Exploring the Effects of Virtual and Physical Escape Rooms in Pharmacy Ethics and Legislation

OBJECTIVE: To develop and evaluate both physical and virtual educational escape rooms (VER) for teaching ethics and legislation in pharmacy and to assess their impact on knowledge and perceptions among third-year pharmacy students. METHODS: A quasi-experimental intervention study was conducted in which the physical and VER were designed around four stations based on various Acts and Regulations in Pharmacy. They were implemented during tutorial sessions across two cohorts of third-year pharmacy students, 2023/2024 and 2024/2025. Pre-and post-knowledge assessments on ethics and legislation were used to measure the effectiveness of the intervention. A 12-item questionnaire captured participants' perceptions, along with demographic data and prior escape room experience. Descriptive statistics summarized demographic data, while non-parametric statistics analyzed knowledge assessments and socio-demographic associations with participants' perceptions. RESULTS: One hundred and thirty-one students participated, with 38.9% attending a physical escape room. Both formats significantly improved participants' knowledge, with the virtual format showing greater gains and retention, reflected in 4% higher final examination performance, with average scores of 79.34 ± 5.94%. Participants reported that either format was effective for reviewing content, learning new information, and supporting understanding of legislation topics. No notable differences in perceptions were observed between the two formats. Gender-related differences in learning concentration under stress were noted, but prior experience with escape rooms did not affect perceptions. CONCLUSION: Educational escape rooms, whether physical or virtual, are effective tools for enhancing pharmacy students' knowledge of ethics and legislation and fostering positive learning perceptions. The virtual format may offer added benefits for knowledge retention.