Title : Escape the operating room: A gamified experience for surgical decision-making
Abstract:
Introduction: Escape rooms are an innovative and increasingly utilized tool in medical education, offering a dynamic and interactive alternative to traditional didactic teaching. By embedding critical thinking, decision-making under pressure, and teamwork into a time-bound, story-driven challenge, escape rooms simulate the high-stakes environment of clinical practice. This study explores the use of a surgically themed educational escape room to enhance medical student engagement, consolidate learning, and evaluate preparedness for clinical placements. It investigates whether this format can serve both as a formative learning experience and as a potential tool for assessment.
Methods: A surgical escape room was developed and piloted at St Peter’s Hospital for penultimate-year medical students from St George’s University. Learning objectives were explicitly aligned with the GMC outcomes and mapped to the surgical undergraduate curriculum. The game’s challenges were rooted in real-life scenarios frequently encountered during placements and incorporated core clinical skills previously taught during the students’ five-week placement.
The escape room comprised a sequence of interlinked tasks embedded within a narrative arc. Activities included: structured A-E assessment with Sepsis 6 initiation, differential diagnosis-matching using a Jenga-style puzzle, surgical incision recognition, suturing techniques, CT interpretation, nasogastric tube insertion, and SBAR handover simulation. A pilot run was conducted by the Simulation Lead and Clinical Teaching Fellow (CTF) to optimize delivery. In April 2025, nine sessions were conducted and video recorded for ethnographic analysis. Informed consent was obtained from all participants. Following the session, participants completed structured Likert-scale questionnaires and open-ended feedback forms. Thematic analysis was applied to qualitative responses and observational data.
Results: All 26 participants were penultimate-year medical students, most of whom had no prior exposure to gamified learning in medical education. Quantitative data demonstrated universally positive feedback, with Likert scale scores ranging from 4.4 to 5.0 across all domains. Participants strongly agreed that the escape room improved their clinical reasoning, communication, and teamwork. Thematic analysis revealed high engagement, appreciation of the realism and challenge, and recognition of the activity’s educational value. Students particularly valued the integration of clinical content with decision-making under pressure. No negative feedback was recorded, and several participants recommended extending the duration of the session.
Discussion: Educational escape rooms represent a promising pedagogical approach in undergraduate surgical education. Their immersive and interactive nature promotes deep engagement, contextual learning, and reinforcement of essential non-technical skills. This study supports the inclusion of escape-room-based simulations as a complementary tool to traditional clinical teaching, with potential applications in both formative assessment and curriculum delivery to better prepare students for real-world surgical practice.
