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. 2025 Aug 27;8:100165. doi: 10.1016/j.crphys.2025.100165

Using digital escape rooms to enhance data analysis skills and student experience in a higher education human physiology module

Nicola Morgan 1, Marriam Yaqoob 1, Matthew Allan Jones 1,⁎
PMCID: PMC12423338  PMID: 40949010

Abstract

Active and gamified teaching methods have garnered significant interest, with an increased demand for higher education institutions to enhance student engagement. One popular example of active learning is the escape room. Escape rooms are playful tools reported to increase students’ key transferable skills, which are valuable for students to boost their employability. In recent years, a transition to “digital” computerised escape rooms has allowed participants similar experiences using significantly fewer resources compared to in-person modalities. In physiology, the ability to analyse and interpret data is vital and an intended learning outcome of physiology modules/units. However, many students possess limited experience or exhibit anxiety when conducting data analysis, which leaves them unprepared to do this within a laboratory setting or employment. Therefore, this project aimed to design and develop a digital escape room to allow students to playfully build their analytical skills and assess its impact on student experience and knowledge acquisition.

The digital escape room was created using the University of Salford's universal digital escape room platform “UoScape”. Students' perceived data analysis skills and experience upon completion were evaluated using pedagogical surveys comprising either open-answer questions or a 5-point Likert scale.

A total of 104 second-year undergraduate students completed the evaluation survey. Most students reported positive benefits to their knowledge of physiological data analysis (74.0 %), overall experience (67.3 %), experience of gamified learning (74.0 %) and that it would enhance their overall degree value (68.3 %). The majority of students stated digital escape rooms would support their education (71.2 %) and upcoming assessments (76.0 %). Individual puzzle analysis identified those with mathematical elements as more challenging than image analysis-based puzzles (73.3 % Vs 51.8 %, P = 0.0006). Interestingly, a positive correlation was observed between challenge and enjoyment within mathematics puzzles (R = 0.308, P = 0.004). Stratification based on socioeconomic factors revealed minimal impact on pedagogical measures, with only self-perceived knowledge acquisition being significantly higher in low-access populations (P = 0.046).

These data show the equitable pedagogical benefits of digital escape rooms, which enhance students’ knowledge of handling physiological data, student experience, and degree value. This highlights the benefits of active gamified teaching methods for physiological concepts within higher education.

Keywords: Physiology education, Digital escape rooms, Higher education, Awarding gaps, Data analysis, Playful learning

Highlights

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    Digital Escape Rooms support data analysis knowledge acquisition.

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    Active learning methods enhance the student experience and degree value.

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    Students enjoy stretching themselves challenging physiology content.

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    Digital escape rooms support equity within physiology education.

1. Introduction

Gamified learning utilises video game techniques to engage students in an educational aspect. Gamifying education is an increasingly popular means of motivating students to learn within higher education institutes (HEI). Gamification includes the use of interactive quizzes (Varannai et al., 2017), card games (Mavroudi et al., 2022), as well as digitally created platforms with puzzles (Morgan and Jones, 2025). Gamified learning allows students to utilise their knowledge in a fun and interactive environment, leading to further understanding and engagement (Aguiar-Castillo et al., 2021). The surge in technology has increased the demand for HEIs to adapt teaching methods to include more digital approaches for the increasingly diverse student cohort (Alenezi, 2023). Though utilising gamification within higher education (HE) has shown to be motivating and empowering (Gironella, 2023), the design of the games needs to be captivating and meaningful for the students for increased engagement to occur (Gupta and Goyal, 2022). Students have reported a preference for digital gamified learning than that of traditional didactic teaching methods (López-Pernas et al., 2019).

