Exploring the Views of Medical Students on Medical Escape Room Experiences With Narrow Learning Objectives and Structured Debriefings

Introduction

Background

Current medical students prefer innovative and interactive education styles such as gamification. Gamification concerns the act of applying game mechanics to a non-gaming environment, e.g. by putting themes of a clinical situation in the frames of a game. This concept is being increasingly frequently used in the education of healthcare professionals, and studies have shown that it appears to be effective to reach the learning outcome. In the study "Priming healthcare students on the importance of non-technical skills in healthcare: How to set up a medical escape room game experience" by Rosenkrantz et al. 2019, a medical escape room was designed to raise awareness about non-technical skills (NTS) among healthcare professionals. The escape room was named Medical Escape Room Gaming Experience (MERGE). As with other common escape rooms, MERGE was designed as a game like exercise with puzzles, which in this room were medical-themed. However, the primary focus is not the medical technical skills, and thus the puzzles are mainly logic-based with a medical twist. This is to keep focus on developing NTS.

Game-like exercises, like MERGE, tend to have a complexity that allows addressing many different learning goals, depending onto what the attention is guided by the educator. In the researchers' experience, often a broad learning goal is initiated by a rather general instruction to pay attention e.g. to the "non-technical skills" or to "communication". This enables many possible discussions, also taking the interest of participants into account. The downside can be that the discussion might be superficial and erratic, as conflicting interests in the group might lead to frequent changes in topics. Another approach is to specify some narrow learning objectives in more detail, e.g. "identify the different sources of information", directing the discussion on very specific aspects of the scenario. This entails that potentially a lot of interesting elements remain uncovered, and that participants might not get the chance to discuss what they think is most important for them. On the other hand, the discussion of the learning objectives can reach deeper reflection levels, as fewer topics need to be covered and as less time is used to coordinate what should be discussed.

Rosenkrantz et al. and several others have proposed that the participants of an escape rooms experiences may achieve a greater learning outcome if they are debriefed by a trained professional after participating in the escape room. The trained debriefer can also be a peer to the learners. Peer-to-peer feedback is suggested to have a positive effect on learning outcome. Debriefing can be defined as the act of reviewing critical actions that unfolded during the course of a simulation scenario, and in its form, it is conversational, bidirectional, interactive, and reflective. Debriefing is known to enhance the learning outcome by allowing for reflection on educational experiences. Several experiments with debriefing after medical escape rooms have been carried out in the last few years. However, only the studies by Friedrich et al. and the two studies by Zhang et al. had the aspect of debriefing as a point of focus. In these three studies, the participants answered different questionnaires, where some of the questions regarded the debriefing. All three studies concluded that the participants appreciated the post-escape room debriefing. In addition, the studies by Zhang et al. concluded that the participants would have preferred a more structured debriefing session to help them analyse aspects of communication and problem-solving. All of the aforementioned studies with post-escape room debriefing had broad learning objectives primarily concerning communication. No studies concerning medical escape rooms have evaluated the use of narrow learning objectives in a medical escape room.