Educational Gaming for Pharmacy Students - Design and Evaluation of a Diabetes-themed Escape Room

Serious digital games for diabetes Mellitus: A scoping review of its current State, Accessibility, and functionality for patients and healthcare providers

The global rise in diabetes prevalence poses a significant challenge to healthcare providers, stimulating interest in digital interventions such as educational games. However, the impact and availability of research-developed diabetes games remain uncertain. This scoping review aimed to provide a comprehensive overview of serious games for diabetes, encompassing their availability, characteristics and health effects. Through an electronic search in multiple databases, a total of 21 articles addressing 23 games were included in the literature review. The majority of these games were inaccessible outside of research settings, despite demonstrating positive effects on various aspects of diabetes management, including knowledge, physical activity, self-management, mental well-being, and HbA1c levels. Most games were designed for mobile phones, targeting both children and adults. A subsequent app store search revealed 13 additional diabetes games, however nearly none (7.7%) of these underwent research scrutiny, leaving their expected effects uncertain. The disparity between evidence-based games and those available in app stores underscores the need for bridging this gap to ensure the availability of effective digital games for diabetes management worldwide.

Escape rooms in pharmacy education: More than just a game

An educational escape room is a form of game-based learning that has been shown to improve students' learning experience. A cardiovascular escape room was designed to promote the development of transversal skills and help students retain learned content knowledge in an integrated pharmacology and therapeutic unit in a Pharmacy course.

OBJECTIVE

This study aims to design, pilot, and evaluate the students' self-perceived transversal skills, learning experience and knowledge acquisition from a cardiovascular educational escape room.

METHODS

The model pharmacy at Curtin University was used as the room that students were challenged to escape. Students were required to acquire a four-digit safe code, with each digit derived from four separate briefcases containing different puzzles and clues. This code enabled students to unlock a lifesaving medication to successfully escape the room and rescue a fictional patient who had collapsed outside of the pharmacy. Each session was followed by a debrief to reflect on the learning experience.

RESULTS

Fifty-four students participated in the study. Eight out of twelve groups successfully escaped the room. There was negligible difference in the score of the pre- and post-knowledge assessments. All students strongly agreed/agreed that the escape room was an effective way to review the cardiovascular content covered in the lecture and tutorial and that the activity should be continued for future students.

CONCLUSION

Students perceived the education escape room as a valuable learning exercise to help them retain content knowledge and develop transversal skills in the learning of integrated pharmacology and therapeutic within a Pharmacy course.

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.

Impact of Facilitation on Cognitive Flow in a Novel Diabetes Management Rehearsal Game for Health Professions Education: Mixed Methods, Open-Label, Superiority Randomized Controlled Trial

BACKGROUND

Though the prevalence of diabetes is set to increase, most serious game solutions typically target patient self-management and education. Few games target health care professions education, and even fewer consider the factors that may increase their efficacies. The impact of facilitation, a prominent feature of health professions education, is examined in the context of a rehearsal-based diabetes management serious game.

OBJECTIVE

In this mixed methods, open-label, superiority randomized controlled trial, we compare student performance, attitudes, and perceptions of a rehearsal-based diabetes management game for health care professionals.

METHODS

Student participants were randomized into 2 groups to play a diabetes management game. The control group played the game alone, and the intervention group played the same game alongside a facilitator tasked to moderate overall challenge levels and address queries. Both groups were administered the Flow Short Scale, a 13-item measure rated on a 7-point Likert scale ranging from 1 ("not at all") to 7 ("very much") immediately after the game. Students were then invited to voluntary focus group discussions to elicit their attitudes and perceptions of the game. Findings were subject to between-group comparisons and inductive thematic analysis respectively.

RESULTS

A total of 48 (26 control, 22 intervention) clinical-year undergraduates from the Lee Kong Chian School of Medicine in Singapore participated in this study, with 18 continuing to the focus group discussions. Flow Short Scale results indicated the superiority of the intervention group for overall flow (t46=-2.17, P=.04) and the absorption subdomain (t46=-2.6, P=.01). Qualitative results indicated students viewed facilitation as helpful and appropriate, and were able to identify improvable elements of the game's theoretical foundations and overall design.

CONCLUSIONS

While serious games are efficacious means of rehearsing previously learned knowledge, facilitation allows for their efficiency to be greatly increased. Such increases are likely crucial in the coming years with the increased digitization of health care professions education and the prevalence of diabetes.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05637749; https://www.clinicaltrials.gov/study/NCT05637749.

The effect of escape room clinical evaluation method on satisfaction, learning, and preparedness to practice as interns of nursing students: A quasi-experimental quantitative study

BACKGROUND

Clinical evaluation utilizing the escape room game is recognized as a novel method for assessing the team-oriented performance of learners. It is a tool for evaluating teamwork skills in clinical settings, which can boost student motivation and learning. This study aimed to investigate the effect of clinical evaluation through escape rooms and feedback provision through the PEARLS (promoting excellence and reflective learning in simulation) approach on pre-internship nursing students' satisfaction, learning, and preparedness to practice as interns.

MATERIALS AND METHOD

The current research is a quasi-experimental quantitative study conducted with a census sample of 42 sixth-semester undergraduate nursing students in 2022. The escape room method was utilized to evaluate entry preparedness into the clinical field. Reliable and valid researcher-made questionnaires were administered to assess the impact of the intervention on learning, satisfaction, and preparedness. The data were analyzed in SPSS version 26 using descriptive and inferential tests. The significance level was considered to be less than 0.05.

RESULTS

Twenty-six males and 16 females constituted the 42 participants (mean age: 23.46 years). The clinical evaluation method of the escape room game was deemed satisfactory or highly satisfactory by 80% of students. From the perspective of 72% of students, escape rooms were definitely or highly effective in shaping their preparedness to enter the clinical field. Comparing the students' mean learning scores (self-assessment of clinical skills) before and after the test revealed that their post-test scores (55/16 ± 13/33) were significantly higher than their pre-test scores (45/58 ± 16/58) (P < 0.001).

CONCLUSIONS

It appears that using the escape room evaluation method in conjunction with other student evaluation methods has helped improve students' interpersonal communication, problem-solving skills, critical thinking, and teamwork. The experience of working in a group not only improves these skills and is enjoyable to students but can also enhance their learning. Clinical education is dependent on teamwork. The escape room test can be viewed as a valuable tool for encouraging students to collaborate as a team. Therefore, it is suggested that students in all medical education groups be evaluated clinically using this test.

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.

Creating and running an escape room for healthcare curricula: AMEE Guide No. 168

In this guide we provide instructions and recommendations about creating and running escape rooms for healthcare education. In recent years there has been a growing interest in adopting escape rooms as an educational tool to be included in healthcare curricula, and we attempt to explain why and how these tools are fit for the particularities of this type of education. We first describe the steps that a design team will have to follow to create an educational escape room from scratch, from core characteristics like target audience and learning goals to actual puzzle design and testing. We then continue by providing recommendations to operators and lecturers about how to run such escape room as part of an overall teaching session that also includes a lecture, briefing, debriefing and evaluation. We finalise this guide by listing a set of tools for validating and evaluating these types of escape rooms.