In recent years, escape rooms or breakout games have been an increasingly popular social activity. During the COVID pandemic, these escape rooms were developed further into digitalised games, allowing groups of people to play across the internet (Makri et al., 2021). The games consist of puzzles which the player or team must solve to eventually ‘break out’ or leave the room. This concept has been redeveloped within educational settings to create academic puzzles with increasing complexity. Educators have become more technologically competent to ensure learning outcomes are met through blended learning. Escape rooms have been shown to increase communication skills, teamwork and confidence (Brown et al., 2019). These types of transferrable skills are essential to enhancing student employability however, physical escape rooms are often impractical for large cohorts found within HEIs, due to limited capacity, necessitating repetition, thus significantly impacting academic workloads. Digital or virtual escape rooms are a useful teaching tool, which can be implemented with no teaching space required. Previous studies have shown a positive impact on student learning with digital escape games, including increased knowledge acquisition (Morgan and Jones, 2025), higher motivation (von Kotzebue et al., 2022) and elevated critical thinking (Chen et al., 2024).

Scenario-based learning (SBL) is a commonly used practice within clinical teaching to ensure students gain practical experience in a safe and organised manner. These SBL sessions can consist of simulation patients; people who are asked to act out clinical problems for students to treat (Kneebone et al., 2005), or virtual SBL, which places the students within a digitally designed environment, simulating that of a clinic or laboratory and enabling the student to complete tasks online (Kassutto et al., 2024). Virtual simulations are a useful tool when utilising blended learning within HEIs. Digital SBL gives students more accessibility, enabling the students to partake in the teaching tools whenever they are able, with research showing that students prefer digital scenarios compared to paper-based scenarios (Gavgani et al., 2015; Schuck and Aubusson, 2010). The application of acquired skills in a scenario has been shown to increase student confidence (Rashwan, 2023) and develop problem-solving and analytical skills (Mio et al., 2019).

Many students today have significant additional responsibilities alongside their studies, with the majority of students now having part-time jobs or caring responsibilities to manage. With some students working full-time or multiple part-time jobs to withstand the cost of living. Therefore, many students do not have the free time to conduct extra reading or partake in extra-curricular opportunities to apply the knowledge they have learnt in timetabled sessions. This is where scenarios and gamified aspects can be useful, acting as a bridge between theory and application, thus enabling a deeper understanding of the subject material (Roach et al., 2018). It may also allow students to appreciate key concepts which they dislike or lack confidence in by showcasing how they can be utilised within the real world.

One of the key concepts in which students lack confidence is mathematics and analytical work. Studies show that students struggle with the leap from further education (FE) to HE, with many demonstrating decreased motivation and an increased probability of dropping out of HE altogether (Pascoe et al., 2020). One of the main confidence dents for students is understanding and using mathematics within their degree, with many students struggling to grasp maths (Gallimore and Stewart, 2014).

This is particularly important in a physiological context, as for all subjects incorporating physiology, there will be an element of data analysis and interpretation requiring students to examine experimental traces and ascertain the efficacy of interventions. This often requires students to perform relatively basic mathematics, such as calculating averages or standard error of the means, to conducting more complicated physiological equations requiring the insertion of experimental values to ascertain organ function. It is this that many students fear and experience mathematics anxiety within the field of physiology. This is where pedagogical concepts such as playful learning (Whitton, 2018) and learning through stealth (Sharp, 2012) could be beneficial, to allow students to learn and apply these mathematical concepts without the anxiety-inducing nature of traditional learning and teaching methodologies. This is where digital escape rooms could play a key role in helping students acquire knowledge of physiological data analysis.

This study seeks to design, embed and evaluate a digital escape room implementing scenario-based puzzles to support students’ learning of physiological data analysis and to determine if this pedagogical approach is equitable across all students irrespective of background.

2. Methodology

2.1. Physiology digital escape room design and development

The physiology digital escape room (https://uoscape.co.uk/physiology-laboratory/) was designed and developed on the institutional digital escape room platform “UoScape” built using WordPress (Automattic Inc., USA) and additional plugins (Elementor v3.24.6 (Elementor, Israel), WordPress virtual reality Pro, HurryTimer, H5P, and Passster) as previously described in detail within Morgan and Jones (2025). Puzzles within the escape room were designed to constructively align with students’ upcoming physiology laboratory assessment, which had a strong emphasis on their ability to analyse and interpret physiological data across a broad range of areas, including cardiac, muscle, renal, respiratory and neurophysiology. Based on these five topics, puzzles were designed to allow students to develop competency in analysing data from these areas in a playful manner.

