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Escape game training to improve non-technical team skills in the operating room

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... Participants often must work together and collaborate to fulfill different tasks successfully. Although research into the impact of escape rooms is still limited, escape rooms have already been used for various serious and learning-related purposes [54][55][56][57]. ...
... An escape room's conceptual structure is useful for enacting communication and collaboration in a digital environment. The learning potential of escape rooms has been increasingly acknowledged in the literature [54][55][56][57][58]. The findings of this study indicate that the conceptual structure is also applicable to a digital environment. ...
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Background Children with autism spectrum disorder (ASD) have social deficits that affect social interactions, communication, and relationships with peers. Many existing interventions focus mainly on improving social skills in clinical settings. In addition to the direct instruction–based programs, activity-based programs could be of added value, especially to bridge the relational gap between children with ASD and their peers. Objective The aim of this study is to describe an iterative design process for the development of an escape room–based serious game as a boundary object. The purpose of the serious game is to facilitate direct communication between high-functioning children with ASD and their peers, for the development of social skills on the one hand and strengthening relationships with peers through a fun and engaging activity on the other hand. Methods This study is structured around the Design Research Framework to develop an escape room through an iterative-incremental process. With a pool of 37 children, including 23 children diagnosed with ASD (5 girls) and 14 children (7 girls) attending special primary education for other additional needs, 4 testing sessions around different prototypes were conducted. The beta prototype was subsequently reviewed by experts (n=12). During the design research process, we examined in small steps whether the developed prototypes are feasible and whether they have the potential to achieve the formulated goals of different stakeholders. Results By testing various prototypes, several insights were found and used to improve the design. Insights were gained in finding a fitting and appealing theme for the children, composing the content, and addressing different constraints in applying the goals from the children’s and therapeutic perspectives. Eventually, a multiplayer virtual escape room, AScapeD, was developed. Three children can play the serious game in the same room on tablets. The first test shows that the game enacts equal cooperation and communication among the children. Conclusions This paper presents an iterative design process for AScapeD. AScapeD enacts equal cooperation and communication in a playful way between children with ASD and their peers. The conceptual structure of an escape room contributes to the natural emergence of communication and cooperation. The iterative design process has been beneficial for finding a constructive game structure to address all formulated goals, and it contributed to the design of a serious game as a boundary object that mediates the various objectives of different stakeholders. We present 5 lessons learned from the design process. The developed prototype is feasible and has the potential to achieve the goals of the serious game.
... Another review of 23 recently published articles found that escape room activities may enhance teamwork and collaboration among healthcare populations as well as facilitate the delivery of content aimed to teach skills required in healthcare environments. 19 For instance, escape rooms have been found to create opportunities to practice non-technical skills, 20,21 improve confidence among medical students, 22 as well as enhance communication and patient safety awareness among interprofessional healthcare teams. 23 Escape rooms have also been effectively utilized to advance learning among pharmacy students 24,25 and radiology residents, 26 and to educate healthcare learners about sepsis assessment 27 and event reporting. ...
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Objective An escape room was used to study teamwork and its determinants, which have been found to relate to the quality and safety of patient care delivery. This pilot study aimed to explore the value of an escape room as a mechanism for improving cohesion among interdisciplinary healthcare teams. Methods This research was conducted at a nonprofit medical center in Southern California. All participants who work on a team were invited to participate. Authors employed an interrupted within-subjects design, with two pre- and post-escape room questionnaires related to two facets of group cohesion: (belonging – (PGC-B) and morale (PGC-M)). Participants rated their perceptions of group cohesion before, after, and one-month after the escape room. The main outcome measures included PGC-B/M. Results Sixty-two teams participated (n = 280 participants) of which 31 teams (50%) successfully “escaped” in the allotted 45 minutes. There was a statistically significant difference in PGC between the three time periods, F(4, 254) = 24.10, p < .001; Wilks’ Λ = .725; partial η2 = .275. Results indicated significantly higher scores for PGC immediately after the escape room and at the one-month follow-up compared to baseline. Conclusions This work offers insights into the utility of using an escape room as a team building intervention in interprofessional healthcare teams. Considering the modifiability of escape rooms, they may function as valuable team building mechanisms in healthcare. More work is needed to determine how escape rooms compare to more traditional team building curriculums.
