Immersive learning in quality improvement: evaluating a virtual reality escape room for medical learners and faculty

Didactic approaches to quality improvement (QI) are often perceived as insufficiently engaging, which may limit learner motivation and application of QI concepts. We developed a virtual reality (VR) escape room to reinforce core QI principles and conducted a Phase 1 evaluation focused on feasibility, usability, and perceived educational utility among medical learners and faculty. We designed a 60-90-minute multi-puzzle VR escape room aligning with QI principles (terminology, SMART aims, root cause analysis, change ideas, Plan-Do-Study-Act cycles, run charts). Twenty-seven participants (undergraduate medical students, residents, faculty) formed teams of three to four. We collected post-session surveys (Likert, yes/no, free-text) and concurrent “think-aloud” observations during gameplay to characterize usability and perceived educational utility. Survey data were collected using a standardized questionnaire administered either electronically or verbally with items read verbatim and responses recorded without prompting. Free-test survey responses and think-aloud field notes were analyzed using a consistent inductive, theme-based approach, and closed-ended survey items were summarized descriptively. This evaluation was intended to inform iterative refinement of the intervention. Overall enjoyment was high (mean 3.9/5). Twenty-three of 27 participants (85%) reported that the VR escape room was perceived as helpful in reinforcing previously taught QI concepts. Analysis of survey free-text responses identified three themes: strengths of the experience (teamwork, engagement, collaborative problem solving), usability challenges (motion sickness, session length), and design preferences (variation in puzzle clarity and perceived linkage to QI concepts). Think-aloud findings similarly highlighted immersion, discussion, and collaboration as positive features, while hardware constraints and physical discomfort limited usability for some participants. Participant feedback informed iterative refinements related to puzzle design, facilitation, and technical setup. This Phase 1 pilot demonstrated that a VR escape room is a feasible and acceptable adjunct to existing QI teaching, providing learners with an immersive opportunity to apply previously introduced concepts. The main contribution of this study is feasibility and usability evidence, as well as implementation considerations (space, staffing, tolerability, and technical setup) to support educators considering immersive QI reinforcement activities. As objective knowledge outcomes were not assessed, future work will evaluate educational effectiveness using pre/post testing and comparative non-VR conditions following further refinement and curricular integration.