The buzzer goes off. Three occupational therapy students are convinced they have worked out what should happen to their patient next. They are wrong.
Nobody is harmed, and no real patient is waiting. The escape room gives students a safe place to practise something healthcare professionals do every day: using their knowledge to make decisions when information is incomplete, situations change and the answer is not obvious. Getting it wrong and trying again is part of the learning.
Healthcare education has a challenge. Students can learn anatomy and physiology, theory and professional standards, but eventually they must use that knowledge with a real person. Real people rarely behave like case studies.
Healthcare can be fast-moving and pressured. Information changes, priorities compete and professionals may have to make decisions without everything they would like to know. The person at the centre may also have different priorities from those the professional expected.
Healthcare professionals therefore need more than knowledge. They need to apply it, adapt it and sometimes rethink it as a situation develops. The Health and Care Professions Council (HCPC) standards for occupational therapists, for example, require practitioners to use professional judgement, analyse information, solve problems and make reasoned decisions.
So how can students practise that before their decisions affect somebody for real?
I designed an escape room for occupational therapy students to explore that question. Working in teams of three, students receive simulated emergency department notes and must decide what matters, make connections and agree what to do next. When they think they have the answer, they press the buzzer.
It sounds like a game because it is one. But making education playful does not automatically make it educational. The escape room provides the activity. What students are required to think about and discuss is what gives it educational value.
Escape rooms are already used across healthcare education. A systematic review of 52 studies found them being used with students in medicine, nursing, pharmacy, dentistry and physiotherapy. Teamwork, experiential learning and discussion afterwards were important features, although evidence that escape rooms produce better learning than conventional teaching remained inconclusive.
In my escape room, the puzzles and buzzer create uncertainty, but students must talk to each other, explain their reasoning and sometimes change their minds.
Research into game-based approaches in healthcare education also suggests potential benefits. A systematic review of gamification found that some approaches improved students’ engagement with learning and sometimes their learning outcomes. However, many of the studies lacked strong comparison groups, so the authors called for more rigorous research.
The important question is therefore not simply whether an activity is enjoyable, but what the game asks students to learn.
When I designed the escape room, I did not start with the puzzles. I started with what the students already knew, what I wanted them to learn and what I wanted them to do with that knowledge. If I only wanted to test whether they could remember facts, I could put multiple-choice questions behind padlocks and call it an escape room.
Instead, uncertainty is built into the experience. Students are not immediately told which information matters. One person may notice something another has dismissed, so they have to listen to different interpretations and reach a decision together.
Sometimes they move forward. Sometimes the buzzer tells them their reasoning has taken them in the wrong direction. It introduces pressure without the consequences of making the wrong decision in real healthcare.
The discussion after the game
The learning does not finish when students escape. Afterwards, they discuss why they made particular decisions, what they overlooked and whether somebody else’s perspective changed their thinking.
That stage is important. A review of clinical reasoning games found that games could give healthcare students opportunities to consider a patient’s situation, gather information and decide what to do. But reflection was one of the parts of clinical reasoning least often incorporated into the games researchers examined.
The discussion afterwards therefore allows students to examine how they reached a decision rather than simply finding out whether it was right or wrong. Reflection is also part of the professional standards for occupational therapists, which require practitioners to reflect on and review their practice.
Learning through doing has particular relevance to occupational therapy. The profession is concerned with what people do and how occupation relates to ideas of doing, being, becoming and belonging. These concepts are used to understand people’s experiences of occupation and the place activities have in their lives.
There is therefore a useful parallel in asking students to learn through activity rather than only hearing or reading about practice.
This approach does not require virtual reality headsets or expensive simulation technology. My escape room uses simulated hospital notes, puzzles, a buzzer and a story, allowing it to be incorporated into an ordinary taught session. What changes is what students are asked to do with the information they are given.
An escape room cannot reproduce the pressure or complexity of making decisions about a real person. But it can let students experience uncertainty, make a mistake, reconsider their reasoning and try again.
Healthcare professionals will encounter situations no lecturer could write neatly into a case study. Preparing students for those moments means teaching them knowledge, but also giving them opportunities to practise what happens when the answer is not immediately clear.
Rhi Carter does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
