Digital escape rooms in medical education: Lessons learned from design and pilot implementation

Innovative learning methods in medical education are steadily growing in interest. Escape room is an educational and social learning setting in which participants, either individually or in small groups, engage in a themed or modular environment to solve a series of problems within a limited time frame. In this context, escape rooms have been used as an experiential, gamified learning approach intended to support developing learners’ critical thinking, problem-solving, decision-making, and collaboration skills. This study aims to share the design principles obtained from the pilot implementation results of digital escape rooms prepared for medical students. The study employed a qualitative design using video recordings, focus group interviews, and a think-aloud protocol, all of which were designed according to the ADDIE (Analyze, Design, Develop, Implement, and Evaluate) model. Pilot implementation was conducted in two rounds. Round 1 included 34 volunteer students (19 Year-IV and 15 Year-V) who completed the escape rooms individually, with screen and room video recordings and post-session semi-structured focus group interviews. Round 2 included four additional students (two Year-IV and two Year-V) who participated in a revised version of the escape rooms using think-aloud protocols. Thematic analysis was primarily based on focus interview data from Round 1, while video recordings and think-aloud data were used for triangulation and identification of design-related issues. Data were analyzed using inductive content analysis to identify recurring themes and inform improvements. Three key themes emerged: (1) Exciting: Students described the games as engaging and motivating, appreciating the opportunity to apply knowledge in a competitive, time-pressured setting; (2) Overwhelming: Some students experienced cognitive overload due to the complexity of the puzzles and the time constraints, which occasionally led to frustration; (3) Needs Improvement: Participants suggested clearer instructions, more accessible hints, and immediate feedback to enhance the learning experience. They also recommended integrating additional mystery elements and refining the scoring system for better clarity and transparency. Digital escape rooms show promise as effective tools for fostering engagement and motivation in medical education. However, balancing challenge with accessibility, incorporating user-friendly features, and offering targeted feedback are critical to optimizing their implementation. These findings provide a foundation for refining digital escape rooms and exploring their broader application in medical training.