The puzzles included electrocardiogram (ECG) analysis and heart rate calculations, spirometry measurement and interpretation, creatinine clearance calculations to determine renal function, reaction time measurement, and the Astrand-Rhyming test calculations to determine VO2 max. Games designed on these concepts were dispersed around a digital mimic of the University of Salford Biomedical Science laboratories, and students were allowed to complete them in any order they wished. Students were allocated a 30-min window from entering the “laboratory” to complete all the puzzles. If students failed to complete all five puzzles within the allotted time, they would be “locked out” and forced to restart the game from the beginning.

2.2. Physiology digital escape room participants

Participants in the physiology digital escape room were enrolled in the second year of the Biomedical Science programme at the University of Salford. The escape room was embedded within the “Human Physiology” module (n = 180), with all students enrolled in the module eligible to participate in the digital escape room as a part of a timetabled workshop. Of the 180 students eligible, 114 students attended the workshop (63.3 % of the cohort), with 108 students (94.7 % of attendees, and 60.0 % of the total cohort) returning the escape room evaluation survey. Of those who completed the survey, 104 consented to the publication of their responses as a part of this study (91.2 % of attendees, 57.8 % of the total cohort).

2.3. Physiology digital escape room evaluation survey design and delivery

To determine the pedagogical impact of the physiology digital escape room, upon completion of the experience, students were asked to complete a physical quantitative survey (Supplementary Table 1) allowing them to rate and provide feedback on practical and technical elements of the digital escape room, in addition to how it impacted their student experience and knowledge acquisition. Students completed the survey independently and were allowed to skip any questions within the survey. All surveys were returned to the study team for subsequent analysis anonymously.

All questions were designed as either open-answer questions or based on a 5-point Likert scale with the responses categorised as scores of one or two indicating a negative response, a score of three indicating a neutral response, and scores of four or five indicating a positive response, as previously described in Hussain et al. (2023) and Jones et al. (2025). The questions used in the survey were distributed into multiple categories to evaluate various aspects of the digital escape room including, technical quality, student experience and knowledge acquisition, puzzle design and difficulty and digital escape room participants’ backgrounds and demographics. Key metrics of higher education access and participation used within previous studies (Hussain et al., 2023; Morgan and Jones, 2025) including POLAR4 (HEFCfE, 2017), TUNDRA LSOA (OfficeforStudents, 2019), ADULT HE (OfficeforStudents, 2020) and the United Kingdom Government Ministry of Housing Communities & Local Government English indices of deprivation (https://imd-by-postcode.opendatacommunities.org/imd/2019) were used to stratify participants based on their backgrounds and likelihood to access higher education.

2.4. Statistical analysis

All statistical analysis was performed using GraphPad Prism version 10.4.0 (GraphPad Software, USA). Data normality was evaluated using the Shapiro-Wilk test or Kolmogorov-Smirnov test for normality, depending on the sample size. All two-group comparisons were conducted using parametric unpaired t-tests, non-parametric Mann-Whitney tests, or Wilcoxon matched-pairs signed rank test as described in the associated figure legends. All multi-group comparisons were performed with either analysis of variance (ANOVA) or a Kruskal-Wallis test followed by pairwise comparisons using a Tukey post-hoc test. To quantify the strength of linear relationships, correlation analysis was conducted using Pearson correlation coefficient (R) tests. All data is expressed as mean ± standard deviation. Statistical significance was set at P ≤ 0.05.

2.5. Ethical approval

The studies involving human participants, along with all questionnaires and analysis procedures were reviewed and approved by the University of Salford's institutional ethics committee (Ethics Application ID: 14273). Participants provided their written informed consent at each stage of the study and were allowed to withdraw at any time before publication without cause.

