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

Abstract

Background Gamification in medical education has gained popularity over the past several years. We describe a virtual escape box in emergency medicine clerkship didactics to teach chest pain and abdominal pain and compare this instructional method to a traditional flipped classroom format. Methods A virtual escape box was designed at our institution and incorporated into the mandatory two-week emergency medicine clerkship. The game consisted of a PDF with four cases containing puzzles to unlock a final clue. Likert scale surveys were administered to assess participants’ perceptions of the escape box format; of clerkship didactics as a whole; and of the clerkship overall. These responses were compared to the prior year’s evaluations on flipped classroom didactics and clerkship. Results One hundred thirty-four learners participated in the escape box and completed the survey. Eighty-six percent strongly agreed with feeling more engaged with the escape box, 84% strongly agreed with learning something new, 81% strongly agreed with finding the escape box to be satisfying, 78% strongly agreed with being able to apply knowledge gained, and 74% strongly agreed with wanting more escape boxes incorporated into medical education. The escape box showed a higher average score (3.6 ± 0.63) compared to chest pain (3.5 ± 0.67) and abdominal pain (3.2 ± 0.77) flipped classroom sessions (p = 0.0491) for the category of “lecturer explaining content clearly and at the proper level of complexity.” For the category of “lecturer provided effective instructional materials,” the escape box showed higher scores (3.6 ± 0.63) compared to flipped classroom for chest pain (3.4 ± 0.77) and abdominal pain (3.1 ± 0.80) (p < 0.001). Conclusions Escape boxes are adaptable to a virtual format and can teach abstract concepts such as teamwork and communication in addition to traditional lecture content. Ratings of didactics were higher for the escape box compared to the flipped classroom, while ratings of overall clerkship experience were not found to change significantly.

Game-based learning in medical education

“…Stud2yBuddy is a card-based board game with four categories that incorporates peer feedback and self-assessment and has the potential to offer the opportunity for improving students' content understanding (52). Moreover, gamification of learning can also shape students' satisfaction and increase their study motivation in teaching activities (53)(54)(55).…”

Design and evaluation of a remote synchronous gamified mathematics teaching activity that integrates multi-representational scaffolding and a mind tool for gamified learning

“…In Huber et al (2021), it was found that using gamification in emergency distance learning could enhance the interaction of distance learning, and Cantwell et al (2022) used gamification to design learning activities and found that gamification was a highly acceptable application in emergency distance learning. These two studies are among the very few studies that have examined the use of gamification in emergency distance learning, however, neither study has examined learning achievement, and both suggested that future studies should examine learning achievement.…”