Development and Design of a Pediatric Case-Based Virtual Escape Room on Acute Iron Toxicity

This virtual escape room (VER) serves as a didactic activity tailored for learners specializing in emergency medicine, pediatrics, and family medicine across all postgraduate years. The VER can be undertaken collaboratively in teams or individually, leveraging virtual platforms and adaptable to various educational settings.

Iron tablets appeal to children due to their vibrant color and sugar coating, resembling candy. Nearly 11,000 cases of iron exposure in children under six are reported annually in the US.1 More severe incidents involve prenatal vitamins and iron preparations containing ferrous sulfate, which has a significantly higher concentration of elemental iron per tablet than other formulations.2 Virtual escape rooms (VERs) are an innovative educational tool for teaching about acute iron toxicity. By integrating gamification into medical education, VERs offer a unique approach as participants can join remotely and interact with a team of other learners in geographically distinct locations.

By the end of the activity, learners should be able to:Recognize the history and clinical presentation of acute iron toxicityDemonstrate knowledge of the necessary workup in suspected iron toxicityIdentify the stages of acute iron toxicityIdentify management of iron toxicity and its complicationsPerform appropriate management in the setting of decompensated hemorrhagic shock and hypovolemiaDemonstrate teamwork through communication and collaboration.

The development process encompassed a seven-step approach: creating a scenario, defining learning objectives, and designing a suitable room.3 Clues and puzzles aligned with the specified learning objectives. The VER was hosted on Articulate 360 (Articulate Global Inc.) and complemented by a facilitator guide that provided content and technical support.

To replicate this activity, a team of facilitators should be present to organize the participants into small groups and distribute the VER link. During our implementation, this link was shared in real-time on Zoom Video Communications Inc. (Zoom), leveraging breakout rooms to assign participants to their respective rooms. Additionally, we conducted this in person with faculty and nursing, where participants were divided into groups accordingly. There was a structured format: pre-briefing, a timed escape room scenario, debriefing, and evaluation. Afterward, learners evaluated the VER and educational content with a survey hosted on Google Docs (Google LLC).

A total of 55 respondents completed post-evaluation surveys. Despite limited experience with previous virtual escape rooms, both trainees and faculty agreed the design was easy to follow (78.2%), fostered teamwork (90.9%), and was a feasible method of education (85.5%).

This activity was successfully implemented with trainees, faculty, and nursing professionals, demonstrating the ability of VER to be utilized in a wide variety of applications. We also successfully implemented this format in both in-person and online platforms. Limitations of this include a need for long-term outcome data. Future studies could further assess knowledge improvement and clinical management of acute iron toxicity.

Acute iron toxicity, emergency medicine, escape room, ingestion, gamification, pediatrics, toxicology, virtual escape rooms.