... Escape games can be considered as educational tools that emphasise the teamwork whilst mobilising technical and non-technical skills. 15 Most educational escape games in the medical field involve the practice or development of teamwork. 14 That is achieved through collaborative work, which is essential to escape games. ...
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Background: Escape games have proven to be an innovative pedagogical tool that allows students to use the professional skills they acquired. The appeal of the game lies in the stimulation of the players' minds and in the diversity of the puzzles. Purpose/objectives: To evaluate the effectiveness of an educational tool aimed at cultivating team spirit and group cohesion in dentistry students through a fun collaborative activity that mobilises their knowledge and skills. Materials and method: Twenty-four students participated to the escape game over a one-day period. In order to win, they had to solve dentistry-related puzzles. Results: Feedback was strongly positive. The balance between manipulations and theoretical questions stimulated them. Students did favor this type of activity which allows to increase interactions between students as well as with the teaching team. Conclusion: Escape games in dental schools fosters a supportive learning environment and stimulated students' motivation and group cohesion.
... This teaching method has been shown to be feasible and enjoyable when developed and tested on radiology trainees [6], as well as undergraduate students on a variety of healthcare topics (e.g. nursing [7,8], pharmacy [9], surgery [10,11] and dermatology [12]). ...
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Objectives: To develop a paediatric radiology themed escape room session for undergraduate education and secondly, to determine participant satisfaction and improvement in knowledge. Methods: A paediatric radiology escape room with accompanying tutorial was developed around key learning objectives set within the RCR and ESR undergraduate curriculum. Students were recruited from two different universities and undertook the escape room themed teaching. An 8-question single best answer (SBA) test was completed before, immediately after and at 2 weeks post-teaching to determine participant improvement and retention of knowledge. The general feedback was also collected. Results: The escape room sessions were held three times, for 19 students (6-7 students per session). All groups completed the escape room in ≤ 20 min. Students enjoyed the experience, assigning an average satisfaction score of 9.4/10 (range 7-10). The majority (17/19, 89.5%) preferred this method of teaching to a lecture-based tutorial alone, although all said they found the tutorial component useful. For the SBA test, there was an average increase in 3.6 marks (range 1-6 marks) per participant between before and after the escape room. This improved knowledge was mostly sustained after 2 weeks, with an average increase of 3.4 marks difference (range 1 to 6) per participant compared to before the teaching. Conclusions: A paediatric radiology themed escape room is a feasible teaching method, enjoyed by participants and associated with an increase in radiological knowledge. Further work with larger sample size and direct comparison with other traditional teaching methods is required.
... The philosophy of the escape room as lived experience is not only attractive to the student but effective in terms of learning and a powerful element within the arsenal of teaching strategies. Terrasi et al. (2019) assertively published the scope of escape rooms in the teaching of non-technical skills, such as communication, teamwork, and leadership in operating rooms. ...
Thesis
This thesis investigated and explored if and how boundary objects and their perspective can contribute to the meaningful design of innovation for the healthcare sector. The concept of boundary objects has found its way into healthcare and health contexts. Boundary object scan have many forms and can trigger different learning mechanisms: identification, coordination, relfection, and transformation. The reflection and transformation mechanisms are underrepresented in existing literature, but pursuing the reflective mechanism in design, development, and implementation projects is beneficial for a fluid and smooth integration of innovation into practice. Our case studies show that it is significant to trigger the reflective mechanism during the design and innovation process. By applying methods and prototypes as boundary objects and by approaching interventions to be developed as boundary objects, we see good effects in terms of acceptance, adoption, and creating (co-)ownership of the innovation, whit an inclusive design as outcome. The boundary object focus and perspective adds value to existing change and innovation frameworks by not pursuing consensus but harmony in differences. Results of this thesis are useful for both the growing design discipline in health as for policymakers in healthcare who have to come up with innovative strategies to meet the challenges healthcare faces today. Future work should focus on a more unambiguous use of the concept in healthcare, a pursuit to trigger the reflective mechanism in innovative processes in health, and adopt more 'designerly ways of knowing’ in health by applying design research in complex healthcare issues.