3. Results

3.1. Physiology digital escape room demographics

The key demographics of participants of the physiology digital escape room are summarised in Table 1. Analysis of key demographics found that the majority of participants were female (69.2 %) and classified as from a minoritised ethnic background (68.9 %), in line with programme group metrics. The average student age was 21.7 ± 5.6 years, with 89.4 % of participants classified as home students (hailing from the United Kingdom). On average, the student participants were classified as from areas of higher social deprivation (2.7 ± 2.5) and intermediate higher education access backgrounds based on the key metrics of POLAR4 (2.8 ± 1.3), TUNDRA LOSA (3.0 ± 1.4) and ADULTHE (2.2 ± 1.4) scores. Participants reported limited previous experience of completing digital escape rooms, with 31.7 % of participants stating they had completed one before this session.

Table 1.

Physiology digital escape room participant demographics.

Participant Demographics
Gender (% Female) 69.2 %
Average age 21.7 ± 5.6
Minoritised ethnic background (%) 68.9 %
Home student classification (%) 89.4 %
Vocational qualifications (%) 49.0 %
Average Multiple deprivation decile 2.7 ± 2.5
Average POLAR4 score 2.8 ± 1.3
Average TUNDRA LSOA score 3.0 ± 1.4
Average ADULTHE score 2.2 ± 1.4
Previous experience of escape rooms (%) 31.7 %
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Averages expressed as mean ± standard deviation.

3.2. Does the physiological digital escape room enhance student experience?

Student experience of completing the digital escape room was positive (Fig. 1), with 67.3 % of students reporting a positive experience overall, with only 11.5 % reporting a negative experience. The majority of students also reported enjoying this gamified approach to learning (74.0 %), with 68.3 % of students stating that this type of learning experience enhanced the value of their degree programme. A large number of students (66.4 %) said that they would recommend digital escape rooms to their peers, highlighting their positive experience of this learning approach. Review of student verbatim comments (Supplementary Table 2) following completion of the escape room were also mostly positive such as “I loved it, it was very fun and informative. I learnt a lot whilst feeling like I wasn't actually learning” from Student 100, in addition to providing highly constructive feedback for further development of the platform including “It was difficult to find things in the room, but the puzzles were visually appealing and fun” from Student 63.

Fig. 1.

Fig. 1

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Student experience question responses following the completion of the physiology digital escape room. Shades of red indicate a negative response, white indicates a neutral response, and shades of blue indicate a positive response. n = 104 for all questions.

3.3. Was the technical performance of the physiology digital escape room of sufficient quality for students?

Students were asked to evaluate the technical performance of the physiology digital escape room to evaluate student consensus about the “UoScape” platform as a tool for the delivery of digital escape rooms, the results of which are visualised in Fig. 2. The majority of students reported that the escape room was well developed (70.2 %) and visually appealing (68.3 %), with only 8.8 % and 10.6 % of students respectively reporting negative responses to these questions. Whilst over half of the students (54.8 %) stated that the digital escape room was easy to navigate, 14.4 % highlighted that it was difficult to navigate, whilst 30.8 % of students provided a neutral response, highlighting navigability as a key area of value for enhancement of student experience completing the digital escape room.

Fig. 2.

Fig. 2

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Student technical performance question responses following the completion of the physiology digital escape room. Shades of red indicate a negative response, white indicates a neutral response, and shades of blue indicate a positive response. n = 104 for all questions.

3.4. Does the digital escape room enhance students perceived knowledge of key physiological concepts

Next, we sought to determine the impact of the physiology digital escape room on perceived knowledge acquisition relating to key physiological data analysis concepts (Fig. 3). Students (71.2 %) reported that the digital escape room was a valuable tool to support their education in physiology, with 74.0 % believing that participation in the physiology digital escape room enhanced their overall physiology knowledge. The majority of students (76.0 %) also stated that engagement with this digital escape room would help them with their upcoming assessments.

Fig. 3.

Fig. 3

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Student physiology knowledge enhancement question responses following the completion of the physiology digital escape room. Shades of red indicate a negative response, white indicates a neutral response, and shades of blue indicate a positive response. n = 104 for all questions.

3.5. Did student experience and knowledge acquisition vary dependent on puzzle type?

Student feedback on each individual puzzle in the physiology escape room was mostly positive when evaluated based on enjoyment, perceived challenge, intriguingness, and knowledge enhancement (Supplementary Fig. 3).