An Escape Game on University Students' Mental Health During the COVID-19 Pandemic: Cocreation Study

BACKGROUND

The COVID-19 pandemic has had a severe impact on students' mental health. Interventions are needed to promote their psychological well-being and prevent mental illnesses in the aftermath of this unprecedented situation. Digital escape games can be an effective tool to support students' mental health. A cocreation approach can improve the acceptability of these interventions by involving different stakeholders (eg, end users, game designers, and health professionals) to obtain audience-specific games.

OBJECTIVE

This study aims to describe the process of testing and optimizing the game "EscapeCovid" on students' mental health, to serve as a model for the cocreation of future similar interventions.

METHODS

The PRODUCES (Problem, Objective, Design, End Users, Cocreators, Evaluation, Scalability) framework was used. Cocreation steps (test and optimization) were detailed for replicability. A total of 45 students tested a pilot version of the game, with 10 undergoing a semistructured interview. Meetings with a group of stakeholders and brainwriting were organized to optimize the game.

RESULTS

We produced a new version of the game incorporating the suggestions provided by student testers and following the stakeholders' guidelines. Improvements were made to both the content and the form of the new version of the pilot game. The storyline, including the protagonist and the scenes, was adapted to the student population.

CONCLUSIONS

Our results suggested that cocreation can contribute to the design of more widely accepted interventions aimed at promoting mental health and preventing psychological disorders. Results also suggest that an end user-centered approach can facilitate intervention tailoring. When conceiving a health-related escape game for students, we recommend using the cocreation approach to enhance players' experience, thus positively influencing their learning process and overall well-being.

A scoping review of international allied health professions escape room practices and scholarship

PURPOSE

The purpose of this scoping review is to assess the literature on allied health professions escape rooms (AHPERs), investigating their common purposes and practices, and the trends in scholarship.

METHODS

This scoping review followed PRISMA-ScR guidelines to assess the size and scope of evidence in the literature, categorize common purposes and practices, and explore trends in AHPER scholarship. Two reviewers developed a review protocol, collected literature using a search strategy aligned with inclusion criteria, and charted review results.

RESULTS

The literature search yielded 6,170 articles. After the final review, 34 unique records met inclusion criteria. Studies were conducted in the United States, Spain, Australia, France, Brazil, and Canada. Most escape rooms reported participants, team size, puzzle type, and outcomes, but few used causal research designs, primarily using pre-post with no control designs. AHPERs represent an increasingly popular pedagogical approach. AHPERs tend to be simply structured, patient themed, and convey either disciplinary or interprofessional lessons. Generally, AHPERs were self-reported as effective and satisfying, but scholarship supporting AHPERs was insufficient in design for causal claims.

CONCLUSION

Developers and scholars may benefit from considering frameworks and guidelines for consistent creation and increased trustworthiness in the AHPER practice and knowledge base. Where AHPER scholars can increase attention to learning outcomes, and plan scholarly works in advance of the escape room, the AHPER body of knowledge will increase.

Assessing the Importance of Content Versus Design for Successful Crowdfunding of Health Education Games: Online Survey Study

Background

Health education games make health-related tasks enjoyable and interactive, thereby encouraging user participation. Entrepreneurs and health educators can leverage online crowdfunding platforms, such as Kickstarter, to transform their innovative ideas into funded projects.

Objective

This research focuses on health education game initiatives on Kickstarter. Through an online user survey, it aims to understand user perceptions and evaluate the significance of 8 distinct components that may influence the success of such crowdfunding initiatives.

Methods

A total of 75 participants evaluated games using 8 dimensions: game rules, learning objectives, narrative, content organization, motivation, interactivity, skill building, and assessment and feedback. The survey data were analyzed using descriptive statistical analysis, exploratory factor analysis, the Wilcoxon-Mann-Whitney test, and multivariate analysis.

Results

Exploratory data analysis showed that, among the 8 dimensions, skill building, content organization, and interactivity were the top-ranking dimensions most closely associated with crowdfunding health education game. The 8 dimensions can be grouped into 3 categories from the exploratory factor analysis: game content-, instruction-, and game design-related components. Further statistical analysis confirmed the correlation between these dimensions with the successful crowdfunding of health education games.

Conclusions

This empirical analysis identified critical factors for game proposal design that can increase the likelihood of securing crowdfunding support.

Educational escape rooms for healthcare students: A systematic review

OBJECTIVES

To synthesize evidence on the implementation and evaluation of educational escape rooms for healthcare students.

DESIGN

A systematic review.

DATA SOURCES

A search of seven databases including PubMed, Scopus, Web of Science, Cochrane, EMBASE, CINAHL, and Education Resources Information Center was conducted for published studies from inception to January 2023. The selected articles were assessed by two independent researchers for meeting the inclusion criteria and methodological quality. The data was narratively synthesised.

RESULTS

Fifty-two studies were included in the review. Escape rooms were employed as learning and assessment strategies for the delivery of diverse topics within dentistry, medical, nursing, pharmacy and physiotherapy pre-registration healthcare education. Most were conducted on nursing students with learning topics focusing on the development of knowledge related to patient care management. Virtual escape rooms became more prevalent following the COVID-19 pandemic. The specific design features of escape rooms were based on the elements of game-based learning including team learning with appropriate size, time limit and sequential path-design of puzzles. Applying the experiential learning approach, the facilitators played a pivotal role in pre-briefing, facilitating the gameplay, and debriefing. Escape rooms were evaluated to be enjoyable and have an impact on students' cognitive, psychomotor, non-technical and affective skills learning outcomes. However, the learning outcomes compared with conventional learning strategies were inconclusive due to lack of randomised controlled trials.

CONCLUSION

Escape rooms are increasingly being used as experiential and game-based learning in healthcare education. It will continue to evolve with virtual technology advancement and is a promising tool to provide virtual team training within interprofessional education for the development of teamwork and communication skills. While more rigorous research using a randomised controlled trial design is needed to evaluate the effectiveness of escape rooms and their design features, qualitative studies, particularly on the perspective of facilitators are needed to unravel the learning process.

Development and evaluation of an escape room based on general pharmacokinetics: Students' perceptions of its motivational climate

We designed an escape room based on the basic principles of pharmacokinetics for undergraduate bachelor students and explored its effect on students' perceived motivational climate and usefulness as a formative assessment via a mixed-method design. The effect on students' perceptions of the motivational climate was measured using pre- and post-test measurements of the MUSIC® inventory. Students' experiences with the escape room and suggestions for improvement were collected by open-ended survey questions. Forty-one students initially joined the study while 28 students completed both the pre- and post-test MUSIC® inventory. Data from the MUSIC® inventory revealed the effect of playing the escape room on students' situational interest was positive with medium to large effect (Cohen's dav  = 0.63). Data from the open-ended questions confirmed the outcome of the MUSIC® inventory. While there was a positive effect on situational interest, students found the escape room not very useful as a tool for formative assessment. Further research should include a control group and focus on the effect of the escape room on academic success and work toward increasing the capacity of the escape room for large-scale courses.

