Blood stains on the hospital bed.
Medication cart drawers flung open.
Defibrillation pads slumped on a bed sheet.
This was the scene Julianne Reilly ’27 MSPAS, PA-S, and five of her Physician Assistant Studies peers walked into last week during a medical escape room activity within one of Bryant University’s simulation labs. With Reilly immediately picking up a blood-soaked dressing gown, Danny Nguyen ’27 MSPAS, PA-S, checking out the hospital monitor, and others surveying the chaotic scene, graduate students sought to uncover what happened to the patient who’d occupied the room. They needed to figure out the patient’s name, date of birth, prognosis, and cause of death.
“The idea of applying reasoning skills to crime and to medicine is something that we’ve always been looking to do in a simulated environment,” says Director of Medical Simulation and Assistant Clinical Professor Stephen Sherman, ’19 MSPAS, PA-C.
Escape room: PA style
The idea to create an escape room in Bryant’s simulation lab came to Sherman two years ago after he completed the puzzle-based activity.
“It stuck in my mind as a good exercise for our PA students because it includes a lot of the same skills we try to teach in the program: deductive reasoning, teamwork under stressful situations, and puzzling out diagnostic problems,” says Sherman, a Sherlock Holmes fan.
He determined that the activity would be part of the PA program’s “Clinical Correlations” course, which students take in their didactic year during terms two through five. As a problem-based learning course, individuals partake in a series of one-hour simulated patient encounters, which get tougher each term. PA Lab Instructor Michael Anderson, who worked alongside Sherman to create the escape room, notes that when students arrived for the medical escape room, they would receive a scenario to set the scene.
“In this case, they’re sitting in a physician's lounge, and one PA student is bragging about how wonderful he or she is and how they can cure everything. The attending physician walks in during this and says, ‘Okay, if you think you’re so smart, there was a significant case that just happened in the emergency room. I want you to figure out what happened,’” says Anderson.
Students then enter the escape room and gather information, which they enter into a Google Sheet while PA faculty observe their interactions behind a one-way mirror. After all information has been entered, faculty members point students to the final clue that will help get them out of the room.
“Exploring skills in a novel environment makes them take the lessons they're learning in the classroom and apply them in a realistic setting. By doing that, they see the value of the knowledge they're getting in the classroom in a different way,” Sherman says.
Team debrief: Identifying themes
Once their hour is up (or they’ve successfully escaped the room — which Reilly’s group did), students head to the PA program’s conference room for a 45-minute debrief. Following their initial responses from the exercise, Sherman, Anderson, PA Lab Instructor Allison Piascik, MHS, PA-C, and Associate Program Director Matthew Lavoie, MPAS, PA-C, CAQ, talked through certain themes and observations that they noticed during the exercise.
“What we’re looking at is what was the action that you took, what was the consequence of the action, and how well did the action result in success or failure in the simulation,” Sherman says.
Commending them on their use of the room’s whiteboard to organize the information they found, he notes that organizing themselves with an explicit leadership structure could have helped the group. They then conducted a deep dive into why students did or did not take on a leadership role within the activity, which revealed students’ perceptions of being viewed as bossy or even insecurities in their abilities.
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“It's often what we fear the most that holds us back from stepping into that leadership role, even if we want to; that thing that's keeping us from taking that last step into a leadership role doesn't exist anywhere except inside us,” says Anderson.
Defining a leadership structure translates well to working in the emergency department, faculty note, adding that, when a swarm team is needed, people who may have never met or worked with each other are coming together to solve a problem.
From discussions on fast-brain and slow-brain thinking to commission bias, Sherman emphasized the importance of speaking up.
“You're going to come across a lot of things that you know aren't normal, but you don't know what the significance is; it's important to bring those things up to the team,” Lavoie says. “As a leader and as a student, you need to be able to delineate when you're in over your head. So, get comfortable with being uncomfortable, and knowing when to step back, but also when to say, ‘How can I get involved?’”
