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Trapped as a Group, Escape as a Team: Applying Gamification to Incorporate Team-building Skills Through an ‘Escape Room’ Experience

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Abstract

Teamwork, a skill critical for quality patient care, is recognized as a core competency by the Accreditation Council for Graduate Medical Education (ACGME). To date, there is no consensus on how to effectively teach these skills in a forum that engages learners, immerses members in life-like activities, and builds both trust and rapport. Recreational 'Escape Rooms' have gained popularity in creating a life-like environment that rewards players for working together, solving puzzles, and completing successions of mind-bending tasks in order to effectively 'escape the room' in the time allotted. In this regard, escape rooms share many parallels with the multitasking and teamwork that is essential for a successful emergency department (ED) shift. A pilot group of nine emergency medicine (EM) residents and one senior EM faculty member underwent a commercial escape room as part of a team-building exercise in January 2018. The escape room required participants to practice teamwork, communication, task delegation, and critical thinking to tackle waves of increasingly complex puzzles, ranging from hidden objects, physical object assembly (i.e., jigsaw puzzles), and symbol matching. Activities required members to recognize and utilize the collective experiences, skills, knowledge base, and physical abilities of the group. After the game, players underwent a structured 'game-master' debriefing facilitated by an employee of the commercial escape room; this was followed by a post-event survey facilitated by a faculty member, which focused on participants' feelings, experiences, and problem-solving techniques. Escape rooms afford learners the opportunity to engage in an activity that rewards teamwork and effective leadership through experiences that directly link to specific ACGME milestones and educational learning theories. EM participants were engaged in the activity and felt that the escape room reproduced an environment analogous to the ED. The debriefing that followed the activity provided a satisfactory conclusion to the experience; but learners preferred a more organized debriefing format that provided them with constructive and specific feedback on their performance.
Received 02/10/2018
Review began 02/12/2018
Review ended 02/24/2018
Published 03/02/2018
© Copyright 2018
Zhang et al. This is an open access
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Trapped as a Group, Escape as a Team:
Applying Gamification to Incorporate
Team-building Skills Through an ‘Escape
Room’ Experience
Xiao Chi Zhang , Hyunjoo Lee , Carlos Rodriguez , Joshua Rudner , Teresa M. Chan ,
Dimitrios Papanagnou
1. Emergency Department, Thomas Jefferson University Hospitals 2. Department of Emergency Medicine,
Thomas Jefferson University 3. Faculty of Health Sciences, Department of Medicine, Division of
Emergency Medicine, McMaster University
Corresponding author: Xiao Chi Zhang, xzhang09@gmail.com
Disclosures can be found in Additional Information at the end of the article
Abstract
Teamwork, a skill critical for quality patient care, is recognized as a core competency by the
Accreditation Council for Graduate Medical Education (ACGME). To date, there is no consensus
on how to effectively teach these skills in a forum that engages learners, immerses members in
life-like activities, and builds both trust and rapport. Recreational ‘Escape Rooms’ have gained
popularity in creating a life-like environment that rewards players for working together, solving
puzzles, and completing successions of mind-bending tasks in order to effectively ‘escape the
room’ in the time allotted. In this regard, escape rooms share many parallels with the
multitasking and teamwork that is essential for a successful emergency department (ED) shift.
A pilot group of nine emergency medicine (EM) residents and one senior EM faculty member
underwent a commercial escape room as part of a team-building exercise in January 2018. The
escape room required participants to practice teamwork, communication, task delegation, and
critical thinking to tackle waves of increasingly complex puzzles, ranging from hidden objects,
physical object assembly (i.e., jigsaw puzzles), and symbol matching. Activities required
members to recognize and utilize the collective experiences, skills, knowledge base, and
physical abilities of the group. After the game, players underwent a structured ‘game-master’
debriefing facilitated by an employee of the commercial escape room; this was followed by a
post-event survey facilitated by a faculty member, which focused on participants’ feelings,
experiences, and problem-solving techniques.
Escape rooms afford learners the opportunity to engage in an activity that rewards teamwork
and effective leadership through experiences that directly link to specific ACGME milestones
and educational learning theories. EM participants were engaged in the activity and felt that
the escape room reproduced an environment analogous to the ED. The debriefing that followed
the activity provided a satisfactory conclusion to the experience; but learners preferred a more
organized debriefing format that provided them with constructive and specific feedback on
their performance.
Categories: Emergency Medicine, Medical Education, Medical Simulation
Keywords: medical education, teamwork, communication, escape room, graduate medical education,
faculty development, simulation
1 2 2 2 3
2
Open Access Technical
Report DOI: 10.7759/cureus.2256
How to cite this article
Zhang X, Lee H, Rodriguez C, et al. (March 02, 2018) Trapped as a Group, Escape as a Team: Applying
Gamification to Incorporate Team-building Skills Through an ‘Escape Room’ Experience. Cureus 10(3):
e2256. DOI 10.7759/cureus.2256
Introduction
Teamwork is arguably one of the most difficult skills to teach learners in the health professions,
especially in chaotic and unpredictable environments, such as the emergency department (ED).
