Gameful Experience and Perceived Educational Value in a Student-Designed Medical Escape Room for Preclinical Medical Education: Cross-Sectional Study.

Abstract

Background: Educational escape rooms are increasingly used in medical education to promote engagement, collaboration, and active problem-solving. However, existing literature varies considerably in theoretical grounding and evaluation methodology, and limited evidence exists regarding how specific dimensions of gameful experience may relate to learners' perceived educational value.

Objective: This study aimed to evaluate preclinical medical students' perceptions of a student-designed medical escape room and to examine associations between dimensions of gameful experience and perceived educational value.

Methods: A cross-sectional study was conducted during the 2023-2024 and 2024-2025 academic years among 144 preclinical medical students participating in a student-designed educational escape room. The intervention integrated foundational medical sciences, collaborative problem-solving, and simulation-based procedural tasks. Participants completed anonymous questionnaires after the activity. Perceived educational value was assessed using the Diabetes Escape Room Perception Scale (DERPS), while gameful experience was measured using the Gameful Experience Scale (GAMEX). Descriptive statistics, reliability analyses, principal component analysis with Varimax rotation, Spearman correlation analyses, one-sample Wilcoxon signed-rank tests, and multiple linear regression models were performed using IBM SPSS Statistics version 29. Statistical significance was set at an α level of .05.

Results: Of the 144 participants, 140 (97.2%) completed all questionnaires. The sample was 52.1% (73/140) female, with a mean age of 20.8 (SD 1.5) years. Participants reported favorable perceptions of the escape room, with DERPS scores exceeding the neutral midpoint (mean 4.00, SD 0.50; t₁₃₉=35.50; P<.001). The GAMEX showed high internal consistency (Cronbach α=0.89), and factor analysis supported the original 6-factor structure. Enjoyment (mean 4.75, SD 0.41), Creative Thinking (mean 4.33, SD 0.56), Activation (mean 3.99, SD 0.63), Absorption (mean 3.70, SD 0.76), and Dominance (mean 3.48, SD 0.81) were above the scale midpoint (all P<.001). Scores on the Absence of Negative Affect dimension (mean 2.11, SD 1.12; P<.001) were below the midpoint, indicating that participants reported some degree of challenge-related negative emotions during the activity. Spearman correlation analyses demonstrated positive associations between DERPS scores and Enjoyment (ρ=0.534; P<.001), Creative Thinking (ρ=0.467; P<.001), and Absorption (ρ=0.319; P<.001). In multivariable regression analyses, Enjoyment was associated with both overall perception scores (β=0.385; P<.001; R²=.442) and educational efficacy scores (β=0.279; P=.004; R²=.350). Dominance was related to educational efficacy scores (β=0.194; P=.04).

Conclusions: This study extends existing research on educational escape rooms by combining a relatively large preclinical medical student sample with validated measures of learner perception and gameful experience. Unlike previous studies that primarily assessed satisfaction, the present study identified specific experiential dimensions-enjoyment and dominance-associated with perceived educational value. These findings contribute to a theory-informed understanding of game-based learning in medical education and provide practical guidance for designing immersive, learner-centered activities. These findings support the use of student-designed, digitally enriched escape rooms as engaging educational activities in preclinical medical education.