed out difficulties settling into the game quickly and visualising static and dynamic errors simultaneously.

CONCLUSION

This ROE simulation improved operators' knowledge and certainty. Longer-term testing should be done to measure knowledge retention over time.

A Scoping Review of Educator Proficiency Interventions in Pharmacy Education Illustrated by an Interdisciplinary Model Integrating Pedagogical Theories into Practice

Pharmacy schools recognize the need for flexibility and comprehensive curricular transformation with a competency-based focus to effectively prepare for the evolving practitioner competencies and challenges of the pharmacy profession. The curricular implementation of evidence-based teaching and learning theories and practices demands educator proficiency through skills development with indispensable faculty leadership support. Our scoping review of online databases and pharmacy education-related journals aims to identify faculty development interventions or teaching proficiency programs that integrate educational and pedagogical theories. Original studies and reviews published between 2010 and 2022 were screened based on four inclusion criteria. Thirty-four manuscripts were eligible for full-text analysis, of which seven results referenced target faculty pedagogy knowledge development. Nine key messages, as Results Statements, synthesize and provide a framework for our results analysis. An ongoing Hungarian intervention model of comprehensive faculty development with strong interdisciplinary cooperation is discussed in our study to illustrate the applicability of the Results Statements through each stage of the process. Educator motivation and relatedness to students or awareness of the educator roles are intrinsic factors, which may not be easily detectable yet significantly impact teaching proficiency and student learning outcomes. The integration of evidence-based pedagogical knowledge and training in educator proficiency development contributes to the sustainability and cost-effectiveness of faculty interventions.

A Systematic Review of Escape Room Gaming in Pharmacy Education

OBJECTIVES

The objectives of this review were to review the current literature on escape rooms in pharmacy education, determine their impact on educational outcomes, and identify areas for future research.

FINDINGS

A literature search retrieved 14 reports, of which 10 studies met all of the study criteria. The majority of the studies used the escape room to review previously taught content (90%). More than half the studies (60%) assessed a change in a student's knowledge. One study testing a broad content area found a decrease in the before and after knowledge assessment from 70% to 67%, while other studies found before and after content knowledge increase. On average, 5.8 faculty facilitators and 33 h were needed for each activity.

SUMMARY

This review suggests that pharmacy students enjoy escape rooms and perceive that it helps in their clinical knowledge and teamwork skills. Additionally, there is a potential that it can demonstrate an increase in content knowledge, particularly escape rooms that had a singular content focus. Faculty planning on implementing an escape room activity should give strong consideration to the preparation, delivery/logistics, and content.

Game-based training to promote handwashing, handrub and gloving for hospital pharmacy operators

OBJECTIVES

Adherence to handwashing, handrub and gloving procedures is mandatory for safe, aseptic drug compounding in hospital pharmacies. This study measured participants' satisfaction and effectiveness of a game-based training tool (Handtastic Box) developed to improve adherence.

METHODS

Handtastic Boxes were played by pairs of pharmacy operators (introductory video, 1 min study of guidelines, game). In module 1, players watched videos of somebody handwashing and had to find the missing step. They examined wooden models of hands under ultraviolet (UV) light, with some areas stained with fluorescein, to find the hand showing contamination. In module 2, players used a fluorescein hydroalcoholic solution and placed their hands under UV light to highlight missing areas. In module 3, players identified major errors that could compromise glove sterility and linked them to a problem explanation. Then, they applied paint to their fingertips and donned gloves-the paint had to stay inside them. Satisfaction about the training was assessed with a 10-question survey; knowledge about procedures was assessed using a before-and-after questionnaire of nine questions, a 100-point confidence score (modules 1 and 2), and the number of before-and-after errors made during donning gloves (module 3).

RESULTS

Operators were very satisfied and felt more competent after training. Average knowledge score increased from 56.3% (SD 18.2%) to 93.7% (SD 9.5%), and confidence in answers increased from 66.4% (SD 18.7%) to 95.7% (SD 5.52%) (n=14, both modules 1 and 2). The mean error score for gloving procedure decreased from 1.7 (SD 0.8%) to 0.3 (SD 0.5%) (n=10, module 3).

CONCLUSION

Handtastic Boxes proved to be a highly effective training method for improving knowledge of handwashing, handrub and gloving.

Use of simulation for education in hospital pharmaceutical technologies: a systematic review

OBJECTIVES

Because of the inherent risks facing pharmacy technicians, and consequently also patients, initial and continuing education on hospital pharmaceutical technologies is essential. Simulation is a pedagogical tool now widely used in healthcare education. This study's objectives are to provide an overview of simulation's current place in the field of hospital pharmaceutical technology education, to classify these uses, and to discuss how simulation technologies could be better used in the future.

