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Demystifying Escape Room Creation: The Poe Case Study

• September 14, 2021

If you’ve been staying up with the blog this month, you know we’re demystifying escape rooms. It’s easy to see the codes, locks, smoke and mirrors of escape rooms and think they’re not for you. But last week we talked about how to make creative escape rooms without the fuss on Google slides, and this week I’m going to walk you through the process I used to brainstorm content, create clues, and choose locks for an escape room on Edgar Allan Poe. You’ll see how to add some complexity without doing anything crazy.

Planning the Content

As with any escape room, the first step is to figure out what material you want students to take in as they play. In this case, I wanted to introduce students to that intriguing pioneer of the modern horror tale, Edgar Allan Poe. I wanted to create an introductory lesson that could function as a stand-alone activity on Poe, if there’s no more time for him, or an introduction to a larger unit on Poe and his work.

For this escape room, I wanted students to learn about Poe’s background, so I found a reliable source for an online bio, and a video tour of his home in Baltimore through the Edgar Allan Poe museum. Then I wanted them to become familiar with three of his most famous works, “The Raven,” “The Tell-Tale Heart,” and “The Fall of the House of Usher.” I found text and audio versions of the first two online, and a full-length version of the third which I snagged excerpts from and combined with some illustrations in Canva to stick on a Google slide deck.

With these choices made, I was ready to create my room and plan my clues.

Building the Room

Let’s start with the room. I found this creepy-looking room in Canva and gradually dropped my visuals on top as I decided how to weave my content into clues in the room. I created a frame story in which students accidentally go through a door in the Poe museum into the house of Usher, and must solve the clues to unlock the locks to escape, so I called the escape room, “Escape the House of Usher.”

Now let’s talk about the clues and the locks, which go together.

The Clues & Locks: #1, Poe’s General Bio

I wanted to share all the materials with students in interesting ways, and then use my locks to check that they had made it through all the material. I wanted to add at least a few puzzles along the way, just to make it feel more mysterious and exciting, like something students had to really “unlock.”

So let’s start with Poe’s bio. I created a meme of Poe which I dropped onto a Google slide, then linked his image to his bio. If students click on the meme in the room, then click on him, then they will go to read his bio.

But just in case they didn’t realize they had to click on his name, I put a hint on the ripped paper they could click to from the wall, with a sentence directing them to click on Poe, “Click on the Poe boy in the meme,” but with the words in the sentence scrambled. They could discover the bio with or without this clue.

Then I created a short crossword puzzle with questions on his bio, and highlighted a few of the letters to be unscrambled into a code word, “terror.” (I used Canva to design this).

The first lock reads: “The Yellow Code: _ _ _ _ _ _.” The answer is “Terror.” This is probably the most complicated answer in the whole room, meaning students will probably have clicked around and looked at most things in the room before they get through lock number one.

The Clues and Locks: #2, The Tour

I used the play button on the laptop on the floor to link to the video tour of Poe’s house. Since I wanted students to watch the whole tour (it’s less than 10 minutes), I wanted to include a lock about it to make sure they did. So for the second lock, I asked when Poe moved away from Baltimore to Richmond, phrasing it with the hint “According to the tour guide…” to help students know where to look for the answer. I added another small hint in the form of the yellow post-it on the sign post. The “6:00” is a time stamp. Students will find the answer in the tour at the six minute mark. This is not the easiest of hints, but sometimes that’s part of the fun.

The Clues and Locks: #3, The Tell-Tale Heart

Since I wanted students to read all of “The Tell-Tale Heart,” I wanted to find a way to hide the full text in the room. So I created a piece of Poe-inspired digital blackout poetry to hang on the wall, which includes many sizes of heart illustrations. If students click on any of those hearts, they will go to a page with the short story where they can either watch a video reading or read the story as text, or both.

For my lock, I just wanted a way to show they had read the full story, so I pulled a quotation from the end. The third lock reads, “Louder, and louder! Louder and louder! What is that noise?” And the answer is “His Hideous Heart.”

Clues and Locks: #4, The Raven

I hid the poem, “The Raven,” in a few places in the room. Students can listen to Hank Green read it on Youtube by clicking on the actual raven in the room, or read the full text by clicking on the phone. With lock number four, I added a little twist. In order for students to realize the lock is about “The Raven,” they need to take a look at the coffee menu on the wall. I had a lot of fun describing these specialty coffees.

Lock number four reads, “Sure, it’s the cheapest coffee, but is it worth it? “And my soul from out that shadow that lies floating on the floor/ _____ _____ _____ _______.” In order to fill in the last four words of this line from “The Raven,” students must realize that “The Raven” coffee is the cheapest, then find the line in the text of the poem.

Clues and Locks #5: The House of Usher

Because the sinking red sun in the window of the room is a reference to “The House of Usher,” students must click on this window to visit a Google slides excerpt from the story. After reading the excerpt, they will know that at the end of the story (SPOILER ALERT), with the blood red moon hanging in the sky, the whole house sinks into a tarn. Then they’ll be able to answer lock number five, “No wonder you need to escape this room from the House of Usher, the whole thing will soon sink into a…”

Types of Locks

To keep things super simple, you can hand students a paper lock sheet for a digital escape room, OR you can use a Google form and click on the option to validate correct answers so students can’t move on to the celebrating success section until they get each answer exactly right.

Here’s what a paper lock sheet might look like:

And what it might look like as a Google form with answer formatting hints and verification turned on:

Celebrating Success

When students break through all five locks, you can either hand them a certificate (if you’re going with paper locks) or have them move on to a celebratory section (if you’re using Google forms).

A paper certificate might look something like this, perhaps accompanied by some candy.

And as a graphic that simply pops up on the screen once they move through section one in their Google form, it would be very similar.

So there you have it, my friend. One escape room walkthrough, to help you break down the mystery. I can practically hear all the ideas humming around in your head right now. I bet you’re swimming in escape room themes and clue possibilities!

I originally created this escape room in its digital and physical version for The Lighthouse, as we’re focused in on escape rooms this month, but I’ve put it into TPT by request, so you can find it here if you’re interested.

I’ll help you find the creative ELA strategies that will light up your classroom. Get ready for joyful teaching!

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Original research article, beyond the early adopters: escape rooms in science education.

• Freudenthal Institute, Utrecht University, Utrecht, Netherlands

Case studies report enthusiastically on the implementation of escape rooms in science education. This mixed-method study explores beyond the early adopting teacher, as the perceptions of 50 teachers and 270 students were investigated. Escape rooms are time restricted games where participants work together and accomplish a specific goal. The escape rooms’ usability for education in terms of goals, experiences during gameplay, outcomes, and boundary conditions are studied, using multiple data sources: online questionnaires, interviews, classroom observations and movie clips made by students about their experiences. The use of mixed methods and large samples on this topic is a novelty. Results show that teachers of different ages, gender and teaching experience were appealed in particular to the diversity of activities offered that call for multiple skills and teamwork. Students experienced the need to think hard using multiple thinking skills and enjoyed the feeling of autonomy and mastery during gameplay. This is interesting, as an escape room setup is very strict, with few degrees of freedom. According to teachers and students, escape rooms are suitable for processing, rehearsing and formative assessment of science knowledge and skills. However, the time restriction during gameplay appears to be an ambiguous factor in student learning.

Introduction

Recently, escape rooms have been finding their way into education worldwide, from primary education to professional development, and into science and medical classes in particular ( Fotaris and Mastoras, 2019 ; Veldkamp et al., 2020 ). “Escape rooms are live-action team-based games where players discover clues, solve puzzles, and accomplish a specific goal (usually escaping from a room) in a limited amount of time” ( Nicholson, 2015 , p. 1). The goals of the first-generation games were ‘escapes’ from a room. Currently, the goals are more diversified; players may break into a vault, solve a murder mystery or defuse an explosive device. Implemented by enthusiastic teachers, escape rooms are gaining popularity as teaching and learning environments in science education ( Veldkamp et al., 2020 ). For secondary education, teachers can share their materials on platforms such as Breakout EDU ( Breakout EDU, 2018 ; Sanchez and Plumettaz-Sieber, 2019 ). As these developments rely on a relatively small group of enthusiastic early adopting teachers, it remains unclear what teachers and students in general perceive as the educational potential of escape rooms beyond the novelty factor. For example, their opinion on what educational goals escape rooms are suitable for, what aspects stimulate students’ learning, or what consider teachers as boundary conditions for implementing these new learning environments in science education. Research from the perspectives of teachers and their students on the educational potential of this worldwide, bottom-up phenomenon, will help teachers to implement these new learning environments more effectively in order to help foster students’ science knowledge and skills.

Escape rooms are inherently team-based games; the assignments tend to ensure that every member of a team is active and can contribute ( Wiemker et al., 2015 ). Within an escape room, all assignments are called puzzles and use a simple loop: a challenge to overcome, a solution and a reward (e.g., a code for a lock, or information needed in the next puzzle). Cognitive puzzles seem to predominate in escape rooms ( Nicholson, 2015 ) and players require skills such as searching, observation, correlation, memorization, math, reading, pattern recognition and compartmentalization to solve them ( Wiemker et al., 2015 ). A gamemaster may provide hints and debriefs to players on the process and what they achieved as far as solving the puzzles ( Nicholson, 2015 ).

Escape rooms are used for various educational purposes. Case studies show that most escape rooms were designed for formal education to foster domain specific skills and knowledge, mostly in medical ( Jenkin and Fairfurst, 2019 ) and science disciplines ( Vörös and Sárközi, 2017 ; Dietrich, 2018 ; Ho, 2018 ; Arnal et al., 2019 ; Healy, 2019 ). Others were implemented to recruit students, to get to know institutional services ( Gilbert et al., 2019 ), or in informal education to create interest in specific science subjects, such as robotics ( Giang et al., 2018 ). Both students and teachers perceive that while participating in escape rooms, students are more engaged and active compared to regular classes ( Cain, 2019 ). Like in recreational escape rooms, a combination of hands-on and minds-on tasks needs to be achieved with a team in a limited time. In educational escape rooms, these tasks are content-based puzzles. For example, when it is unclear how to solve the task, clues are hidden or essential information needs to be found. Finishing a task usually unlocks a new task, information or tool needed ( Glavaš and Stašcik, 2017 ; López-Pernas et al., 2019 ; Peleg et al., 2019 ). Locks only open when a task is solved correctly. This structure provides students with immediate feedback on the correctness of their solution. Monaghan and Nicholson (2017) regard this as one of the powerful aspects of an escape room. In recreational escape rooms, teams usually play one after another ( Nicholson, 2015 ). In educational settings, it varies enormously, usually teams play one team at a time, although a trend is visible that all teams in a class or course play at the same time in the same room ( Veldkamp et al., 2020 ). Usually, the game ends when the first team finishes the game. The review also showed that half of the educational escape rooms is followed by a reflection on the experiences and tasks.

The combination of escape room attributes, such as team-based learning, content-based tasks combining ‘hands-on’ and ‘minds-on’, room for failure and reflection on accomplished tasks, is not unique in its own for education. However, their combination in a playful, physical environment seems unique and appealing to teachers. For secondary science education, claimed benefits for the introduction of escape rooms are students working in an intrinsically motivated way, triggered by content-based puzzles, while developing the four C’s: critical thinking, collaboration, creativity and communication ( Roekel, 2011 ; Pollock, 2015 ; Breakout EDU, 2018 ).

As teachers develop their escape rooms based on their experiences with recreational escape rooms and/or video escape games, little work has been reported on their theoretical foundation in educational science ( Veldkamp et al., 2020 ). However, as the implemented escape rooms are education games, we can resort to theories of Game-Based Learning. De Freitas (2018) review covered systematic reviews and randomized controlled trials on educational games and showed that results on effectiveness were not consonant, but on balance “overwhelmingly positive”. Two systematic reviews not covered by De Freitas, resulted in the same conclusion ( Backlund and Hendrix, 2013 ; Vlachopoulos and Makri, 2017 ). A review of Game-Based Learning in science education argues that the potential for science education is to bring authentic science related environments in the classroom, to promote collaborative problem solving ability and to provide an affective learning environment ( Li and Tsai, 2013 ). Essential aspects of educational games for engaging and learning are: the players ‘identity and role during gameplay’, ‘immersion and discovery oriented experience’, ‘interactivity’ (including collaboration, autonomy and ownership), ‘progression and increasing complexity’, ‘scaffolding learning’ (repetition, feedback, rewards, debriefing) and ‘alignment with curriculum’ ( Annetta, 2010 ; Ke, 2016 ; Lameras et al., 2017 ; Ávila-Pesántez et al., 2017 ). Educational escape rooms can address all these aspects ( Veldkamp et al., 2020 ).

