Background
Systematic reviews (SRs) are an emerging
role for academic libraries [1], resulting in many implementing dedicated SR
services [2-4]. In addition, SRs have become an expected part of doctoral study
[5], with some authors calling for SR methodologies to be a mandatory component
of doctoral training [6]. Indeed, in the context of this case report, SRs
appear in all theses.
Undertaking any type of literature review
can be a novel task for many graduate students, who often encounter
difficulties comprehending different review methodologies, data management
requirements, and writing methods [7]. It is perhaps no surprise that SRs can
be “a daunting task” for PhD students [5, p.535].
To support these students, many academic
health libraries have implemented dedicated SR services for collaboration and
training (for example McKeown and Ross-White [2], Yang et al. [3], and Demetres
et al. [4]). Where teaching practices of librarians have been explored,
didactic teaching methods dominate, with far fewer librarians engaging in
active learning techniques such as collaborative group work, think-pair-share,
and gamification of learning [8]. This lack of active learning utilisation is
despite a growing body of literature demonstrating that students learn more
when actively engaged within the classroom [9].
As a way of engaging students, escape rooms
have been used in many disciplines [10-12]. Within libraries, escape rooms have
also been used for library orientations and literature searching [13], fact
checking and fake news [14], and searching PubMed [15]. These library-focused
escape rooms were not sufficiently evaluated to show increased learning or
knowledge retention but do show intended learning outcomes were met and that
participants enjoyed playing them.
Whilst there is a paucity of literature on
clinical psychology within health librarianship, clinical psychology
meta-analyses show better, but similarly low levels of search strategy
reporting as other health disciplines [16]. In an effort to improve trainee
confidence in searching and reporting for SRs, we have embraced active
learning, utilising approaches that enable trainees to apply knowledge from
teaching [17].
In this study, we investigated whether an
additional active learning intervention in the form of an online escape room
during our orientation with trainees in the Doctorate in Clinical Psychology
(DClinPsy) programme would be an effective way to introduce SR methods and
search skills earlier in the curriculum and help scaffold future learning.
Case Presentation
We are two librarians working in a
research-intensive university and a health service within the same geographic
region. We support DClinPsy trainees on a programme that is collaboratively
funded by both organisations. The trainees are also both health service workers
and enrolled students during the three-year programme. Whilst the two
organisations are separate, with access to both libraries, trainees often
conflate our services. We therefore began joint orientation sessions to help
define our services and direct trainees to the appropriate support for academic
and clinical enquiries. Further conflation existed with a requirement for
trainees to undertake a SR for their academic theses, which is linked to a
research project undertaken in a clinical setting. Our collaboration,
therefore, quickly extended to co-design and delivery of SR teaching.
We have three teaching interventions
embedded within the DClinPsy curriculum that enable us to scaffold learning
across the first two years of study. These are all timetabled and mandatory to
attend. Our interventions start in the first weeks of year one with an hour
in-person orientation session. This is followed by a 1.5-hour online lecture at
the end of the first semester where SR methodologies and search methods are
explained. This lecture aligns with the submission of their research project
proposals, which influences their SR topic. The outline of their SR is due at
the end of semester two in year one.
Our final timetabled session is a full day
online SR search and reporting workshop midway through the first semester of
year two. By the end of the workshop, we aim for trainees to have a first draft
of a search strategy on one database consisting of subject headings and text
words, with appropriate utilisation of syntax and search fields. This workshop
marks the start of their SR, with trainees expected to write their reviews over
the next year, submitting them as part of their theses mid-way through their
third and final year.
Despite our teaching interventions,
optional appointments, and online support resources, we encounter some trainees
with low confidence towards their SRs. Specifically, we have noticed that many
questions could be answered by handbooks (for example, from The Cochrane
Collaboration [18] and JBI Manual for Evidence Synthesis [19]), that trainees
struggled to differentiate systematic and scoping review research questions,
and with nesting, proximity searching, and wildcards.
To further support trainees in these areas,
we decided to experiment by utilising an escape room in our year one
orientation session. To the best of our knowledge, our escape room is the first
to focus on methodological issues and search skills in SRs. Our escape room can
be downloaded and played from https://osf.io/jwf6t/.
