In the IU School of Medicine (IUSM) pathology residency program, most graduates (around 85%) pursue careers focused solely on anatomic pathology. As a result, transfusion medicine had been left behind. Resident exam scores in the subject were lagging, and recent graduates reported that they didn't feel equipped to handle transfusion medicine questions once they became the pathology expert at their workplace.
Dr. Nichole LePage wanted to bring excitement to transfusion medicine. In 2022, she created a bare-bones, handmade prototype of an escape room. One month before the next service exam, she put 16 residents through it at a 7:30am conference, not exactly prime time for enthusiasm. The residents loved it. When the service exam scores came back, transfusion medicine scores had improved markedly.
Dr. Jessica Muldoon, one of the residents who experienced the prototype, went on to pursue a fellowship in transfusion medicine. She helped refine the escape room and pushed a bigger question: could this work for other students too? IUSM has nine campuses spread across the state, with over 300 students per cohort. Part of their curriculum includes small team-based learning sessions, and the faculty saw a chance to turn one of those sessions into an escape room.
The escape room works like this: students show up in small groups and spend an hour working through transfusion medicine content. They solve puzzles, work through equations, and move through multiple-choice scavenger hunts tied directly to transfusion medicine competencies. What might be a standard review packet becomes something hands-on, and students have to work together to finish it.
Scaling from 16 residents to more than 300 medical students across nine campuses was a learning process. Group sizes became the first issue. They started with eight students per group, but a few took the lead while others got left out. In year two, groups included a maximum of four students, ensuring everyone had a voice and stayed engaged.
Technology was another challenge. Students accessed materials early on Canvas and skipped ahead. Some groups split up tasks and moved through without actually solving puzzles together. Year two went low-tech. Coordinators didn't upload materials to Canvas, and students worked with clipboards and printed handouts. Devices were not needed.
In the first year, Dr. LePage and Dr. Muldoon traveled to all nine campuses to train facilitators. This was deliberate. Facilitators weren't always transfusion medicine experts. Some came from emergency medicine or family medicine, and running an escape room was very different from leading a lecture. The in-person training walked them through how to guide students and when to step in with help.
Student feedback showed the escape room was working. Many students called it their favorite session of the first two years. They said they remembered the material because of the activity. Exam scores were harder to interpret. Some of the year-one questions were tied to competencies that had already been retired, so the questions weren't measuring what students learned from the escape room. In year two, the exam questions aligned with updated national guidelines, giving IUSM a clearer way to assess what students retained.
For year three, Dr. LePage and Dr. Muldoon are rethinking competition. The competitive element was supposed to boost energy, but some students got too focused on winning. When the final clues required working across groups, these students were still trying to win. Now LePage and Muldoon are dialing back competition and building in clearer teamwork cues earlier. They're also fixing accessibility issues. Some puzzles used color-coding that didn't work for color-blind students. Future versions will use patterns or labels instead. And they're wondering if the escape room format could work for other topics or even as a virtual option.
They're still learning. Still tweaking group sizes, rethinking competition, and fixing accessibility. That's what they expected. As they put it, "Adopt a growth mindset. Some initiatives will fail, but you learn from them and can iterate." The willingness to let it be imperfect is exactly why it worked. What started as a handmade project to fix lagging scores in one residency program is now permanent across nine IUSM campuses. Transfusion medicine is now something students engage with and remember.
