Escape Boxes: A Serious Game for Teaching Nontechnical Skills Pertinent to Crisis Management

Escape games offer an innovative approach to teaching nontechnical skills essential for managing critical events. The primary aim of this study was to assess how an analog escape box activity affected anesthesiology residents' self-efficacy with 2 nontechnical skills: establishing role clarity and using closed loop communication.

In June 2024 and June 2025, a total of 38 anesthesia interns competed in teams of 4-5 to solve 5 riddles to open a locked box and take a team photo with an education program coordinator. Residents completed pretest/posttest surveys assessing their self-efficacy with establishing role clarity and using closed-loop communication and their satisfaction and perceived workload (mental/physical/temporal demand, performance workload, effort, and frustration). Changes in self-efficacy were analyzed using Wilcoxon signed-rank tests, descriptive statistics were calculated for perceived workload and satisfaction, and comments were analyzed with thematic analysis. The total cost of supplies was $325.56 for 4 escape boxes.

Thirty (79%) of 38 residents completed surveys. Resident self-efficacy for establishing role clarity and using closed-loop communication both increased significantly (p < .001). On a 7-point scale of perceived workload, median mental demand (4.5), temporal demand (4.5), and effort (4) were moderate, whereas physical demand (3), performance workload (2), and frustration (1.5) were low. Mean satisfaction was 3.8 out of 5. Thematic analysis of resident comments revealed teamwork and engagement as key themes.

This study serves as a proof of concept that escape boxes are well-received and can improve residents' self-efficacy in establishing role clarity and using closed-loop communication.