Escape room development
Our online escape room was created using
Microsoft OneNote following an instructional case study [20] and video tutorial
[21]. The short video tutorial shows how to create pages within OneNote for
each puzzle and password protect answer pages. All our puzzles are in the form
of multiple-choice questions; the correct answer is the password to unlock the
next section of the escape room. Each correctly answered section reveals a
character which, when unscrambled, reveals the code to complete the escape room.
The questions focus on methodological guidance, Boolean logic, and search
syntax. The escape room navigation and question development are discussed in
Appendix A.
Using the escape room in class
For our orientation in academic year
2024/25, the trainees were randomly divided into two sets of 19 and 20 people
by the programme administration team due to room capacity. When entering the
room, trainees were free to choose their seats around one of four active
learning tables. This meant that there were eight groups of approximately five
people across both repeated orientations.
Each session lasted one hour. The first 20
minutes of the orientation included a presentation on library services and
group information retrieval exercises from our library catalogue. We then
introduced the escape room and navigation for five minutes, gave the trainees
15 minutes to complete the escape room, and spent the final ten minutes
providing context to the questions and explaining the answers. We allowed
ourselves ten minutes for a welcome and closing of the orientation and
questions from the trainees. During the escape room exercise we checked in with
each table, answering any technical questions and providing prompts as
required.
When closing the session, we introduced our
study and invited trainees to undertake an anonymous online survey. A further
email with details of the survey was sent to trainees immediately after the
session by the DClinPsy admin team on our behalf, with a reminder sent one week
later. The survey closed after four weeks.
Survey development
Our survey was modified from Offord et al.
[20] and PRESS guidelines [22] to be suitable to the trainees and search
methods. The survey employed five-point Likert scales and free-text open-ended
responses. Quantitative questions were analysed using simple descriptive
statistics, with free-text questions using the constant comparison method [23],
allowing us to quickly generate broad codes and themes based on similarities
and differences in the data. As an example of our coding, one response to
whether there were parts of the game participants found difficult was, “The
time pressure of the activity and reaching group consensus on some questions
was difficult. However it was helpful to discuss and reach concensus (sic)
while building our understanding”. This response was coded as “Teamworking” and
“Time pressure”, and added to the theme, “Game experience”. The raw survey data
and our coding structure are available on the Open Science Framework [24].
We received a 90% response rate (35 from 39
potential participants). We believe the high response rate corresponds with our
valued input and trainee enjoyment of the escape room. The survey was also
short, taking a mean average of 3 minutes 36 seconds to complete, and all
questions were optional.
Results
Escape room gameplay
The initial questions in our survey used a
five-point Likert scale to assess whether the trainees enjoyed playing the
escape room and whether they found the game easy or difficult. The options
ranged from ‘Really enjoyed it’ to ‘Did not enjoy it at all’ and ‘Very easy’ to
‘Very difficult’, respectively. The escape room was near universally enjoyed by
all participants with 60% (n=21) ‘really enjoying’ and 34% (n=12) ‘enjoying’
it. 6% (n=2) felt ‘neutral’. Trainees’ enjoyment of the intervention came despite
a larger percentage finding the escape room ‘difficult’ or ‘neither easy nor
difficult’ (Figure 1).
Figure 1 Responses to the
question, “How easy or difficult did you find the game?”
The reasons for people finding the escape
room difficult were elicited in responses to the question, “Were there
particular parts of the game that you found difficult?”. Time pressure was
coded on a quarter of responses (n=9/33). A similar number (n=6) mentioned
difficulties with search skills, particularly with questions on wildcards and
proximity searching. A further five comments were coded with team working.
These responses centred on group organisation and lack of assigned roles,
resulting in individuals working at a different pace, “Doing it in a big group
meant we all couldn’t read at the same pace, so ended up not all being on the
same wavelength”. Several comments were coded to cognitive load, which may be
partly related to time pressure and lack of group working when compared to our
pilot of the escape room with the previous 2023/24 cohort. One person related
cognitive load to their neurodivergence. We reflect on these factors in the
discussion section. Five responses noted no difficulties with the escape room,
but one person said “all of it” was difficult.
