The Use of Escape Room Simulations in Undergraduate Medical Education  > The Society for Simulation in Healthcare

The Use of Escape Room Simulations in Undergraduate Medical Education 


Alexa R. Lauinger, BS1, Athena Ryals BS3, Mae Vogel, MS3, Shandra Jamison, MA1,3 Carlos E. Brown Jr, MD1,2

1 University of Illinois Urbana- Champaign, Carle Illinois College of Medicine, Urbana, Illinois

2 Carle Foundation Hospital, Emergency Department, Urbana, Illinois

3 University of Illinois Urbana-Champaign, Health Care Engineering Systems Center, Urbana, Illinois

Conflict of Interest Statement

The authors have no conflicts of interest to declare.

Corresponding Author

Shandra Jamison, MA, University of Illinois Urbana-Champaign, Carle Illinois College of Medicine, Urbana, Illinois


Brief Description

Undergraduate medical education is constantly growing and adapting to offer students diverse learning strategies while aiming to improve engagement from students and competency of medical skills. Two changes that have been implemented in recent years include the use of simulation and gamification of teaching experiences. Combining aspects of simulation with gamification has led to the use of escape rooms. Studies into the benefits of using escape rooms demonstrate improved student reactions and retention of content. However, there have been few studies looking at the effectiveness of escape room simulations in medical undergraduate education. Most of the research in this area uses nursing students as participants. This review examines the current evidence of outcomes for escape rooms in medical school and the overall format of designing and implementing escape rooms as a teaching strategy. However, there are limitations of small sample sizes, limited follow-up, and heterogeneous methods for implementing this type of simulation, but current research supports the integration of escape room-type sessions into medical schools. 


Medical education is an evolving and adapting field that works to incorporate modern teaching techniques and technologies. Traditional teaching strategies implemented a didactic-based approach for the first part of undergraduate medical education followed by clinical experiences (Pock, et al., 2013). Recently, there has been a shift to earlier clinical experiences, including simulated sessions to give students a safe context to facilitate learning (Herrera-Aliaga, 2022). The outcome of this change led to increased interest in the material, confidence in decision-making, and overall performance (Kimura et al., 2021; Everson et al., n.d.; McInerney et al., 2022). With the development of technology and the continued integration of simulated sessions into medical school, we would expect future simulations to improve these aspects of learning even further. Along with the push for more simulated experiences, gamification has infiltrated undergraduate medical training to allow for diverse educational opportunities with similar benefits to those we saw in simulation-based education (Krishnamurthy et al., 2022). Gamification and the advancement of technology both play a role in escape room simulations for medical education. 

Escape rooms are a type of interactive experience in which a team of players are locked inside a room and must work together to solve puzzles and accomplish tasks within a given timeframe to escape. Recently, escape rooms have been integrated into educational environments to improve student engagement (Backhouse & Malik, 2019; Kinio, 2019). The use of escape room simulations has also been implemented in professional settings to consolidate knowledge, improve interdisciplinary relationships, and evaluate competency (Zhang et al., 2019; Reinkemeyer et al., 2022). An escape room simulation can be a health-care-focused simulated interactive activity that incorporates traditional parts of an escape room into training (Anderson et al., 2021). Educational escape rooms have been adopted across different medical settings, such as nursing schools and medical graduate or residency programs. Healthcare programs using this method of education show improvement in retention, engagement, and teamwork through escape room simulations (Zhang et al., 2019; Reinkemeyer et al., 2022). However, there has been a lack of undergraduate medical programs or medical schools adopting this teaching strategy up to now. 

Although escape room simulations have shown promising results in several healthcare training programs, there is not a validated framework to adapt these teaching strategies to undergraduate education. A more thorough understanding of the key aspects and longitudinal outcomes of escape room simulations is needed before implementation into the current education system. This review aims to 1) describe the current format of escape room simulations, especially in the wake of the COVID-19 pandemic, 2) examine the types of skills which can be effectively taught in medical escape rooms, and 3) summarize the outcomes of studies that evaluate the inclusion of escape room simulations in undergraduate medical training programs. 