Innovators and early adopting teachers ( Rogers, 1962 ) around the world are enthusiastic about the educational potential of their escape room. Therefore, the aim of this study is to explore what teachers and students in general perceive as the educational potential of escape rooms for secondary science education, regarding goals and learning outcomes. In research on educational games, the user experience is an important concept studied to improve the satisfaction, usability and the interaction between player(s) and game ( Nagalingam and Ibrahim, 2015 ). Thus, the research question in this study is: ‘What do teachers and students perceive to be the educational potential of escape rooms in secondary science education?’, decomposed into the following sub-questions:

1. How do teachers and students experience escape rooms?

2. What are teachers’ and students’ perceptions of the usability of escape rooms for science education in terms of goals and learning outcomes?

3. What are experienced or foreseen boundary conditions and barriers for teachers in implementing escape rooms in their classroom?

The results will be compared with the benefits of educational escape rooms as claimed by educational platforms and help teachers to implement these new learning environments more effectively in order to help foster students’ science knowledge and skills.

This descriptive study aimed at inquiring about teachers’ and students’ experiences and perceptions when using an escape room as a teaching and learning environment. Fifty teachers and 270 students participated, in the context of a national ‘Escape the Classroom’ Challenge, that was organized by the Dutch national organization for biology teachers and practitioners. From 100 secondary schools in the Netherlands, seventh grade biology classes joined the challenge, which had biology and science topics as its theme.

The game started plenary with a video clip explaining the context of the game, its rules and the need for teamwork. The teams within a class consisted of 4–6 students and solved the same set of six connected content knowledge-based cognitive puzzles. The puzzles addressed both familiar and new concepts such as life, inanimate, dead, biological levels of organization, and the scientific method. To give an example, one puzzle called ‘Guess what?’, was based on the child’s game ‘Guess who?’. In this puzzle, students need to cross out the right answers on content-based questions, until the remaining answers show information needed in the next puzzle. The students had to relate the puzzle to the child’s game Guess who? otherwise they did not know how to solve it as there were no instructions given. The role of the teacher was not described, except for checking the students’ solutions of one of the puzzles. The game ended when the first team opened the locked vault, within 40 min. The vault contained a prize. The teacher decided whether the escape room was followed by a plenary debriefing in the classroom.

The escape room was developed by the organization, ‘Escape The Classroom ( Escape The Classroom, 2017 ). None of the researchers were involved in its development. The escape room was published on a website, on which schools could enroll. Subsequently, enrolled schools were asked whether they would participate in this study. Experience with escape rooms within the team of seventh grade teachers was not required nor advised. Consequently, we expected that the sample of teachers participating in the escape room activity, was not limited to early adopters, and would consist of a fair representation of the teacher population.

Data Collection

Table 1 shows the data that were collected from various sources to obtain multiple views from teachers and students on their experiences with and opinions about the escape room. Multi-method triangulation was used to increase the internal validity of the study ( Meijer et al., 2002 ).

TABLE 1 . The various data sources.

Classroom observations during the escape room activity were done in fourteen classes. Schools selected for observation were chosen based on travel distance. In each class one or two observers made notes following a protocol with prescribed points of focus on behavior of teacher, students and the interactions in one or two randomly chosen groups within the class (see Supplementary Appendix C ). During gameplay, the observers did not interact with either the students or the teacher.

Immediately after the “Escape the Classroom” event, 270 students were either interviewed or invited to fill in an online questionnaire (see Supplementary Appendix B ). Four questions in the questionnaire asked for demographic data and previous experiences in escape rooms. Six questions inquired about user experiences and possible educational goals. One of these questions gave response options, three were half-open-ended (multiple choice with the option to add or explain an answer) and two were open-ended questions. The questionnaire also included room for other remarks. The questions had been pretested with three students using a think-aloud protocol ( Jääskeläinen, 2010 ). Students from the teams observed during the gameplay, were invited for an interview. Seventeen interviews (10–15 min) took place with a total of 68 students. The interviews used the same questions as the questionnaires with the addition of one open-ended question on the learning outcomes (see Supplementary Appendix B ). The students give their response to each of the questions and could react to each other’s response. Finally, just before the start of the escape room activity, teachers could ask their students who were willing to produce a movie clip of the classroom experiences. The guidelines were brief: send in a short movie clip (1–2 min), showing your experiences during the escape room, as we wanted the students’ open view. Seventeen classes sent in their clips.

Fifty teachers were either interviewed ( N = 11) or completed an online questionnaire ( N = 39) after the escape room activity, see Supplementary Appendix A. Teachers were interviewed individually, immediately after the classroom observations. The questionnaires and interviews for teachers were nearly the same as for the students with the exception that the question on the learning outcomes was replaced by open-ended questions on years of teaching experience, what stimulates students in an escape room, what are success factors, boundary conditions and barriers for the teachers in implementing an escape room in the classroom. Table 2 lists the main characteristics of the teachers and the students.

TABLE 2 . Gender, age and teaching experience for participants in the two main types of data collection.

Data Analysis

Interviews with students and teachers were transcribed verbatim and analyzed per question, except for the open-ended questions. Answers to open-ended questions in the interviews and on the questionnaires were categorized, counted and analyzed by one researcher, using a process of open coding with the main concepts from the questions as sensitizing concepts ( Boeije, 2010 ). Results were discussed with two researchers. A total of four coders analyzed the video clips. For each video clip, the visual content was described and the audio transcribed verbatim. Two coders independently analyzed the clips using a coding scheme, in relation to students’ view on the experience, student behavior, teacher behavior and game elements. The initial agreement between the three pairs of coders in the description and coding of the clips was respectively 71, 77, and 81%. Researchers differed in the grain size of the image descriptions and whether or not soundtracks were transcribed verbatim by the various researchers. Intersubjective agreement was reached after discussion. Finally, all documents from interviews, classroom observations and movie clips were read, reread and hand-coded for overall emerging themes by the first author and checked by two other researchers ( Boeije, 2010 ). During the triangulation process, it was studied whether the results from interviews, classroom observations and video clips aligned and clarified or deepened results from the questionnaires.

This study explored how teachers and students perceive the educational potential of escape rooms in science secondary education, regarding: user experiences, the usability of escape rooms in terms of learning goals and learning outcomes. In relation to future escape rooms, the experienced or foreseen boundary conditions and barriers for implementing escape rooms in science class were studied.

Students’ and Teachers’ Experiences with the Escape the Classroom Challenge

Students’ experiences.

The majority of students (88%) in the questionnaires responded positively about their experience, with 9% neutral and 3% negative. On the question about what aspect of the escape room activity they appreciated the most, answers could be categorized according to three themes: 1) game elements, 2) working and learning in an escape room, and 3) experiences. Table 3 summarizes these answers.

TABLE 3 . Most and least appreciated aspects of the Escape the Classroom Challenge according to students and Stimulators for students to be engaged and success factors of escape rooms (ERs) in the classroom according to teachers, indicated in the open-ended questions on the questionnaire (Q) and mentioned in the interview (I).

The puzzles were most appreciated because of their “diversity” and aspects such as “the discovering of new things”, as students clarified in the interviews. The highly appreciated cracking codes and/or opening the vault and objects such as black lights and red filters were associated by students with the game-like character of the escape room. It was noteworthy that available 3D models (e.g., a torso) that had a decorative function were mentioned, too. Aspects such as winning, competition or the prize were less often mentioned. Nearly one-fifth of the answers on the questionnaires fell in the category of working and learning in an escape room, in which teamwork was the most frequently mentioned aspect, followed by ‘discover or think for yourself’. When students identified the least appreciated aspects, they named the flip side of the same coin (see Table 3 ), explaining in interviews their frustrations with “getting stuck and not knowing how to continue”, “not finishing the game”, “a non-functioning” team, and the difficulty of the puzzles.

The analysis of classroom observations and movie clips confirmed these findings, showing students behaviorally engaged: constantly interacting with materials, puzzles and discussing them with team members. The cracking of codes and/or opening of the vault featured in nearly all clips (15/17), whereas the prize was hardly mentioned (2/17). The added images (e.g., ticking clocks) and texts (“Are they going to make it?”), as well as exciting tunes, stressed their excitement about the escape room. Throughout students’ gameplay, a range of emotions was observed within teams or single persons: tension, confusion, excitement, disappointment or frustration. In the classroom observations, frustration was seen in 9% of the groups, when students got stuck and had no clue how to proceed. After trying a while, these students showed non-functional behavior, such as sitting apart from the team and/or discussing their weekend.

Teachers’ Experiences

The escape room as a learning environment seemed to appeal to teachers of different ages, gender and teaching experiences, as seen in Table 2 . The teachers were asked in questionnaires and interviews about what stimulates students during gameplay and what are success factors. According to the teachers, students were mainly stimulated by competition, the prize or the excitement, as seen in Table 3 . This is remarkable, as winning or the prize were not often mentioned by the students. The puzzles and teamwork were more appreciated by students than teachers had imagined. It is noteworthy that provided objects, such as black lights, red filters and biological 3D models, were very appreciated by students, but not mentioned at all by teachers. For the teachers, the main success factors for escape rooms in classrooms are the diversity of puzzles and the need for and development of teamwork skills.

Previous Experiences with Escape Rooms

Teachers and students were asked for previous experiences with escape rooms. As seen in Table 4 , only 8 out of the 39 teachers in the questionnaires, had already experienced recreational escape rooms. Therefore, the majority of the participating teachers in the study would not be considered to be early adopters or innovators (see Rogers, 1962 ). Students were asked whether previous experiences had been helpful in this escape room or could have been helpful. Although, students seem to think differently (see Table 4 ); the reasoning in their explanations was alike: in escape rooms, the required way of thinking is the same, while the content can vary.

TABLE 4 . Previous experiences of participants with recreational or educational escape rooms (ER), and whether these experiences were helpful in completing the Escape the Classroom Challenge.

The Usability of Escape Rooms for Science Education

Although students and teachers might have very different perspectives on education, their perceptions of the usability of escape rooms for the various educational goals were comparable; therefore, we discuss them in the same section.

Educational Goals

The goals most often mentioned by teachers in the questionnaires were non-content related goals: “to enhance teamwork” (38 out of 39 teachers) and “increase motivation for biology” (33 out of 39 teachers), see Table 5 . However, data on students’ perceptions did not confirm that students expected escape rooms to increase motivation for the subject of biology. The data sources on students were not congruent on this aspect, 40% of the students named it as a possible goal in the questionnaires, but it was not mentioned in the interviews or in any of the other data sources. Students, like the teachers, also mentioned two non-content related goals most often in the questionnaires; these were “to enhance teamwork” (69%) and “a fun lesson” (56%). The most frequently mentioned content-related goals were the same for teachers and students, although the ranking differed: formative assessment and processing and rehearsing of content knowledge and skills.

TABLE 5 . Potential educational goals for escape rooms mentioned by students and teachers in the questionnaires ( N Q ) and interviews ( N I ).

Apart from being the goal mostly frequently mentioned by teachers and students (see Table 5 ), teamwork emerged as a recurring theme in all data sources. In interviews, students explained that the mutual dependence in an escape room is higher than in regular teamwork assignments due to time constraints and the diversity of the puzzles that need to be done at the same time. Furthermore, students mentioned that it is not possible to improve the work of peers before handing it in, as can be done with regular team assignments. In interviews, a few teachers wondered whether teamwork skills are a boundary condition for participation or are developed during gameplay. They observed that teams varied in their teamwork skills and seemed to develop them hardly at all. This observation was confirmed by the classroom observations and student comments in interviews such as “[..] you needed to know how to collaborate, otherwise things mess up”. It was observed that none of the teachers gave instructions about teamwork before the escape room activity; afterward in the debriefing with the class, few of the teachers (3/14) discussed aspects of teamwork or strategies for teamwork. The movie clips showed teams of students working as one group or divided into subgroups. In the clips, the students’ added comments varied from “working very well” to “a little fight”.