Development of search skills
In response to, “What did you learn from
the game?”, participants answers were coded to syntax (n=6/35), Boolean logic
(n=4), and general comments on search skills (n=9). Most responses were
assigned a broad methodology theme (n=18), which included codes for the general
steps in a SR (n=14), with five of these specifically mentioning, and coded to,
guidelines and handbooks. Five responses were also coded under previous SR
experience, which highlights the range of experience within this cohort.
Trainees were then asked how confident they
felt utilising search techniques (figure 2). Across all four measured search
techniques, more people were slightly or very confident utilising these search
methods than very or slightly unsure. However, the data shows a wide variation
in confidence levels indicating that some trainees require further support with
search techniques (table 1). We reflect on these responses in the discussion.
Overall perceptions of the escape room
We asked participants,
“Would you recommend this game to other students undertaking a systematic
review?”. Of the 35 responses, 32 replied “yes” and 3 people “maybe”. When
asked to explain their answer, of the 29 free-text responses, 16 were coded as
fun and ten as engaging, with these exact words often used. Nine responses were
coded with bite-sized learning, with participants observing the escape room as,
“a nice way to explain the knowledge concisely with easy to understand
examples” and that, “It really helped get me thinking about the different
aspects of a SR”. Two of these trainees bookmarked the escape room to review
later. Two people mentioned positive
|
Table 1
Range and average scores for responses to
the question, “Following the escape room, how confident do you feel utilising
the following techniques as part of a systematic review search strategy?”
(where 1=very unsure, 2=slightly unsure, 3=neutral, 4=slightly confident,
5=very confident)
|
|
Search technique
|
Minimum
|
Maximum
|
Mean
|
Count
|
|
Boolean operators (AND, OR, NOT)
|
2
|
5
|
4.11
|
35
|
|
Truncation (*)
|
2
|
5
|
3.91
|
35
|
|
Wildcard (?)
|
1
|
5
|
3.60
|
35
|
|
Proximity (N)
|
1
|
5
|
3.14
|
35
|
aspects of team working through knowledge
sharing, and that it “encouraged conversation”. Of the three people that said
they would “maybe” recommend the game, one person noted that it was fun but
that they did not learn anything new, and the other person said, noting their
neurodivergence, that they required more time and repeated self-directed
attempts for the learning to “stick”. The third person left the open response
blank.
We concluded by asking, “Is there anything
else you would like to tell us about the game?”. From the 23 responses most
noted the fun (n=8) aspect of the escape room, praising its novelty (n=8). We
were also thanked for trying something different (n=6), “It was a great way to
itroduce (sic) these skills in an accessible way”. Two people noted teamwork,
one enjoying the “positive bonding elements”, and the other offering that if
they were able to play the escape room alone, “I think [it] would be more useful,
and could be longer or more complex!”.
Discussion
Overall, our escape room can be considered
a success by the measures of enjoyment, engagement, and beginning to scaffold
learning. With many doctoral theses requiring SRs, and more libraries
supporting SRs, escape rooms may be “a helpful engaging way of learning more
about a dry topic”, as one of our participants noted. There are, however, some
areas where refinement of how the escape room is introduced and managed would
benefit future cohorts and libraries seeking to develop similar interventions.
Pressure to escape rather than develop knowledge
One of the most common codes in the
analysis was time pressure. The orientation timetable necessitates a short time
for the escape room. Trainees also noted positive and negative aspects of the
time limit; some feeling that it improved engagement and gameplay, whilst
others felt pressure to escape rather than reflect on their learning. We based
the 15-minute escape time on our experience with the previous cohort, and
whilst all groups escaped within 15-minutes, many responses on the difficulty
with the game stemmed from time pressure. One participant commented, “Obviously
a time crunch is part of the game but it was a little hard to process some of
the instructions in such a short pace of time. Maybe make it 20?”. Other
participants noted there was not sufficient time to work collegiately within
their groups. We observed that there was less team working within this cohort
compared to the last. To what extent this was due to the time limit or group
dynamics is difficult to tell. Nonetheless, we feel 15-minutes was appropriate
for escaping, but greater team working and learning could be achieved with an
additional 5-10 minutes to escape. We will add this time into future
orientations.
