VCU geriatrics-themed escape room trains health sciences students

By Liz DeFluri

A grocery list. A buckled carpet. Locked trunks. What in the "apartment" could shed light on the life of "Harold Parker," an 81-year-old who was recently discharged from the hospital after suffering a fall?

Though the setting and the man were invented, the lessons for Virginia Commonwealth University health sciences students are grounded in reality. Working in teams during a recent session of the Summer Academy for Geriatrics Exposure, they raced against the clock in an escape room - an interactive learning activity focused on geriatric care. They assessed objects in Harold's apartment, clues related to memory, medications and ability to age in place.

"We've seen that the gamification of the escape room really enhanced interactivity between team members and has made the room feel more like you're actually in a home visit for an older adult," said Kristin Zimmerman, Pharm.D., an associate professor of pharmacotherapy and outcomes science in VCU's School of Pharmacy.

This summer, Zimmerman and department colleague Sarah Wheeler, Pharm.D., received funding from the Virginia Center on Aging to host the second run of their geriatrics-themed escape room.

With this funding, they transformed the simulation by partnering with experts in escape room design and healthcare simulation to create a more immersive and realistic experience. Enhancements included redesigning clinic tasks using escape room mechanics and puzzles, improving the realism of the home environment through authentic props and set design and increasing the integration of patient assessment activities, all to better mirror interprofessional geriatric care.

Set up in VCU's School of Nursing, the escape room mimics a home visit after a patient has been discharged from the hospital for a fall, which is one of the greatest health risks facing older adults. Each puzzle follows the Geriatric 5Ms, a clinical framework that addresses the patient's mind, mobility, medications, multicomplexity (of health conditions and life situations) and what matters most to them. The room also features profession-specific tasks for students studying medicine, pharmacy, nursing, social work, physical therapy and occupational therapy.

"For example, as a pharmacy student, you might be the most well-suited person to do medication reconciliation, but when selecting function and support tools, maybe a physical or occupational therapy student might be best," Zimmerman said. "We're reinforcing the content that they learn through didactics and showcasing the different professions' expertise."

In addition to clinical tasks, the escape room included empathy-building exercises for students to better understand the patient's perspective and lived experiences.

"One of our puzzles simulates what it would be like for somebody with a hearing impairment to try to listen to a cognitive test so [participants] get to hear what the patient hears," Wheeler said.

Based on feedback from last year's session, Zimmerman and Wheeler's improvements to the escape room taught students to really get to know their patients as people and make care decisions relevant to the patient's preferences, goals and priorities.

"Once they left the room, they knew exactly who Harold was. They knew what he liked to do and how he interacted with his family and healthcare providers."

One participant, second-year pharmacy student Luke Ashman, already understood the importance of interacting with patients on a personal level. During the COVID-19 pandemic, he worked at a retirement home.

"I got exposed to this whole shift in environment, and it was shocking to me how much help this population needs and how vulnerable they can be," Ashman said. "That's why I'm here today to lend my skillset to a population that needs it."

Each team had one hour to complete the escape room and 15 minutes to prepare a final Situation-Background-Assessment-Recommendation handoff to communicate their findings and provide the best possible care to Harold.

While the geriatric escape room is currently a VCU-specific initiative, it is designed to work at other universities and institutions, Zimmerman said.

"We plan to take these novel teaching and team-building techniques to other settings to make sure healthcare isn't something that we do to patients, but something that we do with patients," Zimmerman said.