Team members must overcome varied levels of training and expertise, conflicting personalities,
and diverse skill sets to effectively function as a unit. Studies continue to demonstrate that
effective teamwork and collaboration, particularly in high-stakes, high-acuity environments,
have the ability to decrease mortality and cost [1, 2]. Trust has also been cited as a critical
teamwork element in the military literature, in which a team with an established level of trust
can effectively communicate and function with surgical precision [3].
Training opportunities in teamwork must be safe, low-stakes, high-impact, and dynamically-
engaging if they are to nurture the development of collaborative behaviors. Although teamwork
remains a core competency by the Accreditation Council for Graduate Medical Education
(ACGME), there is no consensus as to how to effectively teach this skill. Effective team training
demands receptive and engaged learners, immersive learning activities and experiences, and
participant trust and rapport.
Committed to creating a fun and interactive team training activity, the investigators turned to
the growingly popular ‘Escape Room’ as a medium to immerse learners in an environment
similar to the ED. Escape Rooms are live-action, team-based games where players must work
together, solve clues, and complete a series of mind-bending, fitness-challenging tasks in order
to ‘escape the room’ in under 60 minutes [Nicholson S. (2015). Peeking behind the locked door:
a survey of escape room facilities. White paper available at
http://scottnicholson.com/pubs/erfacwhite.pdf]. Players (or learners) must learn how to quickly
acclimate themselves in a foreign environment with other players (possibly strangers) of
various skill sets, establish trust, and communicate specific goals and tasks in order to assess
the environment, analyze clues, solve complicated problems, reassess the environment, and
set-up additional goals and dispositions. To a certain extent, this experience is analogous to
caring for real patients in an ED setting. While several effective team-building exercises are
described in the healthcare literature [4-7], there is currently no mention of the use of
commercial escape rooms as opportunities for team training for ED providers.
In this technical report, the investigators describe the use of an escape room as a pilot team-
building exercise for providers working in the ED of Thomas Jefferson University Hospital in
Philadelphia, Pennsylvania. The investigators contracted with a local escape room agency to
allow 10 participants from the ED to participate in a one-hour escape room session, followed by
a post-event debriefing.
Technical Report
Study settings
The commercial escape room agency was selected based on convenience of location, given its
proximity to the hospital (less than 1 mile). The average rate of successful ‘escapes’ at this
location is measured by the agency to be 20%. Four unique escape room formats are available at
this particular location, each with a unique theme and unique set of puzzles and challenges.
Each escape room also contains multiple sub-rooms to sequentially escape from as the activity
unfolds.
At the end of the game, players underwent a structured, escape-room debriefing, in which the
escape room ‘game-master’ described the puzzles and respective solutions; this allowed players
to recount their experiences and problem-solving techniques. The observer (XCZ) did not
provide any post-game feedback, nor did he participate in the debriefing.
2018 Zhang et al. Cureus 10(3): e2256. DOI 10.7759/cureus.2256 2 of 9
Study participant selection
Participants were selected on a first-come, first-serve basis, after a flyer that advertised the
activity was electronically mailed to ED residents and faculty. The activity was advertised three
weeks in advance. The investigation was reviewed and approved by the Institutional Review
Board of Thomas Jefferson University.
Materials required
Participants were not required to bring any additional tools or materials to the escape room.
Group structure
Ten participants were assigned to a single group without any predetermined roles or task
designations. Their only assigned group goal was to effectively escape the room within 60
minutes. One of the study investigators (XCZ) also entered the escape room to observe team
behaviors and record team interactions; he did not participate in the activity, and participants
were asked to ignore his presence.
Detailed activity description
To escape the room, participants must practice teamwork, communication, task-delegation,
critical thinking, and divergent thinking to tackle a series of increasingly complex puzzles,
ranging from hidden objects, physical object assembly (i.e., jigsaw puzzles), counting, and/or
symbol matching. Throughout the activity, the game master watches the participants’ progress
through several cameras that are physically mounted throughout the room. Players may receive
sporadic visual hints, displayed on a television monitor in the room, which are provided by the
game master if participants either fail to progress in solving clues or if participants wish to
directly receive a clue.
Specific puzzle information and details surrounding the escape room were unknown to the
authors and the participants prior to reserving the escape room, as this information is
considered proprietary knowledge to the escape room agency.
Activity evaluation
The investigators used a validated, post-study survey evaluation adapted from a post-focus
group interview guide in order to obtain written feedback about the escape room activity [8].
The referenced survey was developed and successfully used at McMaster University for
postgraduate EM resident physicians to assess a modular assessment program. The escape room
questionnaire consists of 18 questions, which are included in Appendix A. Responses from the
questionnaire were evaluated via an open-axial qualitative assessment by XCZ, HL, and CR.
