Introduction

Audiology is a multifaceted profession involved in the assessment and management of hearing loss and balance disorders in adults and children (Audiology Australia, 2020). Audiologists work in a range of settings that can include public, private, education, and primary health care. The Northern Territory audiologist community is a small one with less than 30 audiologists in total. To assist with professional development, an annual event is held to provide training and networking opportunities for audiologists from different sectors.

Effective training of adult learners requires training content and training methods to be meaningful and engaging. Traditional training methods for professionals include didactic or lecture style teaching while contemporary training methods can include gamification or elements of game design to place learners into problem solving and decision-making roles. This creates learning challenges and rewards completion of challenges (Guglielman, 2012).

Game-based learning has many advantages including engaging learners and increasing retention of training content (Totara, 2020; Eukel et al, 2017). Rewards and challenges also appeal to highly competitive learners and individuals who enjoy interacting with others. By 2017, commercial and educational escape rooms had been become increasingly popular (Brown et al, 2019; Clarke et al, 2017).

An educational escape room is a time-limited, live-action group endeavor in which participants unravel a series of problems and puzzles (Zhang et al, 2018; Jambhekar et al, 2019). It incorporates problem-based learning and aids in the development of critical-thinking skills (Jambhekar et al, 2019; Jaramillo et al, 2019; Wu and Hein, 2018). Discipline specific educational escape rooms have shown positive learning outcomes for nursing, pharmacy, and medical disciplines (Wu and Hein, 2018).

Methods

NT Audiology CPD Escape Room session (Sooful, P)

Ethics approval for the project was granted by the Human Research Ethics Committee of the Northern Territory Department of Health and Menzies School of Health Research (HREC reference number (2019-3501).

Audiology Australia’s Northern Territory continuing professional development (CPD) event in February 2020 was selected to trial the educational escape room activity as the final session of the day and was endorsed by Audiology Australia for 1.5 CPD points in category 2 “Development through active participation in guided activities—workshops.”

The escape room was designed so that audiologists from different practice/specialty areas would get to know and collaborate with each other, as well as use effective teamwork approaches to solve the questions and “escape.” The purpose of the educational escape room was not to identify all the correct answers but to generate discussions among team members, learn from each other and acquire information about different areas of audiology that participants might not use in daily practice.

A facilitator guide including six worksheets in different areas of audiology including diagnostics, pediatrics, rehabilitation, vestibular, auditory processing, and the Audiology Australia event were used. Questions for each worksheet involved expert knowledge in that specific area of audiology, as well as random audiology trivia questions. Clues were hidden around the room to help with the trivia questions as well as two reference audiology textbooks. Each worksheet had associated “hint cards” if participants required assistance with answering a question. Bonus questions were also included for teams to gain addtional points.

Participants were divided into two teams, and each team had 30 minutes to complete the escape room activity. The aim was to answer the worksheets to find the puzzle pieces that made up the escape room key within the time limit. An online countdown clock was used, so teams could keep of their progress and time. Three lockboxes were placed around the room which contained clues and information for future tasks (see FIGURE 1).

FIGURE 1. Audiology escape room layout
FIGURE 1. Audiology escape room layout

Data Analysis

The Audiology Australia event used an online numerical rating system for the session facilitator and a free text box where participants’ submitted a reflective statement on learnings from the session. Qualitative data from the audiology escape room was synthesised using an inductive, descriptive, thematic-analysis method based on processes described by Braun and Clarke (2006). Sample comments are provided as direct quotes retaining original spelling and grammar.

Results and Discussion

Fifteen audiologists and three non-clinical staff participated in the escape room activity. Participants rated the facilitator as excellent (n=15), very good (n=1), and good (n=2).

Eighteen free-text short-sentence comments were provided. Thematic analysis of the learner reactions indicated that participants found the escape room an enjoyable and engaging way to learn about the subject matter and improve team dynamics (See photos)

“Highlight of the day! I’ll never forget Jonkees formula” – Participant comment.