Implementing a Large-Scale Escape Room: An Intervention to Increase Electronic Health Record Downtime Competence

The purpose of this project was to evaluate an escape room's impact on electronic health record downtime competence. Seventy-four nurses simultaneously completed a sequentially designed, tabletop escape room to escape a zombie invasion. Results showed 92% of participants were motivated by the escape room; 90% reported it significantly influenced their learning. Findings were reinforced when the institution had an unplanned electronic health record downtime 2 days after the event.

Evaluation of a Patient Education Game Design Activity

BACKGROUND

Game-based learning has been used in pharmacy education settings with the instructor developing a game for students to play to enhance learning. However, there is a paucity of data about health sciences students designing a game themselves to further their understanding of a complex topic. The purpose of this study was to describe and assess a game design activity focused on patient education of anticoagulants in a pharmacotherapy skills laboratory setting.

INNOVATION

Second-year pharmacy students enrolled in a pharmacotherapy skills laboratory course worked in teams in a one-hour active learning activity to design a game intended to educate patients about their medication. A pre/post analysis of student attitudes about game-based learning and the activity, as well as knowledge, was conducted.

FINDINGS

The large majority of students (80.5%) agreed that the activity was an effective way to develop patient education strategies. Through the survey and free-response questions, students reported that the game design activity facilitated positive group collaboration and allowed students to take the perspective of their patients. Students also requested additional time to complete the activity. Knowledge assessment scores of key patient education points increased from 66.5% prior to the activity to 71.5% one week following the activity (p<0.05).

CONCLUSION

The game design activity served as a novel teaching method for pharmacy students to actively learn about anticoagulant medications while developing an innovative patient education strategy. Although there was an increase in knowledge scores, students highlighted the impact on group collaboration and taking the perspective of their patients.

Incorporating a peer-teaching, virtual, educational activity to teach newly approved medications in a senior seminar capstone course

BACKGROUND AND PURPOSE

Peer teaching and serious gaming are effective pedagogical approaches to actively engage learners, foster collaboration, and promote student accountability for self-directed learning. Literature describing how students learn about and are assessed on knowledge of newly approved medications is lacking. The objective of this project is to describe the design and implementation of a peer-taught virtual educational gaming activity, assess impact on knowledge of newly approved medications, and describe student perceptions of the activity.

EDUCATIONAL ACTIVITY AND SETTING

Pharmacy students in the fourth professional year developed and delivered a topic discussion focusing on newly approved medications to peers utilizing a virtual escape room gaming format. The activity was delivered via Zoom, Version 4.6.9 (Zoom Video Communications, Inc). A pre- and post-activity knowledge-based assessment and perception-based questionnaire were administered to participants. Observations regarding teamwork and communication were collected by facilitators.

FINDINGS

Sixteen students participated in this activity. Mean scores on the knowledge quiz were higher post-activity compared to pre-activity (8.1 vs. 6.3). The activity was perceived positively by participants with 100% of respondents agreeing or strongly agreeing that they "enjoyed the escape room theme for the activity and would recommend it to a friend." Zoom was perceived an effective platform to deliver this activity. All facilitators observed students working effectively as a team to complete the activity.

SUMMARY

Virtual gaming developed and facilitated by peer teachers may be an effective method for delivering educational content and positively influencing student learning.

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

Audience

The target audience for this small group session is post-graduate year (PGY) 1-4 emergency medicine (EM) residents, pediatric EM (PEM) fellows, and medical students.

Introduction

Pediatric emergency department visits have been declining since the start of the COVID-19 pandemic, leading to decreased exposure to pediatric emergency care for EM residents and other learners in the ED.1 This is a major problem, given that the Accreditation Council for Graduate Medical Education (ACGME) mandates that a minimum of 20% of patient encounters or five months of training time for EM residents must occur with pediatric patients, with at least 50% of that time spent in the ED setting.2,3 A minimum of 12 months must be spent in the pediatric ED for PEM fellows,2 and an average of 7.1 weeks of medical school are spent in pediatric clerkships.4 This decrease in pediatrics exposure in the post-pandemic environment can be addressed through simulation and gamification. We selected the gamification method of an escape room to create an engaging environment in which learners could interface with key pediatric emergency medicine clinical concepts via group learning.

Educational Objectives

By the end of this small group exercise, learners will be able to:Demonstrate appropriate dosing of pediatric code and resuscitation medicationsRecognize normal pediatric vital signs by ageDemonstrate appropriate use of formulas to calculate pediatric equipment sizes and insertion depthsRecognize classic pediatric murmursAppropriately diagnose congenital cardiac conditionsRecognize abnormal pediatric electrocardiograms (ECGs)Identify life-threatening pediatric conditionsDemonstrate intraosseous line (IO) insertion on a pediatric modelDemonstrate appropriate use of the Neonatal Resuscitation Protocol (NRP®) algorithms.

Educational Methods

An escape room - a form of gamification - was utilized to engage the learners in active learning. Gamification is an increasingly popular educational technique being utilized in graduate medical education and refers to the conversion of serious, non-trivial material into a fun activity fashioned like a game in order to enhance engagement in learning.5 This educational method seeks to enhance knowledge, attitudes, and skills via components of games - such as puzzles and prizes - outside of the context of a traditional game.6 Though high-quality research data on the effectiveness of gamification methods in graduate medical education is limited, studies have shown that gamification enhances learning, attitudes, and behaviors.5,7 One randomized, clinical-controlled trial investigating the use of gamification to enhance patient outcomes found that patients of primary care physicians randomized to the gamification group reached blood pressure targets faster than in the control group.8 Escape rooms as a modality for education have been suggested to improve active learning and enhance learner engagement in the learning process.9 In an escape room, learners are "locked" in an artificial environment (whether digitally or in person) and must utilize their group or individual knowledge to solve puzzles and escape from their "entrapment."9,10 Escape rooms utilized as part of EM residency didactic training have demonstrated learner enthusiasm,11,12 desire to repeat the activity again,13 preference for escape rooms over traditional learning methods,14,15 improved confidence in communication and leadership skills,11,15 and improvement scores from pre- to post-testing.16We developed an escape room in which learners were divided into teams and informed that they would need to "escape" from our resident lounge by successfully completing all nine stations. The first team to complete all nine stations would win a prize. Only after the last team completed the ninth station and debriefing was complete could all teams be "freed" from the escape room.

Research Methods

Learners provided anonymous online survey feedback regarding the quality of the educational content and the efficacy of the delivery method.

