Physiology is a vital component to medical curricula, but to succeed as future doctors, medical students must learn to apply their knowledge of physiology to clinical scenarios. Although teachers can design classroom sessions that incorporate this critical skill, many students seek online resources to supplement their studies, and the majority of these resources focus on passive learning (e.g. watching videos). Therefore, there is a need for interactive physiology revision/consolidation resources that facilitate application of knowledge and that can be accessed by students in their own time.

The aim of this study was to design a digital escape room on the topics of cardiac electrophysiology and arrhythmias and evaluate whether the resource can support learning and enjoyment of physiology outside of the classroom.

The digital escape room – “The Emergency Department” – was created on a freely-accessible WordPress site (http://activephysiology.com) as a series of interactive puzzles (e.g. H5P). The escape room incorporated a countdown timer (Hurrytimer) and password protected elements (Passster) for a more realistic gaming experience. The activity was timetabled as a synchronous, remote, group learning activity for second year medical students (Keele University) as part of their cardiovascular pathophysiology module. Student engagement was evaluated by comparing the number of puzzle page views vs. exits and puzzle difficulty was quantified using the average time spent on each puzzle page (Google Analytics). Students’ perception of the digital escape room’s difficulty, functionality, and usefulness as a revision/consolidation exercise was assessed using a feedback questionnaire (Microsoft Forms). Ethical approval for the study was granted by The Keele Institute for Innovation and Teaching Excellence Educational Research Ethics Committee (KIITE EREC; Keele University).

Of the 48 groups of students (n=172 individuals) that were invited to play the escape room, a total of 58 unique page views were recorded for Puzzle 1, suggesting that either students split themselves into smaller groups or more than one student per group accessed the game. Analysis of Google Analytics data suggests that puzzles were created across a range of difficulties, with the amount of time spent on each puzzle ranging from 3 min and 50 s to 11 mins and 11 s. Furthermore, most groups (74.1%) were able to complete the exercise. All students who filled in the feedback questionnaire (n=11) found the escape room “Engaging” or “Very Engaging”. 82% of participants thought the escape room helped them to practice applying their knowledge, 64% thought it helped them to consolidate their knowledge, 91% said that they enjoyed playing the digital escape room and 91% said that they would recommend the resource to their peers.

In conclusion, digital escape rooms may provide a fun and engaging alternative to passive revision resources more commonly found online. While medical students felt that this new resource helped them to practice applying their knowledge of cardiovascular physiology, future studies will aim to recruit students studying physiology as part of other (non-medical) courses.