As shown in Table 5 , both teachers and students perceived an escape room as a good learning environment for 1) processing, 2) rehearsing, and 3) formative assessment of content knowledge and skills. As the argumentation on these three goals was largely similar, we discuss them together. In the interviews, students mentioned that escape rooms seem very suitable for these goals because they cannot skip questions, there are no answer keys or informational books available for easy checking, there is a time constraint and they do not want to consult the teacher. Consequently, you need to think harder, students explained. Teachers and students who considered escape rooms less suitable for formative goals mentioned that in the end, students get no precise overview of their knowledge gaps. Students added that teamwork limits the view of their own capacities, and in case of grading, mutual dependence was viewed negatively. Another argument mentioned only by students was that escape rooms require additional thinking skills than those practiced in regular lessons; for instance, they mentioned “linking information” and “out-of-the box” thinking and suggested to keep the type of formative and summative assessments congruent. Except for two, all students responded negatively about the use of an escape room as a summative test, using the same arguments as mentioned above.

Only one-third of the teachers and students who responded to questionnaires assigned acquiring content knowledge as a suitable goal for the use of an escape room. In the interviews, teachers and students were even more critical on that point. None of the 68 interviewed students thought this was a good idea, as the acquisition of knowledge calls for tranquility and reflection, which conflicts with acting within time constraints. In addition, teachers pointed out that the development of science knowledge requires careful relating (and understanding) of the concepts, and they concluded that an escape room is too unstructured and random for that purpose. Furthermore, some students and teachers stated that thinking skills such as “linking” and “out-of-the-box thinking” are prerequisites for acquiring content knowledge and skills. In addition, it was argued that unknown knowledge in an unstructured environment with uncertainties about what to do and how to proceed asks too much from most students.

Evaluation of Learning

“What did you learn in the escape room?” During the interviews, sixteen of the student groups reported that they learned new knowledge, or strengthened and/or enhanced their knowledge. For example, “I knew that there are animal cells, but I didn’t know what they looked like”; “Well, more on biology, much more! I had forgotten, for example, what an organ was, now I’ll remember it better because it was fun to do”. The students’ answers can be categorized as referring to 1) biological content matter and skills, 2) information and thinking skills and 3) social and mental skills. Most students had difficulty concretizing the biological content matter and skills for the puzzles they had completed. However, students could describe more concretely the various non-domain-specific skills they had used. Besides teamwork and out-of-the-box thinking, students described the following information skills; to get an overview of the information, to select, to relate and to combine information. The social and mental skills they described were to reduce stress, to persist, and to “stay nice to peers under pressure”. A few students observed that “focusing under stress is harder”. In classroom observations, it was noted that students were very active and focused on the (cognitive) puzzles. A repetitive theme in student interviews was the perception that they needed to think “hard”, “deep”, “fast”, “smart”, “critically” or “thoroughly” during gameplay, for reasons mentioned in section “Educational Goals”. Students seemed very cognitively engaged in the escape room. It was observed that students’ engagement dropped spontaneously, when the first team opened the vault and started celebrating their victory.

Escape Rooms in the Future

Foreseen and perceived boundary conditions and barriers.

By means of open-ended questions on the questionnaire and in the interviews, teachers were asked about boundary conditions and barriers when implementing an escape room in science education. The teachers’ answers can be categorized as addressing the following themes: 1) escape rooms as learning environments, 2) organizational aspects of implementing escape rooms and 3) required personal qualities of teachers and students (see Table 6 ).

TABLE 6 . The number of students and teachers who want to participate in future educational Escape Rooms and the teachers’ boundary conditions for its implementation in their classroom.

According to the teachers, in an escape room as a learning environment the puzzles need to be aligned with the curriculum, be very clearly described and doable, and enhance teamwork. Half of the organizational aspects mentioned concerned time: time available within the curriculum, time to develop an escape room, time to set it up and the time required to reset the game between classes. A few teachers mentioned time for reflection with the students afterward as a boundary condition for learning. In the interviews, required personal qualities for teachers and students were mentioned. Teachers need monitoring skills and students need internal motivation for this type of puzzle, competitiveness and curiosity. The teachers were also asked about barriers to implementing educational escape rooms in their class. The boundary conditions related to time all reappeared as barriers (71%, data not shown). Additional barriers for teachers were, for example, the balance between the teacher’s time investment and the student’s learning outcomes.

Future Use of Escape Rooms in the Classroom

Despite the barriers mentioned, most teachers (31 out of 39) intended to use an escape room in the classroom again; see Table 6 . The rest of the teachers (8 out of 39) were doubtful, referring to the boundary conditions and barriers mentioned before.

The students’ willingness to experience future escape rooms in the classroom was high (87% in the questionnaires); see Table 6 . In their explanations (not shown), students reasoned that it worked better or faster for them than regular lessons, because they are more active, need to think harder, there is more diversity in the activities and it is more exciting. Only 2% of the answers referred to greater motivation for biology. In the questionnaires, 2% of the students did not want any more escape rooms, for no outstanding reasons. According to nearly all of the teachers (36 out of 39), escape rooms are suitable for all age groups in secondary education and pre-vocational education. Two teachers perceived escape rooms as suitable only for lower secondary education and pre-vocational education. However, one teacher reasoned that escape rooms are suitable for all age groups in secondary education, but not for pre-vocational education. In interviews, teachers at pre-vocational schools commented that their students would require more internal and external guidance during the game.

Conclusion and Discussion

This study explored the perceptions of teachers and their students on the educational potential and degree of support for escape rooms in secondary science education. We focused on user experiences, usability for science education and boundary conditions and barriers for future escape rooms. In addition to discussing the main outcomes on these aspects, the following topics are addressed: the merging themes in overall data, claims made by educational platforms (see “Introduction” section), recommendations and directions for future research on escape rooms in science education.

User Experiences

In this study, only 13 out of the 50 teachers (in questionnaires and interviews), had experienced an educational escape room before. The educational escape room appealed to science teachers of different ages, gender and teaching experiences, which is in accordance with Nicholson’s inventory of adult visitors to recreational escape rooms ( Nicholson, 2015 ). Teachers perceived that students were competition or prize driven and engaged in their work. They appreciated the diversity of content-related activities, the need for or development of teamwork and the increased motivation for biology. However, based on this study, the assumed development of teamwork and communication skills is doubtful.

Nearly all students enjoyed the escape room as a learning activity, and looked forward to the next one. No gender differences in preferences were shown, unlike for some types of educational games ( Kinzie and Joseph, 2008 ). The most appreciated aspects (diversity of puzzles with a problem-solving and discovery nature, the need for physical objects and cooperation), are characteristics of exploratory and problem-based play ( Kinzie and Joseph, 2008 ). Kinzie and Joseph showed that in order to attract both girls and boys in the underlying science content and skills, educational games need to use both types of play (2008). Students perceived that in escape rooms, the way of thinking that is required is the same, whereas the content can vary.

Usability for Science Education

In our study, students described being more active, mutual interdependent and thinking more thoroughly or critically than in a regular lesson (see “Educational Goals” section). Hence, escape rooms seem to create environments for collaborative learning, as important elements in collaborative learning are positive goal interdependence, complementary roles, dividing information or other resources and constructive competition ( Johnson and Johnson, 2009 ). Students enjoyed the feeling of autonomy, discovery, ownership and mastery during gameplay. Educational games need to be designed in a way that they give room for these experiences ( Arnab et al., 2015 ; Barab et al., 2010 ; Lameras et al., 2017 ; Sin et al., 2014 . Interesting in the current study is that students experienced autonomy, ownership and discovery, even though the escape room setup was very strict and had few degrees of freedom, due to its design involving codes and locks. In this respect, the escape room is an example of Trninic’s proposed integration of guided repetition and discovery by students ( Trninic, 2018 ), with the opportunity to scaffold learning processes without losing the students’ feeling of ownership, discovery and victory.

Nearly all teachers considered escape rooms to be suitable learning environments for all ages and school types. However, they seem suitable mainly for enhancing teamwork, for increasing motivation for a subject, in this case biology, and for processing, rehearsing, and formative assessment of content knowledge. A review study confirms that educational escape rooms are used mainly for these goals ( Veldkamp et al., 2020 ). This current study shows their rationale, as two-thirds of the teachers and students in the questionnaires perceived that an escape room is not suitable for acquiring new biological knowledge. Teachers stated that the development of biological knowledge requires careful linking and understanding of the concepts, which conflicts with the seemingly unstructured environment. Students also reasoned that learning new content knowledge requires more tranquility and reflection than the gameplay can offer. Students perceived that for all escape rooms the strategic thinking is the same, whereas the content of the puzzles can vary. This has, according to some students, consequences for the use of an escape room as an environment for assessment. In their opinion, the ways of assessment in the formative and summative assessment need to be congruent. This form of congruence is called constructive alignment ( Biggs, 2011 ). A few teachers and students suggested that thinking skills such as “linking” and “out-of-the-box thinking”, might be prerequisites for acquiring or fostering content knowledge and skills. Likewise communication and teamwork skills appeared necessary to finish in time. Appropriate use of social skills is mentioned by Johnson and Johnson (2009) as requisite for collaborative learning. An escape room might be a suitable environment to enhance these skills, if initial instructions, coaching and debriefing are provided on these skills, as Seto’s study showed ( 2018 ).

An escape room is a time restricted game. In an educational setting it addresses various educational aspects. Time restriction enhances the authenticity of medical educational escape rooms, as the ability to work under (time) pressure is a medical professional skill. ( Wu et al., 2018 ; Brown et al., 2019 ; Gómez-Urquiza et al., 2019 ). Students perceived that time restriction improved their ability to delegate tasks related to patient care and kept them focused on providing care ( Brown, et al., 2019 ). In the current study, time restriction appears to be an ambiguous factor in learning. On one hand, it gives urgence to players’ thinking, acting, and creates mutual dependency. On the other hand, it limits ‘learning by explaining’ and time to reflect on the content. The stress involved might prevent the connection of incoming information with pre-existing knowledge ( Vogel et al., 2018 ) or newly formed memory cells to survive ( Kim et al., 2015 ; Price and Duman, 2020 ). In addition, the learning process during gameplay stops for all students once the first team opens the vault and sets the fastest time. Offering a vault for every team can tackle this problem. To conclude, the time pressure during the gameplay, urges the need for a thorough reflection on the content knowledge afterward.

Boundary Conditions and Barriers for Future Escape Rooms

Limited time is also the main theme teachers mentioned about barriers for implementing educational escape rooms; e.g., regarding development and setup of an escape room. The boundary conditions most mentioned by teachers were common requirements for any type of learning activity (e.g., alignment with curriculum). Despite the barriers, most teachers 42 out of 50 teachers intended to implement a future escape room. Time is for teachers a limited resource and one of the greatest constraints to any innovation, whether at the individual, classroom, or school level ( Collinson and Cook, 2001 ; Hargreaves, 1990 ). Therefore, it is surprising that so many teachers find time to adapt the concept of escape rooms for their classes. These pioneering teachers mentioned that the development is time-consuming, especially in relation to effective time with students, however it is satisfying to see students active in class ( Vörös and Sárközi, 2017 ; Boysen-Osborn et al., 2018 ; Guigon et al., 2018 ; Mosley et al., 2018 ; Franco and DeLuca, 2019 ; Järveläinen and Paavilainen-Mäntymäki, 2019 ; Morrell and Ball, 2019 ). Specific time consuming aspects are alignment to the curriculum ( Brown et al., 2019 ), testing prototypes ( López-Pernas et al., 2019 ), and organizing the gameplay ( Dietrich, 2018 ). As these teachers are early adopters and teachers in general are very limited in their time, science centers develop escape rooms, schools can visit or borrow ( Peleg et al., 2019 ; Science Centre Delft, 2020 ).

Emerging Themes in Overall Data

After qualitative analysis, the triangulated data shows the following recurring (sub)themes: engagement (cognitive, behavioral and affective) and teamwork. A review study on serious games also distinguishes these aspects of engagement ( Hookham and Nesbitt, 2019 ). A meta-study on engagement in education showed that engagement positively influences academic achievement ( Fredricks et al., 2004 ). Behavioral engagement is associated with development of basic skills and prevents dropping out. Cognitive engagement is related to analysis, synthesis, and deep-level understanding of content. Affective engagement encompasses positive and negative emotions and is presumed to influence the willingness to do work. None of the reviewed studies comprised an intervention that evoked all of these aspects of engagement, like the escape room in our study.