Results

A post-participation survey was disseminated to 55 residents, 32 of whom attended the PEM Escape Room, with a response rate of 9% (3/32 residents). One hundred percent of respondents felt that the activity content was applicable to their needs as an emergency physician. The session was rated as excellent by 33.3% of respondents, and 66.7% of respondents rated the session as above average. A second survey was disseminated seven months after the event to the 24 remaining residents who attended the event, with a response rate of 46% (11/24 residents); eight attendees had graduated at the time of this survey dissemination. Results of the second survey indicated that 100% (24/24 residents) felt that the activity content was applicable to their needs as an emergency physician, 73% (17/24 residents) rated the session as excellent, and 27% (7/24 residents) rated the session as above average.

Discussion

Though we received limited survey responses (3/32 on the first survey and 11/24 on the second survey), respondents felt that the educational content met their learning needs and was of high quality. We had six faculty members present to facilitate the escape room while there were four groups of residents (eight per group). The ideal faculty to resident ratio would be one faculty member per group with three to six players, based on prior literature showing that teams of more than six players take longer to complete escape room tasks.17,18 We also recognized the importance of sending out the feedback survey link early because we believe the delay in our survey being emailed to the residents contributed to the low response rate (three trainees).One participant provided the following feedback: "I think the 'escape room' struck an excellent balance with regard to trying to address knowledge that was relevant but also obscure or difficult enough that group/collaborative effort was required. I enjoyed the process and low stakes atmosphere." This quote nicely summarizes our take-aways: That the PEM escape room incorporates key tenets of adult learning theory. Also known as andragogy, adult learning theory posits that adult learners are self-directed, have prior life experiences that shape their learning process, learn for practical reasons (ie, choose to learn in order to fulfill the demands of their social role), and are problem-oriented in their learning.19 Though andragogy does not technically apply only to adults (as many children are self-directed learners),20 having an understanding of the practical and experiential nature via which adults approach learning allows the adult educator to appropriately cater educational activities to meet the adult learner's needs.This escape room aligned with the core tenets of adult learning theory in several ways. Specifically, residents were given autonomy of participation in the escape room and thus had to take initiative to promote their own learning.21 Topics featured in the escape room stations were selected based on their clinical challenges and high-yield for board examinations and patient care, making their relevance immediately obvious to learners; this is a key feature of catering to adult learners.22 The escape room provided a comfortable and collegial environment in which residents felt comfortable learning, fostering an ideal setting for mature learners.21 Direct and immediate feedback are key components of adult learning theory, and faculty members were physically present to provide feedback at each escape room station.22 Finally, working in teams required the learners to engage in active learning rather than acting as passive recipients of cognitive information.21 Thus, the PEM escape room serves as an ideal framework to meet the needs of the adult learner.

Topics

Pediatrics, emergency medicine, pediatric emergency medicine.

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.

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.

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.

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.

Development and Assessment of Integrated Virtual Escape Rooms to Reinforce Cardiology Content and Skills

Objective. To describe the development and assessment of an integrated virtual escape room in a cardiology course.Methods. A virtual escape room was developed to reinforce therapeutics, pharmacology, pharmacokinetics, medicinal chemistry, pharmacogenomics, and calculations related to cardiology in an integrated pharmacy course and was completed by two student cohorts. Groups of four to five students had 40 minutes to complete virtual escape room puzzles, and each puzzle had to be solved correctly prior to advancing. After completion of the activity, learners met with facilitators to debrief. Students completed pre- and postsurveys to assess knowledge changes and their perceptions of the experience.Results. One hundred twenty-six second-year Doctor of Pharmacy (PharmD) students completed the escape room, and 79% (n=55) and 93% (n=52) of students completed pre- and postsurveys for the 2020 and 2021 cohorts, respectively. Results showed a significant improvement in student knowledge on pre- to postsurvey knowledge questions (2020 presurvey mean [SD]=43.1 [22.6], postsurvey mean [SD]=74.1 [19.6]; 2021 presurvey mean [SD]=52.0 [15.8], postsurvey mean [SD]=67.1 [19.2]). Most students in both cohorts (88%) agreed that logistics of the escape rooms were amenable to learning and applying information, and 86% enjoyed working through puzzles.Conclusion. The virtual escape room was well received by students and served as an effective tool for reinforcing and integrating cardiology concepts. The virtual nature of the activity makes it practical and easily replicable to implement at other institutions, which can benefit from using the format, logistics, and materials described in this study to decrease faculty workload and costs associated with implementing this educational technique.

Building digital escape rooms for learning: From theory to practice

Digital games are increasingly used to support learning across a diverse range of cognitive, affective and psychomotor domains in health professions education. Game-based learning will likely become an important competency for educators. However, educators can perceive game building as out of their reach due to a lack of expertise in digital technology. This toolbox offers advice to health professions educators who would like to build a simple game for learning known as a digital educational escape room.

Gamification in pharmacy education: a systematic quantitative literature review

OBJECTIVES

Gamification involves applying game attributes to non-game contexts and its educational use is increasing. It is essential to review the outcomes and the efficacy of gamification to identify evidence to support its use in pharmacy education.

THIS ARTICLE

systematically and quantitatively reviews and evaluates the alignment of learning outcomes and the quality of peer-reviewed literature reporting gamification in pharmacy education.

KEY FINDINGS

A literature search was undertaken in February 2022 using CINAHL Complete, MEDLINE, Science Direct, Scopus and ERIC databases, via keywords (game* OR gaming OR gamif*) AND pharmac* AND education. Google Scholar was searched using 'gamification of pharmacy education' and 'serious games in pharmacy education'. Data extracted included type of gamified intervention, mode of delivery, game fidelity, intended learning outcomes and outcomes reported. Quality assessments aligned with key aspects of the SQUIRE-EDU Reporting Guidelines. Of 759 abstracts and 95 full-text papers assessed, 66 articles met the inclusion criteria. They described gamification from 12 countries in the education of 8272 pharmacy and health professional students. Gamified interventions ranged from board games to immersive simulations, with escape rooms most frequently reported. Reporting quality was inconsistent, with observed misalignment between intended learning outcomes and outcomes reported, an apparent overreliance on student perceptions as primary data and a lack of reference to reporting guidelines.

SUMMARY

Gamification is included in the curricula of many pharmacy degrees, across multiple subject areas. This review identified evidence gaps and reinforces the need for improved quality of gamification research, critical alignment of learning outcomes with evaluation, and use of reporting guidelines.

An Introductory Over-the-Counter Simulation for First-Year Pharmacy Students Using a Virtual Pharmacy

Objective. First-year pharmacy students at two institutions were required to complete a virtual over-the-counter (OTC) simulation during their community pharmacy practice skills laboratory course. The simulation was designed to introduce first-year pharmacy students to OTC product selection and consultation prior to didactic coursework and community introductory pharmacy practice experiences. The objective of this study was to assess the impact of the OTC simulation on students' knowledge and confidence of OTC medications and overall perceptions of the activity.Methods. Patient simulation cases in the virtual community pharmacy setting were developed and delivered to students using the MyDispense platform. Students concurrently completed a Google Form that provided directions for the virtual activity, including a combination of didactic and active learning strategies within the online platform. Student surveys assessed knowledge and confidence before and after the activity, with perceptions added to the postsurvey.Results. Total knowledge scores for the 142 students from two institutions who completed both the pre- and postsurvey significantly improved and, when assessed individually, improved for seven out of 10 individual knowledge questions. All five confidence statements significantly increased after students completed the OTC simulation. Student perceptions were overall very positive.Conclusion. Introduction of OTC counseling processes to first-year pharmacy students through a virtual pharmacy simulation resulted in increased student knowledge and confidence in providing OTC recommendations. Students perceived the activity favorably.