Three databases (PubMed, Web of Knowledge, and Scopus) were queried for publications relating to the implementation of escape room simulation in medical education with a focus on the undergraduate level. The search strategy for the databases used was: (Escape AND Room) AND (Medical AND School) OR (Residency) OR (Nursing AND school). The included papers were limited to full-text articles published in English. Abstracts, editorials, and reviews were excluded. The included papers were reviewed for skills utilized in the simulation, assessment types, and outcomes. Results are summarized in this literature review. 


Our literature search hit upon nine papers that focused on the outcomes and effectiveness of utilizing escape room simulations in medical undergraduate education (Table 1). Together these studies involved 568 medical students as participants, with most sessions catering to preclinical students.

Of the studies included, eight out of nine integrated a post-simulation assessment to gauge students' attitudes toward the escape room experience, conversely only one study conducted a pre-simulation survey. Additionally, two out of nine studies employed both pre- and post-simulation tests to evaluate participants of which one study assigned grades to the assessment while the other included a follow-up test two weeks after the session.

Published papers included a debriefing session to answer questions and discuss objectives with participants following the escape room activity. Only one study compared the escape room simulation with another type of learning session, specifically case-based learning. Notably, the escape room simulation was implemented across a diverse array of medical topics (Table 1).


Table 1: Publications that evaluate the use of escape room simulations in undergraduate medical education. 



Format of Escape Room Simulations 

Since the implementation of escape room simulations into medical education, there have been specific frameworks and key aspects that have been suggested as necessary for successful outcomes (Hawkins et al., 2020). There has also been an increase in the number of studies which outline the process of designing, testing, and implementing escape rooms into the curriculum (Dittman et al., 2022; Eukel & Morrell, 2021). The important facets to include when creating and implementing an escape room simulation are: 

· Objectives: define specific, measurable skills the simulation will teach participants 
· Design: determining the resources and time available for the simulation then develop appropriate puzzles and tests for the escape room 
· Piloting: testing the simulation, especially for the inability to skip clues 
· Prebrief: preparation by participants for the simulation 
· Debrief: discussion post-simulation to discuss questions and review objectives with participants 

The above aspects of the experience allow for an informal and low-pressure challenge for students (Hawkins et al., 2020). The use of these tactics can help standardize the development of simulations to ensure the effectiveness of escape room simulations and can improve the ability of programs to incorporate escape room models into their curriculum without increased obstacles from trial and error. 

Adaptation to Remote Simulations 

In the wake of the COVID-19 pandemic, there has been a push to convert some lessons into remote learning opportunities which includes simulated sessions. The study of escape room simulations in this context demonstrates the adaptability of strategies such as escape rooms that are encouraging Donovan et al. outlines the creation, implementation, and outcomes of a remote escape room using create-your-own-adventure software combined with online surveys and educational programs (Donovan, n.d.). Horn also used a combination of standalone, online programs to create and publish a remote escape room based on cardiac physiology (Horn, 2023). The use of remote platforms for the medical escape room demonstrates similar responses in engagement, enjoyment, and functionality as the in-person sessions (Grupel et al., 2022; Diaz et al., 2021). Results further support the use of escape room simulations since they are adaptable and can accommodate a variety of school curriculums and resources. The use of virtual escape rooms has shown the ability to be targeted towards developing nontraditional skills such as information searching and summarization (Diaz et al., 2021). This can add to the variety of skills that simulations have been used to build and solidify students’ education. 

Context of Teaching 

Apart from objectives, piloting, and briefing, it is also important to examine the learning content that is being targeted. Escape room simulations have been employed within medical residency programs, nursing schools, and pharmacy schools to not only teach procedures, dosage calculations, and conduct assessments, but also to foster the development of interpersonal skills and other such soft skills (Powers et al., 2022; Millsaps et al., 2022; Fusco et al., 2022; Rosenkrantz et al., 2019); studies focused on medical schools have targeted nontechnical skills, orientation to simulations, knowledge development, and assessments (Liu et al., 2020; Akatsu et al., 2022; Martin & Gibbs, 2022). Across the different objectives previously listed, there have been similar outcomes in the engagement and enjoyment of students throughout the experiences.