The emerging themes, engagement and teamwork, correspond with those found in a study on escape rooms in medical education: engagement, frustration and teamwork ( Hermanns et al., 2017 ). Our data showed subcategories of engagement; cognitive, behavioral and emotional. Affective engagement relates to the emerging theme of “frustration” in the study of Hermanns et al. (2017) . However, in our study, frustration was only one of a range of observed emotions, and strong affective engagement was shown during gameplay. In both studies, the background of the frustration is the same: getting stuck while having time pressure. The theme of teamwork is discussed within other sections.

Confirmation of the Claims Made by Educational Platforms

Educational platforms that promote and help science teachers with the introduction of educational escape rooms claim that students work actively together on a diversity of content-based puzzles, triggered in different ways and intrinsically motivated, while developing the four C’s: critical thinking, collaboration, creativity and communication ( Pollock, 2015 ; Breakout EDU, 2018 ). The triangulated data confirm that students worked in an engaged way on a diversity of content-based puzzles. Students were indeed triggered in different ways, felt cognitively engaged and described different thinking skills. The claimed critical thinking was not specifically investigated in this study. Collaboration and communication skills seem boundary skills needed in order to understand and solve the content-based puzzles. The creativity fostered needs to be defined in more detail, as the creativity needed in escape rooms is the creativity to find the teachers’ programmed answers, not to solve open-ended problems.

Recommendations and Future Research for Secondary Science Education

Students’ engagement positively influences academic achievement ( Fredericks et al., 2004 ). Students’ engagement will be enhanced when tasks provide extrinsic rewards, cultivate intrinsic interests, create a sense of ownership, provide opportunities for collaboration, permit diverse forms of talents, are authentic and fun to do ( Newmann et al., 1992 ). This study showed for all these criteria, except ‘the cultivation of intrinsic interests’, that educational escape room address them. At the same time, the criteria may function as guidelines for designers of an educational escape room in order to assure its educational potential. Based on this study, we would recommend puzzles that create mutual interdependence in a team with a combination of discovery learning, different thinking skills, cracking codes or vaults and physical objects.

It is promising that students experienced the need to think harder than in regular lessons and to use different thinking skills, and they “learned a lot”. However, students could not give very concrete descriptions of their’ self-reported learning of content knowledge. On the contrary, the social, team and thinking skills they used were described very specifically. The incongruence between perceived and actual learning is in line with findings on other educational escape rooms ( Veldkamp et al., 2020 ) and practical work or inquiry that enhances knowledge of science ( Abrahams and Millar, 2008 ; Minner et al., 2010 ). These studies conclude that without active linking of knowledge during the intervention or reflection afterward, the interventions appeared not to be effective in enhancing content knowledge. Therefore, we recommend designing puzzles in a way that it requires discussion about the content, and a debriefing on the process and content afterward. Another important focus of further research is the balance between the teachers’ scaffolding and students’ feeling of mastery and ownership, which may lead to more guidelines for teachers and the prevention of students dropping out during gameplay. To enhance the educational potential of educational escape rooms, it would be interesting to develop an escape room by design based research, based on design criteria taking into account the differences between the goals and context for recreational and educational escape rooms.

This study is limited as the sample of teachers is not-randomized; teachers volunteered to participate in the National Challenge and in this study. As only 13 out of the 50 teachers had previous experiences with educational escape rooms, this study gives a more generic view of teachers’ perceptions on the educational potential escape rooms (see Table 4 ). Participating teachers did not make a differentiation for their specific subject, as escape room puzzles can be adapted to all sciences as they make use of concepts, problem solving and calculations. As seen in this study, the attraction of escape rooms is the diversity of content-based activities, the need for different skills, and the engagement of the students. In addition, science teachers also mention teaching of content knowledge and skills in authentic contexts such as crime scenes makes escape rooms attractive (Ferreiro-Gonzáles et al., 2019; Healy, 2019 ; Peleg et al., 2019 ).

In conclusion, case studies stated that early adopting teachers and students are enthusiastic about the implementation of escape rooms in education. This study shows that teachers of different ages, gender and teaching experiences are attracted to the activity. In addition, this study demonstrates that the student engagement consists of cognitive, behavioral and affective engagement. Furthermore, it appoints why the game is appreciated by both boys and girls, and which game elements are preferred. There is a high degree of support among science teachers and students for the educational potential of escape rooms in secondary science education as an engaging, problem-based environment for processing, rehearsing, and formative assessment in which thinking and teamwork skills are required, with the opportunity for teachers to scaffold learning processes without losing students’ feeling of ownership, discovery and victory.

Data Availability Statement

The original contributions presented in the study are included in the article/ Supplementary Material , further inquiries can be directed to the corresponding author.

Ethics Statement

Ethical review and approval were not required for the study on human participants in accordance with the local legislation and institutional requirements. When required, in accordance with the national legislation and the institutional requirements, informed consent was acquired.

Author Contributions

All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

The authors gratefully acknowledge NIBI, the Dutch national organization for biology teachers and practitioners, the participating schools, teachers, students and especially Michiel van Harskamp, Rian Ligthart and Sophia Scheper for their participation and time.

Supplementary Material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/feduc.2021.622860/full#supplementary-material .

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Keywords: science education, escape rooms, student engagement, educational games, game-based learning

Citation: Veldkamp A, Knippels M-CPJ and van Joolingen WR (2021) Beyond the Early Adopters: Escape Rooms in Science Education. Front. Educ. 6:622860. doi: 10.3389/feduc.2021.622860

Received: 29 October 2020; Accepted: 11 January 2021; Published: 11 March 2021.

Reviewed by:

Copyright © 2021 Veldkamp, Knippels and van Joolingen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Alice Veldkamp, [email protected]

KeithRN Clinical Reasoning Escape Rooms Develop Student Clinical Judgment by Integrating Educational Best Practices

Take the Next Step

There are currently three KeithRN Clinical Reasoning Escape Rooms available:

• Pediatric DKA
• Heart failure
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These are foundational topics that students will encounter in professional practice, and working through these escape rooms will allow students to practice making clinical decisions.

How frequently are you using an active learning activity that requires application of knowledge in the context of clinical practice?

Closing Thoughts

Fostering the development of clinical judgment in nursing students through engaging and meaningful classroom content continues to challenge nurse educators. Data suggests that most graduate nurses, even if they pass NCLEX, do not possess clinical judgment skills for safe practice (Kavanagh & Sharpnack, 2021).

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Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A call for radical transformation . San Francisco, CA: Jossey-Bass.

Kavanagh, J.M., Sharpnack, P.A., (January 31, 2021) “ Crisis in Competency: A Defining Moment in Nursing Education ” OJIN: The Online Journal of Issues in Nursing, Vol. 26, No. 1, Manuscript 2.

McLean, S. (2016). Case-based learning and its application in medical and health-care fields: A review of worldwide literature. Journal of Medical Education and Curricular Development , 39. doi: 10.4137/JMECD.S20377

Molina-Torres, G., Cardona, D., Requena, M. Rodriguez-Arrastia, M., Roman, P. & Ropero-Padilla, C. (2022). The impact of using an “anatomy escape room” on nursing students: A comparative study. Nurse Education Today , Volume 109.

Reinkemeyer, E.A., Chrisman, M. & Patel, S.E. (2022) Escape rooms in nursing education: An integrative review of their use, outcomes, and barriers to implementation. Nurse Education Today , Volume 119.

Martha Johnson, MSN, RN, CEN, the author of this article, is the founder of Breakout RN , a company she created to empower nurse educators to successfully transition from lecture to active learning. She believes active learning does not have to be hard or overwhelming, educators should just take it one activity at a time.

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Escape Rooms in Medical Simulation: Downloadable Sepsis Scenario & More

Have you ever tried an Escape Room? How about an Escape Room of Medical Simulation ? Human factors such as effects of teamwork, tasks, equipment, workspace, culture and organization are increasingly being shown to affect patient outcomes. Escape Rooms are perfect opportunities for teams that have never met before (or even better if they have) and asks them to quickly solve under time pressure the uniquely random sets of (hopefully) solve-able problems — albeit strictly for fun! Imagine we could combine a healthcare simulation learning scenario, from the framework of an “Escape Room”? Today Dr. Kim Baily PhD, MSN, RN, CNE, previous Simulation Coordinator for Los Angeles Harbor College and Director of Nursing for El Camino College helps us do just that!

(Editors Note: HealthySimulation.com and Dr. Baily wish to thank Nichole Holte BS, RN, CHSE and her colleagues at Essentia Health, Fargo, ND for sharing their detailed 8 page sepsis escape room simulation scenario shared below!)

Human factors research also aids in understanding why errors occur, when errors might occur in the future and how systems can be redesigned to prevent errors. Medical education for physicians, nurses, pharmacists and other allied disciplines must include human factors as part of their curricula. Creating effective teaching strategies to improve communication and teamwork is challenging.

Traditional classroom teaching remains the most common method in healthcare education however, this may leave the learner with inadequate soft skills. Experiential learning strategies, such as simulation, have been shown to enhance communication and teamwork skills. More recently, gaming and in particular escape room activities have been introduced as a learning strategy to enhance soft skills. The goal of gaming strategies is to create a fun and engaging environment that incorporates soft skills such as teamwork. This article reviews four recent studies related to the use escape rooms in medical education.

What is an Escape Room?

An escape room, aka an escape game, is a fun event in which a team of players cooperatively discover clues, solve puzzles, and accomplish tasks in one or more rooms in order to progress and accomplish a specific goal in a limited amount of time. The goal is often to escape from the site of the game. Escape rooms became popular in North America, Europe and East Asia in the 2010s. Rooms look (or simulate) a time and place from the old west to the future of space, and found clues come together to solve the puzzles and unlock the door (which is never really locked in case of real emergency). This video sums them up just fine:

Non Medical Escape Room Experience Helps ED Doctors

In a recent study by Zhang et al. (2018), ten ED residents and faculty participated in a commercial escape room which was available to the general public and which had no connection with any medical institution. No roles were assigned and the team had 60 minutes to “escape” from the room. To escape the room, participants had to practice teamwork, communication, task-delegation, critical thinking, and divergent thinking to tackle a series of increasingly complex puzzles, ranging from hidden objects, physical object assembly (i.e., jigsaw puzzles), counting, and/or symbol matching.

The investigators used an 18 question validated, post-study survey evaluation adapted from a post-focus group interview guide to obtain written feedback about the escape room activity. Nine out of 10 participants thought the escape room mimicked an ED in that the experience involved co-managing stressful situations, settling differences in opinion, and providing periodic status updates. Half of the participants would have preferred a more structured debriefing , similar to a debriefing following a simulation. (Zhang X, Lee H, Rodriguez C, et al. (March 02, 2018) Trapped as a Group, Escape as a Team: Applying Gamification to Incorporate Team-building Skills Through an ‘Escape Room’ Experience. Cureus 10(3): e2256. doi:10.7759/cureus.2256).

A Suitcase Escape Room:

The British Medical Journal Education Improvement Report entitled Escape into patient safety : bringing human factors to life for medical students by Blackhouse and Malik described an escape room in which learners solved a series of clinical and communication-based tasks in order to treat a fictional patient while avoiding ‘clinician error’. This escape room is easily portable since all the clues and props are contained within a suitcase. Students must complete a series of clinical tasks: making a diagnosis; calculating a National Early Warning Score (NEWS); looking up treatment in the British National Formulary; completing a drug chart to prescribe medication within 30 minutes.

The escape is obtained when the patient is treated appropriately without harm. The escape room is followed by an After Action Review (AAR) which allows students to reflect as a group on their experience, explore factors which led to a successful or not so successful completion of the game and reflect on the role of human factors on the outcome. All of the students a greed that they gained new knowledge and skills and insights and felt confident that they would be able to apply what they had learnt in the future. ( http://dx.doi.org/10.1136/bmjoq-2018-000548 ).

Escape Room and Simulation Combined:

The third article by Brown, Darby and Coronel involved the use of an “escape room” within a high fidelity simulation. Rather than using an escape room, the “escape” involved determining the combination of a series of four locks on boxes which allowed the learners to progress through a urosepsis simulation within 60 minutes (Brown, N., Darby, W., & Coronel, H. (2019, May). An escape room as a simulation teaching strategy. Clinical Simulation in Nursing , 30(C), 1-6).