DATA SOURCES

Two pharmacists independently searched PubMed, Embase, and Web of Science on 21 July 2020 and included studies in English or French that used simulation as an educational tool in the field of hospital pharmaceutical technologies, whether in academic teaching or professional practice.

DATA SUMMARY

Our search criteria resulted in 6248 articles, of which 24 were assessed for eligibility and 13 included in the qualitative synthesis. Simulation in hospital pharmaceutical technology education is used in three different ways: first, as a playful pedagogical tool, with error-based simulations (cleanrooms and preparation sheets with errors), or game-based simulations (escape games, role-plays, and board games); second, as an electronic tool with virtual reality (virtual cleanrooms and serious games), or augmented reality (3D glasses); finally, to evaluate chemical contamination (fluorescein and quinine tests) and microbiological contamination (media-fill tests) during compounding to periodically requalify pharmacy technicians.

CONCLUSION

Further studies, including non-technical skills evaluations, are needed to confirm the usefulness of this innovative technique in training as efficiently as possible actual and future pharmacy professionals.

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.

The Geriatric Virtual Escape Room in Pharmacy Education: Female Students Escape Significantly Faster than Male Students

Due to COVID-19 and the limitation of face-face teaching, electronic adaptation for formative and continuous assessment methods were greatly used and documented between 2020 and 2021. This study aims to implement a virtual escape room that will help assist and refine problem-solving skills in fifth-year pharmacy students by reviewing Beer’s criteria and selecting the most appropriate management. A descriptive cross-sectional study was conducted following the implementation of the virtual escape room using google form. Students had to unlock five puzzles using Beer’s criteria. To evaluate pharmacy students’ perception of this method, they completed a survey to identify their views of the game. Of the 128 students enrolled in the geriatric course, all were able to escape (100%). A one-sample t-test indicated statistical significance between gender. Female students escaped statistically faster than male students (p < 0.00002) and were more likely to recommend the game to other students and thought the game encouraged them to think of the material in a new way, whereas male students were more neutral towards it. In conclusion, the geriatric virtual escape room was successfully implemented as a pilot innovative method to assist in virtual learning. However, future studies should investigate virtual gamification in pharmacy education and its impact on learning, as well as identify if there were any gender-specific differences in using these tools.

The impact of using an "anatomy escape room" on nursing students: A comparative study

BACKGROUND

Anatomy is an important part of health science education. In teaching anatomy, new teaching strategies have been studied in comparison with traditional-based approaches. In this manner, strategies such as the escape room-based approach have been used as an innovative learning approach in nursing education, but little is known about its application in an Anatomy module.

OBJECTIVE

To evaluate the effectiveness of the escape room for anatomy-related knowledge retention in nursing and the perceived value of the game.

DESIGN

In the first semesters of the academic years 2017-2018 and 2018-2019, a comparative cross-sectional study was conducted.

SETTINGS

This study took place at the University of Almeria with students enrolled in the Anatomy module.

PARTICIPANTS

A total of 248 first-year nursing students took part in the study.

METHODS

The study included two groups: an experimental group (EG) that participated in an escape room in the final session of their Anatomy module, and a control group (CG) that received a traditional-based teaching approach in their final lesson.

RESULTS

Students enrolled in the Anatomy module were randomly assigned to either the experimental (EG, n = 128) or control groups (CG, n = 120). The escape room was conducted in groups of four and lasted no more than 15 min. In terms of satisfaction with the escape room, EG scored above the mean. The item "I enjoyed playing" received the highest score (4.88 ± 0.35). Taking the final scores of each group into account, the EG had a final average score of 8.94 ± 0.96, while the CG had a final average score of 7.70 ± 1.25 (p = 0.001).

CONCLUSIONS

According to the findings, the "Anatomy Escape Room" is a game-based approach that motivates students and constitutes a down-to-earth resource for anatomy learning in healthcare students.

Development of an innovative educational escape game to promote teamwork in dentistry

BACKGROUND

Escape games have proven to be an innovative pedagogical tool that allows students to use the professional skills they acquired. The appeal of the game lies in the stimulation of the players' minds and in the diversity of the puzzles.

PURPOSE/OBJECTIVES

To evaluate the effectiveness of an educational tool aimed at cultivating team spirit and group cohesion in dentistry students through a fun collaborative activity that mobilises their knowledge and skills.

MATERIALS AND METHOD

Twenty-four students participated to the escape game over a one-day period. In order to win, they had to solve dentistry-related puzzles.