When average student response scores were analysed based on the puzzle (Fig. 4), it was found that there was no significant difference between scores relating to enjoyment (Fig. 4A), interestingness (Fig. 4C), and topic-specific knowledge enhancement (Fig. 4D). We observed a significant difference in student response scores relating to the level of puzzle challenge between the renal physiology and neurophysiology puzzles, with the renal physiology puzzle being rated as significantly more challenging than the neurophysiology puzzle (4.1 ± 1.0 Vs 3.5 ± 1.3, n = 83–86, P = 0.0006, Fig. 4B).

Fig. 4.

Fig. 4

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Comparisons of the pedagogical impact of each puzzle type within the Physiology data analysis escape room. Students rated each puzzle based on A) enjoyment, B) challenge, C) interestingness and D) knowledge enhancement. Scores of 5 indicated strongly positive or very hard, whereas scores of 1 indicated strongly dislike or very easy. Data presented as Mean ± SD. n = 83–86. Statistical significance was determined using a one-way ANOVA followed by a Tukey post-hoc test. ∗∗∗ indicates P < 0.001.

Further analysis revealed an interesting pattern between students’ level of puzzle enjoyment and perceived level of challenge. Correlation analysis revealed significant positive relationships between the level of challenge and enjoyment in the renal physiology (R = 0.308, P = 0.004, Fig. 5B), respiratory physiology (R = 0.218, P = 0.045, Fig. 5C) and exercise physiology puzzles (R = 0.375, P = 0.0005, Fig. 5D). No correlation between challenge and enjoyment was observed for the cardiac physiology (R = −0.07, P = 0.499, Fig. 5A) and neurophysiology puzzles (R = −0.06, P = 0.589, Fig. 5E).

Fig. 5.

Fig. 5

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The relationship between challenge and enjoyment of puzzles within the physiology digital escape room. All puzzles based on A) cardiac physiology, B) renal physiology, C) respiratory physiology, D) exercise physiology and E) neurophysiology were examined. Dashed lines indicate 95 % confidence intervals. Statistical significance was determined using Pearson R correlation analysis. Statistical significance was determined by P < 0.05.

3.6. Does student experience and knowledge acquisition vary dependent on socioeconomic factors

Participants were stratified based on key influencers of higher education awarding gaps (minoritised ethnicity and university entry qualification) and socioeconomic parameters (POLAR4, TUNDRA LSOA and ADULT HE Scores) to determine if these factors impacted student experience and knowledge acquisition. Stratification revealed no significant impact on key metrics of student experience (Fig. 6 and Supplementary Figs. 2–5) and knowledge acquisition (Fig. 7).

Fig. 6.

Fig. 6

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Awarding gap and socioeconomic factors did not influence participants' value of the physiology data analysis digital escape room to enhance their student experience. Participants were stratified based on their A) minoritised ethnic status, B) university entry qualification, C) likelihood to participate in higher education (POLAR4 score), D) area representation in higher education (TUNDRA LOSA), and E) participants' areas abundance of higher education qualifications (ADULT HE). Data expressed as Mean ± Standard deviation. Statistical analysis was conducted using Mann-Whitney or Kruskal-Wallis analysis. ns = not significant.

Fig. 7.

Fig. 7

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Socioeconomic factors influenced participants value of the physiology data analysis digital escape room to enhance their perceived physiology knowledge acquisition. Participants were stratified based on their A) minoritised ethnic status, B) university entry qualification, C) likelihood to participate in higher education (POLAR4 score), D) area representation in higher education (TUNDRA LOSA), and E) participants' areas abundance of higher education qualifications (ADULT HE). Data expressed as Mean ± Standard deviation. Statistical analysis was conducted using Mann-Whitney or Kruskal-Wallis analysis. ns = not significant.