Results
Ten total participants (eight second-year EM residents, one third-year EM resident, and one EM
faculty member) participated in this activity. There were approximately 10 to 12 unique puzzles
with topics ranging from, but not limited to, recognizing hidden objects, symbol substitutions,
mathematical challenges, searching for objects in images, rearranging objects based on visual
aids, light manipulation, assembly of a physical object, riddles, and pattern identification. The
team received only three hints throughout the activity (average per agency, 10-15) and escaped
the room in 46 minutes (average success rate per agency, 20%).
A post-activity survey analysis (n=10) revealed that eight out of 10 participants had previously
participated in escape room activities. Everyone, however, had previously participated in a
2018 Zhang et al. Cureus 10(3): e2256. DOI 10.7759/cureus.2256 3 of 9
team-building activity, with ‘sports’ being the most common activity (nine out of 10
participants). All participants reported similarities between the escape room and the ED, with
common themes focusing on chaos, communication, strategic thinking, differential diagnoses,
teamwork, uncertainty, task delegation, and time constraints. Participants also contrasted the
escape room to the ED, highlighting that the escape room felt more linear, clue-based, and low
stakes (Table 1).
Survey Questions Common Themes
Q4 - Please recall the interaction you had with your colleagues
in the game. Were they similar to tasks you perform in the ED?
Task Switching; Task Delegation; Data
Compilation; Plan Development; Task
Specification; Disposition Planning
Q5 - Please recall the interaction you had with your colleagues
in the game. Were they similar to the interactions you have
had with your applications in the ED?
Polite; Taking Turns; Independent Data Collection;
Collective Brainstorming and Data Sharing
Q6 - Please recall the debriefing conducted by the game
master at the conclusion of the game. Was this similar to the
debriefing at the end of your shift?
Different than Healthcare Debriefing; Inadequate
Debriefing; Different Debriefing Style
Q10 - What are some immediate lessons you learned by
working with your peers in the Escape Room?
Contribution of Unique Skills; Appreciation of
Skill Development Outside the Workplace; Organic
Practice of Leadership Skills
Q17 - If you were to redesign this team-building activity, what
would you want to include to make it a more effective activity
that focuses on team work and communication?
Fewer Sequential Puzzles; More Concurrent
Puzzles; Diversifying Participants; More
Comprehensive Debriefing with Constructive
Feedback
TABLE 1: Selected Participant Survey Responses Following the Escape Room
ED = Emergency Department
Nine out of 10 participants endorsed similarities in the social and interpersonal interactions
that take place in both the game and the ED; these include co-managing stressful situations,
settling differences in opinion, and providing periodic status updates. While all of the
participants appreciated the post-escape room debriefing, half of the participants would have
preferred a more structured debriefing, similar to a debriefing following a simulation, which
typically includes formative feedback based on observed behaviors. Nine participants reported
that the escape room experience motivated them to learn more about teamwork, specifically
how to overcome barriers to teamwork, how to manage conflicting personalities (i.e. introverts
vs. extroverts), how to multitask, and how to resolve personal differences. All participants rated
the escape room as an effective, fun, teambuilding activity, and even recommended including
additional puzzles and additional personnel of varied professions (i.e., nurses, technicians) and
varied levels of training for heightened realism.
Discussion
The authors propose that commercial escape rooms can be utilized as effective team building
activities by immersing participants in interactive, unpredictable, and chaotic environments
2018 Zhang et al. Cureus 10(3): e2256. DOI 10.7759/cureus.2256 4 of 9
that can encourage team members to exercise their unique skill sets to seek out and solve
different challenges. Escape rooms share several similarities to the clinical environment, which
make them successful learning adjuncts for members of clinical teams.
Open-axial qualitative assessment of the survey responses revealed common themes in clinical
(i.e., ED) and escape-room interactions, such as task switching, role delegation, and working
together towards a common goal. Additional common themes included a preference for fewer
sequential puzzles (versus simultaneous challenges that occur in parallel) to more closely align
with the multiple demands that are expected when working in an ED. Participants would have
also preferred a more organized and constructive debriefing.
The educational philosophy of this activity is rooted in behaviorism, social learning, and
cognitivist and constructivist learning theories. In behaviorism, ‘positive’ behavior is
reinforced by providing progression through the escape room process, whereas ‘negative’
behavior either does not help the players (i.e. learners) escape the room or even negatively
impacts their ability to escape (Table 2). There is a large aspect of social learning in this
activity, as learners imitate or perpetuate behaviors of successful puzzle solving. Learners can
also assimilate their previous knowledge and skills (i.e. pattern recognition, mathematical
fluency, trivia knowledge) to help them process environmental clues. The latter is akin to the
cognitivist approach to learning.
