March 8, 2021By Timothy C. Clapper, PhD

Escape Rooms: Active Learning Resources for Passive Gaming

Escape rooms are a great way for healthcare simulation teams to work together to practice quickly solving problems under pressure and time constraints — all while simultaneously having fun. In the article below, “A Prescription for Passive Gaming: A Healthy Dose of Escape Rooms,” author Timothy C. Clapper, PhD, discusses how escape rooms can be used as a learning tool to organize a strategic response which can later translate to the efficient and effective facilitation of clinical interventions. Clapper, who is the former editor of the Simulation & Gaming (S&G), also shares a number of escape room simulation resources which clinical simulation educators may add to their current academic initiatives.

For more than five decades, Simulation & Gaming (S&G), an interdisciplinary journal of theory, practice and research, has served as a leading international forum for the exploration and development of simulation/gaming methodologies. The journal has explored the uses of simulation and gaming across education, training, consultation and research. Simulation & Gaming is published bi-monthly and seeks to appraise both academic and applied issues.

Simulation & Gaming relates to escape rooms because an escape game is essentially a fun “game” through which players can cooperatively discover clues, solve puzzles and accomplish tasks in one or more rooms. By accomplishing these tasks, the players can progress to further achieve a specific goal in a limited amount of time. To “win the game,” the goal is often for the players involved to escape from the site of the room. For this reason, escape rooms can be considered a game-based, immersive learning solution.

Sponsored Content:

In 2019, as editor at the time, I asked Dr. Desiree A. Díaz to become an associate editor for Simulation & Gaming (S&G). Once on board the editorial team, she reached out to me with a novel idea for a special symposium. She mentioned that the topic of escape rooms was a hot one at a recent International Meeting on Simulation in Healthcare (IMSH) conference and that the healthcare simulation community was in need of a way for facilitators to share their ideas and solutions for using this learning tool.

When we think about games or gaming in general, a common mental model may involve us envisioning people sitting around a table, passively looking down on a board, often topped with game pieces, strategizing about how to advance along some path from start to finish points. We may also picture a setting with what seems like infinite amounts of time for decision-making and navigation through the game.

Unfortunately, this image of gaming may not accurately portray the way that events unfold in real life. So, if we are attempting to simulate the decision-making and knowledge-to-application process, we must provide conditions, including creating some sense of urgency that more closely mirrors (even if at times vastly accelerated) what team members experience in real-world events in their professions.

I participated in an escape room in downtown New York City a few years ago with our entire simulation team in a commercial business not involving healthcare whatsoever. Handcuffed together and separated by gender in two locked rooms, we had to work together, using our existing knowledge and experiences to look for clues that would allow us to escape from the handcuffs, our initial staging rooms, and ultimately the larger space, within a set time limit.

Sponsored Content:

I intentionally italicized the phrase in the previous sentence because here lies the purpose of escape rooms as it applies to our learning objectives. This goal makes this learning strategy appropriate across professions and specializations. Using escape rooms, we can provide participants with an opportunity to demonstrate what they know and what they can do.

Options for escape room activities are endless. Participants can use their knowledge to find a clue or cue to the next part of the process in the escape, but this can also require that procedures or skills be applied as well. For example, teams may be faced with managing a maternal cardiac arrest or code. If they identify the current cardiac rhythm and intervene appropriately, they may see a return of circulation and the patient may murmur the next clue. Improving maternal hemodynamics and relieving aortocaval compression may be facilitated by delivery of the baby.

Affixed to the baby may be a clue in the escape. Likewise, the environmental scan by team members may result in recognizing that the patient is on a magnesium sulfate drip. If they suspect magnesium toxicity and stop the drip, they may order calcium gluconate or calcium chloride to be provided. At that time, the next clue could be affixed to the backside of the medication vial or bristojet that they reach for in the code cart.

Last year, Kim Baily (2020) shared an article about several resources available for incorporating escape rooms as a learning strategy. That article provided a wealth of information for simulationists to get started. In addition, when Jared Kutzin and his team (Kutzin et al., 2020) offered a session on escape rooms for the 2020 International Telesimulation in Healthcare Conference, his peer-reviewed workshop quickly reached the cap on the number of registrants, attesting to the popularity of this topic and his reputation for facilitating dynamic and innovative workshops. The simulation community is thirsty for ways to engage their learners in active, fun and valuable simulation and gaming opportunities.

The symposium on escape rooms in Simulation & Gaming (Feb 2021) provides additional resources, including blueprints, ideas and templates that also include some pilot research (Díaz, & Clapper, 2021) on the value of this learning tool. Among this collection of articles, Anderson et al. (2020) provide an important scoping review of the literature leading to an expanded definition of escape rooms for the healthcare simulation community. Added to the resources shared a year ago by Baily, and thanks to Dr. Díaz’s vision and leadership in leading the S&G symposium, simulationists now have even more medication to cure the common simulation or game.”


  • Anderson, M., Lioce, L., M. Robertson, J., O. Lopreiato, J., & A. Díaz, D. (2021). Toward Defining Healthcare Simulation Escape Rooms. Simulation & Gaming, 52(1), 7–17.
  • Baily, K. (2020, January 7). Escape rooms in medical simulation: Downloadable sepsis scenario & more. Healthy Simulation.
  • Díaz, D. A., & Clapper, T. C. (2021). Escape Rooms: A Novel Strategy Whose Time has Come. Simulation & Gaming, 52(1), 3–6.
  • Kutzin, J., Strother, C. G., & Sanders, J. E. (2020). Virtual Escape Rooms to Build Teamwork and Enhance Communication. Conference workshop at the 2020 International Telesimulation in Healthcare Conference: NYC.

Learn More About Serious Games

Today’s article was guest authored by Timothy C. Clapper, PhD.

Have a story to share with the global healthcare simulation community? Submit your simulation news and resources here!

Sponsored Content: