Break out of the Classroom: The Use of Escape Rooms as an Alternative Teaching Strategy in Surgical Education

Gamification involves the application of game design elements to traditionally nongame contexts. It is increasingly being used as an adjunct to traditional teaching strategies in medical education to engage the millennial learner and enhance adult learning. The extant literature has focused on determining whether the implementation of gamification results in better learning outcomes, leading to a dearth of research examining its theoretical underpinnings within the medical education context. The authors define gamification, explore how gamification works within the medical education context using self-determination theory as an explanatory mechanism for enhanced engagement and motivation, and discuss common roadblocks and challenges to implementing gamification.Although previous gamification research has largely focused on determining whether implementation of gamification in medical education leads to better learning outcomes, the authors recommend that future research should explore how and under what conditions gamification is likely to be effective. Selective, purposeful gamification that aligns with learning goals has the potential to increase learner motivation and engagement and, ultimately, learning. In line with self-determination theory, game design elements can be used to enhance learners' feelings of relatedness, autonomy, and competence to foster learners' intrinsic motivation. Poorly applied game design elements, however, may undermine these basic psychological needs by the overjustification effect or through negative effects of competition. Educators must, therefore, clearly understand the benefits and pitfalls of gamification in curricular design, take a thoughtful approach when integrating game design elements, and consider the types of learners and overarching learning objectives.

The purpose of this study was to compare learning satisfaction and effectiveness using traditional lecture or educational game in teaching medical students about ectopic pregnancy. Third-year medical students were randomized to instruction about ectopic pregnancy through either standard lecture or educational Jeopardy style game. Students in each group completed a pretest, posttest, and satisfaction survey. Experts in ectopic pregnancy validated the pretest and posttest. The satisfaction survey was taken from published validated tests. Paired samples t test was used to compare pretest and posttest scores. Independent samples t tests were used to compare test scores and satisfaction responses between groups. Chi-square tested dichotomous satisfaction responses. All 104 students in both groups showed significant improvement in learning about ectopic pregnancy (P < .001) on pre- and posttest comparison, with scores being almost identical. Students in the group randomized to game format rated it higher in stimulating faculty/student interaction, helping retain information, and overall enjoyment than students participating in the lecture method (P < .001). In addition, students in the game group responded positively that the format was interactive, stimulated their interest, and kept them engaged in class content (P < .001). The innovative educational game format was as effective as standard lecture in educating students about ectopic pregnancy, while being more enjoyable and stimulating. Based on these conclusions, we hope to motivate other teachers in obstetrics and gynecology to use innovative teaching methods to provide a more enjoyable, stimulating, and active means of effective medical education.