The Research Escape Hunt: An Escape Room-Scavenger Hunt for Resident Education

Background: Research and evidence-based medicine (EBM) education are important parts of residency training in Emergency Medicine (EM), however curricular time is limited and trainees are exposed to very large amounts of learning material in a short period of time. EM educators integrate novel strategies to engage learners and improve understanding and retention, including case-based strategies, flipped-classrooms, workshops, simulation, and traditional lecture-based methods. The escape-hunt, a hybrid escape room and scavenger hunt activity, presents an opportunity to integrate an active learning strategy that capitalizes on the benefits of improved engagement and collaborative learning in adults. Educational Objectives: We sought to develop, implement, and evaluate a novel research escape hunt educational experience to teach emergency medicine residents basic research and EBM skills. Goals included enhancing understanding of: test characteristics and predictive statistics (sensitivity, specificity, positive and negative predictive values); interpreting visual data displays (Kaplan-Meyer curves, receiver operating characteristic curves, forest plots); interpreting p-values and confidence intervals; qualitative and quantitative study designs; odds ratios, relative risk and prevalence estimates; power and sample size; the required elements of informed consent; and the Belmont Report ethical principles (beneficence, justice, respect for persons). Curricular Design: A nine-station escape room was developed around the educational content. Each station focused on one topic, for example, on understanding test characteristics. Stations required participants to use a variety of strategies (computation, multiple choice questions, crossword puzzles, blacklight activities) to solve a puzzle, with correct puzzle responses contributing to the station’s lock combination. Opening each station’s lock revealed the location of the team’s next station and provided the team with a station-completed ‘ticket’ and a small reward (chocolate). Teams worked together to solve each station’s puzzles, rotating through each station as the escape hunt progressed. Faculty were present to help guide teams through the stations and to re-set stations and locks with each successful completion. The first team to successfully complete all nine stations won the game. One week prior to the escape hunt event, participants were provided with preparatory educational materials including summary sheets and podcast links with instructions to review the material prior to the event. Following the event, learners participated in a debriefing, including a review of the rationale for all responses. Post-activity assessments were grounded in Kirkpatrick’s evaluation model and focused on participants’ reactions, learning, and behavior. Impact/Effectiveness: 21 EM resident physicians participated in the escape hunt event. Participants reported high levels of satisfaction and engagement with the activity, reported increased comfort with the research and EMB concepts covered, and demonstrated improvements in knowledge across each content area presented. In addition, participants reported that skills and strategies used during the escape hunt were similar to those used in clinical practice including working as a team, task switching, task delegation, brainstorming and solving complex problems together. Challenges included the time necessary to develop the escape hunt materials, costs associated with purchasing materials, limitations on the space required to optimize the event, and the number of faculty required to ensure flow game progression