“Escape room was interactive and a nice way to bring the best in the teams. It covered five areas of Audiology, a good balance between textbook information and practical experience” – Participant comment.

“A very fun exercise which brought out some long dormant knowledge in certain areas!” – Participant comment.

“Very good coverage of different domains within audiology in a very engaging format.”  – Participant comment.

“Fun way to end the day. Great to have to work as a team and be able to make use of the variety of specialities that we brought to the table. Would be very happy to repeat this experience.” – Participant comment.

 

Audiologists and non-clinical staff who participated found the escape room to be decidedly engaging and unique. The audiology-themed, educational escape room supported contemporary adult learning principles and encouraged teamwork and collaboration as well as increased discipline specific knowledge in audiology domains. Further research is required to evaluate longer term impact on use and transfer of training knowledge gained in the escape room to daily clinical practice.

NT Audiology CPD Escape Room session (Sooful, P) ​

Problems, Conflicts, and Constraints

The venue was predetermined by the host organizer, and although the main training room was ideal, the second group used a smaller space outside the training room. There were no conflicts observed within the groups.

Lessons Learned

Although the escape room activity was implemented as planned with no major issues, for future events, stricter rules around mobile-phone use for answers will be put into place as well as having a more structured group debrief after escape room to fully explore how participants from each group tackled the tasks and communicated as team.

Each group requires its own facilitator to keep the groups on track and requires rooms of a similar size. Having a facilitator proved to be useful; however, post event, this guide was updated to include additional information, instructions for facilitators and structured debrief questions.

This escape room was trialled pre-COVID-19 physical distancing restrictions. The facilitator guide has been further updated to include suggestions on how to run this type of activity with post-COVID-19 considerations (i.e., sanitised lockboxes, physical distancing, temperature checks, etc.).

Conclusion

The educational escape room in this case study was shown to be a successful contemporary method to training health professionals in discipline-specific knowledge as well as facilitating teamwork and group communications. This case study supports and adds to the previous literature in this area by providing additional learnings to support effective escape room implementation. By placing learners in decision-making and problem-solving roles that reward effective communication, escape rooms can be used to as valuable teambuilding and training activities.


Disclaimer

This project received no funding.


References

Audiology Australia. 2020. https://audiology.asn.au/Audiology_and_You/About_Audiologists.

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Guglielman E. (2012) The aging brain: meuroplasticity and lifelong learning. eLearning Papers 29:1–7.

Totara. Gamification Guide. (2020) www.totaralearning.com/resources/how-use-gamification-improve-learner-engagement.

Eukel H N, Frenzel J E, Cernusca D. (2017) Educational gaming for pharmacy students: Design and evaluation of a diabetes-themed escape room. Am J of Pharm Educ 81(7):1–5.

Brown N, Darby W, Coronel H. (2019) An escape room as a simulation teaching strategy. Clin Simul Nurs 30:1–6.

Clarke S, Peel D J, Arnab S, Morini, L, Keegan H, Wood O. (2017) escapED: A framework for creating educational escape rooms and interactive games for higher/further education. Intl J Ser Games 4(3):73–85.

Zhang XC, Lee H, Rodriguez C, Rudner J, Chan TM, Papanagnou D. (2018) Trapped as a Group, Escape as a Team: Applying Gamification to incorporate team-building skills through an “escape room” experience. Cureus 10(3):e2256.

Jambhekar K, Pahls RP, Deloney LA. (2019) Benefits of an Escape Room as a Novel Educational Activity for Radiology Residents. Academic Radiology.

Jaramillo Rincon SX, Trujillo Mejia A. (2019) The learning behind the escape room. Med Teach 1.

Wu C, Wagenschutz H, Hein J. (2018) Promoting leadership and teamwork development through Escape Rooms. Med Ed 52(5):561–562.

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