Aspects of constructivism are also embedded in this activity: learners construct their own
knowledge based on real-time experiences of advancing through several challenges in the
escape room. In accordance with the ACGME EM Milestones, escape rooms also afford the
learners the opportunity to practice several milestones: Patient Care (PC8 – Task Switching)
and Interpersonal Communication Skills (ICS1 – Interpersonal and Communication Skills and
ICS2 – Leading Patient-Centered Care Teams) (Table 2). In order to escape the room, each
player must demonstrate the ability to switch tasks between assimilating clues, solving puzzles,
and reassessing the environment under high-stress situations using flexible communication
strategies. Participants must coordinate their efforts to solve complicated puzzles and
recommend changes in their team to establish optimal efficiency (i.e. redistributing the team
members from focusing on one puzzle to searching for additional clues). These challenges
could not be more similar to a busy Monday shift in the ED.
2018 Zhang et al. Cureus 10(3): e2256. DOI 10.7759/cureus.2256 5 of 9
ACGME
Milestone Escape Room Activity Relevant Educational Learning
Theories
PC8: Task
Switching
Level 1: Solves a single puzzle amidst a chaotic
environment; Level 2: Pays attention to discovered clues while
completing a task; Level 3: Actively communicates with team
members to share new hints or solutions; Level 4: Actively
reassesses environment to assign new tasks after a stage is
completed
Constructivist: Players use
previous puzzle-solving
knowledge to help process
clues. Cognitivist: Players
acquire new knowledge based
on real-time puzzle solving
ICS1:
Interpersonal
and
Communication
Skills
Level 1: Establishes rapport with fellow players; Level 2:
Negotiates and manages simple conflicts during the game;
Level 3: Effectively communicates with struggling players to
minimize stress when engaged in a complex puzzle; Level 4:
Uses flexible communication strategies to assign appropriate
tasks to assist with puzzle-solving
Social Learning: Players
imitate puzzle-solving
behaviors with
success. Behaviorism: Positive
behavior is reinforced by
progression in the escape
room
ICS2: Leading
Patient-
Centered Care
Teams
Level 1: Participate as an individual player; Level 2:
Communicates pertinent clues and/or solutions to the team
leader; Level 3: Demonstrates clear communication with team
members; Level 4: Recommends changes in team behaviors to
solve complicated puzzles (i.e. assigns a new player to a
problem or considers an alternate approach)
Social Learning: Players
imitate puzzle-solving
behaviors with
success. Behaviorism: Positive
behavior is reinforced by
progression in the escape
room
TABLE 2: Accreditation Council for Graduate Medical Education (ACGME) Milestones
Specific to Emergency Medicine (EM) with Corresponding Learning Theories Found
in an Escape Room Activity
ACGME = Accreditation Council for Graduate Medical Education
PC = Patient Care
ICS = Interpersonal and Communication Skills
Source: https://www.acgme.org/Portals/0/PDFs/Milestones/EmergencyMedicineMilestones.pdf [9]
There are several limitations worth noting. While this activity was originally designed to be an
inclusive team-building event that was open to all eligible ED staff, the study investigators were
unable to accrue a diverse group of participants within the enrollment period due to scheduling
conflicts. Furthermore, commercial escape rooms can be expensive, making it costly to conduct
this activity with a large group of students, residents, and/or faculty. It is possible, however, to
divide larger groups into more manageable sizes of six to 10 learners. The presence of an
observer in the escape room may have led to a Hawthorne effect, which can be addressed in
future iterations using the surveillance recorders available in the escape room. Finally, the
debriefing was limited to the post-activity discussion facilitated by the agency's game master;
future team-building exercises may benefit from a standard debriefing, focusing on observed
behaviors and results to provide learners with constructive feedback. An economical alternative
2018 Zhang et al. Cureus 10(3): e2256. DOI 10.7759/cureus.2256 6 of 9
to commercial escape room is to construct an emergency department-themed escape room with
EM-specific puzzles and challenges set in a private residence with each room representing
different locations in the ED. This allows the creators and participants to become more engaged
in puzzle solving and enables more constructive feedback.
Conclusions
The escape room team-building activity was well received by our EM residents and faculty. It
allowed learners to immerse themselves in an engaging, fun, non-threatening, non-clinical,
low-stakes activity that rewarded teamwork and effective leadership. Next steps will include
expanding interprofessional inclusion (i.e., nurses and technicians), as well as designing escape
rooms with more complex puzzles that require parallel processing to closely approximate the
chaotic nature of the ED. The authors found that while the game debriefing provided insight
into actions taken during the game, participants would have preferred a more constructive
feedback session to help them analyze aspects of communication and problem-solving that can
be applied in subsequent scenarios, including the clinical environment.
Appendices
Appendix A – Post escape room survey questionnaire
1. Have you ever used an escape room?
1a. If yes to question #1
1b. What were your initial reactions to it?
1c. I’d like you to compare your expectations to when you were first introduced to it and now,
after having had some time working with the system. Was it any different from what you
expected?
2. Have you ever participated in team-building activities (i.e. team steps, sports activities)?
2a. If yes, what were the activities?
