Escape rooms, which can be facilitated naturally through simulation, authentically support adult learning. Generalizations can then be applied to new situations, as the learning cycle repeats. 10 By actively participating in an escape room, the participant is engaged in a concrete experience and then has the opportunity to reflect on that experience in the form of debriefing, which assists in forming a generalization of the experience. 9 These stages of the learning cycle can be further simplified into the stages of feeling, watching, thinking, and doing, respectively. Kolb breaks down experiential learning into four discrete stages: concrete experience, observations and reflections, formalization/generalizations of concepts, and testing concepts in new situations. Adults are experiential learners and learn from active participation in, and reflection on, a specific activity or experience. Participatory learning experiences such as the escape room 8 engage adults both cognitively and affectively. Escape rooms are live-action, team-based games where players must work together, solve clues, and complete a series of mind-bending, fitness-challenging tasks to escape the room in less than 60 minutes. The decision to use the escape room as the educational medium for this initiative was rooted in adult learning theory. We hypothesized that creating a patient safety escape room simulation would allow us to address the aforementioned learning objectives more effectively than a simple didactic through the incorporation of active learning and gamification. To engage incoming PGY 1 trainees during orientation to our local safety priorities and the use of our voluntary reporting system, we created a version of a simulated escape room. 6 On a more local front, a survey of house staff at Thomas Jefferson University Hospital identified a lack of comfort with how to report an error and what to actually report as significant barriers to reporting, especially for learners in their first year of graduate training. The Accreditation Council for Graduate Medical Education clinical learning environment report found that few resident trainees appreciated the benefits of this practice. 4, 5 Unfortunately, resident and fellow physicians rarely submit incident reports. 1– 3 If effectively engaged, learners can provide critical information to better identify the drivers of patient harm. Students and residents are on the front lines of care, which demands training in pertinent safety practices including how to use voluntary error-reporting systems. Teaching patient safety and error reporting to graduate medical education audiences is challenging.
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