Note, the boxes came from a company called Breakout EDU which sells “breakout” EDU kits and offers an immersive learning game platform which is adaptable to any subject or grade level. Initially, goals and learning objectives were created for the simulation and escape room. Learners reported that the addition of an escape room contributed to their learning and their ability to delegate tasks and function as part of a team.

Escape Room for Hospital Staff

The last article was created by two RNs Gabriel and Lieb in an effort to create a fun learning experience for hospital staff on World Sepsis Day at Penn Medicine Sepsis Alliance. Staff from various disciplines such as social workers, physical therapists, physicians, nursing assistants, nursing students, and nurses volunteered to participate in the escape room. The staff had 25 minutes to solve four puzzles and interpret clues to detect and treat sepsis in a mock patient before they could escape.

One puzzle related to administration of IV antibiotic therapy. The room had an IV pump set up with four antibiotics that were tangled together and the patient only had two working IVs . Faculty debriefed each team of 6-7 staff members. Post escape room evaluations confirmed that staff had a better understanding of sepsis and the availability of sepsis tool kits available at the hospital. The escape room was so popular that additional sessions were offered.

Download the Sepsis Escape Room Scenario Here!

Only 13% of students enrolled in a baccalaureate nursing program are over the age of 30 years of age ( NLN survey). Since millennial students are strongly connected to technology and gaming, escape rooms could make a good strategy for engaging learners. More research needs to be done to determine the effectiveness of escape rooms as a learning methodology and to compare the cost of escape rooms with more traditional simulation.

Learn More About an Escape Room Sim for Sepsis!

Have a story to share with the global healthcare simulation community? Submit your simulation news and resources here!

Dr. Kim Baily, MSN, PhD, RN, CNE has had a passion for healthcare simulation since she pulled her first sim man out of the closet and into the light in 2002. She has been a full-time educator and director of nursing and was responsible for building and implementing two nursing simulation programs at El Camino College and Pasadena City College in Southern California. Dr. Baily is a member of both INACSL and SSH . She serves as a consultant for emerging clinical simulation programs and has previously chaired Southern California Simulation Collaborative, which supports healthcare professionals working in healthcare simulation in both hospitals and academic institutions throughout Southern California. Dr. Baily has taught a variety of nursing and medical simulation-related courses in a variety of forums, such as on-site simulation in healthcare debriefing workshops and online courses. Since retiring from full time teaching, she has written over 100 healthcare simulation educational articles for HealthySimulation.com while traveling around the country via her RV out of California.

4/23 @ 9AM PDT: Overcoming Obstacles to Trauma Simulation 4/24 @ 9AM PDT: Navigating Deployment of XR / VR at Children's Hospital of Philadelphia 5/2 @ 9AM PDT: Replacing Traditional Clinical Rotations with Nursing Simulation 6/18 @ 10AM PDT: An Interprofessional, Experiential, Performance-based Model for Healthcare Professions

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Escape Rooms as a Learning Strategy for Special Education Master’s Degree Students

Ana manzano-león.

1 Department of Psychology, University of Almería, 04120 Almería, Spain; se.lau@075lma (A.M.-L.); se.lau@oreuglasoirad (D.S.G.)

José M. Rodríguez-Ferrer

José manuel aguilar-parra, ana maría martínez martínez.

2 Department of Education, University of Almería, 04120 Almería, Spain; se.lau@178mma (A.M.M.M.); se.lau@euqula (A.L.d.l.R.); se.lau@501cfj (J.M.F.C.)

Antonio Luque de la Rosa

Darío salguero garcía, juan miguel fernández campoy.

Escape rooms and breakout are learning strategies that can facilitate motivation of learning through challenges. In these strategies, students must work as a team and use their reasoning, knowledge, and skills to solve puzzles and challenges related to the content of the curriculum, allowing them to solve the game in a limited time. The aim of this study was to determine the effects of the implementation of an escape room on classroom flow, academic performance, school motivation, and prosocial and antisocial behaviours with higher students in a Special Education master’s degree course. The quantitative results show a significant improvement in classroom flow, academic performance, and classroom climate, and a better score in prosocial and antisocial behaviours. The qualitative findings provide a better understanding of these results, and support the conclusion that the use of escape rooms is fun and motivating for students, and facilitates their learning achievement.

1. Introduction

One area of investigation in higher education is the use of active teaching strategies combined with ludic elements, such as gamification [ 1 ] and game-based learning [ 2 ]. The use of escape rooms is also beginning to be studied [ 3 ]. Escape rooms are immersive games played by small groups of three to eight people, in which participants are required to solve puzzles to escape from a room or, in the case of breakout, open a final chest.

The experience of the escape room has been a global phenomenon for almost a decade [ 4 ]. Escape rooms involve being “voluntarily” locked in a room, solving a series of riddles, unlocking locks, and finding hidden clues to escape. Using a variety of scenarios and challenges, the escape rooms create an experience that is simultaneously motivational and educational for the participants. To escape the room, players often open several four-digit coded locks. For this purpose, players must solve different puzzles to discover the code. They need to perform the task in a certain period, usually less than one hour [ 5 ]. Riddles are usually of the following forms: decrypt messages; find information in text; read text in a mirror; reveal invisible messages with UV light; search for items in strange places; combine parts; or activate a magnetic lock. The essential elements of an escape room are: Pattern: Escape rooms are built based on a pattern that can be linear (an orderly sequence of challenges), open (the final task is solved with the combination of the solutions of challenges of all teams), or multilinear (those in which you can simultaneously develop two or more lines of clues/puzzles throughout the game). Challenges, puzzles or tasks: These are the diverse elements whose resolution lead to the exit, or the discovery of a mystery, a cure, etc. Physical/online elements to solve tasks within an escape room: The most common are padlocks, puzzles, hidden codes, encrypted messages, riddles, and hidden objects. Clues: When the team of players fails to advance in the escape room, the Game Master (GM) can offer a clue to allow participants to continue moving forward, thus ensuring the group does not become frustrated. Depending on the type of escape room these clues must be obtained or requested directly from the master. The clues can be obtained via voice (calls, videos, walkie-talkies, audio signals, etc.), in person (either because the organizer is present or because they can respond through a device), or written (hidden, slipped under the door, projected, etc.). Narrative: an escape room is more than a sequence of puzzles to open boxes; the narrative is a thread by which all of the challenges are related. Educational escape rooms are not always designed with a narrative. The design is simplified if the narrative does not act as a guiding thread that relates all of the challenges; however, this is less immersive because the narrative itself is part of that initial impact that motivates the player to undergo the experience.

Real-life escape rooms are a new game genre based on live action role-playing games, treasure hunts, and online escape rooms [ 6 ]. Most escape rooms are purely recreational; however, educational escape rooms are becoming more popular with professional programs to involve students in their learning environment, and encourage collaboration and the development of social skills [ 7 ]. The results of recent studies show that games and the use of escape rooms have been effective in involving students in the learning process and helping them retain information [ 8 ]. Dietrich [ 9 ] reinforces this idea because his study shows that an escape game in the classroom encourages students to discover scientific concepts in a team environment and playful manner, and provides opportunities to develop adaptive and receptive skills, compete with and against their classmates, show their individual skills, interact with each other, and experience moments of discovery and victory. Problem solving and critical thinking can be highlighted among the skills that can be developed with the use of escape rooms in the classroom. Critical thinking consists of being able to understand thoughts, make sense of ideas, and make logical decisions [ 10 ]. The escape rooms pose different challenges and tasks that make students question and evaluate their ideas, and solve problems.

Escape rooms can generate intrinsic motivation in the players. Other advantages include favoring learning, improving attitudes and social skills, and involving students with the subject and teamwork [ 11 , 12 ]. Ultimately, escape rooms could provide an exciting engagement for higher education programs.

Studies have shown that playful learning experiences generate motivation and commitment among most participants [ 13 ]. Game-based learning can involve students in a learning activity, thus achieving high levels of commitment (concentration, interest, and enjoyment). This can be accomplished by increasing the levels of challenges and skills during the game [ 14 ]. Ensuring the game is a challenge, therefore, is an especially strong predictor of learning outcomes. The motivation to undertake challenging tasks is related to classroom flow. Flow is defined as a state of total immersion and fusion of action and consciousness [ 15 ], and is associated with positive emotional, motivational, and cognitive experiences [ 16 ]. The degree to which students enjoy a subject and their degree of motivation can be predictors of their results [ 17 ].

The use of gamification and playful strategies improves motivational learning because it allows students to experience and discover, while practicing skills and learning in a playful manner [ 18 ]. Other benefits of using escape rooms may be as a potential avenue for co-workers, classmates, or friends to explore and improve their collaborative skills, socialize with others, and develop team morale [ 19 ]. Collaborative learning is an effective approach to improve student outcomes. These tasks allow small groups of students to collaborate and share perspectives, discuss points of disagreement, question and understand the points of view of others, solve complex problems, and reach agreements [ 20 ]. In addition, the development of collaborative skills can be positively related to prosocial behaviours [ 21 ], defined as a set of behaviours whose objective is to establish socially empathic and cooperative relationships. In contrast, antisocial behaviours are behaviours intended to harm and distress other people [ 22 ]. Other playful strategies such as gamification facilitate the creation of a relaxed climate, reducing disruptive behaviours and generating a sense of control and responsibility towards learning [ 23 ].

There is emerging evidence that escape rooms and breakout are being used in university education, and that this can have a positive impact on motivation and the relationships between students [ 3 , 8 , 24 ]. However, this approach is not yet a consolidated learning strategy for master’s students. Our study aimed to fill this knowledge gap and evaluate the impact of escape rooms on learning, motivation, classroom climate, and overall satisfaction of the experience of Special Education master students. Specifically, the objectives of this study were: (1) To determine the effectiveness of an intervention through an escape room in relation to classroom flow, academic performance, classroom climate, and the prosocial and antisocial behaviours of the students; (2) to explore the relationship between the use of the escape room and the learning and motivation of the students.

2. Materials and Methods

2.1. participants.

The context of this study was the implementation of an educational room escape in the subject “Psychic Disability” of the Master of Special Education of the University of Almería during the academic year 2018/2019. A total of 26 female and 4 male students, with ages between 21 and 44 years ( M = 26.06; SD = 7.12), participated in the experience and voluntarily completed the questionnaires and interview.

To select the participants, a convenience sample was chosen. The inclusion criterion for the experimental group was a willingness to participate in the escape room organized by the teaching staff and researchers. Participants received information about the project and gave written informed consent. Prior to data collection, the students were informed about the nature of the study and were assured of their anonymity. The final evaluation was carried out by the class teachers according to written instructions. Students completed the questionnaire during a regular class.

This study complied with the recommendations of the American Psychology Association. The entire process was conducted in accordance with the Helsinki Declaration [ 25 ]. All the participants also gave their oral and written informed consent. Ethics approval was obtained from the Research Ethics Committee of the University of Almería (Ref. UALBIO 2021/01).

2.2. Design of Escape Room

In the subject “Psychic Disability” of the Master of Special Education at the University of Almería, it was proposed to experience an escape room in the penultimate session of practical classes. The entire group was separated into 6 groups of 5 students. In the days prior to its completion, students were urged to review the documentation and content of the subject for “a complementary activity”. Until that day, the students were not informed that they would experience the escape room, and the escape room was a large surprise. Two external professionals were masters of each other’s game. Both professionals had more than 5 years of experience in the organization and development of playful experiences such as escape rooms, and coordinated with the teacher of the subject so that the quests had a didactic purpose related to the subject. These rooms were thematically decorated with books, posters, photographs, and materials related to the challenges of the escape room. In each of the classrooms, the students of each team were “locked up” with all of the material necessary to carry out the activity, and were prevented from contacting the other team, which played simultaneously ( Figure 1 ).

The escape room design and implementation. ( 1 ) Students distributed around the room looking for clues to exit; ( 2 ) final photo after the escape room; ( 3 , 4 ) students working cooperatively to solve challenges of the escape room; ( 5 ) some of the elements of the escape room.