As noted, group dynamics were different
between cohorts of trainees. The 2023/24 cohort were more self-organising – one
person read the escape room instructions and questions, and the other team
members worked in groups of two, sharing laptops, to investigate each possible
answer to the questions. These trainees discussed their findings as they
progressed, helping the groups share learning, collaboratively decide upon the
answer, and escape quicker. This appeared an effective way of learning, sharing
knowledge, and developing team bonds, which seemed especially useful to
trainees newer to SRs. We will suggest this as a method of working when
introducing the escape room in future.
Individual differences and contextualisation
A further point of reflection comes from a
participant mentioning their neurodivergence. In future, we will add additional
time to escape, which should reduce the pressure on trainees. We will also
provide information on the orientation in advance so that trainees know what to
expect. However, it is also important to note that active learning
interventions should not be considered as a one-off event. Across our DClinPsy
teaching, we provide a range of self-directed learning, and individual, small,
and large group active learning activities that offer trainees a framework to
develop and reflect upon their learning. This range of activities and learning
materials help account for individual differences.
Relatedly, we find that contextualising the
escape room questions and answers at the end of the activity allows trainees to
review and reflect upon their learning. One person commented that it was,
“Really helpful generally to see the mistakes people tend to make, and have
Paul talk us through it afterwards”. This point supports our decision to add
questions on SR guidelines and discuss methodological issues rather than focus
solely on search skills. We have found in the past that issues we help resolve
are caused by a lack of methodological knowledge or poor practices learnt from
abridged SRs undertaken in undergraduate or taught post-graduate study. One
trainee summarised this by saying, “I think it highlighted some elements of a
systematic review I had skimmed or even avoided when doing one before.”
Despite trainees feeling they developed
their understanding of different search techniques, and mean scores for
confidence in utilising search techniques ranging between ‘neutral’ to
‘slightly confident’, some trainees were still ‘slightly unsure’ or ‘very
unsure’ in these skills (table 1), especially with proximity syntax. This is
not surprising given that this is our first orientation with the trainees, and
confidence can potentially be attributed to prior experience with SRs instead
of, or in addition to, the intervention. The escape room has, however, helped
us introduce these concepts at an earlier stage with this cohort, and the
responses will help us scaffold future teaching and develop support resources.
Our escape room took three days to develop.
This timescale is relatively short compared to creating didactic teaching
materials and can therefore be a useful starting point for librarians looking
to develop active learning techniques.
Conclusions
We have demonstrated that active learning
can be challenging to implement effectively, and structured guidance needs to
be provided to participants ahead of and during teaching. By evaluating and
reflecting on our escape room, we have illustrated how these challenges can be
minimised in future.
Our SR escape room does, however,
demonstrate that key methodological concepts and search skills can be taught in
a fun and engaging manner, and help scaffold learning for latter in-depth
teaching. As described in the appendix, the questions we chose were based on
our unpublished research and the SR thesis requirement. We believe the escape
room questions could equally be adapted to other forms of knowledge synthesis.
Our future research will focus on a pre- and post-test to assess whether
confidence to undertake SRs improves after active learning.
We would encourage librarians looking to
develop innovative teaching methods to learn from our findings and utilise
escape rooms as part of a suite of active learning interventions.
Conflict of interest
The authors have no conflict of interest to
declare.
Funding
This study received no funding.
Acknowledgements
The authors wish to thank Jennifer McGhie
for helping to run the escape room activity, and Dr Matt Offord for sharing
their escape room survey with us.
Data availability statement
All data supporting this study are
available at https://osf.io/jwf6t/.
Author Contributions
Paul Cannon: Conceptualization, Data
curation, Formal analysis, Investigation, Methodology, Visualisation, Writing –
original draft. Tracey McKee: Conceptualization, Investigation, Validation,
Writing – reviewing & editing.
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Supplemental Files
Appendix A
Authors’ Affiliations
Paul Cannon, PhD, paul.cannon@glasgow.ac.uk, https://orcid.org/0000-0001-8721-1481,
University of Glasgow, Glasgow, Scotland
Tracey McKee, Tracey.McKee@nhs.scot, https://orcid.org/0000-0001-7792-5296,
NHS Greater Glasgow & Clyde, Glasgow City, Glasgow, Glasgow, Scotland
Received January 2025; accepted June 2025
