Gamified Simulation in Medical Education: Do Escape Room–Based Interventions Improve Clinical Decision-Making UnderTime Pressure and Cognitive Load? A Systematic Review
DOI:
https://doi.org/10.47363/ys3xne24Keywords:
Gamification, Simulation Based Education, Escape Room, Medical Education, Clinical Decision, Making, Cognitive Load, Experiential LearningAbstract
Background: Escape room–based simulation has emerged as an innovative approach in medical education, integrating gamification, time pressure, and collaborative problem-solving. While its effects on engagement and teamwork are increasingly recognized, its influence on clinical decision-making under cognitive load remains unclear.
Objective: To systematically evaluate the impact of escape room–based simulation on clinical decision-making, cognitive load, and educational outcomes in medical training.
Methods: A systematic review was conducted in accordance with PRISMA guidelines. Multiple databases were searched for studies published between 2018 and 2025 examining escape room–based interventions in medical education. Eligible studies included undergraduate and postgraduate learners. Due to heterogeneity in study designs and outcome measures, a structured narrative synthesis was performed. Outcomes were categorized into cognitive, affective, and behavioral domains.
Results: Twenty-six studies met inclusion criteria. Escape room–based learning was consistently associated with high levels of engagement, motivation, and learner satisfaction. Improvements in teamwork, communication, and collaborative problem-solving were frequently reported. Gains in knowledge acquisition were observed across several disciplines; however, direct assessment of clinical reasoning and decision-making under pressure was limited. Few studies evaluated cognitive load using validated measures, and most relied on descriptive or quasi-experimental designs.
Conclusions: Escape room–based simulation represents a promising educational strategy that enhances engagement and team-based competencies. However, its impact on higher-order cognitive processes, particularly decision-making under pressure and cognitive load, remains insufficiently defined. Future research should prioritize rigorous study designs and the integration of objective, theory-informed assessment tools to better elucidate its role in medical training.