Before starting the activity, the game masters explained the rules necessary to perform the escape room. The rules were simple: all of the clues are at players’ fingertips, it is not necessary to use force or break anything, and the clues and tasks only have one use; for example, a code will only open a lock, it will not serve to open others. In addition, the game masters explained the narrative situation through which they entered the escape room, to contextualize the situation and create a suitable environment. The escape room narrative consisted of a good practice pedagogical cabinet in which a group of educators had been kidnapped by a group of “bad pedagogical practices” professionals. Once the students entered the room, they listened to an audio where that bad group had also locked them up so they wouldn’t tell their secrets. Subsequently, the countdown appeared and each team, cooperatively, had to solve the five challenges of the escape room. One of these was purely playful and involved removing a ball from a box. However, the other four challenges (two boxes with padlocks and two QR code locks) were related to the contents of the subject, and participants were required to look for clues in the room about how to diagnose or intervene with students with psychic disabilities.

The objective of this educational escape room was to review the content of the Psychic Disability course and for the students to learn to work cooperatively. The proposed educational challenges were:

• (a) Solve a quiz to defuse a bomb, relating the names and definitions of Down syndrome, autism spectrum disorder, intellectual disability, and mental disorder.
• (b) Correctly answer 4 single-solution questions regarding the curriculum content, with 5 alternative answers, to open a physical lock.
• (c) Correct 10 educational reports for students with mental disabilities, identify those that are incorrect to be able to discard them, and identify the appropriate schooling modality of the 4 correct reports to indicate the final answer of the door code.

The Game Masters encouraged participants to work as a team, find clues around the class, and make the most of the time among all of the members. If they observed that the students were frustrated or asked for a clue, they offered assistance so that the game had the appropriate pace of challenge and difficulty. It is important to note that most of the students had no previous experience of a conventional or educational escape room. Once the group escaped, a photo was taken in the classroom with their escape time and their team’s name.

The total escape room time for each group of students was between 40 and 100 min, depending on how long it took them to solve the case. It took 20 min to reorder the clues on the stage between the different groups. The use of two professionals allowed two identical escape rooms to be replicated in two university classrooms.

2.3. Instruments

A unique case study was conducted with a mixed methods approach in a parallel convergent design [ 26 ] to examine the relationship between escape room design and student development. This design implies that the researcher uses quantitative and qualitative techniques at the same time during the same phase of the research process. The priority of the methods is the same in both approaches, which are separated and independent during the analysis. The results are finally combined during a joint interpretation.

Quantitative data were collected in a pretest-posttest group design with the following questionnaires:

• Brief Inventory of Optimal Experiences [ 27 ] was applied. The inventory comprises 9 items, from which a total score of optimal experience in the evaluated activity is obtained. The 9 items have 5 response options from totally agree to totally disagree. Cronbach’s Alpha values were 0.864.
• The Short Class Climate Scale [ 28 ] which has 11 items, divided into 2 dimensions (Group cohesion and Group leadership) and 5 subdimensions (Satisfaction and involvement, Peer cohesion, Teacher–student relationship, Order and organization, and Orientation to the task) ranked on a 4 point Likert scale, which presents 4 possibilities of response: never, sometimes, frequently, and always. A Cronbach’s alpha coefficient of 0.83 was obtained for the scale.
• The scale of prosocial antisocial behaviours [ 29 ]. This instrument has 20 items, divided into 2 factors (Prosocial Behaviors and Antisocial Behaviors) and 4 subfactors (Prosocial Teammate, Prosocial Opponent, Antisocial Teammate, and Antisocial Opponent) ranked on a 5-point Likert scale, from strongly disagree to strongly agree. Cronbach alpha values of the factors and subfactors were greater than 0.70 and gender-invariant. For this study, the Prosocial Teammate and Antisocial Teammate subscales were used.
• Five ad-hoc questions of the subject with four answer options, one correct and three incorrect. An example of the question was: “How do teachers evaluate participation, interaction and socials roles in students with severe intellectual disability?”. Students were asked to complete the questionnaire before beginning (t1) and at the end (t2) of the escape room.

2.4. Data Analysis

To examine the results of the study, a mixed methodology was performed. First, a t -test was performed for related samples because the students were measured before and after developing the escape room. To complete this analysis and quantify the effect size, Cohen’s d was used. The SPSS 25.0 statistical package (IBM, United States) was used for quantitative data analysis. Qualitative data were collected in semi-structured interviews [ 30 ] of students who participated anonymously and freely expressed their opinions on the escape room project. All information was organized for analysis and treatment through the Atlas.li software (version 8.4.2, ATLAS.ti Scientific Software Development GmbH, Berlin, Germany). The analysis process, based on the grounded theory [ 31 ], was carried out through three processes: open coding, axial coding, and selective coding [ 32 ].

After collecting the transcript, open encoding was performed first. This consists of a careful examination of the data to identify the meanings of the students’ responses. To ensure the validity and thoroughness of the analysis, two researchers, separately, recorded the first open codes that expose the thoughts and meanings of the surveys. Then, in axial coding, these two researchers combined their codes and unified or divided one of them if necessary. In the case of doubts about the interpretation, the help of a third investigator was requested. In this phase, the categories and subcategories of the stories were related. Once the categories and subcategories were collected in the axial coding, selective coding was carried out. In this phase, the categories found in the stories were organized into relationship networks or concept maps. Structural networks or flow diagrams graphically represent possible structures or systems of relationships between categories or codes. In this network, the interpretations are made explicit, and it allows reviewing of all the elements that can support one or another argument or conclusion [ 33 ]. This phase was also carried out based on the discussion of two researchers and, in the case of disagreement, a third researcher was contacted.

Table 1 shows the results related to the study variables before and after the escape room. As can be seen, there were statistically significant improvements in the variables flow, academic performance, and classroom climate, with the exception of the task orientation subfactor. There were also improvements, although not statistically significant, in prosocial and antisocial behaviours; there was an increase in the means in prosocial behaviours and a decrease in antisocial behaviours between pre- and post-test. The size of the effect, calculated using Cohen’s d , showed a very strong effect on flow, academic performance, peer cohesion, and teacher–student relationship. There is also a strong effect in order and organization, a moderate effect in satisfaction and involvement, and a low effect in the remaining variables.

Pre-test and post-test differences between the experimental group.

After the analysis of the interviews conducted with the students, the following categories were identified ( Table 2 , Figure 2 ). The first number in the following tables represents the name of the student, anonymized as S (which stands for student) and a number (which was chosen for each student in a linear order).

Network diagram of student’s experiences about the educational escape room.

Qualitative results after implementing the escape room.

Note: Chapeau is a generic expression that is used as appreciation or respect in France and other countries of Europe.

3.1. Escape Room Design

The escape room design includes all of the playful and educational elements that were taken into account when preparing the activity. When designing escape rooms, special emphasis is placed on the link between puzzles, challenges or puzzles to solve, and narrative. In education, the challenges introduced should not only be fun and related to the narrative, but also have a didactic purpose that has an impact on students and helps them learn new skills or reinforce acquired content. The results of the interview analysis show that the students found that the design of the escape room had balanced tasks (20% of the student statements), and the challenge (43.4% of the student statements) was satisfactory and exciting. Another interesting aspect of the escape room was the possibility of evaluating curricular contents from the tests carried out in a playful manner with the objective of offering feedback on their abilities. A share of 30% of the students mentioned in their interviews that the evaluation of their abilities was very positive because they did not feel pressured and were having fun, and 6.7% mentioned that the presence of the teacher in the classroom encouraged them to solve the tests. Students realized the relevance of the use of escape rooms in education because 20% of them talked about its usefulness in their future elementary classes.

3.2. Experience

In educative escape rooms, the experiential aspect is vital for motivating students because it aims to provide a memorable learning experience. To be a credible experience, the narrative and the tasks must be connected to the narrative and the message it is trying to convey. In addition, these tasks must meet flow conditions such as clear objectives, feedback, and linkage to the game. Within the category of experience, the effects mentioned by the students focused on positive feelings, emotions, and results, which were divided into the subcategories of flow, motivation, fun, and looking forward to repeating the experience. For most students (90%), the escape room was fun. They mentioned that it was different and more fun than traditional classes, and consequently more motivating (83.4% of the students’ statements). The design of the challenge and the need to collaborate was a very positive and motivating factor for the students. In addition, the level of challenge (neither too easy nor too difficult) was adequate, and the goals were clear for the students. Thus, the experience was enriching with a high flow (83.4% of the students’ statements).

3.3. Learning

The main objective of the educational escape rooms is to create a creative learning environment, which can be designed for any educational level, and uses the characteristics of the escape room’s design to incorporate specific educational elements and purposes. As a result of the interview analysis, the category of learning includes the acquisition and improvement of educational and interpersonal skills. Students indicated that their own capacities, such as problem-solving and critical thinking (16.7%), collaborating and team building (50%), and learning to work under pressure (13.4%), were put into practice during the escape room. Furthermore, it was mentioned again in this category that the learning acquired in the escape room seemed more significant than that in traditional education.

3.4. Disadvantages of Escape Room

During the interview students were asked to mention the escape room factors they did not like or could be improved. It should be noted that 60% of the students considered that there was nothing to improve. However, any educational activity has a range of improvement. Within this category, the results found from a small portion of the students related to nervousness and fear of failure during the test (3.4%). These sensations were produced due to the limited time of the escape room and the feeling of being watched by peers during the experience. Another participant mentioned that the number of students (7/8 per group) was very large for the class size. Finally, the difficulty was mentioned (13.4% of the students’ statements). The moment of feedback inside the escape room was key to obtaining the flow environment because if the clues arrived too early, a balanced challenge would not be achieved, whereas if the clues arrived too late, the participants would feel frustrated because it will seem too difficult.

4. Discussion

Educational escape rooms are gradually being established in formal education settings, where it has been observed that the experiences enhance the development of skills and competences for students, in addition to being a motivating element in their education. To the best of our knowledge, this type of game has not been previously used in education master studies, although it has been used in other university degrees [ 34 , 35 ]. According to the students consulted, the escape room was fun, it helped them to review the contents of the subject, and they were able to enjoy working in teams and active learning. Students also mentioned that more learning strategies of this type should be used during the master’s degree. The impact of gamified activities and escape rooms in university studies, and the desire of students to apply more games of this type in other educational subjects, demonstrate that these teaching strategies are suitable for motivating students. This finding is supported by the findings of previous studies, such as that of Nicholson [ 36 ].

Our study showed the effectiveness of escape rooms in relation to classroom flow, and obtained statistically significant improvements. These results coincide with other studies such as that of Shernoff [ 37 ], who states that for students to reach a state of flow it is necessary to generate experiences that simultaneously provoke concentration, interest, and enjoyment. This is based on an optimal classroom flow in which the aspects of challenge (concentration) and play (enjoyment) are favored. This allows the experience to be intrinsically significant and fulfils a preventive function regarding the negative consequences for learning [ 38 ]. This is reinforced by the qualitative data, which indicated that the students perceived the escape room as a challenging cognitive task that they could enjoy as a team and, consequently, this allowed a high level of classroom flow. There were also significant improvements in the ad hoc academic performance test. This indicates that the use of escape rooms can improve the acquisition of curriculum content. Our results reinforce previous research [ 11 , 39 , 40 , 41 ], which found that escape rooms can be a fun and motivating teaching–learning strategy to reinforce and evaluate the curricular contents of university teaching.

The low cost of escape rooms is another positive aspect compared to the implementation of learning projects with video games, virtual reality, or serious games in which specific software and hardware must be developed and maintained. The design of this escape room only required the purchase of four boxes, chains, and four padlocks with combinations, in addition to making two digital locks with QR codes. However, to ensure the room had greater ambience and looked more like a conventional escape room, a larger budget may be required.

Regarding prosocial and antisocial behaviours and the classroom climate, no significant differences were found. However, improvements were found after the escape room. This result can be explained because the activity was only undertaken in one session and these variables need more stimulation time for these changes to occur. Previous research, such as that of Tobón [ 42 ], supports the idea of a profile of social responsibility in students, within which prosocial and antisocial behaviours exist, based on values and moral development. This profile would be based on university education and articulated with psychosocial factors, such as age, family structure, and economic and political factors that are transversal in the development of prosocial, collectivist, and moral behaviours. Considering these data, we conclude that a specific activity of one or several days is not enough to be able to achieve significant changes in prosocial and antisocial behaviours. The climate in the classroom is a multifaceted concept. Alonso-Tapia, et al. [ 43 ] studied how teacher action patterns can have an effect on the overall classroom climate, and how the set of interactions between students also exerts an important influence on positive interactions. Students and peers provide personal validation and emotional support, help solve problems, and help to develop a perspective and empathy. These characteristics serve as the basis for cooperative, prosocial, and non-aggressive behaviours. There is a lack of empirical research on the impact of escape rooms and other recreational strategies on the relationship between teachers and students, and that of students among themselves. However, we consider it remarkable that better scores were obtained for the classroom climate and prosocial and antisocial behaviours after the intervention, and that it is necessary to study its use with a greater number of implementation sessions.