The broader context demonstrates the ability of escape rooms to teach soft skills, such as teamwork, communication, and leadership; the use of escape room simulations to solidify procedures suggests that similar experiences can be applied to medical schools to teach students technical practices (e.g., intubation and CPR). An unexpected application of simulation escape rooms is their use in the assessment of the aforementioned skills. Unlike traditional simulations, escape rooms vary in the puzzles used and the possible measurements which can be used to assess success. Consequently, the frameworks and objects of the simulation must be set well before implementing the assessment.  

Outcomes of Escape Room Simulations

As previously mentioned, escape room simulations have been used for several years across healthcare training programs. In comparison, there have been few studies on the impact of escape room simulations within undergraduate medical education. However, the studies found do support the use of escape room simulations to create a low-pressure setting to teach a variety of material, including nontechnical skills and competency (Akatsu et al., 2022; Rosenkrantz et al., 2019). Overall, the studies demonstrate improved student reactions, retention, and teamwork in the teaching sessions (Wu et al., 2018; Rosenkrantz et al., 2019; Podlog et al., 2019). Escape room simulations are an effective teaching method compared to case-based learning (Faysal et al., 2022). In each study, there were a variety of puzzles and challenges implemented to evaluate and practice different technical skills. Apart from the technical knowledge utilized in the simulation, each study noted a degree of development in communication and teamwork. Consistently, there was an increase in student engagement and enjoyment during the sessions (Wu et al., 2018; Rozenkrantz et al., 2019; Podlog et al., 2019). Overall, early studies examined the use of escape room simulations in undergraduate medical education and support the integration of these techniques into medical schools. 

The Future of Escape Rooms in Medical Education 

Escape room simulations have been successful for several years across a range of healthcare training programs, and early evidence of their integration into undergraduate medical education has shown encouraging results (Diaz et al., 2021; Cerenzio & Ocheretyaner, 2021; Khanna et al., 2012). The simulations have the potential to train students in an exciting, low-pressure environment that improves engagement, enjoyability, and consolidation of the material. In addition to being effective, simulations are also highly adaptable to a variety of skills, resources, and settings (Grupel et al., 2022). Drawing from the reported results, escape room simulations are likely to be integrated further into undergraduate medical education in the next several years. As escape room simulations become more standardized across schools, we will better understand the long-term impacts of the sessions and their ability to improve students' learning experiences. We will also see the adaptation of such methods to a wider variety of skills that are necessary for students to practice.  

Limitations of Current Research 

Limitations of current research in this field are the short length of studies that have been published. Only recently have escape rooms been used in medical schools. As a result, there is limited information on the long-term effects of these teaching methods. Most outcomes are measured using a post-simulation survey and lack a baseline or a follow-up assessment for retention. The current studies also include a limited number of participants. As demonstrated in Table 1, several of the studies mentioned a limitation being sample size due to enrollment and the difficulty of running the escape room (Backhouse & Malik, 2019; Kinio et al., 2019; Guckian et al., 2020; Liu et al. 2020). The small sample sizes of the studies reported on naturally lend themselves to higher potential errors in the data; it is more difficult or impossible to eliminate outliers. Further research is needed comparing the outcomes of escape room simulations to other forms of teaching with more objective outcome measures and a longer follow-up time. 


Undergraduate medical education is an ever-changing field that must utilize a range of teaching strategies to improve student engagement, confidence, and competency. The newest addition to teaching strategies is the simulated medical escape room which combines medical simulation and gamification into interactive, low-pressure sessions. Although these methods have been integrated into other healthcare training programs, there are limited studies of their effectiveness in medical schools. While early evidence indicates success with integrating the methods, escape room simulations should be explored further for long-term outcomes and improved sample sizes during the integration of these strategies into standard practice. 


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