When student experience parameters were evaluated following stratification, we observed no significant difference between student experience scores for students from minoritised backgrounds and non-minoritised ethnicities (4.0 ± 0.82 (n = 32) Vs 3.8 ± 1.1 (n = 72), P = 0.27, Fig. 6A). However, we find non-significantly mildly elevated experience scores when students are stratified based on their likelihood to participate in higher education. With students less likely to participate in higher education having a more positive experience than those with a greater likelihood based on POLAR4 (4.0 ± 0.9 (n = 31) Vs 3.8 ± 0.9 (n = 19), P = 0.74, Fig. 6C), TUNDRA (4.0 ± 1.0 (n = 32) Vs 3.7 ± 1.0 (n = 36), P = 0.33, Fig. 6D) and ADULT HE (4.0 ± 1.0 (n = 53) Vs 3.7 ± 1.0 (n = 15), P = 0.71, Fig. 6E) scores.

Similar findings were observed when stratifying students based on their responses related to physiology knowledge acquisition (Fig. 7). We observed non-significantly higher knowledge acquisition scores for students from non-minoritised ethnicities (4.1 ± 1.0 (n = 32) Vs 4.0 ± 1.1 (n = 72), P = 0.58, Fig. 7A). However, there was a significantly higher knowledge acquisition score from low POLAR4 participants compared to those from high POLAR4 backgrounds (4.4 ± 0.8 (n = 31) Vs 3.7 ± 1.3 (n = 19), P = 0.046, Fig. 7C). When stratified based on TUNDRA score, students from low TUNDRA backgrounds reported higher knowledge acquisition compared to those from high TUNDRA backgrounds (4.3 ± 0.9 (n = 32) Vs 3.8 ± 1.1 (n = 36), P = 0.08, Fig. 7D) to non-significant levels.

4. Discussion

Students studying physiology-aligned subjects require the capacity to evaluate physiological data and be able to draw accurate conclusions. Whilst practical options provide students with the highly effective capability to acquire these skills, students across bioscience subjects are increasingly fearful of mathematics, with the thought of conducting even basic biological mathematics (averages and standard deviation) inducing anxiety in student populations. This is increasingly true in students from widening participation backgrounds, who may elect to study biomedicine on the assumption that there will be limited mathematics, based on their FE qualifications in biology (Tariq, 2008; Watters et al., 2022). Therefore, students need to be reintroduced to mathematics and subsequent data analysis in a manner that safely scaffolds students through core concepts whilst decreasing their anxiety with handling data. Playful learning activities such as escape rooms may offer a novel approach to teaching these concepts. However, due to increasing cohort sizes, physical escape rooms are not viable to be delivered at scale; thus, the need for digitisation to ensure access for all. Based on this, our study sought to design and evaluate a digital escape room suitable for teaching physiological data analysis to biomedicine students.

Our study highlights the feasibility of designing and implementing a digital escape room to support students with physiological data handling but also finds that its embedding into the curriculum results in positive student experience, knowledge acquisition and overall degree value (Fig. 1, Fig. 3). We also find that this approach to learning is equitable irrespective of pre-university education or socioeconomic status, with similar student scores observed related to student experience (Fig. 6) and knowledge acquisition (Fig. 7), with this approach potentially benefiting students with a low likelihood to participate in higher education based on POLAR4 scoring (Fig. 7C), thus decreasing institutional awarding gaps.

This study corroborates and supports the findings of the author's previous pilot study, in which they showed that digital escape rooms were viable tools to enhance first-year bioscience student's experience and microbiology knowledge (Morgan and Jones, 2025). Our current study further expands on this by showcasing the versatility of a digital escape room platform and highlights that these benefits continue to be observed in an expanded cohort size and a later stage of study. We also highlight, using a statistical approach, how puzzle content directly relates to students' perceptions of enjoyment, challenge and knowledge acquisition (Fig. 4), in addition to the intersectionality between puzzle content, perceived challenge and overall enjoyment (Fig. 5).