Virtual escape room paired with simulation improves health professions students' readiness to function in interprofessional teams

BACKGROUND

This project investigated the change in nursing, pharmacy, and physical therapy students' interprofessional socialization after participation in a virtual interprofessional escape room and case conference simulation.

INTERPROFESSIONAL EDUCATION ACTIVITY

Interprofessional teams of nursing (n = 93), pharmacy (n = 75) and physical therapy (n = 33) students completed asynchronous, online learning (sepsis recognition and total hip replacement post-operative precautions) followed by a virtual escape room and a virtual simulated patient case conference. During the case conference, interprofessional student teams developed a discharge plan for an individual after a hip replacement complicated by post-operative sepsis. Before and after the experience, students completed a knowledge test and a validated survey instrument that assessed their interprofessional socialization (Interprofessional Socialization and Valuing Scale-21). During the simulated patient case conference, faculty assessed student performance using a standardized rubric. After the experience students completed a program evaluation.

DISCUSSION

Interprofessional socialization significantly increased (5.5 ± 0.9 vs. 6.0 ± 0.9) among all students with a medium effect size (Cohen's d = 0.56). Faculty assessment of individual student's team performance during the virtual simulation revealed a moderate rate meeting competency, with good interrater reliability. Students highly valued this learning experience as being both effective and important to their professional development, as indicated on the program evaluation.

IMPLICATIONS

A virtual interprofessional experience consisting of asynchronous online learning, a virtual escape room, and a virtual case conference positively influenced students' interprofessional socialization. Students valued the experience and recognized its importance in their development as student health professionals.

ESCAPE the Boring Lecture: Tips and Tricks on Building Puzzles for Medical Education Escape Rooms

Escape rooms in medical education are a novel, game-based learning approach for teaching medical topics. In these escape rooms, learners complete a sequential series of medical-themed puzzles leading them to "escape" a specific story. Designing puzzles can be anxiety-provoking and may be the gatekeeper for educators in medicine to create their own escape rooms. Though there have been publications on the importance and methods of building a healthcare-themed-escape room, there is a gap in the literature on designing puzzles to teach specific learning objectives successfully. In this Scholarly Perspective, the authors share puzzle ideas and support tools and use Bloom's taxonomy as the framework to teach educators how to design challenging and engaging escape room puzzles.

Nursing students' opinion on the use of Escape ZOOM® as a learning strategy: Observational study

The teaching-learning process has gone through major changes due to the COVID-19 pandemics and it has been left to professors to adapt the teaching process and find ways to keep students engaged. There has been a need to establish collaborative and active strategies for working in the online environment. The development of a game for both teaching and evaluating de interdisciplinary learning content on an online platform may create a gameful experience and stimulating environment that makes complex learning goals achievable. To analyze how nursing students feel in relation to their participation and learning in an Escape Room activity taking place in an online environment. This is a descriptive and exploratory cross-sectional cohort study. The study was carried out in a higher education institution. The sample consisted of 73 students. After implementation of Escape Zoom® in the first semester of 2021, adapted questionnaires to assess students' satisfaction and perception of learning were applied. In the Educational Practices Questionnaire, all statements obtained greater than 70% agreement, which revealed students' satisfaction, especially with learning with colleagues. As for learning, 93.2% of students' statements expressed that the Escape Zoom® favors teamwork and 91.8% of student's statements agreed that the activity is effective for learning and would recommend it to other colleagues. The Escape Zoom® is an effective teaching strategy, perceived with satisfaction by students as a form of learning with colleagues, in a game-oriented way. It also has the potential to promote the development of soft skills.

The design, implementation and evaluation of hybrid cancer clinic simulations: Escaping the norm

INTRODUCTION

Simulation and gamification are two popular educational tools utilized to enhance student learning and engagement. This study aimed to evaluate the effectiveness of integrating a hybrid cancer clinic simulation into the curricula for third-year pharmacy (P3) students.

METHODS

This prospective, single-arm pilot study incorporated a mixed-method learning activity involving patient simulation and escape room elements. Two cancer clinic simulations were developed by faculty members. For each clinic, students were randomly divided into 6 groups and tasked with completing a series of Pharmacist Patient Care Process (PPCP) activities involving patient actors. The PPCP activities were interwoven with engaging puzzles and games to simulate an escape room. Student learning and retention was measured by pre- and post-simulation quizzes and course level exams. A perceptions survey was administered after each simulation activity.

RESULTS

Thirty-six students participated in both cancer clinic simulations, with 100% completing all aspects of the study. Mean student quiz scores improved from 61.4% to 81.7% (p < 0.0001) and 52.6% to 81.8% (p < 0.0001) following the first and second simulations, respectively. Exam performance improved for 16 out of 19 exam questions, with a significant increase in 4 questions (p < 0.05). Students overwhelmingly agreed that the cancer clinic simulations 1) reinforced knowledge, 2) facilitated PPCP, 3) improved their ability to make chemotherapeutic recommendations, 4) enhanced problem-solving skills, and 5) encouraged collaboration.

CONCLUSION

This innovative hybrid simulation enhanced oncology-related knowledge and supported an interactive environment that improved student confidence and teamwork. Students enjoyed the simulations and recommended continuation for all future cohorts.

Exploring Medical Students' Learning Around Uncertainty Management Using a Digital Educational Escape Room: A Design-based Research Approach

Introduction

Medical professionals meet many transitions during their careers, and must learn to adjust rapidly to unfamiliar workplaces and teams. This study investigated the use of a digital educational escape room (DEER) in facilitating medical students' learning around managing uncertainty in transitioning from classroom to clinical placement.

Methods

We used design-based research to explore the design, build, and test of a DEER, as well as gain insight into how these novel learning environments work, using Community of Inquiry (CoI) as a guiding conceptual framework. This study represented a mixed methods pilot test of a prototype DEER. Twenty-two medical students agreed to participate, and data were collected through qualitative (i.e., focus groups, game-play observations) and quantitative (i.e., questionnaires) methods.

Results

Eighty-two per cent of participants agreed or strongly agreed that the DEER supported their learning around uncertainty. Participants offered diverse examples of how the game had facilitated new insights on, and approaches to, uncertainty. With respect to the learning environment, multiple indicators and examples of the three domains of CoI - cognitive, teaching and social presence - were observed.