RESULTS

Feedback was strongly positive. The balance between manipulations and theoretical questions stimulated them. Students did favour this type of activity which allows to increase interactions between students as well as with the teaching team.

CONCLUSION

Escape games in dental schools foster a supportive learning environment and stimulated students' motivation and group cohesion.

Game-Based Learning in Pharmacy Education

Game-based learning (GBL) involves adding game elements to non-game activities to encourage engagement. Pharmacy curricula are required to incorporate active learning to meet accreditation standards. The literature supports that well-designed GBL holds the attention of students and improves knowledge in some instances. Furthermore, these adaptable experiences can be leveraged for a variety of content areas in pharmacy education. Some activities utilized by educators require large amounts of technological expertise, while others involve minimal use of technology. The incorporation of technology can create highly immersive experiences for learners; however, there are barriers (e.g., financial and technology prowess) to implementation compared to simpler designs. One area of GBL that is not well defined in the literature is how to adequately assess student learning outcomes. Most current studies describe subjective attitudes and confidence or assess content knowledge through objective pre- and post-tests. In the future, more defined and connected methods for assessment—such as active demonstrations within the game—will be needed to better incorporate GBL into pharmacy curricula. Based on the collective evidence in the literature, some GBL activities may serve as useful tools to improve pharmacy student engagement and learning.

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.].

Escape Rooms in STEM Teaching and Learning—Prospective Field or Declining Trend? A Literature Review

In the last decade, game-based learning has received growing attention in educational contexts in general and science education in particular. A recent game trend, which has also found its way into STEM classrooms, is escape rooms. In this type of game, players have to work through several puzzles to achieve a specific goal (mostly to escape from an actual room). We conducted a systematic literature review to find out whether the “market” for such games is already saturated or if there is still potential for further development. After searching the common databases (ERIC, Web of Science, and Google Scholar, as well as the German database FIS Bildung), we analyzed 93 journal articles, book chapters, and conference papers in English and German from the following domains: chemistry, physics, biology, mathematics, computer science, general science (interdisciplinary), environmental science, and medicine. We selected the ones that targeted a specific educational level (primary, secondary or tertiary education) and were designed for formal educational settings. It transpired that there is a need for more easily adaptable escape rooms as well as for more empirical evidence on their actual effects.

Efficiency of four solutions in removing 23 conventional antineoplastic drugs from contaminated surfaces

BACKGROUND

Residual contamination by intravenous conventional antineoplastic drugs (ICAD) is still a daily issue in hospital facilities. This study aimed to compare the efficiency (EffQ) of 4 different solutions to remove 23 widely used ICADs from surfaces.

METHOD AND FINDINGS

A solution containing 23 ICADs (4 alkylating agents, 8 antimetabolites, 2 topo-I inhibitors, 6 topo-II inhibitors and 3 spindle poisons) was spread over 100 cm2 stainless steel. After drying, decontamination was carried out using 10×10 cm wipes moistened with 300 μL of one of the following solutions: 70% isopropanol (S1); ethanol-hydrogen peroxide 91.6-50.0 mg/g (S2); 10-2 M sodium dodecyl sulphate/isopropanol 80/20 (S3) or 0.5% sodium hypochlorite (S4). Six tests were performed for each decontamination solution. Two modalities were tested: a single wipe motion from top to bottom or vigorous wiping (n = 6 for each modality). Residual contamination was measured with a validated liquid chromatography with tandem mass spectrometry detection method. Solution efficiency (in %) was computed as follows: EffQ = 1-(quantity after decontamination/quantity before decontamination), as median (min-max) for the 23 ICADs. The overall decontamination efficiency (EffQ) of the 4 solutions was compared by a Kruskall-Wallis test. Decontamination modalities were compared for each solution and per ICAD with a Mann-Whitney test (p<0.05). EffQ were significantly different from one solution to the next for single wipe motion decontamination: 79.9% (69.3-100), 86.5% (13.0-100), 85.4% (56.5-100) and 100% (52.9-100) for S1, S2, S3 and S4 (p<0.0001), respectively. Differences were also significant for vigorous decontamination: EffQ of 84.3% (66.0-100), 92.3% (68.7-100), 99.6% (84.8-100) and 100% (82.9-100) for S1, S2, S3 and S4, respectively (p<0.0001). Generally, vigorous decontamination increased EffQ for all tested solutions and more significantly for the surfactant.

CONCLUSION

Decontamination efficiency depended on the solution used but also on the application modality. An SDS admixture seems to be a good alternative to sodium hypochlorite, notably after vigorous chemical decontamination with no hazard either to materials or workers.