# Enhancing Knowledge Retention in Medical Education Through Escape Box Games

## TL;DR

This study explores how escape box games can improve medical students' engagement and confidence in pre-clinical topics like dialysis access.

## Contribution

The novel use of escape box games in medical education is evaluated for its impact on student engagement and knowledge retention.

## Key findings

- Students found escape box games more stimulating and interesting than traditional lectures.
- Escape box participants showed a statistically significant increase in confidence regarding dialysis access.
- No correlation was found between personality traits and confidence gains from the escape box game.

## 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.