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Interview with a Simulation Escape Room Expert

In recent years, simulation escape rooms as an educational modality have piqued the interest of many educators in healthcare. Educators and learners alike find escape rooms more engaging, interesting, and fun. More importantly, the use of game-based teaching strategies and a realistic “story” make the learning in an escape room stick.

We interviewed Janine Valko, MSN, BN, CEN, Simulation Education Manager, STAR Center at the Allegheny Health Network in Pittsburgh, Pennsylvania. She has years of experience planning, designing, and running simulation escape rooms in healthcare. We are grateful that she was willing to take the time to share her knowledge with us.

To read Janine’s responses, click each question below.

Escape rooms seem to be the newest trend in educational settings. Why do you think they are becoming so popular?

I attribute the popularity of escape rooms in the educational setting to the fact that today’s learners are different. Today’s learners grew up immersed with digital technologies. Educators must be able to solve important issues of adapting the learning process to students who have different learning styles and new requirements for learning. Educators must challenge students to be analytical and creative, engage students with technology and create opportunities for active learning.

The escape room methodology is an example of Game Based Learning (GBL) which is an educational approach that increases the motivation and engagement therefore meeting the needs of today’s learner.

The audio and visual elements of an escape room stay longer in the learners’ minds than with traditional learning environments. I refer to the simulated escape room as a connected learning experience. Each step of the escape room is connected to a puzzle that the learner can relate and associate to in the future.

One of the most important aspects that attributing to the popularity of escape rooms is simply that the escape room engages participants by making learning fun. When learning is fun, learning sticks.

By now, you’ve run multiple escape rooms in your organization’s simulation lab. What inspired you to create your first simulation escape room?

Our STAR team attended the 2018 IMSH Conference Escape Room in a Simulated Environment Session. Our team decided to create the our first escape room by using an innovative approach to teach one of the STAR Center’s most requested courses; Mock Codes.

We determined that in managing a mock code by protocol, the sequential steps would fit perfectly into the template of a linear escape room model.

How have your participants responded to their experiences in the escape room?

Overwhelmingly, we have had positive feedback with each facilitation of the escape room. Our learners truly appreciated this modality of teaching.

Our psychometrician, Dr. Laura Daniel designed a unique evaluation for our escape rooms. After her analysis was completed, at least 94% of 54 participants surveyed strongly agreed or agreed to 19 out of 20 evaluative statements.

Learners stated it helped them think critically and creatively, process and prioritize while using effective communication skills. The feedback on the evaluations consistently repeated adjectives such as ‘Fun’, ‘Innovative’ and ‘Engaging’. Learners stated that they did not realize that 30 minutes had passed and could see the value of the overall educational experience.

Who can benefit from participating in a simulation escape room?

Escape rooms encourage the skills of teamwork, problem solving, communication, critical thinking, interprofessional collaboration and attention to detail making the escape room methodology of teaching very attractive for clinical, academia and leadership settings.  

We have successfully facilitated escape rooms for nursing students, clinical staff and executive leaders of our organization.

Simulation labs provide the perfect setting for an escape room, but it’s just as feasible to run one without a formal simulation center. What is the value in creating a simulation escape room in an in situ environment?

The main value in creating an in situ escape room is the team building benefit the escape room promotes. Facilitating the escape room in situ would permit teams to naturally come together and attend the sessions engaging them to work together as they would in their own environment to problem solve and think critically, tapping into each other’s strengths to successfully achieve a goal.

There is quite a bit of planning that goes into creating a simulation escape room. What resources did you find most useful during the design stages?

Indeed, escape rooms will test your organizational skills as you use your imagination to create puzzles and tasks to escape a room. There are multiple design templates available online to utilize that will assist you in your design. Using one of these templates will guide you to have success in matching the puzzle with each step of the unfolding case leading to the next sequential task and eventually escaping the room.  

What types of puzzles would you say are the well-received by learners?

In my experience, the most well- received puzzles are those that are challenging, but do not cause too much of a distraction to achieve the learning objectives. The only way to verify this is to put your puzzles to the test!

Once you have designed each step of your escape room it is essential to beta test all of your puzzles with your internal team to examine their level of difficulty.

