Are Escape Rooms an Antidote for Anxiety in Simulation? An Experimental Randomized Study Comparing High-Fidelity Simulation to an Escape Room Format

Abstract

Introduction: Simulation-based education is well established in graduate medical education and augments medical knowledge acquisition. While a highly effective tool, some potentially negative impacts such as cognitive overload and anxiety have been described. The use of escape rooms to “gamify” simulation has been shown to be an enjoyable way to engage learners. However, it is unknown if the format causes a similar level of anxiety compared to scenario-based simulation. This study compares a traditional scenario-based simulation to an escape room format to demonstrate the effect on self-reported learner anxiety. Methods: A peer-reviewed pediatric emergency medicine simulation case was modified into an escape room simulation. Emergency medicine (EM) residents were consented and randomized into the scenario-based control group or escape room intervention group. The primary outcome was comparing self-reported anxiety levels of the residents pre- and post-simulation. The secondary outcome was the acquisition of medical knowledge, as measured by improvement on pre- and post-simulation medical knowledge quizzes. Descriptive data and differences of means by two-tailed t-test are reported. Results: Fifty-two EM residents participated, with 40 available for analysis. Post-simulation self-reported anxiety levels of participants in the scenario-based simulation group were slightly increased (50.71–52.38), whereas the levels for those in the escape room format were significantly decreased (52.05–31.10), p = 0.002. Both groups showed similar improvement on the post-simulation medical knowledge quiz (73%–80%, p = 0.016 and 71%–79%, p = 0.004, scenario-based and escape room, respectively), with no difference between the groups (p = 0.665). Conclusions: When comparing scenario-based simulation to an escape room format, medical knowledge acquisition was achieved equally, while anxiety levels were markedly lower in escape room participants. Escape room simulation shows promise in decreasing anxiety among the participants while teaching equal medical knowledge compared to traditional scenario-based simulation.