Discussion

Our findings suggested that DEERs offer a valuable online learning environment for students to engage with complex and emotion-provoking challenges, such as those experienced at transitions. The study also suggested that CoI can be applied to the design, implementation, and evaluation of DEER learning environments, and we have proposed a set of design principles that may offer guidance here.

Escape rooms in nursing education: An integrative review of their use, outcomes, and barriers to implementation

OBJECTIVES

Escape rooms are becoming a popular teaching method in a variety of fields and settings, but have not been examined for their effectiveness in nursing education. The aim of this integrative review was to map trends in escape rooms in nursing research and evaluate support for using this innovative, simulation-based teaching method.

DESIGN, DATA SOURCES, AND REVIEW METHODS

Using Whittemore and Kanfl's framework, this integrative review analyzed the use of simulation-based escape rooms in nursing and nursing education. Results were refined using inclusion and exclusion criteria, and evaluated with use of the Mixed Methods Appraisal Tool. Databases searched were PubMed, CINAHL, PsychINFO, Google Scholar, and ERIC.

RESULTS

A total of 18 studies were included. Common categories identified included student satisfaction with escape rooms and barriers of cost and time to educators. Desired outcomes of the studies reviewed focused on teamwork, perceived learning or increased confidence, or increase in knowledge. Optimal group size and theoretical support recommendations for escape rooms are lacking with the need for further research.

CONCLUSIONS

Escape rooms are effective at improving knowledge in a variety of nursing education topics, and their use has been well-received in a variety of nursing and professional health students. Long-term outcomes have not been assessed. There is need for more research in assessing ideal group size when using escape rooms in education settings, more rigorous study design to determine effectiveness of escape rooms to produce education-focused outcomes, and more consensus on appropriate theoretical frameworks that can guide the implementation and study of escape rooms in practice.

An online escape room used to support the growth of teamwork in health professions students

Effective teamwork in the online environment is essential to patient care and safety. The need for training health professionals to work together on a virtual interprofessional team has become even more important since the start of the COVID-19 pandemic as telehealth, or the provision of virtual healthcare to patients, has become more common. This resource describes the development of an online escape room activity using free online resources. The activity aimed to enhance health profession students' abilities to communicate effectively, work together to complete a task, and develop knowledge of the unique roles of healthcare team members in a course dedicated to interprofessional education. Teams of five to seven students met online and completed seven puzzles to escape a virtual room. Results obtained from the pre-post surveys of 176 students across six disciplines showed the activity aided in increasing participants perceptions of their ability to communicate respectfully and work together to complete a task, while developing knowledge of the unique roles of members of the healthcare team, all components of the Interprofessional Education Collaborative (IPEC) Core Competencies. This activity lays the groundwork for collaborative, interprofessional activities, such as telehealth, which students will be exposed to in their futures, and the results infer that the activity can help to build collaboration among team members, even team members that are not in the same physical space.

Insurance Adjudication Simulation Across Multiple Institutions and Levels of Learners

Objective. A virtual educational innovation was designed and implemented to have student pharmacists simulate insurance processing. This article describes the impact of this third-party payer simulation on student knowledge and confidence and reports student perceptions of the activity.Methods. First-, second-, and third-year pharmacy students (P1, P2, and P3 students, respectively) at four institutions completed the self-paced simulation. Knowledge was assessed by comparing results of multiple-choice questions on the pre- and post-assessments and evaluated by the Wilcoxon signed rank test. Confidence was assessed by students' change in self-reported confidence scale measurements and compared using the chi-square test.Results. The simulation had a significant impact on student knowledge. The largest improvement was in P1 students, with a pre- to post-assessment average score difference (scale 0-100) of 16.6 compared to 7.2 for P2 and 10.2 for P3 students. Significant improvement was seen on most of the knowledge questions, with variations for certain questions between groups. All groups had significantly improved self-rated confidence in their abilities. Most students agreed that they would recommend this activity to other students (91.7%) and that it encouraged them to think about the material in a new way (85%).Conclusions. Through an innovative simulation on prescription insurance processing, positive results were seen across all three levels of learners. Knowledge assessments significantly improved, and student confidence increased across all groups and all confidence items. Participants would recommend this activity to other students and felt it was an effective way to learn about insurance adjudication.

The Impact of Escape Room Gamification Using a Teleconferencing Platform on Pharmacy Student Learning

OBJECTIVE

The purpose of this study is to design and implement a virtual escape room game using the Zoom video conferencing platform to enhance third professional doctor of pharmacy students' knowledge of self-management of sexual health and pregnancy prevention and to assess student's perception of the activity.

METHODS

Students were divided into five pre-assigned breakout rooms of five to six students each using the Zoom video conferencing platform, following the conclusion of the self-care sexual health and pregnancy prevention lecture. Once in the breakout room, students worked as a group to complete seven activities to gain access to a code needed to "escape the room." At the completion of the activity, students were asked to fill out a perceptions survey.

RESULTS

Twenty-six students participated in the virtual escape room activity, with all students completing the activity within the allotted time. Overall, students expressed positive attitudes toward the escape room activity, reporting it helped them check their knowledge of the subject, remain motivated, and connect with their classmates.

CONCLUSIONS

Overall, the virtual escape room had a positive impact on student learning and application of subject material.

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.

A novel game to review pharmacoeconomic content in a pharmacy program

BACKGROUND AND PURPOSE

This study reports on the development of a new game designed specifically for a pharmacoeconomics course to meet three objectives: (1) identify four main types of pharmacoeconomic analyses, (2) understand different outcomes for each analysis, and (3) interpret findings of pharmacoeconomic analyses.

EDUCATIONAL ACTIVITY AND SETTING

The game simulated real-world applicability of pharmacoeconomic analyses in a classroom setting using a candy theme. Groups of pharmacy students (N = 62) competed by building formularies that incorporated a minimum number of medications (candies) from each outcome category and at least two specialty services. Each medication and service were assigned a cost and rating according to the outcome associated with each analysis type. The following class session served as a debriefing to assess student perceptions using a written survey. Survey responses ranged from a score of 1 (strongly agree) to 5 (strongly disagree). A separate open-ended question collected feedback on the strengths and weaknesses of the game and analyzed into themes.

FINDINGS

Student responses averaged 1.96 (SD = 1.1) for all questions. The highest rated question, "I attained the stated goals/objectives of this activity," scored 1.81 (SD = 1.1). Four overall themes emerged: engaging (n = 10), valuable (n = 19), confusing (n = 17), and disconnected (n = 8). Students highlighted the value of the gaming activity for providing practical, real-life examples to increase their understanding.

SUMMARY

The design and application of gaming in a pharmacoeconomics course proved practical and valuable for student learning.

