Escape rooms as formative knowledge assessment: A quasi-experimental study

Background: Escape rooms offer an immersive approach to nursing education, serving as versatile tools for assessment and skill development. While research has explored their potential as alternatives to traditional assessments, their role as formative assessment and impact on knowledge retention in nursing education remain largely unexplored, prompting the need for further investigation.

Aim: The study aims to explore the impact of escape rooms as formative assessment on first-year nursing students' knowledge retention.

Design: We employed a quasi-experimental research design.

Settings: Four escape rooms themed around medication, patient safety, low blood sugar, and sepsis were physically set up in a public university located in the southeast U.S. Student teams of two or three went through each room for an alternative formative assessment.

Participants: 134 first-year nursing students, in clinical groups, were randomly assigned into an experimental condition and a control condition.

Methods: A gameful experience questionnaire developed by Högberg et al. (2019) was adapted, comprising 47 items across six categories. Additionally, a test consisting of seventeen multiple-choice questions was administered online for pre-test, post-test, and retention test. Students' perceptions of their learning experiences were also gathered through an open-ended question, with themes identified from their responses.

Results: The paired t-test on GamefulQuest scores revealed a significant difference between escape rooms and traditional assessment methods, with the experimental group showing notably higher levels of accomplishment, guidance, immersion, playfulness, and social experience. No statistically significant difference was found between the two groups on knowledge retention. Student feedback on escape room experiences highlighted entertainment, educational value, collaboration dynamics, and logistical considerations, underscoring the multifaceted nature of these immersive learning environments.

Conclusions: Escape rooms promoted students' positive perception of learning experience, but showed no significant advantage over traditional assessment methods in terms of retention, aligning with existing literature on problem-based learning (PBL).