3. I invite you to think about your clinical settings, how do those environments compare to the
escape room?
3a. Can you identify any differences or similarities?
4. Please recall the tasks you performed in the escape room, were these similar to the tasks you
perform in the emergency department (ED)?
5. Please recall the interaction you had with your colleagues in the game, were they similar to
the interactions you have with your applications in the ED?
6. Please recall the debriefing conducted by the game master at the conclusion of the game,
were they similar to the debriefing at the end of your shift?
6a. Why or why not?
7. How do you prepare for your clinical shifts?
2018 Zhang et al. Cureus 10(3): e2256. DOI 10.7759/cureus.2256 7 of 9
8. How do you prepare for the clinical team interactions you have on shifts?
9. How do you prepare for the debriefing that takes place at the end of the shift?
10. What are some immediate lessons you learned by working with your peers in the escape
room?
10a. Do you find this experience useful? Why or why not?
11. Thinking back, which experience from the escape room will motivate you to learn more
about working in a team?
12. Thinking back, which experience from the escape room will dissuade you from working in a
team?
13. What is your perception of teamwork and communication in emergency medicine?
14. How do you determine the value of effective teamwork and communication?
15. How do you determine the value of debriefing at the end of a clinical shift?
16. Was the escape room activity an effective team building activity?
16a. What made it effective?
16b. How will you use this information?
17. If you were to redesign this team building activity, what do you want to include to make it a
more effective activity that focuses on team work and communication?
17a. Prompt: What will you want to take out or change?
17b. Prompt: Why would you implement that change?
18. Do you have any questions for me? Are there topics that we’ve yet to cover? Is there
anything you want to discuss?
Additional Information
Disclosures
Human subjects: Consent was obtained by all participants in this study. Sidney Kimmel
Medical College at Thomas Jefferson University issued approval #18E.055. The Institutional
Review Board (IRB) has evaluated the involvement of human subjects in the proposed research
study entitled: Applying Gamification to Incorporate Team-Building Skills via an Escape-the-
Room Experience" (Departmental) 45 CFR 46.101 (2-anonymous survey) Control #18E.055. In
accordance with Federal-Wide Assurance #00002109 to the U.S. Department of Health and
Human Services, the study was determined to be EXEMPT from IRB review on 02/01/2018
pursuant to Title 45 Code of Federal Regulations Part 46.101(b) governing exempted protocol
declarations. Board #152 was notified of this exemption status at its 02/01/2018 meeting.
Animal subjects: All authors have confirmed that this study did not involve animal subjects or
tissue. Conf licts of interest: In compliance with the ICMJE uniform disclosure form, all
2018 Zhang et al. Cureus 10(3): e2256. DOI 10.7759/cureus.2256 8 of 9
authors declare the following: Payment/services info: All authors have declared that no
financial support was received from any organization for the submitted work. Financial
relationships: All authors have declared that they have no financial relationships at present or
within the previous three years with any organizations that might have an interest in the
submitted work. Other relationships: All authors have declared that there are no other
relationships or activities that could appear to have influenced the submitted work.
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... Elements of constructionism and behaviorism are also recognizable (Ouariachi & Wim, 2020). Social constructivism is manifested in cooperation and constructive knowledge based on realtime experience (Zhang et al., 2018). This theory emphasizes the influence of those social circumstances that frame the social interactions between participants. ...
... This theory emphasizes the influence of those social circumstances that frame the social interactions between participants. Behaviorism is evident in the elements that reward positive behavior (Ouariachi & Wim, 2020;Zhang et al., 2018). ...
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... The positive results about the usefulness of the escape room as a game for evaluating and teaching concepts in healthcare professions are in line with other studies [14,16,17,19,26] that have informed that this kind of game is fun and satisfactory for the students and medical residents and that it promotes teamwork and communication skills and help to reproduce clinical situations and feelings. ...
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Game-based learning is increasing in nursing education. Also, the assessment of the utility of the escape room game is growing. To explore nursing students' opinion about the escape room as an evaluation game, a qualitative observational study with nursing students was carried out. An ad hoc questionnaire with open questions was sent after the game learning experience. The escape room included knowledge and techniques from different specialties. The escape room learning game was a positive experience for the students. The main highlighted characteristics were fun, dynamic, and motivating way to study and learn. Other interesting variables were: "Working as a team and under pressure" (It's a group activity in which everyone must work together. It is a good challenge to learn how to work in urgent situations) and "Different way to assess students´ learning" (In this type of game, I can show more things and not only theoretical knowledge). Game-based learning is increasing in nursing education, as well as the assessment of the utility of the escape room game. Using an escape room for assessing nursing students' knowledge is a positive experience. This learning experience can be also used with nurses in different specialties to promote teamwork and working under pressure.