Nursing students' experience using an escape room for training clinical skills and competencies on emergency care: A qualitative observational study

Game-based learning is increasing in nursing education. Also, the assessment of the utility of the escape room game is growing. To explore nursing students' opinion about the escape room as an evaluation game, a qualitative observational study with nursing students was carried out. An ad hoc questionnaire with open questions was sent after the game learning experience. The escape room included knowledge and techniques from different specialties. The escape room learning game was a positive experience for the students. The main highlighted characteristics were fun, dynamic, and motivating way to study and learn. Other interesting variables were: "Working as a team and under pressure" (It's a group activity in which everyone must work together. It is a good challenge to learn how to work in urgent situations) and "Different way to assess students´ learning" (In this type of game, I can show more things and not only theoretical knowledge). Game-based learning is increasing in nursing education, as well as the assessment of the utility of the escape room game. Using an escape room for assessing nursing students' knowledge is a positive experience. This learning experience can be also used with nurses in different specialties to promote teamwork and working under pressure.

Escape box and puzzle design as educational methods for engagement and satisfaction of medical student learners in emergency medicine: survey study

BACKGROUND

Gamification in medical education has gained popularity over the past several years. We describe a virtual escape box in emergency medicine clerkship didactics to teach chest pain and abdominal pain and compare this instructional method to a traditional flipped classroom format.

METHODS

A virtual escape box was designed at our institution and incorporated into the mandatory two-week emergency medicine clerkship. The game consisted of a PDF with four cases containing puzzles to unlock a final clue. Likert scale surveys were administered to assess participants' perceptions of the escape box format; of clerkship didactics as a whole; and of the clerkship overall. These responses were compared to the prior year's evaluations on flipped classroom didactics and clerkship.

RESULTS

One hundred thirty-four learners participated in the escape box and completed the survey. Eighty-six percent strongly agreed with feeling more engaged with the escape box, 84% strongly agreed with learning something new, 81% strongly agreed with finding the escape box to be satisfying, 78% strongly agreed with being able to apply knowledge gained, and 74% strongly agreed with wanting more escape boxes incorporated into medical education. The escape box showed a higher average score (3.6 ± 0.63) compared to chest pain (3.5 ± 0.67) and abdominal pain (3.2 ± 0.77) flipped classroom sessions (p = 0.0491) for the category of "lecturer explaining content clearly and at the proper level of complexity." For the category of "lecturer provided effective instructional materials," the escape box showed higher scores (3.6 ± 0.63) compared to flipped classroom for chest pain (3.4 ± 0.77) and abdominal pain (3.1 ± 0.80) (p < 0.001).

CONCLUSIONS

Escape boxes are adaptable to a virtual format and can teach abstract concepts such as teamwork and communication in addition to traditional lecture content. Ratings of didactics were higher for the escape box compared to the flipped classroom, while ratings of overall clerkship experience were not found to change significantly.

Simulation-Based Education Implementation in Pharmacy Curriculum: A Review of the Current Status

Simulation-based education (SBE) is a fundamental teaching method that complements traditional teaching modalities. SBE has improved students' knowledge, understanding, and numerous essential skills within undergraduate pharmacy education, similar to traditional teaching methods. However, SBE has become crucial for developing students' teamwork, decision-making, and communication skills. Even though the Accreditation Council for Pharmacy Education (ACPE) has acknowledged the benefit of SBE in interprofessional education (IPE) and the introductory pharmacy practice experience (IPPE). This article provides evidence that SBE can be effective beyond that. This narrative review is focused on the literature related to SBE modalities and the assessment methods of student learning outcomes in the undergraduate pharmacy curriculum. The review illustrates that SBE is an effective teaching method that could be utilized within the pharmacy curriculum. The review also could help pharmacy educators decide on the best modality and placement of integrating patient simulation within the pharmacy curriculum. Combining multiple simulation techniques may be the best way to achieve the desired student learning outcomes.

Emergency and critical care professionals' opinion on escape room as a health sciences evaluation game: A cross-sectional descriptive study

New teaching and evaluation methods are growing in health sciences. The escape room is a game that is showing benefits for assessing knowledge and important competencies in healthcare professionals. The aim of this study is to analyse the opinion of emergency and critical care professionals on the use of escape rooms as an evaluation game.A quantitative, descriptive, cross-sectional study was conducted using an ad-hoc questionnaire with a Likert-type scale. The study included emergency and critical care professionals who participated in the escape room "The Frustrated Emergency and Critical Care Professional," that took place during an emergency and critical care national congress. Data collection was carried out in June 2019.The sample was composed of n = 50 emergency and critical care professionals, 52% of whom were physicians and 48% were nurses. Professionals believe that this is a good teaching game for evaluation and useful for strengthen knowledge (4.7 points), as well as to improve teamwork and the ability to work under pressure (4.9).The escape room is a useful evaluation game in the context of emergency and critical care units that also allows training the teamwork and working under pressure competencies.

DIABESCAPE: An innovative educational project on diabetes

INTRODUCTION

The aim of this study was to assess the effectiveness of a gamification-based educational intervention to improve knowledge about diabetes, targeting GCSE-level vocational training students who will work in the field of social/health care.

MATERIALS AND METHODS

This was a quasi-experimental study aimed at further education students in Auxiliary Nursing Care and Care of People in a Situation of Dependency at the educational centres in the Autonomous Region of Navarra. After assessing the students' prior knowledge, a random draw was carried out to determine which classes would form part of the control group and which the intervention group. In the traditional programme, a one-and-a-half-hour session was held and in the innovation programme, they had an Escape Room with a brief explanation lasting a total of two hours. In both educational programmes, they completed a pre-test and then a post-test one week after the interventions to assess the degree of knowledge acquisition, in addition to a satisfaction questionnaire. The project ran from October 2019 to February 2020.

RESULTS

302 students took part (162 from the intervention group and 140 from the control group) with a mean age of 18.4 years; 87.4% were female; and 52.7% were studying in vocational training in Care for People in a Situation of Dependency. The post-test knowledge score was 32.70 (SD 10.637) in the control group and 38.07 (SD 11.421) in the intervention group (p = 0.000). Meanwhile the level of satisfaction was 8.19 (SD 1.594) in the control group and 8.60 (SD 1.163) in the intervention group (p = 0.020).

CONCLUSIONS

Gamified education enhances knowledge acquisition with respect to the traditional methodology and improves student satisfaction. Further studies are needed to verify the effectiveness of these innovative educational methods in the medium and long term.

A medical escape room to build intern workplace social capital in an internal medicine residency program

PURPOSE

Trainee well-being is a growing focus in graduate medical education. One emerging area in occupational literature is the psychosocial environment of the workplace, of which a large component is workplace social capital (WSC). WSC encompasses how well a group connects to one another. Medical escape rooms (MERs) recently have been studied in various healthcare settings and are one proposed intervention to increase WSC.

METHODS

This is a single-center before-and-after survey study at the Loyola University Medical Center in 2021 to measure the effect of a MER on WSC amongst interns. Our Chief Resident created a 1-hour MER. WSC scores were measured using a modified version of a validated WSC scale. Scores were analyzed with paired t-test analysis and chi-square analysis. Open-ended feedback was also collected.

