Participants received the results of the tests in envelopes after they purchased them with tokens. The teams earned the tokens by answering written board exam style questions (some sourced from existing board review question banks and others written by the instructor) from volunteer senior residents. Labs and ECG cost 1 token and more expensive diagnostics cost 3-5 tokens. This corresponded to an added educational objective to teach residents about resource utilization and cost of care. Results were made available for tokens, with the cost of the tests similar in scale to what patients might encounter in the ED. The groups then had to order diagnostic laboratory and imaging tests to further evaluate the patient described in the theme case. Once they calculated the risk scores they were able to unlock the box and were given the theme case history of present illness, physical exam, and instructions for the next puzzle. This first mini puzzle had 3 cases with risk stratification scores that could be deduced. They then had to unlock a box using a 4-digit passcode. The teams were given the case stem introducing the patient, chief complaint, and vital signs. The interns had access to smartphones during the activity, and were encouraged to utilize them to access risk stratification tools during the first mini puzzle.Ī theme case of obstructive shock secondary to catastrophic thrombosis of an IVC filter was presented in pieces as the teams unlocked additional components of the case. Two senior residents, one per group, assisted with the question-and-answer portion of the game. Interns were split into 2 groups to compete against each other and race the clock to solve the case within 45 minutes. Game Materials Description of the Innovation Note: If interested in obtaining printouts used in this activity, please contact Dr.Printed clues, questions and theme case components (Fig 1).As this game comprised part of the intern core curriculum, all participants were interns, with the puzzles targeted to the expected knowledge base of a PGY-1 EM resident.To improve teaching of acute VTE to EM residents, we created a puzzle-based activity called “Acute VTE Escape Room.” Two teams competed against each other to solve the theme case by unlocking clues with mini puzzles, similar to the format of commercial escape rooms.ĮM residents commonly encounter acute venous thromboembolism (VTE) in the ED and must know the spectrum of presentations and approach to evaluation and treatment, including the use of risk stratification calculators. Puzzle-based activities can successfully facilitate team building in medical education. Core emergency medicine (EM) topics lend themselves well to interactive methods such as gamification. Adult learning theory supports medical educators in moving away from long lectures with minimal engagement from the learners.