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{ "pk": 52192, "title": "Development and Design of a Pediatric Case-Based Virtual Escape Room on Acute Iron Toxicity", "subtitle": null, "abstract": "<p class=\"MsoNormal\" style='margin: 0in; font-size: medium; font-family: \"Times New Roman\", serif; border: medium; color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-line: none; text-decoration-style: solid; text-align: justify; vertical-align: baseline;'><strong><span style=\"font-family: Calibri, sans-serif; color: black;\">Audience:<span class=\"Apple-converted-space\"> </span></span></strong><span style=\"font-family: Calibri, sans-serif;\">This virtual escape room (VER) serves as a didactic activity tailored for learners specializing in emergency medicine, pediatrics, and family medicine across all postgraduate years. The VER can be undertaken collaboratively in teams or individually, leveraging virtual platforms and adaptable to various educational settings.</span></p>\n<p class=\"MsoNormal\" style='margin: 0in; font-size: medium; font-family: \"Times New Roman\", serif; border: medium; color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-line: none; text-decoration-style: solid; text-align: justify; vertical-align: baseline;'><strong><span style=\"color: black;\"> </span></strong></p>\n<p class=\"MsoNormal\" style='margin: 0in; font-size: medium; font-family: \"Times New Roman\", serif; border: medium; color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-line: none; text-decoration-style: solid; text-align: justify; vertical-align: baseline;'><strong><span style=\"font-family: Calibri, sans-serif; color: black;\">Introduction:</span></strong><span style=\"font-family: Calibri, sans-serif; color: black;\"><span class=\"Apple-converted-space\"> </span></span><span style=\"font-family: Calibri, sans-serif;\">Iron tablets appeal to children due to their vibrant color and sugar coating, resembling candy. Nearly 11,000 cases of iron exposure in children under six are reported annually in the US.</span><sup><span style=\"font-family: Calibri, sans-serif;\">1</span></sup><span style=\"font-family: Calibri, sans-serif;\"><span class=\"Apple-converted-space\"> </span>More severe incidents involve prenatal vitamins and iron preparations containing ferrous sulfate, which has a significantly higher concentration of elemental iron per tablet than other formulations.</span><sup><span style=\"font-family: Calibri, sans-serif;\">2</span></sup><span style=\"font-family: Calibri, sans-serif;\"><span class=\"Apple-converted-space\"> </span>Virtual escape rooms (VERs) are an innovative educational tool for teaching about acute iron toxicity. By integrating gamification into medical education, VERs offer a unique approach as<span style=\"color: black;\">participants can join remotely and interact with a team of other learners in geographically distinct locations.</span></span></p>\n<p class=\"MsoNormal\" style='margin: 0in; font-size: medium; font-family: \"Times New Roman\", serif; border: medium; color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-line: none; text-decoration-style: solid; text-align: justify; vertical-align: baseline;'><strong><span style=\"color: black;\"> </span></strong></p>\n<p class=\"MsoNormal\" style='margin: 0in; font-size: medium; font-family: \"Times New Roman\", serif; border: medium; color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-line: none; text-decoration-style: solid; text-align: justify; vertical-align: baseline;'><strong><span style=\"font-family: Calibri, sans-serif; color: black;\">Educational Objectives</span></strong><span style=\"font-family: Calibri, sans-serif; color: black;\">:</span></p>\n<p class=\"MsoNormal\" style='margin: 0in; font-size: medium; font-family: \"Times New Roman\", serif; border: medium; color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-line: none; text-decoration-style: solid; text-align: justify; vertical-align: baseline;'><span style=\"font-family: Calibri, sans-serif; color: black;\">By the end of the activity, learners should be able to: 1) r</span><span style=\"font-family: Calibri, sans-serif; color: black;\">ecognize the history </span><span style=\"font-family: Calibri, sans-serif;\">and <span>clinical presentation</span> of<span> acute iron toxicity; 2) d</span></span><span style=\"font-family: Calibri, sans-serif; text-indent: -0.25in;\">emonstrate knowledge of the necessary workup in suspected iron toxicity; 3) i</span><span style=\"font-family: Calibri, sans-serif; color: black;\">dentify the stages of acute iron toxicity; 4) i</span><span style=\"font-family: Calibri, sans-serif; text-indent: -0.25in;\">dentify management of iron toxicity and its complications; 5) p</span><span style=\"font-family: Calibri, sans-serif; color: black;\">erform appropriate management in th</span><span style=\"font-family: Calibri, sans-serif;\">e setting of decompensated hemorrhagic shock and hypovolemia; and 6) d</span><span style=\"font-family: Calibri, sans-serif; color: black;\">emonstrate teamwork through communication and collaboration.