RESULTS

Of 52 eligible intern residents, 51 (98%) participated in the MER, and 41 (80%) completed the pre- and post-activity survey. All six survey statements had a greater percentage of positive responses following the MER. The average score across all participants and questions was 4.66 out of 5 on the pre-survey, and 4.90 on the post-survey (p < 0.001).

CONCLUSIONS

The MER significantly improved intern resident WSC scores, and proved a valuable addition to our curriculum.

Digital Storytelling Review in a Pharmacy Self-Care Course

Digital storytelling is a type of active learning that allows instructors to simulate real-life situations through a series of connected videos. While this technique has been used in other healthcare education disciplines, its use in pharmacy has not been well documented. A digital storytelling model was incorporated in a required self-care pharmacy course to assess if the technique was helpful to improve the knowledge, confidence, and satisfaction of students. Due to a shift in online learning, the self-care course offered a remote exam review session containing a digital storytelling model, and this approach was compared to an in-person exam review that followed a lecture-based model held earlier in the course. Pre- and post-knowledge assessments were given to determine the impact of the digital storytelling review. There were 50 students involved in both sessions and there was a 70% response rate in the digital storytelling group and a 90% response rate in the lecture-based group. Students’ knowledge numerically improved, but not to a statistically significant level for most questions. Nonetheless, students reported more confidence (p < 0.05) in their ability to pass the upcoming exam following the digital storytelling review. Thematic analysis revealed that the digital storytelling session was engaging and interactive, though time-management and breakout rooms could be further optimized. Based on these results, exam review in a required self-care pharmacy course using a digital storytelling format may be a suitable method for students to apply course content and may particularly be of utility in online or hybrid courses.

Crossword puzzle as a learning tool to enhance learning about anticoagulant therapeutics

BACKGROUND

Educational games make the learning process more enjoyable, fun, and create a competitive classroom environment that can positively affect learning. The purpose of this study was to evaluate pharmacy students' perceptions of crossword puzzles (CWPs) as a learning tool in the pharmacotherapy cardiovascular module focusing on anticoagulants' therapeutics and assessing if students' preference of learning style influenced their perception.

METHODS

Clues for the puzzle were developed, validated, and piloted by course faculty. A free internet puzzle generator was used to create puzzles with 10 to 20 clues. Students were given 30 min to solve the puzzle following six hours of didactic lectures about the topic. An 8-item survey instrument and Pharmacists' Inventory of Learning Styles (PILS) questionnaire were administered to examine students' perceptions of the game and their learning style preference, respectively.

RESULTS

Two hundred sixty-seven students participated in the activity from both undergraduate programs (BPharm and PharmD) over three consecutive course offerings. Most students expressed favorable perceptions of the puzzle. Female and BPharm students had significantly more favorable perceptions than male and PharmD students on several perception items. The dominant preferred learning style (PLS) was converger (35.6%), followed by assimilator (25.3%), while 15.1% had mixed learning styles. The study did not find a significant association between PLS and students' perceptions toward the CWP.

CONCLUSIONS

The CWP game presented an innovative, creative, and easy active learning tool to enhance information recall, retention, and class engagement while accommodating all learning style preferences.

Design, Discover, and Decipher: Student-Developed Escape Rooms in the Virtual Ecology Classroom

There has always been a need for engaging assessments in online learning environments, though the COVID-19 pandemic further emphasized this need. Instructors across science, technology, engineering, and mathematics (STEM) disciplines have begun to implement escape room activities as effective and engaging learning tools in their classrooms. For our virtual introductory ecology course in spring 2021, we developed a student-designed escape room assessment which aligned with several course goals and covered a broad range of ecology concepts. The learning objectives of this assignment asked students to (i) create a themed "room" filled with ecology-based riddles and puzzles that represented a novel virtual escape room for their peers based on an important ecological topic, (ii) summarize and synthesize primary literature into clues and locks to educate their peers about an ecological topic, and (iii) use critical thinking and discussion of ecological topics with peers to solve their peers' escape rooms. We found that while students generated distinct escape room activities and focused on various ecological topics, student scores on this assessment, as well as student feedback, indicated that the escape rooms were conducive to learning, novel, and accessible in the virtual learning environment. We suggest that student-designed escape room assessments are an effective way for students to learn course material in a fun, engaging, and creative manner, and our spring 2021 implementation suggests that this activity may be an effective assessment for online settings.

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.

Evaluation of an escape room approach to interprofessional education and the opioid crisis

BACKGROUND

The use of an escape room in education helps promote communication, teamwork, and leadership amongst interprofessional learners in a unique and engaging manner; however, it is unknown if this method can change clinical knowledge related to the opioid crisis and interprofessional attitudes. Our objective was to evaluate the use of an interprofessional escape room activity to increase clinical knowledge related to the opioid crisis and to change attitudes toward interprofessional collaboration.

INTERPROFESSIONAL EDUCATION ACTIVITY

The session was developed as part of an interprofessional program at University of Colorado Anschutz Medical Campus. In this educational escape room activity, teams of interprofessional students solved six puzzles to gain knowledge of the opioid crisis. Knowledge gains were assessed using a pretest and posttest, while changes in interprofessional attitudes were assessed using the Student Perceptions of Interprofessional Clinical Education-Revised (SPICE-R) instrument.

DISCUSSION

Of the 88 total participants, 70 students from six different health professions completed both the pretest and posttest and were included in the analysis. Knowledge of the opioid crisis improved, particularly in identifying signs of opioid overdose. Overall, SPICE-R ratings increased, which was driven by improvement in understanding professional roles and responsibilities.

IMPLICATIONS

The use of an interprofessional escape room as an educational method was effective in increasing some aspects of opioid crisis related knowledge and enhancing attitudes toward interprofessional collaboration. The educational model is applicable to various topics and interprofessional groups.

Creation and implementation of a drug discovery and development game

BACKGROUND AND PURPOSE

Gamification is a commonly employed active-learning technique to increase student engagement and learning. Few games teaching the drug discovery and development process exist.

EDUCATIONAL ACTIVITY AND SETTING

A six hour component of the elective course Non-traditional Pharmacy Career Routes focused on drug development. Four of the six hours were devoted to a game designed to mimic the drug discovery and development process. The 17 enrolled students were split into smaller groups designated to represent large pharmaceutical, start-up, or generic companies. The number of resources each group began with varied depending on the type of company they were assigned. Students worked to develop and bring to market the most drugs and gain the most money. To reinforce the reflective and innovative learning process, students created "failure" cards before the game started that had reasons for failures during the drug development process.

FINDINGS

Two questions about the drug discovery and development process were on a pre-/post-assessment. The first question was answered correctly by 12 of 16 students on the pre-assessment, while 15 of 17 students answered correctly on the post-assessment. The second question was answered correctly by 13 of 16 students on the pre-assessment and all students on the post-assessment. The students enjoyed playing the game and felt that it helped them to understand the drug development process.

SUMMARY

A novel, role-play game that allows students to learn the drug discovery and development process has the potential to be implemented in similar courses.