From the completion of this study, it is considered that educational gamification can achieve multiple benefits: it is an innovative learning strategy that encourages active student learning and pursuit of engagement; it also stimulates the curiosity and participation of students, provides opportunities to achieve a well-designed classroom flow, and creates a positive classroom climate and allows meaningful learning. From the evaluation, we can conclude that that educational escape rooms have a complementary function to traditional didactic teaching as an innovative and motivating learning strategy. Most of the interviewed participants claimed that the escape room was very motivating and fun, and served to consolidate their knowledge about the subject. The students also noted the potential use of the escape rooms to evaluate their knowledge in a playful manner. However, it should be noted that a small portion of the participants felt stressed or were afraid to fail during the activity.

Finally, the limitations of this study are mentioned. First, there was a lack of a control group with which to compare the variables. Although there are positive changes within the same group, it would be interesting for future research to evaluate the effectiveness of the escape room with respect to a control group that carried out traditional classes in the variables studied with validated instruments, and the performance of the complete subject through a school performance test. Second, it is also recommended to increase the study sample to generalize the results.

Another limitation is the lack of control for possible confounding variables (individual dispositions or interpersonal skills of the people involved in the study) that can affect the manner in which they participate in an escape room. In future research, these variables could be studied descriptively to determine if they act as a predictor of enjoyment or rejection of these playful experiences.

Regarding the design of the escape room, to make it more functional and have greater possibilities of replication in other university groups, it would be possible to create an open room escape system combined with online tools. One of the limiting factors of the escape rooms is that the size of the team must remain relatively small to optimize collaboration and commitment [ 44 ]; however, ordinary classrooms of universities have large enrolments of more than 100 students. The author made an escape room with that number of students, creating a blended environment. As a future line of research, it is proposed to carry out a longitudinal study of repeated measures with a control group and an experimental group to explore the long-term effects of the use of playful strategies on academic performance, educational flow, school motivation, classroom climate, and prosocial behaviors. Another future line of research could be to study whether there are differences in these variables, using other playful strategies such as gamification or game-based learning, in addition to whether there are statistically significant changes depending on the time of application of the programs.

5. Conclusions

In conclusion, the use of escape rooms in university education can have benefits in the motivation, flow, and acquisition of student knowledge, and can be combined with other strategies of active learning and traditional learning. Limited research has been undertaken on the use of recreational strategies in education students. Thus, significant information could be obtained about the development of key teaching skills, such as educational innovation, teamwork, and collaboration, with this type of teaching strategy.

Author Contributions

Conceptualization, A.M.-L. and J.M.R.-F.; methodology, J.M.A.-P.; software, A.M.M.M.; validation, A.L.d.l.R.; formal analysis, J.M.F.C.; investigation, A.M.-L.; resources, D.S.G.; data curation, J.M.A.-P.; writing—original draft preparation, J.M.R.-F.; writing—review and editing, A.M.-L.; visualization, A.L.d.l.R. and A.M.M.M.; supervision, J.M.F.C. All authors have read and agreed to the published version of the manuscript.

This research has been funded, in part, by the Ministry of Universities through the University Teacher Training Program (FPU2019). The support of the Ministry does not imply acceptance of its contents, which is the sole responsibility of the authors.

Institutional Review Board Statement

The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Ethics Committee of University of Almería (UALBIO 2021/01).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Conflicts of Interest

The authors declare no conflict of interest.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Inspirations for Digital Engagement Activities

Case Study: Escape Room

Case study contributed by Marcus Pedersen , Learning Technologist, and Ashish Chokshi , Principal Optometrist, Moorfields Eye Hospital and Institute of Ophthalmology  

We developed a new method of teaching the medical process of diagnosing. Basing the activity on the concept od an ‘escape room’ we developed an environment in which the students needed to input certain information to clear each stage, moving from patient to patient. It was created in a short amount of time and we are going to make it a better learning experience for the next rendition.

We need to create a variety of resources for the spectrum of different learners. If we only stick to traditional methods, we are alienating certain learners. It is important to note that we had very little time to complete the resource.

How : It requires someone who can navigate WIX and someone with in depth medical knowledge.

When : this activity can be run at any time and could be expanded to other classes, it is not only useful for Ophthalmology.

Resources needed : Case studies and images.

Workload : MVP about 8hrs.

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Perceptions of medical students on narrow learning objectives and structured debriefing in medical escape rooms: a qualitative study

• Tami Jørgensen 1 , 2 ,
• Oscar Rosenkrantz 1 , 3 ,
• Kristine Elisabeth Eberhard 1 , 4 ,
• Theo Walther Jensen 1 , 5 &
• Peter Dieckmann 1 , 7 , 6  

BMC Medical Education volume  24 , Article number:  403 ( 2024 ) Cite this article

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Escape rooms are increasingly used in medical education as a complementary learning technique or even alternative to traditional educational approaches. Few studies focus on debriefing following medical escape rooms and how escape rooms can be used to achieve pre-defined learning objectives. Evaluating the use of narrow learning objectives may increase the depth of reflections and transform an engaging team event into an effective learning opportunity. This study aimed to explore participants’ experiences and perceived learning outcomes of narrow learning objectives in a medical escape room with debriefing.

In this explorative, qualitative study, participants saw a video lecture, participated in an escape room experience, and in a following debriefing. Throughout this learning session, the learning objectives concerned “exchange of information” and are therefore relatively narrow. Participants then participated in a semi-structured focus group interview and completed a demographic questionnaire. Participants were volunteer final-year medical students. Focus group interview recordings were transcribed and analysed using systematic text condensation.

Thirty-two students in eight groups completed the study. Five themes were described in the analysis of the focus group interviews: Experience with the narrow learning objectives, topics discussed in the debriefing, learning mechanisms, learning outcomes concerning exchange of information and influences of the learning approach.

Conclusions

Narrow learning objectives and structured debriefing seem to increase perceived learning depth of medical escape room sessions. Using semi-structured debriefing still allows for discussions of other elements relevant to the students.

Clinical trials

Clinical.trials ID NCT04783259.

Peer Review reports

There is increasing evidence that medical students prefer interactive education styles with elements of gamification [ 1 , 2 , 3 ]. Gamification is applying game mechanics to a non-gaming environment [ 4 ], which improves achievement of learning goals compared to traditional teaching methods [ 5 , 6 , 7 ].

One interactive gamification technique is escape rooms, a themed exercise that involves solving puzzles and riddles to get out of a room within a specific time limit [ 8 ]. An example of an educational escape room is the Medical Escape Room Game Experience (MERGE) [ 9 ]. It is designed to raise awareness about non-technical skills (NTS) [ 10 , 11 ] among healthcare students by presenting medically themed logic- and skill-based puzzles to be solved as a team. NTS are defined as the social, cognitive and personal management skills necessary for safe and effective performance. These skills are important across various high risk industries including nuclear power, aviation and healthcare [ 12 ].

Like simulations, escape rooms are experiential learning settings. Compared to a simulation, however, participants engage less in role-play and more in a game. Where a simulation at least sometimes asks participants to assume a professional role other than their own, participants in an escape room typically enter as “themselves.”

In such a learning situation, participants share the experience but perceive it from different angles. Debriefing can enlighten differences and strengthen the learning outcome from experiential learning situations by allowing reflection on the educational experience [ 13 , 14 , 15 ]. Therefore, debriefing will supplement an escape room’s inherent entertainment value to increase learning [ 16 ]. Further, the debriefer can be a peer to the learners as peer-to-peer feedback is suggested to affect the learning outcome positively [ 17 ].

The considerable number of debriefing structures published indicate that there is value in organising the debriefing in one way or another. The research group also experienced that structure in the debriefing is appreciated by participants and facilitators. On a theoretical basis, structured debriefings might positively affect the collaboration between facilitators and participants, as both know what to expect, once the structure is established [ 18 , 19 ].

In a debriefing, learning objectives can be predetermined [ 14 , 20 ] with narrow or broad wording. The research group differentiates between narrow and broad learning objectives. Narrow learning objectives concern focused and well-defined questions as opposed to broad learning objectives that are more open and likely to spur many different discussions depending on the learner. The “breadth” metaphor is always relative: “Knowing how errors occur” or “Discussing communication” are examples of broader learning goals with many possible subtopics whereas “Understanding the role of eye contact in non-verbal communication” in contrast is relatively narrow. When using narrow rather than broad learning objectives, the discussion can reach deeper reflection levels, as fewer topics are covered [ 21 , 22 ]. The discussion might not cover topics of interest to participants if they are outside the narrow learning objectives, resulting in discussions being terminated during a debriefing.

Only four studies evaluated escape room debriefing [ 23 , 24 , 25 , 26 ] and concluded that participants would have preferred more structured debriefing relating to specific outcomes for the escape room sessions.

Published studies applied broad learning objectives or had no pre-set learning objective. Thus, no knowledge exists about how narrow learning objectives in a medical escape room are perceived by participants and how they affect the learning experience. The research group believes this knowledge might optimise the overall learning outcome of medical escape rooms by helping educators choose suitable learning objectives. Focusing on learning objectives during debriefing can optimise learning and emphasise the educational character of these entertaining activities. When having learning objectives tailored to the needs of the participants, it is, in the research group’s experience, easier for the educator to provide a high-quality learning session. This can be done by emphasising certain aspects of the learning objectives (e.g., spending more time on discussing them) to satisfy the learning needs and wishes of the participants.

For other experiential learning settings, like simulation, debriefing was declared the “heart and soul” of learning [ 27 ]. Therefore, the research group assumes that debriefing is valuable for escape rooms as well. Given the richness and openness of the learning situation in an escape room it is unclear whether the debriefing should focus on “everything” or specific potentials in the situation. Both approaches likely have advantages and disadvantages.

This study aimed to explore participants’ experiences and perceived learning outcomes of narrow learning objectives in a medical escape room with debriefing.

This was a qualitative study using semi-structured focus group interviews and text condensing. The research group was interested in exploring participants’ perceptions and needed a method that allowed participants to express those experiences. Given the character of the learning objectives, the cognitive aspects of participants’ learning were of interest. Therefore, verbal descriptions in an interview would be a valuable method to collect data and answer the research question [ 28 ]. The research group operated within the constructivist paradigm as it tried to understand a phenomenon from the perspective of those experiencing it.

This section describes the approach, but the supplementary material should be read to understand the experimental work clearly.

The escape room followed the MERGE manual [ 9 ] and was conducted at Copenhagen Academy of Medical Education and Simulation (CAMES) at Herlev Hospital, Denmark. The theme was a zombie apocalypse. It consisted of seven medically themed, logic- and skill-based puzzles that had to be solved sequentially, and the award at the end was the cure for the fictive zombie virus. The MERGE ‘Triage’ puzzle was exchanged with a puzzle box with laparoscopic forceps, focussing on teamwork (see Appendix 2 ). Behind a see-through mirror, a facilitator monitored the escape room events. Participants had 45 min to solve the puzzles. If they struggled in progress, the facilitator provided planned scenario lifesavers to help keep the time frame [ 29 ]. All the faculty had experience facilitating experiential learning settings, including simulation and escape room experiences.

Data collection

Following the escape room, participants were interviewed semi-structured in focus groups and the individuals involved answered a questionnaire about their experience, perceived learning outcome, and demographic information (see Appendix 1 ).

The puzzles in the escape room were in English, while participants communicated in Danish. The video lecture, debriefing, focus group interview, and questionnaire were in Danish. Illustrative citations from the condensation process were translated from Danish into English.

Participants

Participants were medical students who had completed four out of six years of their studies at the University of Copenhagen (UCPH), Denmark. Participants had completed at least four months of internship, experienced clinical practice close to that experienced by young physicians, and had some experience with simulation. Participants were recruited via social media, signed up in groups of four to five, and chosen based on the order of application. Participants did not receive any compensation.