</span></p>\n<p class=\"MsoNormal\" style='margin: 0in; font-size: medium; font-family: \"Times New Roman\", serif; border: medium; color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-line: none; text-decoration-style: solid; text-align: justify; vertical-align: baseline;'><strong><span style=\"color: black;\"> </span></strong></p>\n<p class=\"MsoNormal\" style='margin: 0in; font-size: medium; font-family: \"Times New Roman\", serif; border: medium; color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-line: none; text-decoration-style: solid; text-align: justify; vertical-align: baseline;'><strong><span style=\"font-family: Calibri, sans-serif; color: black;\">Educational Methods:</span></strong><span style=\"font-family: Calibri, sans-serif; color: black;\"><span class=\"Apple-converted-space\"> </span></span><span style=\"font-family: Calibri, sans-serif; color: black;\">The development process encompassed a seven-step approach: creating a scenario, defining learning objectives, and designing a suitable room.</span><span style=\"font-family: Calibri, sans-serif; color: black;\"><sup>3</sup></span><span style=\"font-family: Calibri, sans-serif; color: black;\"><span class=\"Apple-converted-space\"> </span>Clues and puzzles aligned with the specified learning objectives. The VER was hosted on Articulate 360 (Articulate Global Inc.) and complemented by a facilitator guide that provided content and technical support.</span></p>\n<p class=\"MsoNormal\" style='margin: 0in; font-size: medium; font-family: \"Times New Roman\", serif; border: medium; color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-line: none; text-decoration-style: solid; text-align: justify; vertical-align: baseline;'><strong><span style=\"color: black;\"> </span></strong></p>\n<p class=\"MsoNormal\" style='margin: 0in; font-size: medium; font-family: \"Times New Roman\", serif; border: medium; color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-line: none; text-decoration-style: solid; text-align: justify; vertical-align: baseline;'><strong><span style=\"font-family: Calibri, sans-serif; color: black;\">Research Methods:</span></strong><span style=\"font-family: Calibri, sans-serif; color: black;\"><span class=\"Apple-converted-space\"> </span>To replicate this activity, a team of facilitators should be present to organize the participants into small groups and distribute the VER link. During our implementation, this link was shared in real-time on<span class=\"Apple-converted-space\"> </span></span><span style=\"font-family: Calibri, sans-serif; color: black;\">Zoom Video Communications Inc. (</span><span style=\"font-family: Calibri, sans-serif; color: black;\">Zoom)</span><span style=\"font-family: Calibri, sans-serif; color: black;\">,</span><span style=\"font-family: Calibri, sans-serif; color: black;\"><span class=\"Apple-converted-space\"> </span>leveraging breakout rooms to assign participants to their respective rooms. Additionally, we conducted this in person with faculty and nursing, where participants were divided into groups accordingly.<span class=\"Apple-converted-space\"> </span></span><span style=\"font-family: Calibri, sans-serif; color: black;\">There was a structured format: pre-briefing, a timed escape room scenario, debriefing, and evaluation. Afterward,<span class=\"Apple-converted-space\"> </span></span><span style=\"font-family: Calibri, sans-serif; color: black;\">learners evaluated the VER and educational content with a survey hosted on Google Docs (Google LLC).<span class=\"Apple-converted-space\"> </span></span></p>\n<p class=\"MsoNormal\" style='margin: 0in; font-size: medium; font-family: \"Times New Roman\", serif; border: medium; color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-line: none; text-decoration-style: solid; text-align: justify; vertical-align: baseline;'><strong><span style=\"color: black;\"> </span></strong></p>\n<p class=\"MsoNormal\" style='margin: 0in; font-size: medium; font-family: \"Times New Roman\", serif; border: medium; color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-line: none; text-decoration-style: solid; text-align: justify; vertical-align: baseline;'><strong><span style=\"font-family: Calibri, sans-serif; color: black;\">Results:</span></strong><span style=\"font-family: Calibri, sans-serif; color: black;\"><span class=\"Apple-converted-space\"> </span>A total of 55 respondents completed post-evaluation surveys. Despite limited experience with previous virtual escape rooms, both trainees and faculty agreed the design was easy to follow (78.2%), fostered teamwork (90.9%), and was a feasible method of education (85.5%).