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. 2025 Apr 20;17(4):e82634.
doi: 10.7759/cureus.82634. eCollection 2025 Apr.

Enhancing Knowledge Retention in Medical Education Through Escape Box Games

Anya Ramsamooj  1 , Jean Shanaa  2 , Ethan Bernstein  2 , Robert Augustynski  3 , Nathaniel A Sands  4 , Michayla Mabourakh  4 , Hannah Chang  5 , Jennifer Gullo  4
Affiliations

Enhancing Knowledge Retention in Medical Education Through Escape Box Games

Anya Ramsamooj et al. Cureus. .

Abstract

Background: Gamification in medical education is a novel strategy to enhance student learning and engagement that is growing in popularity. One such game is an escape box, where players solve a series of challenges and riddles within a limited time to unlock a box or escape a virtual scenario. Building on the ongoing success of game-based learning, this study aims to expand on the use of games in medical school curricula by implementing an escape box-themed game as an effective strategy to teach pre-clinical science to first-year medical students.

Methods: The study, approved by the California Northstate University Institutional Review Board, involved first-year medical students divided into two groups: those who participated in the escape box game and lectures and those who attended lectures only. The study was conducted over three phases: a pre-game survey, the escape box game, and a post-game survey. Overall, the surveys included four questions that assessed confidence in renal medical concepts, three questions that assessed student engagement with the escape box game, and five questions that assessed personality traits based on the Big-Five OCEAN personality model.

Results: A total of 72 students participated, with 65 completing both pre- and post-game surveys. The final analysis included 40 students in the escape box, plus the lecture group, and 25 students in the lecture-only group. The escape box group of students found the escape box-themed game to be more stimulating and more interesting than traditional lecture, and for most students, it enhanced engagement beyond previous game-based learning methods. In addition, the overall increase in pre- versus post-game confidence was higher, but statistically insignificant in the escape box group. However, for one question regarding dialysis access, there was a statistically significant increase in confidence of 1.261 ± 0.13 for the escape box group and 0.763 ± 0.272 for the lecture-only group (p = 0.00434). No correlation was found between personality traits and an increase in confidence after escape box game learning.

Conclusion: Students found the escape box-themed game substantially more engaging than traditional lectures. There is a strong potential for its use to increase confidence in various other pre-clinical medical concepts. This study demonstrates that gamification of medical education topics, such as dialysis access, enhances student engagement, confidence, and retention (p = 0.00434). Future research should evaluate the longevity of knowledge retention and learning outcomes through longitudinal incorporation of game sessions and assessments throughout medical curriculum phases.

Keywords: escape box; gamification; medical education; pre-clinical learning; retention.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. California Northstate University Institutional Review Board issued approval 2403-02-144. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all 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.

Figures

Figure 1
Figure 1. Study design algorithm
Figure 2
Figure 2. Students participating in the escape box game session
Figure 3
Figure 3. Number and percentage of students from the escape box game + lecture group who answered “completely agree” or “somewhat agree” to the engagement questions in the post-game survey (N = 40)
Figure 4
Figure 4. Side-by-side comparison of each group's pre- and post-confidence scores for each question
See this image and copyright information in PMC

References

    1. Gamification in medical education: identifying and prioritizing key elements through Delphi method. Wang YF, Hsu YF, Fang KT, Kuo LT. https://pubmed.ncbi.nlm.nih.gov/38194415/ Med Educ Online. 2024;29:2302231. - PMC - PubMed
    1. Deterding S, Dixon D, Khaled R, Nacke L. Proceedings of the 15th International Academic MindTrek Conference: Envisioning Future Media Environments, MindTrek. New York (NY): Association for Computing Machinery; 2011. From game design elements to gamefulness: defining gamification; pp. 9–15.
    1. Educational games for health professionals. Akl EA, Sackett KM, Erdley WS, Mustafa RA, Fiander M, Gabriel C, Schünemann H. https://pubmed.ncbi.nlm.nih.gov/23440807/ Cochrane Database Syst Rev. 2013:0. - PubMed
    1. Disaster day: a simulation-based competition for educating emergency medicine residents and medical students on disaster medicine. Gue S, Cohen S, Tassone M, et al. https://pubmed.ncbi.nlm.nih.gov/37704963/ Int J Emerg Med. 2023;16:59. - PMC - PubMed
    1. The application of the spot the difference teaching method in clinical skills training for residents. Yang L, Li W, Zou J, et al. https://pubmed.ncbi.nlm.nih.gov/35836172/ BMC Med Educ. 2022;22:542. - PMC - PubMed

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