Article
Purpose Trainee well-being is a growing focus in graduate medical education. One emerging area in occupational literature is the psychosocial environment of the workplace, of which a large component is workplace social capital (WSC). WSC encompasses how well a group connects to one another. Medical escape rooms (MERs) recently have been studied in various healthcare settings and are one proposed intervention to increase WSC. Methods This is a single-center before-and-after survey study at the Loyola University Medical Center in 2021 to measure the effect of a MER on WSC amongst interns. Our Chief Resident created a 1-hour MER. WSC scores were measured using a modified version of a validated WSC scale. Scores were analyzed with paired t-test analysis and chi-square analysis. Open-ended feedback was also collected. Results Of 52 eligible intern residents, 51 (98%) participated in the MER, and 41 (80%) completed the pre- and post-activity survey. All six survey statements had a greater percentage of positive responses following the MER. The average score across all participants and questions was 4.66 out of 5 on the pre-survey, and 4.90 on the post-survey (p < 0.001). Conclusions The MER significantly improved intern resident WSC scores, and proved a valuable addition to our curriculum.
Article
Escape Rooms are gaining prominence as education modalities, employing principles of game design shown to augment knowledge acquisition in a fun, team-based learning experience (“edutainment”). In this report, we outline some of the medical literature and then provide our step-by-step approach and lessons learned when building what was, to our knowledge, the first continuing medical education Escape Room at a national scientific meeting. We then comment on how this innovative educational offering was re-imagined the following year for remote (virtual) learning because of the COVID-19 pandemic.
Article
Résumé L’erreur médicale serait responsable d’un grand nombre de décès évitables. Les chiffres varient selon les auteurs. La complexification du soin modifie les stratégies pour atteindre les performances optimales. L’erreur humaine est inévitable, des outils existent pour en limiter la fréquence et les conséquences. Les Facteurs Humains et Organisationnels sont une discipline scientifique à part entière, qui permet de comprendre la performance de la médecine périopératoire. D’autres milieux professionnels rencontrent les problématiques de la complexité et de la sécurité. C’est le cas notamment de l’aviation civile. Le monde de la santé peut s’inspirer des outils utilisés en aviation pour améliorer la sécurité (simulation, régulation du temps de travail, utilisation du Crisis Ressource Management, check-lists, boîte noire, retour d’expérience, communication standardisée). Des compétences non techniques, individuelles et collectives, ont été décrites avec précision et complètent le savoir et les compétences techniques. Les prises de décision sont soumises à des biais cognitifs qu’il faut connaître pour en limiter l’impact. L’interaction avec l’environnement, l’anticipation, l’utilisation d’aides cognitives et le partage d’informations en équipe permettent d’optimiser les ressources cognitives individuelles des soignants. C’est le principe de la cognition située. La sécurité repose sur un équilibre entre sécurité normée et sécurité gérée, entre compliance et résilience. L’inflation normative peut être contre-productive et tous les outils et protocoles de sécurité doivent être mis en place par les acteurs de première ligne, au plus près du patient. La non-punition des erreurs est un élément fondamental pour sécuriser le soin. Nous traversons un changement culturel qui repose sur de nouvelles valeurs décrites par Atul Gawande : l’humilité, la discipline, et le travail d’équipe.
