Escape Intern Orientation! - A Capstone and Team Building Activity for New EM Interns

This activity is designed as a team building capstone exercise for new interns to review important content from intern orientation at an emergency medicine residency program.

Medical students matriculate into residency with various backgrounds, medical knowledge base, and personalities. As they orient themselves into their respective specialties, interns are commonly taught using lectures and slide decks with varied and unclear effectiveness.1,2 It has been recommended that intern orientation should incorporate active learning, such as simulation as well as a collaborative environment to bolster retention and encourage teamwork.1,3 Escape rooms are becoming increasingly popular in medical education as an adjunct to traditional lecture-based learning that encourages collaboration amongst learners.4 We embraced this modality to create a capstone and teambuilding experience for our new interns that was delivered at the completion of our intern orientation activities. Topics taught in our intern orientation include resuscitation of the critically ill patient, airway management, acute coronary syndromes, EKG reading, basic ultrasound, stroke care, and foundational pediatric topics. In this activity, an escape room is used to recall and apply topics learned during the emergency medicine intern orientation, while also promoting teamwork and camaraderie amongst a new intern cohort.

By the end of this small group exercise, learners will be able to:Identify first, second, and third-degree heart block on a 12-lead ECG.Recognize STEMI pattern on a 12-lead ECG.Categorize appropriate images that make up an EFAST exam for a trauma patient.Recall the proper management of a tension pneumothorax.Identify an organized approach to emergency department rapid-sequence intubation (RSI).Recognize acute otitis media (AOM).Locate the appropriate antibiotic and pediatric dose to treat acute otitis media via the Harriet Lane Handbook.Demonstrate how to apply evidence-based guidelines to a clinical case of neonatal pediatric fever.Recall common clinical findings of basilar skull fracture.Identify important concepts in the management of stroke syndromes.Recognize vital sign abnormalities that could indicate sepsis.Review important concepts related to the management of septic patients.

The use of game-based learning or gamification has become increasingly popular within medical education as a form of active learning.5 There is a growing body of literature among health care professionals highlighting improvement in participants' skills and learning through games as well as the ability of this method in encouraging peer education and socialization.6-8 Escape rooms are a form of game-based learning employing various puzzles and settings specifically designed to meet educational objectives in an active learning environment.9 Recently, literature has shown that escape rooms can be an instrument to foster relationships amongst co-workers in addition to facilitating improved learning outcomes via active learning.10We developed an escape room to review and solidify important content from our intern orientation as well as to encourage teamwork and camaraderie on the last day of orientation. The intern class was divided into three teams, each with four participants. Each team selected their own team name and were informed during a pre-briefing that they would only be able to escape intern orientation by completing all six stations. A facilitator at each station timed the teams. The team with the fastest time was deemed the winner which was announced after a short debrief of the activity.

All interns who participated in the escape room completed an anonymous online survey after the activity. The survey was designed to solicit feedback on the effectiveness of the activity in reviewing material taught during orientation as well as overall satisfaction with the escape room experience measured as a recommendation to continue the activity in the future.

All twelve (100%) interns that attended the escape room completed the post participation survey. Ninety-two percent (11/12 interns) thought the activity was moderately to extremely effective in reviewing the content delivered during intern orientation and 100% (12/12 interns) recommended we continue the escape intern orientation activity for future classes. Representative free response comments soliciting general feedback on the activity included "Great event, do it again. Very interactive and fun." As well as "Great activity to tie in all that we learned this month. Very creative and clever! Also, a great team building opportunity as well."

Intern orientation is a necessary, high-yield time for new doctors to learn foundational specialty and hospital specific topics.11 As educators are being challenged to move away from traditional classroom lecturing, gamification has emerged within medical education as an active learning tool to increase engagement, promote team building, provide immediate feedback, and make content more interesting.12 Escape rooms fall within a constructivist theory of learning because participants are challenged to incorporate existing knowledge to draw conclusions, ultimately unlocking their "escape."13Further, intern orientation is also a time of social gathering and team building. Because camaraderie is connected to wellbeing, it is highly valued in emergency medicine residencies.14 When interns matriculate into their residencies, social interactions are encouraged among the group. In our escape room activity, gamification is used to enhance social interaction in a way that encourages relationship building and teamwork. This is important as cohesiveness amongst the resident group is a key factor for their success in residency.15.

Intern, emergency medicine, heart blocks, extended focused assessment with sonography in trauma (EFAST), rapid sequence intubation, pediatric fever, stroke, sepsis.