... L'intérêt est plutôt porté sur l'utilisation des escape games comme outils pédagogiques et l'on retrouve l'adaptation de ces jeux grandeur nature en salle de classe dans différents domaines et à différents niveaux (Olombel et al., 2021 ;Bucaille et Levenq, 2018 ;Eukel et al., 2017 ;Clarke et al., 2017). Plus largement, l'escape game est également utilisé pour montrer l'efficacité de son utilisation pour le développement de certaines compétences et la gestion de situations d'urgence, ou encore le renforcement de la cohésion d'équipe entre collègues (Morrell et al., 2020 ;Zhang et al., 2018 ;Pan et al., 2017). Les travaux qui se focalisent sur l'escape game en tant qu'objet d'étude sont restreints et se trouvent principalement dans le domaine des sciences du jeu. ...
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Cette étude propose une analyse de la transmission des savoirs dans les interactions entre des joueurs d’escape game. Une attention particulière est portée sur le type de savoirs transmis et sur la répartition de ces savoirs entre les joueurs. À partir d’une analyse linguistique, nous étudions l’introduction de nouveaux référents et l’intégration de nouvelles informations aux savoirs partagés entre les locuteurs. Nos résultats démontrent que les joueurs transmettent une grande partie des informations au groupe et non à un joueur en particulier. On distingue également différents types de joueurs en fonction de la répartition des informations.
... El término escape room también ha experimentado una notable evolución en los últimos años, pasando a convertirse en una expresión con presencia en ámbitos muy diferentes: ocio, social, empresarial y, por supuesto, educativo (Zhang et al., 2018). Se trata de un término no siempre fácil de definir, ya que ni siquiera implica necesariamente un juego en el que haya una habitación de la que escapar (Clare, 2015). ...
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Escape room digital para el desarrollo del aprendizaje colaborativo en educación superior Integrating new game-based learning environments, such as Digital escape rooms, can improve cognitive, motivational, emotional, and social processes. In this study, we developed a model to investigate the influence of motivational factors on the intention to use escape rooms in higher education and their influence on collaborative learning. 238 Infant, Primary, and Social Education Students participated in the experience. An ex post facto research design based on the survey method was used, and descriptive, correlational, and regression analyses were carried out. The results indicate that enjoyment and perceived usefulness are the factors most related to the escape room being perceived as a collaborative work and learning facilitator. However, the ease of use of the escape room is not a variable that influences teamwork, nor the level of acceptance of the escape room. It is concluded that the pleasure and enjoyment produced by the digital escape room increase the intention to use it and thus the engagement to work and learn in a group. La integración de nuevos escenarios de aprendizaje basado en juego, como el caso de los escape rooms digitales, pueden mejorar los procesos cognitivos, la motivación, el plano emocional y el ámbito social. En este estudio se ha desarrollado un modelo para investigar la influencia de los factores motivacionales en la intención de utilizar los escapes room en educación superior y su influencia sobre el aprendizaje colaborativo. 238 estudiantes de los Grados de Educación Infan-til, Primaria y Social participaron en la experiencia. Se utilizó un diseño de investigación ex post facto basado en el método de encuesta y se realizaron análisis descriptivos, correlacionales y de regresión. Los resultados señalan que el disfrute y la utilidad percibida son los factores que más se relacionan con que el escape room se perciba como facilitador del trabajo y aprendizaje cola-borativo. Sin embargo, la facilidad de uso del escape no es una variable que influye en el trabajo en equipo, ni en el grado de aceptación del escape. Se concluye que el placer y el disfrute que produce el escape room digital aumenta la intención de uso y con ello el compromiso para trabajar y aprender en grupo. Palabras clave Escape room; Aprendizaje colaborativo; Educación Superior; TAM; Gamificación.
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Objectives Escape rooms are becoming a popular teaching method in a variety of fields and settings, but have not been examined for their effectiveness in nursing education. The aim of this integrative review was to map trends in escape rooms in nursing research and evaluate support for using this innovative, simulation-based teaching method. Design, data sources, and review methods Using Whittemore and Kanfl's framework, this integrative review analyzed the use of simulation-based escape rooms in nursing and nursing education. Results were refined using inclusion and exclusion criteria, and evaluated with use of the Mixed Methods Appraisal Tool. Databases searched were PubMed, CINAHL, PsychINFO, Google Scholar, and ERIC. Results A total of 18 studies were included. Common categories identified included student satisfaction with escape rooms and barriers of cost and time to educators. Desired outcomes of the studies reviewed focused on teamwork, perceived learning or increased confidence, or increase in knowledge. Optimal group size and theoretical support recommendations for escape rooms are lacking with the need for further research. Conclusions Escape rooms are effective at improving knowledge in a variety of nursing education topics, and their use has been well-received in a variety of nursing and professional health students. Long-term outcomes have not been assessed. There is need for more research in assessing ideal group size when using escape rooms in education settings, more rigorous study design to determine effectiveness of escape rooms to produce education-focused outcomes, and more consensus on appropriate theoretical frameworks that can guide the implementation and study of escape rooms in practice.
