JMIR Publications

ABSTRACT

Background:

Early exposure to research methodology is essential in medical education, yet many students show limited motivation to engage with non-clinical content. Gamified strategies such as educational escape rooms (EERs) may help improve engagement, but few studies have explored their feasibility at scale or evaluated their impact beyond student satisfaction.

Objective:

To assess the feasibility, engagement, and perceived educational value of a large-scale escape room specifically designed to introduce third-year medical students to the principles of diagnostic test evaluation.

Methods:

We developed a low-cost immersive escape room based on a fictional diagnostic accuracy study, with six puzzles mapped to five predefined learning objectives: (1) identifying key components of a diagnostic study protocol, (2) selecting an appropriate gold-standard test, (3) defining a relevant study population, (4) building and interpreting a contingency table, and (5) critically appraising diagnostic metrics in context. The intervention was deployed to an entire class of third-year medical students across 12 sessions between March and April 2023. Each session included 60 minutes of gameplay and a 45-minute debriefing. Students completed pre-/post-intervention questionnaires assessing their knowledge of diagnostic test evaluation and perceptions of research training. Descriptive statistics and paired t-tests were used to evaluate score changes; univariate linear regressions assessed associations with demographics. Free-text comments were analyzed using Reinert’s hierarchical classification.

Results:

Among 530 participants, 490 completed the full evaluation. Many participants had limited prior exposure to escape rooms (206/490, 42% had never participated), and most reported low initial confidence with critical appraisal of scientific articles. All student teams completed the scenario, with a mean completion time of 53 (±4) minutes. Mean overall knowledge scores increased from 62/100 (±1) before to 82/100 (±2) after the activity (+32%, p<0.001). Gains were observed across all learning objectives and were not influenced by age, sex, or prior experience. Students rated the EER as highly entertaining (9.1±1.1/10) and educational (8.2±1.5/10). Following the intervention, 87% (393/452) felt more comfortable with critical appraisal of diagnostic test studies, and 79% (357/452) considered the escape room format highly appropriate for an introductory session. Thematic analysis of open-ended feedback identified six clusters, including engagement, teamwork, and perceived usefulness of the pedagogical approach. Word clouds showed a marked shift from negative to positive attitudes toward research training.

Conclusions:

This study demonstrates the feasibility and enthusiastic reception of a large-scale, reusable escape room aimed at teaching the fundamental principles of diagnostic test evaluation to undergraduate medical students. While not designed to cover the broader spectrum of research designs or methods, the intervention successfully addressed targeted objectives within a specific area of research appraisal. This approach may serve as a valuable entry point to engage students with evidence-based reasoning and pave the way for deeper exploration of medical research methodology.