October 16, 2020

An Escape Room Activity for Preceptor Development

by Elizabeth Akers, Doctor of Pharmacy Candidate, University of Mississippi School of Pharmacy

Summary and Analysis of: Richter LM, Frenzel JE. Design and Assessment of a Preceptor Development Escape Room. Am J Pharm Educ. Published online July 28, 2020: ajpe8073. doi:10.5688/ajpe8073

Learning is often informative but boring.  Or it can be entertaining.  But I think the best learning is both informative and fun! When learning is fun, it helps grab my attention and engages me in the topic.  That’s why a recent article published in the American Journal of Pharmaceutical Education got my attention. The investigators created an escape room activity for preceptor development. Escape rooms are a form of amusement where a group of participants works together to actively solve puzzles in order to “escape” confinement from a room. Applying escape room principles to health professions education allows learners to participate in life-like scenarios but in a low-stakes environment. They offer an opportunity to learn and change perspectives based on experience in a practice scenario. While this instructional strategy was initially used to provide instruction to student pharmacists, this study looked at changes in preceptor knowledge following participation in an escape room game.

When structuring this game, the investigator wanted to create an interactive, fast-paced, hands-on preceptor development program.1 The intent of this hands-on experience was for participants to use the school’s preceptor handbook, locate and understand the School of Pharmacy’s mission and vision statement, use the pharmacist's patient care process (PPCP), and problem-solve a patient case. The escape room activity was offered on two separate occasions, one to preceptors at a district meeting of the North Dakota (ND) Pharmacists Association and at the ND annual pharmacy convention. Facilitators created a virtual escape room which consisted of five rooms, each with a puzzle.  The participants were given a total of 45 minutes to escape. To move from one puzzle to the next, the participants had to submit their answers using a Google Form. The Google Form would “unlock” the next puzzle when the correct answer was submitted and this directed them to move on to the next station in the room. Teams also received a PPCP passport to document their progression through the PPCP wheel. If a puzzle was solved incorrectly or the team ran into a roadblock, teams could write a preceptor pearl in exchange for a hint. Teams were instructed to be efficient.  The team that solved all of the puzzles in the shortest amount of time was considered the “winner.” After all of the teams had completed the game, the faculty facilitators debriefed to enforce the core concepts that were encountered during the experience.

To document the impact of the escape room method, the investigators asked participants to complete an electronic survey via Qualtrics immediately before and after the experience.  They collected demographic information about the preceptor’s practice experiences and administered a knowledge-based multiple-choice test about the PPCP and the school’s mission, and asked questions about the preceptor’s perceptions of the game. They analyzed the perception and knowledge questions using a paired t-test to determine if participation in the escape room lead to statistically significant improvements when compared to the baseline responses.

Preceptors (n=15) who participated in the escape room experience had statistically significant increases in their perceived abilities to locate and access the preceptor handbook and to describe and use the PPCP. Before the experience, only nine preceptors could correctly order the 5 steps of the PPCP.  Following the escape room activity, 13 preceptors were able to do so. On the other hand, preceptors were less likely to correctly answer the type of approach the PPCP uses. Of the preceptors participating, ten had previously participated in an escape room and all 15 participants stated they would recommend the experience to another preceptor. Preceptors indicated they were open to the gaming format and their preference for using various resources remained unchanged.1

The methods used to perform and evaluate this study were appropriate. A strength of the study was the diverse group of preceptors (from different practice environments) and it was offered on two different occasions in different locations. The weaknesses of this study included a very small sample size and previous exposure to escape rooms. Some participants felt less inclined to contribute compared to others. This could be due to the size of the team or their attitudes towards other team members. The time constraint and pace of the game could have caused participants to miss information needed to answer the post-game questions. The post-survey was also completed with a limited amount of time; therefore, they could have rushed through and not provided errant responses. Participants who had no experience with escape rooms would likely be less efficient at solving the puzzles and this may have reduced their motivation to participate in gameplay. Based on previous work, the investigators also discovered many preceptors prefer online preceptor development programs over face-to-face programs.2 This led researchers to believe an online escape room may be more appealing and draw in a larger number of participants.

Previous studies have examined the impact of escape rooms on educating student pharmacists.3-5  The previous studies showed mixed effects on learning but participants generally had positive perceptions of the escape room format.3-5 In one study, students performed poorly on the post-assessment test but reported a positive perception of the game.4 Another study found that while the escape room was an effective method for reinforcing course content, knowledge retention was poor.6 Similarly, the participants stated they had positive experiences and believed they would use institution-specific tools more often.

This study demonstrates that an escape room is an interesting and fun way to learn. An escape room might not be the most efficient way to learn and didactic instruction might still be needed.  Moreover, learners might miss some of the key concepts if the activity isn’t reinforced by debriefing afterward with the facilitator. Using game-like scenarios in an escape room provides an opportunity for learners to practice teamwork which is an important skill in health care today. 


  1. Richter LM, Frenzel JE. Design and Assessment of a Preceptor Development Escape Room. Am J Pharm Educ. Published online July 28, 2020: ajpe8073. doi:10.5688/ajpe8073
  2. Davison M, Medina MS, Ray NE. Preceptor preferences for participating in electronic preceptor development. Pharm Pract 2009;7(1):47-53.
  3. Eukel HN, Frenzel JE, Cernusca D. Educational gaming for pharmacy students – design and evaluation of a diabetes- themed escape room. Am J Pharm Educ. 2017;81(7):6265.
  4. Clauson A, Hahn L, Frame T, et al. An innovative escape room activity to assess student readiness for advanced pharmacy practice experiences (APPEs). Curr Pharm Teach Learn. 2019;11(7):723-728.
  5. Kavanaugh R, George S, Lamberton N, Frenzel JE, Cernusca D, Eukel HN. Transferability of a diabetes escape room into an accelerated pharmacy program. Curr Pharm Teach Learn. 2020;12(6):709-715.
  6. Nybo SE, Klepser SA, Klepser M. Design of a disaster preparedness escape room for first and second-year pharmacy students. Curr Pharm Teach Learn. 2020;12(6):716-723.

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