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Educational escape rooms are beneficial for student learning as it relates to critical thinking, decision making under time constraints and practical exploration of real-life work scenarios. This type of learning experience is beneficial across many disciplines with emphasis for healthcare management due to the dynamic nature and common pressures of professional healthcare. The following paper contributes to existing literature by presenting an educational escape room designed as a pedagogical innovation for teaching healthcare management. Future research and future assessment directives are discussed.
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ABSTRACT There has always been a need for engaging assessments in online learning environments, though the COVID-19 pandemic further emphasized this need. Instructors across science, technology, engineering, and mathematics (STEM) disciplines have begun to implement escape room activities as effective and engaging learning tools in their classrooms. For our virtual introductory ecology course in spring 2021, we developed a student-designed escape room assessment which aligned with several course goals and covered a broad range of ecology concepts. The learning objectives of this assignment asked students to (i) create a themed “room” filled with ecology-based riddles and puzzles that represented a novel virtual escape room for their peers based on an important ecological topic, (ii) summarize and synthesize primary literature into clues and locks to educate their peers about an ecological topic, and (iii) use critical thinking and discussion of ecological topics with peers to solve their peers’ escape rooms. We found that while students generated distinct escape room activities and focused on various ecological topics, student scores on this assessment, as well as student feedback, indicated that the escape rooms were conducive to learning, novel, and accessible in the virtual learning environment. We suggest that student-designed escape room assessments are an effective way for students to learn course material in a fun, engaging, and creative manner, and our spring 2021 implementation suggests that this activity may be an effective assessment for online settings.
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Learn how using healthcare escape rooms can provide knowledge-based team learning, optimize communication, and enhance learner engagement.
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This is fourth article in a series of articles on Leadership and Strategic Management. It describes the importance of team work in health care. It describes the stages of forming, storming, norming, performing and adjourning and also two phases of creation and performance. Their are behaviours of individual team member that facilitate team work and others that impede team work. The article also describes motivation skills and techniques to strengthen group work.
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Background: Assessing resident competency in emergency department settings requires observing a substantial number of work-based skills and tasks. The McMaster Modular Assessment Program (McMAP) is a novel, workplace-based assessment (WBA) system that uses task-specific and global low-stakes assessments of resident performance. We describe the evaluation of a WBA program 3 years after implementation. Methods: We used a qualitative approach, conducting focus groups with resident physicians in all 5 postgraduate years (n = 26) who used McMAP as part of McMaster University's emergency medicine residency program. Responses were triangulated using a follow-up written survey. Data were analyzed using theory-based thematic analysis. An audit trail was reviewed to ensure that all themes were captured. Results: Findings were organized at the level of the learner (residents), faculty, and system. Residents identified elements of McMAP that were perceived as supporting or inhibiting learning. Residents shared their opinions on the feasibility of completing daily WBAs, perceptions and utilization of rating scales, and the value of structured feedback (written and verbal) from faculty. Residents also commented extensively on the evolving and improving feedback culture that has been created within our system. Conclusion: The study describes an evolving culture of feedback that promotes the process of informed self-assessment. A programmatic approach to WBAs can foster opportunities for feedback although barriers must still be overcome to fully realize the potential of a continuous WBA system. A professional culture change is required to implement and encourage the routine use of WBAs. Barriers, such as familiarity with assessment system logistics, faculty member discomfort with providing feedback, and empowering residents to ask faculty for direct observations and assessments must be addressed to realize the potential of a programmatic WBA system. Findings may inform future research in identifying key components of successful implementation of a programmatic workplace-based assessment system.
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Aim: The aim of this study was to assess the effects of team-building on communication and teamwork (i.e. teamwork skills and team effectiveness) among nursing students. Background: Team-building is effective for improving communication and teamwork among the nursing organization. However, the effects of team-building are not well known especially in Korea. Methods: This study used a quasi-experimental design. The sample was composed of 195 junior-year nursing students in Korea. The experimental group (100 subjects) participated in team-building activities over a 100-day period, whereas no intervention was applied to the control group (95 subjects). Pretest was conducted in both groups, and post-test was conducted after the 100-day intervention. Findings: The pre-post change in mean communication competence score did not differ between the two groups. However, the mean scores for teamwork skills and team effectiveness differed significantly between the two groups after team-building activity. Limitations: This study was not a double-blind test, and randomized sampling was not implemented. Caution should thus be used when interpreting the findings. Conclusion: Team-building activities were effective for improving the teamwork skills and team effectiveness among Korean nursing students. Implications for nursing education: It is recommended that team-building activities should be included regularly as an integral educational approach in nursing education. The findings suggest that suggests that team-building for improving communication and teamwork should be designated as one of the required criteria for nursing college programme accreditation in many countries, including Korea. However team-building requires further testing to verify this across cultures. Implications for nursing policy: Nurses need to receive formal team-building training for improving communication and teamwork, and formal education should be included in their job training schedule. It is recommended that communication competence and teamwork be used as one of job performance evaluations in their workplace.
