Escaping the Professional Silo: Implementing An Interprofessional Escape Room

Guest Post:  Hilary Teaford, PharmD Candidate

THE NEED FOR COLLECTIVE COMPETENCE
Imagine an environment with the following characteristics: a time-constraint,  several activities happening at once, multiple people playing important roles, the need for clear communication, several points of uncertainty in reaching an overall goal.   Sounds like healthcare, right? A hospital or clinic certainly fits the bill with the fast-paced, complex environment that requires not only individual professional expertise but also strong communication, problem solving ability and efficiency amongst the entire group.  Many problems in healthcare result not from lack of individual competence, but lack of collective competence  (Lingard 2016).  Nonetheless,  health-care education primarily focuses on training and assessing individuals (Lingard 2016).  To this end, the  University of Minnesota’s Interprofessional Education (IPE)  Program, 1Health, sought to address this educational gap and work to build collective competence  by adapting a current fad sweeping the country – the escape room.

ESCAPE ROOMS AS AN INNOVATIVE EDUCATIONAL TOOL
Today, some 1,950 escape room companies in the United States  (Spira 2017) offer challenge-seekers the thrilling experience of “escaping” by solving timed, 3D puzzles.  Commercial escape rooms generally have themes inspired from pop-culture or history, but multiple institutions have successfully adapted escape rooms for health professional education. Examples include a diabetes-themed room for pharmacy students and a vascular surgery-themed room for medical students, both which facilitate learning of specific clinical skills ( Eukel, 2017; Kinio, 2017). While similar in nature, our escape rooms, which are the first reported in the IPE sphere, place focus on teamwork, communication and conflict resolution.  

DEVELOPMENT OF THE INTERPROFESSIONAL ESCAPE ROOMS
The 1Health escape room development team has created two escape rooms: one for early learners to promote communication and teamwork,  and the other for more advanced learners to also integrate their profession-specific knowledge.  A nursing student colleague, Ally Taubenheim, and I spearheaded the creation of the puzzles, some inspired by real escape rooms that we attended. A nursing faculty, Dr. Cheri Friedrich,  supported us and coordinated the integration of the experience into the curriculum after we conducted several pilots to refine the puzzles. A medical faculty, Dr. Brian Sick, also contributed significantly to our scholarly activities and a medical student at the time who has now moved on to residency, Patrick Boland, played roles in the design and manuscript-writing phases of the beginning escape room.

1HEALTH BEGINNING AND ADVANCED ESCAPE ROOMS AT A GLANCE

Beginning Escape Room Advanced Escape Room
Audience Early learners without significant clinical or practice experience Advanced learners in their last years of their professional programs
Objectives 1) Practice efficient teamwork and communication skills needed to provide patient-centered care communication skills

2) Understand how and when to consult with other healthcare professionals based upon roles and responsibilities

3) Understand how to include the patient and patient’s family in determining next steps and developing a care plan

1) Address team conflict in a respectful manner and identify strategies to be used when conflict arises

2) Apply concepts of care coordination

3) Understand the strengths of the various roles of health professionals

4) Identify ways in which team care can lead to improved outcomes for patients

5) Express ideas and concerns in a clear, concise manner

6) Express ideas and concerns without being judgmental

Story-Line A 85 year old patient who develops chest pain at the dental office now presents at the Emergency Room with a suspected myocardial infarction. The students must ultimately find the key to lock up his belongings as he goes to a procedure. A 55 year old male with a past medical history of bipolar disorder and type I diabetes presents to the emergency room with diabetic ketoacidosis, triggered by a recent manic episode.  The students must solve the puzzles to ultimately create his discharge plan.
Timeline
  • Students arrive and receive introduction (10 minutes)
  • Students split into groups of 8-10 and complete the room (45 minutes for beginning and 60 minutes for advanced).   3-4 identical rooms are offered at once.
  • Students come back together for a facilitated debrief  (20 minutes)
Example Props Black light, medical reference books, test tubes, puzzle pieces, Rubik’s cube, sudoku puzzles, locking drawers, locking pouches Batteries, musical buttons, black light, whiteboard with magnets, glucometer, human anatomy poster, plastic balls, patient videos, students’ smartphones
Example Puzzle Students have have a  hospital directory from a previous puzzle.  The  last names of  theses clinicians are authors of well known reference books (i.e. Pharmacist Koda-Kimble)  A “care plan”  provided to the students instructs them to “page” a variety of different professionals on the care team.
The students must discover that the people they need to “page” match up with reference books they can find in the room and the “pager” numbers on the wall represent the page they must flip to in each book.
The text on the pages is written in invisible marker. A  black-light must be acquired through a different puzzle for the students to see the text written on the pages, which is a clue to the next puzzle (where they obtain  the patient’s medications).  
In the room, a magnetic whiteboard with several food pictures and number stickers on it sits next to the patient’s dietary recall from the dietician.
The students are instructed on a clue sheet to determine the carbohydrate content in the foods on the recall and place magnets attached to string on the different food pictures on the board, in order from highest to lowest number carbohydrates.
Next, the clue sheet tells them to calculate the amount of insulin needed to cover the foods he ate and place a second set of magnets on the number stickers on the whiteboard
Once placing the magnets correctly, the patient’s A1C emerges from the string on the board.  The students use the A1C in a future puzzle to determine the discharge insulin regimen for the patient.

CHALLENGES & LESSONS LEARNED
While students in the advanced escape room reported that depending on each others specific knowledge added to the sense of team accomplishment, ensuring that all students could use profession-specific knowledge proved challenging. The medical, nursing and pharmacy backgrounds of the designers led to puzzles focused on these professions.  Even though the beginning room did not require profession-specific knowledge, students who could “see” themselves in the emergency room environment generally had more positive feedback. Thus, to further engage occupational therapy, social work and dental hygiene students, we obtained ideas from students and faculty in these areas for both creation of the advanced room and revision of the beginning. In other words, creating an interprofessional escape room certainly requires an interprofessional team of designers!

NEXT STEPS
We are  currently in the process of publishing our findings from the beginning escape room and look towards publishing the results of the advanced one. In the upcoming months, we plan to start the process of  publishing specific details about every puzzle, a facilitator’s guide, and a supplies list on MedEdPORTAL to provide open access for other sites to replicate the experience at their institutions.

Contacts: The development team currently includes  Nursing faculty Dr.Cheri Friedrich, Medical faculty Dr.Brian Sick,  Hilary Teaford (4th year pharmacy student: teafo001@umn.edu) and Ally Taubenheim (4th year nursing student: taube032@umn.edu).

 

IMG_5295Engaged students working on puzzles in the advanced 1Health Escape Room


References

Eukel, Heidi N., Jeanne E. Frenzel, & Dan Cernusca.(2017). Educational Gaming for Pharmacy Students-Design and Evaluation of a Diabetes Themed Escape Room.  American journal of pharmaceutical education, 81(7). doi: 10.5688/ajpe8176265

Kinio, A., Dufresne, L., Brandys, T., & Jetty, P. (2017). Break Out of the Classroom: The Use of Escape Rooms as an Alternative Learning Strategy for Surgical Education. Journal of Vascular Surgery, 66(3). doi:10.1016/j.jvs.2017.07.034

Lingard, L. (2016). Paradoxical Truths and Persistent Myths. Journal of Continuing Education in the Health Professions, 36. doi:10.1097/ceh.0000000000000078

Spira, L. (2017, August 01). Three Years of Room Escapes: The Growth of the US Market. Retrieved November 21, 2017, from https://roomescapeartist.com/2017/07/30/three-years-of-room-escapes-the-growth-of-the-us-market/

 

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