Feasibility of a paediatric radiology escape room for undergraduate education

Abstract

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.

Keywords: Education; Escape room; Gamification; Paediatric; Radiology; Teaching.

Fig. 1

‘Read the signs’: an example of one of the puzzles in the escape room. a A poster detailing three different paediatric radiographs with abnormalities is placed on one of the walls of the room. The students need to find a hidden folder of ‘radiology signs’ somewhere in the room containing 20 different imaging signs and match the images on the poster to that in the folder to solve the three number combination code. b An example of one of the pages in the clear plastic presentation folder matching the second image on the poster. In this example, the second number for the combination code would be ‘3’

Fig. 2

‘Location, location, location’: another example of a puzzle in the escape room. The participants need to identify whether a chest radiograph is normal or abnormal. If abnormal, then the location of the consolidation should be determined and matched to the number code given in the box in the bottom left corner of the poster. For example, in this game, the three number combination is 2, 6 and 1

Fig. 3

‘Diagnose Doctor Perry Osteum’: another example of a puzzle in the escape room. a A poster of various body parts some with and some without fractures are shown. The participants need to identify which bones have an abnormality and match it to the (b) large paper skeleton in the other corner of the room. This skeleton has numbers written on every bone, and only by correlating the correct bone and laterality can the students resolve the three-number combination. In this example, the bones to be interrogated on the skeleton would be the distal right radius, posterior right ribs and proximal left tibia

Fig. 4

‘Radiation dosages’ puzzle: In this puzzle (a) the patient scenarios are placed on the wall, with a list of (b) radiation dosages on another wall, based on the WHO 2016 publication, ‘Communicating radiation risks in paediatric imaging’ [27]. Students are required to calculate the radiation dosages from the different radiology modalities and examinations to solve the three-number combination. In this example, the combination code was 0, 3 and 2

Fig. 5

Equipment in the escape room. a The equipment on the central desk included a copy of the escape room rules, the kitchen timer to time the participants (yellow arrow), the four tin containers (white arrow) which were each locked with a three-number combination lock and contained a note for the final crossword puzzle, and clues on how to unlock the briefcase containing the puzzle (dashed white arrow). Photo frames containing images of Roentgen and an early example of a hand radiograph were not part of the escape room puzzles, and only placed on the table for decoration. b All the equipment was easily transportable between teaching sites within a single carry bag

Fig. 6

Crossword puzzle. a This image demonstrates the four different notes that were contained within the four containers shown in Fig. 5. They provide clues to the crossword puzzle (b). The answers to the crossword are 1—RED DOT; 2—FRONT; 3—THYMIC; 4—CANCER. The escape room word was ‘ROENTGEN’

Fig. 7

The layout of the escape room. The puzzles listed in Figs. 1, 2, 3 and 4 are colour coded in this image. Those with more than one component are intentionally placed on opposite sides of the room to force students to interact with each other and communicate findings. The escape room rules read to students prior to the activity had already informed them that removing posters from the wall or use of mobile phones was not allowed