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Collaboration characterized by mutual capacity building, asset sharing, and tangible outcomes that work to further health equity are central tenets of community-based participatory (CBPR) approaches to research. Such efforts require the establishment, development, and maintenance of trusting relationships between community and institutional stakeholders. The objective of the strategies discussed here was to strengthen a community-academic partnership by facilitating communication and empowering project partners. Team-building activities and experiential exercises were intentionally utilized with project stakeholders to clarify roles and responsibilities, provide alternative avenues for authentic communication, and share power.Lessons Learned: Team-building activities can be effective in promoting CBPR partnerships when utilized appropriately. Through the course of the partnership building process, best practices emerged for utilizing experiential learning exercises to enhance partnership dynamics. Team-building activities provide a useful tool for developing supportive environments that encourage open dialogue.
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We prospectively studied the relationship between interdisciplinary collaboration and patient outcomes in the medical intensive care unit (MICU) using nurses' and residents' reports of amount of collaboration involved in making decisions about transferring patients from the MICU to a unit with a less intense level of care. Either readmission to the MICU or death was considered a negative patient outcome. Nurses' reports of collaboration were significantly (p = 0.02) and positively associated with patient outcome, controlling for severity of illness. Patient predicted risk of negative outcome decreased from 16%, when the nurse reported no collaboration in decision making, to 5% when the process was fully collaborative. There was an interaction of collaboration with availability of alternative choices in the transfer decision-making situation. When alternatives were available, collaboration was more strongly associated with patient outcome. There was no significant relationship between residents' reports of collaboration and patient outcomes. The correlation between amount of collaboration reported by nurses and residents about the same decisions was quite low (r = 0.10).
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To demonstrate that by using the knowledge and skills of the primary care provider and by applying statistical and scientific principles of quality improvement, outcomes can be improved and costs significantly reduced. A before and after quasi-experimentally designed trial using historical controls plus an analysis of costs in areas not influenced by intensive care unit (ICU) practice to control for possible secular changes. A tertiary ICU. All patients admitted to the above-mentioned ICU from January 1, 1991, through December 31, 1995. a) A focused program that applied statistical and scientific quality improvement processes to the practice of intensive care. b) An organized effort to modify the culture, thinking, and behavior of the personnel who practice in the ICU. Severity of illness, ICU and hospital lengths of stay, ICU and hospital mortality rates, total hospital costs as analyzed by the cost center, and measures of improvement in specific areas of care. Significant improvement in glucose control, use of enteral feeding, antibiotic use, adult respiratory distress syndrome survival, laboratory use, blood gases use, radiograph use, and appropriate use of sedation. A severity adjusted total hospital cost reduction of $2,580,981 in 1991 dollars when comparing 1995 with the control year of 1991, with 87% of the reduction in those cost centers directly influenced by the intervention. A focused quality improvement program in the ICU can have a beneficial impact on care and simultaneously reduce costs.
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The purpose of this report is to describe and evaluate the impact of a 1-day retreat focused on developing leadership skills and teambuilding among postgraduate year 1 residents in an internal medicine residency. A group of organizers, including members of the staff, the chief medical residents, administrative individuals in the residency office, and an internal organizational development consultant convened to organize an off-site retreat with activities that would provide experiential learning regarding teamwork and leadership, including a "reef survival exercise" and table discussions regarding the characteristics of ideal leaders. In addition, several energizing activities and recreational free time was provided to enhance the interaction and teamwork dimensions of the retreat. To evaluate the impact of the retreat, attendees completed baseline and follow-up questionnaires regarding their experience of the retreat. Attendees universally regarded the retreat as having value for them. Comparison of baseline to postretreat responses indicated that attendees felt that the retreat enhanced their abilities to be better physicians, resident supervisors, and leaders. Follow-up responses indicated significant increases in attendees' agreement that good leaders challenge the process, make decisions based on shared visions, allow others to act, recognize individual contributions, and serve as good role models. Results on the survival exercise indicated a high frequency with which team-based decisions surpassed individual members' decisions, highlighting the importance and value of teamwork to attendees. Our main findings were that: participants universally found this 1-day retreat beneficial in helping to develop teamwork and leadership skills and the experiential learning aspects of the retreat were more especially highly rated and highlighted the advantages of teamwork. In the context that this 1-day retreat was deemed useful by faculty and residents alike, further study is needed to assess the impact of this learning on actual clinical practice and the durability of these lessons.
Trust in Teams: A review of the Literature. Report to the Defence and Civil Institute of Environmental Medicine
  • B Adams
  • J Sartori
Adams B, Sartori J: Trust in Teams: A review of the Literature. Report to the Defence and Civil Institute of Environmental Medicine. Human Systems Incorporated, Ontario, Canada; 2006.
  • Zhang
Zhang et al. Cureus 10(3): e2256. DOI 10.7759/cureus.2256 9 of 9