Escape Room Training Puts Emergency Doctors to the Test in Critical Care

Emergency medicine residents spend years preparing for the moments when a patient’s life hangs by a thread, yet the traditional lecture hall has long been criticized for leaving them underprepared for the chaos of real resuscitation bays. Now a team at Tehran University of Medical Sciences has traded slideshows for locked doors and hidden clues, showing that a carefully engineered educational escape room can immerse doctors in critical care scenarios while earning strikingly high satisfaction scores from the very residents it was built to train.

The study, published in BMC Medical Education, set out to design, implement, and evaluate a theory-informed escape room focused specifically on critical care concepts for emergency medicine residents with more than six months of clinical experience. Unlike most prior research, which has concentrated on undergraduate learners, this pilot targeted postgraduate physicians in training, a group whose daily work already involves high-stakes decisions where hesitation can cost lives.

The engineering behind the intervention was anything but casual. A multidisciplinary team constructed the escape room through a structured, multistep process, weaving together clinical scenarios, puzzles, and the core competencies defined by the Accreditation Council for Graduate Medical Education. The final design comprised five scenario-based challenges spanning resuscitation, airway management, trauma management, anaphylaxis, and poisoning, each one forcing participants to translate textbook knowledge into rapid, coordinated action under time pressure.

Crucially, the experience did not end when the final lock clicked open. Every session was followed by a structured three-phase debriefing that moved from immediate reactions to detailed scenario analysis and finally to a summary of key lessons. This debriefing architecture, a cornerstone of simulation-based education, is where much of the durable learning is believed to occur, allowing participants to dissect their decisions, confront gaps, and consolidate insights while the adrenaline of the challenge is still fresh.

Before the full intervention, the team ran a pilot session with three residents, using it to stress-test the puzzles, timing, and clinical fidelity of the room. Feedback from that pilot drove refinements to the design, and the final version was then completed by six residents. In total, nine of 24 eligible residents, or 37.5 percent, volunteered to take part, a small but committed sample that reflects the practical realities of recruiting busy physicians for experimental educational formats.

The results from the final group were remarkable for a pilot. Overall satisfaction with the escape room experience reached a mean score of 4.35 out of 5, with a standard deviation of 0.41. The debriefing session itself scored 4.42, the quality of the escape room 4.23, and the alignment with learners’ needs 4.5, suggesting that the design had struck a rare balance between entertainment and educational relevance.

Perceived learning was rated just as favorably, with a mean score of 4.30 and a standard deviation of 0.53 among the final intervention group. For a format often dismissed as a gimmick, these numbers indicate that residents felt the experience genuinely advanced their grasp of critical care concepts, from airway algorithms to toxicological emergencies, rather than simply providing an amusing hour away from the wards.

The technical significance of this work lies in its deliberate grounding in educational theory. Rather than assembling puzzles for their own sake, the designers mapped every challenge onto specific ACGME competencies, ensuring that each locked box and cipher pushed residents toward measurable clinical skills. This theory-informed approach distinguishes the intervention from commercial escape rooms retrofitted for education and offers a reproducible template that other institutions could adapt for their own training programs.

Escape rooms belong to a broader family of gamified, active learning strategies that have gained momentum across medical education in recent years. Their appeal is rooted in experiential learning theory, which holds that knowledge is consolidated most effectively when learners act, reflect, and receive feedback in cycles rather than passively absorbing content. The time pressure and collaborative problem-solving inherent to escape rooms mirror the cognitive demands of real emergency care, where teams must communicate clearly and act decisively despite incomplete information.

The authors caution that this was a pilot evaluation in a small volunteer sample, so the findings speak to feasibility and acceptability rather than to definitive evidence of improved clinical outcomes. Still, the successful implementation following pilot testing and refinements demonstrates that such programs can be built and run within a medical skills laboratory without external funding. As emergency departments worldwide grapple with how to prepare residents for the unforgiving tempo of critical care, this study suggests that the future of medical training may look less like a lecture and more like a race against the clock, with lives, clues, and learning all hanging in the balance.

Beyond the headline satisfaction figures, the study offers a window into the practical mechanics of building simulation-based education from the ground up. The decision to house the escape room within a medical Skills Laboratory is significant, because such laboratories are typically reserved for procedural training on manikins and task trainers. Repurposing this infrastructure for a gamified format demonstrates that institutions need not invest in elaborate standalone facilities to deliver immersive learning; existing space, equipment, and faculty expertise can be recombined in novel ways to produce an experience residents rated highly for alignment with their educational needs.