Article
Background Escape rooms have been adapted from a range of educational purposes across disciplines, including healthcare simulation. The use of this technique has become increasingly popular among industry and faculty members. We sought to clarify the characteristics of healthcare simulation escape rooms in order to work toward a shared mental model and definition. Methods A scoping review of the literature with an environmental scan of websites and other public information was performed to identify concepts which describe educational and healthcare simulation escape rooms to differentiate between and determine key features and scope of this clinical education tool to provide an interprofessional definition. Twenty-three references were used. Results Healthcare simulation escape rooms share many of the characteristics of those being used for education and may be utilized for teaching a variety of skills. These may be conducted either within a simulation scenario, within the simulation/simulated environment, and/or with associated equipment. It is essential that the development and implementation of these escape rooms follow design standards of best practice for healthcare simulation for optimal learning. Only one definition of simulation escape rooms was found. Discussion While similar to escape rooms utilized in other forms of education, there are principal differences between those escape rooms and ones used in healthcare simulation. Key features include utilization of core healthcare simulation principles, including providing a safe and realistic learning environment. Conclusion Escape rooms may be used to engage learners in a simulation experience. It is important to differentiate between true simulation escape rooms and escape rooms that do not reflect healthcare simulation-based learning experiences. An expanded definition is provided, as reflected by the literature review, to provide a clearer understanding of the term as applied to healthcare simulation and enhance repeatable studies to advance the science of healthcare simulation.
Article
Objective: Development of nontechnical skills for surgeons has been recognized as an important factor in surgical care. Training tools for this specific domain are being created and validated to maximize the surgeon's nontechnical ability. This systematic review aims to outline, address, and recommend these training tools. Design: A full and comprehensive literature search, using a systematic format, was performed on ScienceDirect and PubMed, with data extraction occurring in line with specified inclusion criteria. Setting: Systematic review was performed fully at King's College London. Results: A total of 84 heterogeneous articles were used in this review. Further, 23 training tools including scoring systems, training programs, and mixtures of the two for a range of specialities were identified in the literature. Most can be applied to surgery overall, although some tools target specific specialities (such as neurosurgery). Interrater reliability, construct, content, and face validation statuses were variable according to the specific tool in question. Conclusions: Study results pertaining to nontechnical skill training tools have thus far been universally positive, but further studies are required for those more recently developed and less extensively used tools. Recommendations can be made for individual training tools based on their level of validation and for their target audience. Based on the number of studies performed and their status of validity, NOTSS and Oxford NOTECHS II can be considered the gold standard for individual- and team-based nontechnical skills training, respectively, especially when used in conjunction with a training program.
Article
Medical error is not included on death certificates or in rankings of cause of death. Martin Makary and Michael Daniel assess its contribution to mortality and call for better reporting The annual list of the most common causes of death in the United States, compiled by the Centers for Disease Control and Prevention (CDC), informs public awareness and national research priorities each year. The list is created using death certificates filled out by physicians, funeral directors, medical examiners, and coroners. However, a major limitation of the death certificate is that it relies on assigning an International Classification of Disease (ICD) code to the cause of death.1 As a result, causes of death not associated with an ICD code, such as human and system factors, are not captured. The science of safety has matured to describe how communication breakdowns, diagnostic errors, poor judgment, and inadequate skill can directly result in patient harm and death. We analyzed the scientific literature on medical error to identify its contribution to US deaths in relation to causes listed by the CDC.2 Medical error has been defined as an unintended act (either of omission or commission) or one that does not achieve its intended outcome,3 the failure of a planned action to be completed as intended (an error of execution), the use of a wrong plan to achieve an aim (an error of planning),4 or a deviation from the process of care that may or may not cause harm to the patient.5 Patient harm from medical error can occur at the individual or system level. The taxonomy of errors is expanding to better categorize preventable factors and events.6 We focus on preventable lethal events to highlight the scale of potential for improvement. The role of error can be complex. While …