When compared to other studies, we find our data corroborates the findings of previous physiology-focused digital escape rooms (Horn, 2022), but also those from other disciplines (Bezençon et al., 2023; Vidergor, 2021) who found enhancement of student enjoyment and knowledge acquisition through the utilisation of digital escape rooms. Both of these factors are associated with students' likelihood to succeed in their studies, maintain engagement with higher education and ultimately progress in a timely fashion, in line with UK governmental requirements for HEIs (Bradley and Quigley, 2023). It is therefore imperative that HEIs employ active educational approaches, such as digital escape rooms, to diversify learning methodologies utilised within the classroom and actively engage students with their learning. Increases in active engagement are not only preferred by students over traditional didactic lectures (Hussain et al., 2023) but have also been shown to boost students’ understanding of key threshold concepts (Olaniyi, 2020; Walker, 2013), further supporting its implementation within HE curricula.

Interestingly, despite students reporting positive impacts on their self-reported knowledge acquisition, analysis of student grades revealed no significant change in student grades compared to the previous year, where it was not implemented (data not shown) for the assessment directly associated with the handling of physiological data. We hypothesise that this is likely due to the complete removal of multiple-choice questions from the assessment, with alternative question types such as short answer and calculations-based questions being utilised instead, thus not a direct comparison. Whilst we cannot confirm this hypothesis within this study, it is well known that multiple choice questions are inherently easier for students to successfully answer compared to more complex critical thinking-based question types (Chan and Kennedy, 2002; Roediger III & Marsh, 2005; Wilkinson and Shaw, 2015). Therefore, the authors believe that the addition of the escape room has resulted in a positive impact on student attainment; however, further study would be required to confirm this hypothesis.

Analysis of individual puzzles revealed that students reported higher levels of challenge in puzzles with more complicated mathematical components, such as the creatinine clearance calculations used within the renal physiology puzzle, compared to more image analysis-based puzzles such as the reaction times puzzle used to explore basic neurophysiological functions (Fig. 4B). Interestingly, we observe significant positive correlations in three puzzles between challenge and enjoyment (Fig. 5). This indicates that students have a positive experience when the puzzles are challenging, making them push themselves and work collectively as a team to try to correctly answer the questions and escape the digital escape room. This offers the opportunity for students to stretch themselves and work through complex challenges, gaining positive psychological benefits and increasing self-value when they successfully complete a puzzle that they found challenging (Froiland et al., 2012; Yeager and Walton, 2011). This positive affirmation allows the student to realise they can complete a task and that they should not be fearful of pushing their limits or trying something which they find difficult. This aligns with the learning concept of stretch and challenge, which utilises learning approaches to push students beyond their comfort zone to achieve higher levels of learning and development in line with concepts within Bloom's Taxonomy (Bjork and Bjork, 2011; Bloom et al., 1956; Livingston, 2010).

These findings further support the justification for enhancing mathematical provision within bioscience programmes to help students successfully transition to HE (Clark and Lovric, 2009; Hussey and Smith, 2010), whilst alleviating known influencing factors of students’ dislike for data handling. Thus, empowering them to progress into careers associated with biological data analysis, such as academic research where there is an increasing sector-wide push to diversify postgraduate research students and inspire the next generation of research scientists from widening participation backgrounds (Redwood and Gill, 2013; Richardson et al., 2020). Therefore, introducing these potentially off-putting threshold concepts, such as data analysis, using fun, active pedagogical approaches, may support this effort. The findings of this study corroborate this, with no significant differences in enjoyment (Fig. 6), degree value (Supplementary Fig. 4), or opinion of gamified learning (Supplementary Fig. 2), with a positive influence of perceived knowledge acquisition from students with a lower likelihood to participate in higher education (Fig. 7C). This highlights the equity in access, knowledge acquisition and experience when conducting the physiology data analysis digital escape room.

With sector-wide awarding gaps emerging within higher education based on factors such as minoritised ethnic status, disability status, HE entry qualification, and socioeconomic status, HE providers should seek to collaboratively identify solutions and best practices from across the sector, with the aim of closing these gaps, thus ensuring equal opportunity for all students to thrive in higher education. Though numerous approaches embedded within our biomedicine curriculum at the University of Salford (Amar et al., 2025; Hussain et al., 2023; Jones et al., 2024, 2025; Morgan and Jones, 2025; Namvar et al., 2021, 2023), we have shown that the addition of gamified or more active approaches to learning are preferred by students, enhance their knowledge, boost employability outcomes and safeguard equity which may minimise awarding gaps in future years.