<span class=\"Apple-converted-space\"> </span></span></p>\n<p class=\"MsoNormal\" style='margin: 0in; font-size: medium; font-family: \"Times New Roman\", serif; border: medium; color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-line: none; text-decoration-style: solid; text-align: justify; vertical-align: baseline;'><strong><span style=\"color: black;\"> </span></strong></p>\n<p class=\"MsoNormal\" style='margin: 0in; font-size: medium; font-family: \"Times New Roman\", serif; border: medium; color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-line: none; text-decoration-style: solid; text-align: justify; vertical-align: baseline;'><strong><span style=\"font-family: Calibri, sans-serif; color: black;\">Discussion:</span></strong><span style=\"font-family: Calibri, sans-serif; color: black;\"><span class=\"Apple-converted-space\"> </span>This activity was successfully implemented with trainees, faculty, and nursing professionals, demonstrating the ability of VER to be utilized in a wide variety of applications. We also successfully implemented this format in both in-person and online platforms.<span class=\"Apple-converted-space\"> </span></span><span style=\"font-family: Calibri, sans-serif; color: black;\">Limitations of this include a need for long-term outcome data. Future studies could further assess knowledge improvement and clinical management of acute iron toxicity.<span class=\"Apple-converted-space\"> </span></span></p>\n<p class=\"MsoNormal\" style='margin: 0in; font-size: medium; font-family: \"Times New Roman\", serif; border: medium; color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-line: none; text-decoration-style: solid; text-align: justify; vertical-align: baseline;'><strong><span style=\"font-family: Calibri, sans-serif; color: black;\"> </span></strong></p>\n<p class=\"MsoNormal\" style='margin: 0in; font-size: medium; font-family: \"Times New Roman\", serif; border: medium; color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-line: none; text-decoration-style: solid; text-align: justify; vertical-align: baseline;'><strong><span style=\"font-family: Calibri, sans-serif; color: black;\">Topics:<span class=\"Apple-converted-space\"> </span></span></strong><span style=\"font-family: Calibri, sans-serif; color: black;\">Acute iron toxicity,</span><strong><span style=\"font-family: Calibri, sans-serif; color: black;\"><span class=\"Apple-converted-space\"> </span></span></strong><span style=\"font-family: Calibri, sans-serif; color: black;\">emergency medicine,</span><strong><span style=\"font-family: Calibri, sans-serif; color: black;\"><span class=\"Apple-converted-space\"> </span></span></strong><span style=\"font-family: Calibri, sans-serif; color: black;\">escape room, ingestion, gamification, pediatrics, toxicology, virtual escape rooms</span><span style=\"color: black;\">.</span></p>\n<p class=\"MsoNormal\" style='margin: 0in; font-size: medium; font-family: \"Times New Roman\", serif; border: medium; color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-line: none; text-decoration-style: solid; text-align: justify;'><em><span style=\"font-family: Calibri, sans-serif; color: black;\"> </span></em></p>", "language": "eng", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "Acute iron toxicity" }, { "word": "Emergency Medicine" }, { "word": "Escape Room" }, { "word": "ingestion" }, { "word": "Gamification" }, { "word": "pediatrics" }, { "word": "toxicology" }, { "word": "virtual escape rooms" } ], "section": "Small Groups", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/6h14n4ts", "frozenauthors": [ { "first_name": "Kaitlyn", "middle_name": "", "last_name": "Boggs", "name_suffix": "MD", "institution": "Medical University of South Carolina", "department": "Division of Pediatric Emergency Medicine" }, { "first_name": "Manu", "middle_name": "", "last_name": "Madhok", "name_suffix": "MD, MPH", "institution": "Children’s Minnesota", "department": "Division of Emergency Medicine" }, { "first_name": "Tania", "middle_name": "", "last_name": "Ahluwalia", "name_suffix": "MD, MPH", "institution": "University of Washington/Seattle Children's Hospital", "department": "Division of Emergency Medicine" } ], "date_submitted": "2024-08-21T19:05:20Z", "date_accepted": "2026-01-04T02:00:10.596000Z", "date_published": "2026-01-31T19:49:00Z", "render_galley": { "label": "Boggs K, et al. Development and Design of a Pediatric Case-Based Virtual Escape Room on Acute Iron Toxicity. JETem 2026. 11(1)SG1-28", "type": "pdf", "path": "https://journalpub.escholarship.org/uciem_jetem/article/52192/galley/48068/download/" }, "galleys": [ { "label": "Boggs K, et al. Development and Design of a Pediatric Case-Based Virtual Escape Room on Acute Iron Toxicity. JETem 2026. 11(1)SG1-28", "type": "pdf", "path": "https://journalpub.escholarship.org/uciem_jetem/article/52192/galley/48068/download/" } ] }