Admittedly, the most successful puzzles seem to be the ones with the most creativity. For example, we placed our first clue above the door on a banner. Learners are too engaged in looking for clues located around the room; they neglect to look up above the door behind them where the clue is overtly located.

You’ve previously stated that you would encourage others who are new to running a simulation escape room to beta test the room before bringing in learner participants. What are some important things to look for during a beta test?

The most important element to focus on during a beta test is the flow of the escape room. You want to let your design play out and take notes of barriers or stumbling blocks that may need to be revised. You want to be sure your escape room flows logically in sequence of the objectives you are teaching. You want to give the learners time to critically think, but you do not want obstacles that will impede the flow and their learning.

For example when we beta tested our escape room, we realized that operationalizing one of the locks was difficult for the learners. They were entering the correct combination on the lock, but the lock would not open. Therefore we changed the type of lock to allow for a better functionality of that specific step of the escape room.

In your experience, what impact has the simulation escape room had on learning outcomes?

The impact I have seen the simulation escape room has had on learning outcomes is giving students the opportunity to recall educational information in a new perspective. Learners connect each puzzle or task with a nugget of learning which is definitely part of the appeal and advantage of escape rooms.

Escape rooms make the answers less obvious, while keeping the process, policy or procedure clear.

 For example, if the rate of compressions in a mock code situation is the code for a lock, then instead of just giving them the number, create a riddle or puzzle with letters/numbers missing where the answer would be 100 or 120. They would have to problem solve to enter the correct number and combination of the lock.

Have any of your participants shared any stories in which they were able to transfer skills learned in the escape room to a patient’s bedside?

Yes, I have had participants from our nurse residency program state that the mock code escape room felt very much like the interprofessional collaboration that is needed to run a code on their unit.

They reported that the puzzles felt like the real tasks you need to complete timely in a code situation; such as prepare a vasopressor drip for a patient using the patient’s weight and pharmacological calculations. Nurses have also reported that this education helped them remember how to prioritize the care of a patient coding according to protocol.

It seems like there’s a lot of time and effort involved in pulling off a successful simulation escape room. Where is the value, or ROI, for an organization?

The value and ROI for organizations to successfully facilitate escape rooms are that participants will improve their core values such as teamwork, time management, critical thinking and problem-solving to name a few. This will in essence foster a better work culture, further unifying your team.

What are the most profound lessons that have come from your escape room debriefs?

The most profound lessons learned coming from my escape room debriefs would center on ensuring you have completed detailed briefing sessions; both prebriefing and debriefing. Learners need structure and guidance as they complete the activity. By properly prebriefing and debriefing your learners, you will likely have success meeting your learning objectives while making learning enjoyable. The amount and type of guidance should be factored in when designing your escape room experience.

Additionally, I learned that the participants truly appreciated the challenging puzzles and felt accomplished escaping the room and solving the case! It was a bonus that they were able to recite the correct steps of the protocol when we reflected on the steps they conquered to escape the room.  

Any final advice to those interested in running their own simulation escape room? Any pitfalls to avoid?

My advice for anyone interested in designing and facilitating and escape room would be to go for it!

The time spent creating, designing and building will be time well spent.  When you see your learning outcomes achieved and the learners truly enjoying their experience you’ll know it was well worth the effort.

The only pitfall I would avoid would be to design your escape room to be challenging but not too complex. You would not want your learner to be preoccupied by the complexity of the puzzles instead of learning the process, policy or procedure you are teaching. This of course would not hold true if you were building an escape room for the pure pleasure of a team building experience.

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Janine Valko, MSN, BN, CEN

Simulation Education Manager, STAR Center, Allegheny Health Network

Janine Valko has logged over thirty-five years of nursing experience with an emphasis in emergency nursing, leadership and education. Her combination of clinical education and experience provide a strong academic foundation to support her role as a Simulation Education Manager at the STAR (Simulation, Teaching, Academia and Research) Center serving Allegheny Health Network. Most recently, Janine has devoted much of her efforts integrating the escape room modality into the simulated environment as an innovative approach to learning.  In 2019, she presented the ‘STAR Center Escape Room Case Study’ at the IMSH Conference and presented an ‘Escape Room Mock Code’ with Laerdal at the Spring and Fall SUN Conferences. In January 2020, Janine will present ‘Build Your Own Escape Room of Errors’ at IMSH.