Purpose
Serious games blend gameplay with education, enhancing intrinsic motivation for classroom participation. Gamification shows promise in boosting learner participation, especially for high-stakes exam readiness. However, evaluations of game-based learning sessions grounded in theory are scarce, yet they are essential for making informed pedagogical decisions. To address this gap in gamification literature, we developed and evaluated an escape room for preclinical medical students to review biochemistry in preparation for Step 1. This study is guided by the mechanics, dynamics, and aesthetics (MDA) framework to evaluate a high-yield review escape room session on learners’ participation, motivation, and perceived exam preparedness. While the tasks for this game were biochemistry, this game design can be adapted to other disciplines.

Methods
This escape room was played in person or asynchronously with digital objects. The escape room game was divided into 5 parts consisting of 2-3 NBME style questions that combine to a single answer. A pilot study was conducted in 2024 to gather preliminary data with additional data collection planned in the spring 2025 iteration. Data will include observational metrics (completion time, error rates) and post-game surveys featuring Likert scales and open-ended queries. Evaluation will emphasize game mechanics, dynamics, and aesthetics (MDA Framework), assessing player interactions, challenge levels, team strategies, emotional responses, and overall game experience.

Results
Our pilot study indicated an average completion time of 28.4 minutes (±6.6) for 12 student groups within a 45-minute timeframe. Error rates correlated with answer complexity, impacting game progression. Attendance showed a notable 55% increase compared to non-gamified sessions in prior years.

Conclusions
Preliminary data suggests that in-person escape rooms enhance attendance and participation in high-stakes exam reviews. Complex answer combinations increase game difficulty and completion time. Data collected in Spring 2025 will be presented to demonstrate how educators can optimize participation and satisfaction in review sessions through gamification.