The multidisciplinary composition of the design team deserves particular attention. Educational escape rooms that fail clinically often do so because puzzle designers lack medical insight, or because clinicians lack game design literacy. By bringing together contributors with complementary expertise, the Tehran team was able to embed authentic clinical decision points into the puzzle architecture itself, so that solving a challenge required applying resuscitation knowledge or toxicology principles rather than merely deciphering arbitrary codes. This fusion of content validity and engaging mechanics is widely regarded as the central design challenge in gamified medical education, and the structured multistep development process described here provides one documented pathway through it.

The five clinical domains chosen for the scenarios were not arbitrary. Resuscitation, airway management, trauma, anaphylaxis, and poisoning represent time-critical presentations in which delays or errors carry immediate consequences, and each maps naturally onto competencies that emergency medicine training programs are expected to certify. Anchoring the scenarios to these accreditation frameworks also creates a bridge between an unconventional teaching format and the formal assessment structures of graduate medical education, which may ease adoption by program directors who must justify curricular innovations to oversight bodies.

The three-phase debriefing structure employed after each session reflects a well-established convention in simulation pedagogy. Beginning with reactions allows participants to discharge the emotional residue of a stressful experience before analytical work begins, a step considered essential for maintaining psychological safety. Moving next to scenario analysis invites learners to examine what happened and why, surfacing knowledge gaps and decision errors in a non-punitive setting. The concluding summary phase consolidates the takeaways into transferable principles. The fact that debriefing received the highest component score in the satisfaction data, at 4.42 out of 5, is consistent with a growing body of literature identifying debriefing quality as the single strongest determinant of learning outcomes in simulation-based education.

Several methodological features of the study merit careful interpretation. The evaluation relied on participants’ self-reported perceptions rather than objective measures of knowledge acquisition or clinical performance, which is appropriate for a feasibility study but leaves open the question of whether perceived learning translates into durable competence. The volunteer sample introduces a further caveat, since residents who choose to join a game-based intervention may be systematically more enthusiastic about active learning than their peers, potentially inflating satisfaction scores relative to what a mandatory cohort might report. The participation rate of 37.5 percent among eligible residents, while modest, is not unusual for studies requiring busy physicians to commit time outside clinical duties, and the authors’ transparency about these limitations strengthens the report’s credibility.

The pilot-then-refine sequence also illustrates a principle of iterative design that is often neglected in educational innovation. The three-resident pilot functioned as a formative evaluation, exposing weaknesses in pacing, puzzle difficulty, or clinical realism before the final intervention. This mirrors quality improvement methodology in clinical care and suggests that institutions attempting similar projects should budget time and personnel for at least one full dress rehearsal before formal implementation.

The study’s context in Iran adds to its significance for the global medical education community. Much of the published escape room literature originates from North American and European institutions with generous simulation budgets, so evidence that a well-received, theory-informed escape room can be developed without external funding broadens the plausible reach of this format to resource-constrained settings. The open access publication under a Creative Commons licence further lowers barriers, allowing educators anywhere to examine the design process and supplementary materials in detail.

Looking forward, the natural next steps for this line of research are clear. Larger and more diverse samples, controlled comparisons against conventional teaching, and objective outcome measures such as retention testing or performance in subsequent simulations would establish whether the enthusiasm documented here corresponds to measurable educational benefit. Long-term follow-up could reveal whether escape room learning persists and transfers to real clinical encounters. Until such studies arrive, this pilot stands as a careful, honest demonstration that rigorous instructional design, rather than novelty alone, is what makes gamified learning credible, and that the tools of serious educational science can be applied even to an activity that looks, from the outside, like a game.

Subject of Research: Design, implementation, and evaluation of an educational escape room for critical care learning among emergency medicine residents

Article Title: Design, implementation, and evaluation of an educational escape room for critical care learning among emergency medicine residents

Article References: Atousa, A., Parisa, S., Hamideh, A., Mohammad, E., & Mohammad, J. (2026). Design, implementation, and evaluation of an educational escape room for critical care learning among emergency medicine residents. BMC Medical Education. https://doi.org/10.1186/s12909-026-10605-z

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10605-z

Keywords: Design, implementation, evaluation, educational, escape, room, critical, care, learning, emergency, medicine, residents