Throughout this study, we have shown the positive impacts and equitable enhancement of physiological data analysis, thus supporting students’ confidence in handling data. This poses the question: would digital escape rooms be an appropriate tool for supporting the transition of students into higher education through the gamification of learning key study skills, or as tools to scaffold students through developing their confidence in mathematics upon enrolment into bioscience degree programmes? We believe, based on our findings, that this would be the case and warrants the further development of the digital escape room platform to introduce mathematics for biosciences, with the scope for further downstream expansion to utilisation in statistics-associated content, another mathematics-based concept in which students lack confidence. It would also be of interest to examine how the use of digital escape rooms impacts student outcomes, success and career readiness in a longitudinal manner, rather than a singular one-off intervention. This would allow for student development of key transferable skills, such as communication, teamwork and problem-solving, to be continuously developed through continued engagement with escape room activities and if this facilitates long-term improvement in graduate outcomes and employability.

The authors would like to acknowledge that due to the nature of the project, the data is all acquired from a single cohort within a single institution. While our findings are highly positive, it may be the case that the positive impacts are not observed to the same extent within other cohorts or institutions. However, due to strong positive impact measures observed in our cohort, and no negative impacts on students associated with awarding gaps or lower socioeconomic status, we believe the benefits of digital escape rooms are translatable to most cohorts studying physiology.

5. Conclusion

These data demonstrate the positive pedagogical impacts of using digital escape rooms to enhance physiology data analysis education, through promoting positive student experience and perceived knowledge acquisition. We also highlight the equitable nature of this active learning approach to drive outcomes in student populations associated with awarding gaps within higher education.

Data availability statement

All anonymised data analysed as a part of this manuscript is available from the corresponding author upon reasonable request. Requests to access the datasets should be directed to the corresponding author: Dr Matthew Jones, E-mail: M.A.Jones9@salford.ac.uk.

CRediT author statement

Nicola Morgan: Conceptualization, Funding acquisition, Project administration, Resources, Investigation, Methodology, Visualization, Writing–original draft, Writing–review and editing. Marriam Yaqoob: Investigation, Methodology, Writing–review and editing. Matthew Allan Jones: Conceptualization, Data curation, Funding acquisition, Project administration, Resources, Formal Analysis, Investigation, Methodology, Visualization, Writing–original draft, Writing–review and editing.

Funding statement

This project was funded by a University of Salford Learning and Teaching Enhancement Centre (LTEC) Learning and Teaching Scholarship 2023 under the project ID: TLAA10. The funding for Marriam Yaqoob's summer internship was kindly provided as a part of the University of Salford's Postgraduate Research Office Widening Participation Summer School for Research 2024.

Declaration of competing interests

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgements

We would like to thank the Walter Bodmer teaching laboratory technical team, specifically Rebecca Tarbox and Hannah Skidmore, at the University of Salford for their support in preparing for the laboratory workshop in which the physiology digital escape room was embedded. We would like to also thank the University of Salford Postgraduate Research Office and Dr Hannah Helm for providing funding and support during Marriam Yaqoob's summer internship as a part of the University of Salford's Widening Participation Summer School for Research 2024.

The authors would also like to acknowledge Davina Whitnall and Dr Craig Morley, as well as the Learning & Teaching Enhancement Centre (LTEC) team for their support as a part of the Learning and Teaching scholarship which supported the delivery of this project.

Footnotes

This article is part of a special issue entitled: Current Research in Physiology Education published in Current Research in Physiology.

Appendix A

Supplementary data to this article can be found online at https://doi.org/10.1016/j.crphys.2025.100165.

Appendix A. Supplementary data

The following is the Supplementary data to this article.

Multimedia component 1
mmc1.docx (1,016.7KB, docx)

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Multimedia component 1
mmc1.docx (1,016.7KB, docx)

Data Availability Statement

All anonymised data analysed as a part of this manuscript is available from the corresponding author upon reasonable request. Requests to access the datasets should be directed to the corresponding author: Dr Matthew Jones, E-mail: M.A.Jones9@salford.ac.uk.

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