Development of an integrated framework for designing virtual escape rooms in health sciences education

Abstract Background Virtual escape rooms (VERs) are emerging as an innovative, scenario-based approach in Health Sciences Education. However, their systematic design requires an integrated instructional framework that extends beyond their use as isolated gamified activities. This study aimed to identify the core dimensions and components of VERs and develop a coherent framework to guide their design in Health Sciences Education. Methods This sequential exploratory mixed-methods study was conducted in two phases. In the qualitative phase, semi-structured interviews were conducted with 25 experts in e-learning, educational technology, and Health Sciences Education using purposive and snowball sampling, and data were analyzed through conventional qualitative content analysis. In the second phase, the extracted components were structured by a panel of 10 experts using Interpretive Structural Modeling (ISM) and DEMATEL. The content validity and applicability of the framework were then evaluated by a separate group of 15 experts using a researcher-developed questionnaire. Results The final framework comprised four interrelated dimensions (pedagogical, learning experience design, technological, and contextual) encompassing 14 design components organized into four hierarchical levels. Interpersonal learning objectives, technical infrastructure, and contextual adaptation formed the foundational level of independent drivers. Individual learning objectives, scenario and puzzle design, group interactions, in-game feedback, motivational mechanisms, digital media, and user-interface design formed a mutually dependent core design cluster, followed by scalability and, at the most dependent level, assessment and feedback and the educational-game ecosystem. Data security and privacy had the highest net influence but no strong link to any single component, acting as a cross-cutting requirement. The independent expert panel rated the framework’s comprehensiveness and practical applicability favourably. Conclusions The findings suggest that VERs should be conceptualized as layered socio-technical instructional systems rather than merely gamified tools. The developed framework provides a theoretically informed and expert-derived structure for guiding the systematic design of VERs in Health Sciences Education. Further empirical implementation studies and external validations are required to examine feasibility, implementation processes, and learning outcomes of this framework in authentic educational settings.