Intervention

The intervention was a structured learning session comprising four parts: a video lecture, focused instructions before the escape room, the escape room scenario, and a post-session debriefing. It was conducted in March 2021.

The learning session focused on two narrow learning objectives: “ Recognising the different ways of exchanging information ” and “ Discussing the impact of exchanging information on problem solving ”. These were chosen based on previous focus points and learning wishes by former participants [ 9 ]. The first learning objective concerned knowledge and comprehension of Bloom’s taxonomy, and the second concerned application and analysis [ 30 ].

The video lecture concerned theory of exchange of information in general terms, thus preparing participants to work with the concrete learning objectives and was developed within the research team (see Appendix 3 ). The focused instructions included practical information on the escape room’s course and emphasised the need to focus on exchange of information, as it was the learning objective. Debriefing was a semi-structured conversation steered by TJ, who has practical experience in the peer-to-peer debriefing of medical students and facilitated the discussion following a manual (Appendix 4 ) based on an established debriefing model [ 13 ].

Semi-structured focus group interviews

Immediately after debriefing, participants were focus group interviewed with a semi-structured interview guide by KE or PD (see interview guide, Appendix 5 ). Focus group interviews concerned participants’ experiences and perceived learning outcomes of narrow learning objectives in a medical escape room with debriefing. Some of the main questions explored how they felt about the format, if and why participants would have preferred a less structured format and whether or not they felt limited by the narrow focus of the debriefing. Furthermore, participants were asked when they experienced learning outcomes and what these were.

Focus group interviews were estimated to last 30 to 45 min and were video and audio recorded. Interviewers emphasised that all points of view were relevant and essential, including perceived challenges.

Focus group interviews were transcribed ad verbatim by TJ and OR and analysed using systematic text condensation [ 31 ]. Condensation focussed on participants’ statements. Unclear and explicitly irrelevant citations (e.g. chit-chat) were excluded. The coding was done in Microsoft Excel. The citations were loaded into one column, where each row represented a different speaker. After initially reading the focus group interview transcripts several times, the coding proceeded with paraphrasing each cell in the next column on a similar level of abstraction by TJ. Themes were assigned to each paraphrase, condensing content of the focus group interviews. Themes were used by TJ and OR to identify all citations relevant to the study aim. These steps were repeated until researchers concluded that saturation had been reached by watching the remaining focus group interviews, and no more codes or themes were identified. TJ condensed the statements, selecting and translating representative citations from Danish to English before grouping them into main themes. Three research group members not involved in the coding and condensation (KE, TWJ, PD) cross-checked the coding and condensation process.

Because of the qualitative character of this study, the purpose was to describe participants’ perceptions as detailed as possible but not to describe how widespread each perception was. Further quantifications were avoided, as the semi-structured nature of the focus group interviews possibly would strongly influence how often a point was made (e.g. when a follow-up question was posed). Points made by a single participant were therefore reported and treated equally important as those made by “some” or “all”.

The questionnaire provided some quantifiable information used in the discussion and conclusion to describe the general tendencies.

Several themes of interest not directly associated with the narrow learning objectives were included in a separate analysis, as they provided valuable insights into escape rooms and debriefings in general; the protocol did not cover this. The study protocol was uploaded to clinicaltrials.gov on 05/03/2021 (ClinicalTrials ID: NCT04783259).

Focus group interviews and participants

Eight groups, with a total of 32 participants completed the study. Participants were in their late twenties and evenly distributed amongst gender (see Table  1 ). In the post-interview questionnaire, they reported prior experience, educational preferences and familiarity (see Table  2 ). Focus group interview duration had a median of 36 min and ranged from 23 to 43 min. After coding and analysing six focus group interviews, saturation was reached, as no new themes could be identified from the last two focus group interviews. This was confirmed by TJ and OR watching the remaining focus group interviews on video. The remaining two focus group interviews were neither transcribed nor analysed.

Themes related to narrow learning objectives

Five main themes were identified from the focus group interviews (Table  2 ).

Within the first theme, experience with narrow learning objectives , participants expressed that they did not feel restricted by the narrow learning objectives but experienced the possibility of discussing other topics important to them.

Topics discussed in the debriefing were mainly about exchange of information . Participants understood the term communication as broader than exchange of information . Participants also discussed leadership and situational awareness .

Learning mechanisms : The single and narrow focus was seen to increase the depth and perceived outcome of the debriefing. Participants explained that the debriefer helped maintain focus on the learning objectives and increased the perceived learning outcome by guiding participants in their reflection.

Perceived learning outcomes in relation to exchange of information that were identified included: Knowledge of different ways of communicating and the importance of optimising communication when working together; skills in ignoring redundant information; and change of attitude by becoming aware that others perceive a situation differently. A few participants reported no learning outcome due to being familiar with the learning objectives prior to the intervention.

Influence of the learning approach covered the parts of the whole learning experience besides the debriefing, focussing on how each of the different phases affected perceived learning of participants. Participants expressed that the video lecture contained little educational value but supported the rest of the approach by setting the scene. Regarding the scenario briefing, some participants wished for more emphasis on the learning objectives just before entering the room. Some participants explained that they got caught up in the game and did not focus on the learning objectives during the escape room. Finally, participants indicated that they liked the coherence of the experience in that each part supported the next and enabled deeper reflection.

Other findings

The focus group interviews provided points beyond discussing the narrow learning objectives (Appendix 6 ). Two main themes were identified. Meta-learning regarding the debriefing itself, where participants realised the usefulness of debriefings in an educational context. And the general experience of the escape room , where participants stated that the experience was relevant to clinical practice. Some participants also described how learning within an escape room differed from conventional communication training because the lack of formal pressure promoted more genuine communication that reflected real-life behaviour. Furthermore, the format was engaging and fun, and the low requirements on medical expertise were appreciated as they did not steal focus.

Post-interview questionnaire

The questionnaire results concerning the learning objectives and their perceived learning outcome are presented in Table  3 . It shows that all participants experienced learning about exchange of information and many about other topics as well. The vast majority liked the narrow focus of the learning objectives and would not have preferred a broader learning objective.

This qualitative study identified narrow learning objectives and structured debriefing to increase perceived learning depth and general outcome of medical escape room sessions. Using semi-structured debriefing allowed for discussions of other elements relevant to the students.

Narrow learning objectives were not restricting

Unstructured game-like learning exercises allows for many different learning objectives catering to participants’ interests but can result in superficial and erratic discussions with frequent changes in topics. To increase the learning outcome, there is a need for some structure. According to the questionnaire, most participants preferred a narrow learning objective though they did not have a comparable experience with a broad learning objective. During the focus group interviews, participants did not feel restricted by the narrow learning objectives and felt free to discuss other topics of their interest. This is a benefit of the semi-structured rather than fully-structured debriefing format and illustrates an educational duality: participants feel a need for autonomy but also for being paced by the educator to focus on the learning objectives and return to the topic when getting off-topic. The results suggest that many educators’ fear– that guiding the debriefing is seen as negative by participants [ 32 ]– might not have an empirical basis. However, the current setting took several steps to focus on the narrow learning objectives (video lecture, scenario briefing, and debriefing). Therefore, this focus was more stringent than is typical in simulation practice.

Structuring debriefings affect perceived learning outcomes

By making participants verbalise perceptions and experiences during the escape room and their perception of aspects of the experience related to the narrow learning objective, the educator increased the perceived learning outcome by increasing the depth of the debriefing. Though the research group defines this as facilitation techniques, the participants refer to it as structure . This complies with others’ findings that participants prefer structured debriefing sessions [ 23 , 24 , 25 ]. This study emphasises that such structure indeed can improve– at least the perceived– learning outcome.

Medical expertise in the escape room

Participants expressed it as an advantage that the level of ambition for medical expertise in the escape room puzzles was low. If there had been difficult medical challenges, these could have reduced learning related to exchange of information . This could be related to matching the amount of new information to avoid an overload, as described in cognitive load theory [ 33 ]. It can also be challenging, especially for novice facilitators, not to overwhelm learners, as they might do so to avoid risking the participants perceiving the learning session as boring [ 34 ]. This study can make it easier for educators to accept that less can be more: participants see the value of discussing fewer topics in more depth.

Exchange of information as a learning objective

The learning objectives were “Recognising the different ways of exchanging information” and “Discussing the impact of exchanging information on problem solving”. Participants were thoroughly introduced to the definition of exchanging information and reminded of the learning objectives throughout the learning experience, yet participants widely used the term communication during the focus group interview. When asked, participants explained that they perceived exchange of information as a more narrow and instrumental term than communication . Participants considered the reflections in the debriefing to concern both the instrumental factors, such as structuring a message and taking notes, and elements, such as non-verbal communication and the distribution of roles within the group.

This exemplifies a challenge in concept learning [ 35 ]: Educators need to balance conceptual sharpness and keep learners motivated about a new concept. The literature on learning (second) languages shows that it may lead to steeper learning and acceptance curves if skills are presented practically with a focus on implementation instead of insisting on conceptual sharpness in using terms [ 36 , 37 , 38 ]. However, this may increase the risk of misunderstanding concepts and terms. Focusing on definitions can be frustrating for many and may slow down learning.

Limitations

In participant recruitment, the research group may have created a selection bias by having voluntary admissions for the study, thus risking a sample of the general population with a specific interest in innovative and interactive education. This potential bias is of little concern since the aim concerned the learning objectives, not the innovative and interactive education style.

The study design increases the risk of a social-desirability bias. The researchers attempted to pre-empt this by explicitly informing the participants of the importance of enlightening both positive and negative aspects.

As a medical student at UPCH, TJ had met some of the participants before, but none of the interviewers had met the participants. Although it cannot be ruled out that familiarity between participants and TJ affected the debriefing, the data collected during the focus group interview session is without this bias.

Narrow learning objectives and structured debriefing can increase perceived learning depth of medical escape room sessions. Using semi-structured debriefing still allows for discussions of other elements relevant to the students.

The findings of this study encourage the use of narrow learning objectives and semi-structured debriefings in future conductions of medical escape room sessions. This will hopefully aid educators in choosing suitable learning objectives to optimise the overall learning outcome of medical escape rooms.

Data availability

Not applicable.

Abbreviations

Copenhagen Academy of Medical Education and Simulation

Medical Escape Room Gaming Experience

Non-technical skills

University of Copenhagen

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Acknowledgements

We thank CAMES for funding the expenses required to set up and run the escape room and the participants for their time and insights.

No external funding was received for the conduct of the study.

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Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark, Borgmester Ib Juuls Vej 1, 2730, Copenhagen, Denmark

Tami Jørgensen, Oscar Rosenkrantz, Kristine Elisabeth Eberhard, Theo Walther Jensen & Peter Dieckmann

Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark

Tami Jørgensen

Department of Anaesthesia, Center of Head and Orthopaedics, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark

Oscar Rosenkrantz

Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark

Kristine Elisabeth Eberhard

Prehospital Center, Region Zealand, Denmark

Theo Walther Jensen

Department of Public Health, University of Copenhagen, Copenhagen , Denmark

Peter Dieckmann

Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway

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Contributions

T.J. wrote the main manuscript and prepared Tables 1, 2, 3 and 4. All authors participated in conducting the intervention, analysing the data and reviewing the manuscript.

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Correspondence to Tami Jørgensen .

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A formal review was waived by the National Committee on Health Research Ethics (nr.: 21014792). Participants were informed about study procedures and publication plans and were informed that they could withdraw consent at any moment without consequences. They also gave written consent before participation. Thus, informed consent was obtained from all the participants in the study. All methods were performed in accordance with the relevant guidelines and regulations.

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Competing interests.

Dieckmann holds a professorship with the University of Stavanger, Norway, which was established by an unconditional grant to the university by the Laerdal Foundation and is today financed by the university itself. Dieckmann is part of the leadership of the EuSim group, a network of simulation educators and centres providing faculty development courses. We believe that these activities do not substantially impact the study presented here. The other authors report no conflicts of interest.

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Jørgensen, T., Rosenkrantz, O., Eberhard, K.E. et al. Perceptions of medical students on narrow learning objectives and structured debriefing in medical escape rooms: a qualitative study. BMC Med Educ 24 , 403 (2024). https://doi.org/10.1186/s12909-024-05295-4

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Received : 02 December 2022

Accepted : 11 March 2024

Published : 11 April 2024

DOI : https://doi.org/10.1186/s12909-024-05295-4

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