Purpose
With decreasing curricular time allocated to basic sciences in medical schools, finding effective ways to engage students and reinforce learning has become increasingly important. Gamification including escape rooms (ERs) has emerged as a popular strategy for applying knowledge. Despite their success in various contexts, ERs have been slower to integrate into hands-on settings like gross anatomy laboratories. This study aimed to evaluate the impact of anatomy-themed ERs as a review activity on medical students’ satisfaction, perceived skill application, and academic performance.

Methods
Two in-person ERs (ER1 & ER2) were incorporated as optional review activities into an 8-week human anatomy course for first-year medical students (n = 153) in Virginia, USA. Each featured ten stations with anatomy-based puzzles to test student knowledge within the gross anatomy laboratory. Data collection included midterm and final student examination grades along with a post-survey assessing perceptions using a Likert scale and open-ended questions. Quantitative data were analyzed using t-tests and regression analysis to compare the ERs and outcomes with previous cohorts, while open-ended survey responses underwent thematic analysis.

Results
While student participation in both ERs was similar (mean = 98.5; 64.38%), ER2 was favored overall. Highly rated survey items (n = 34) included enjoyment, collaboration, identifying knowledge gaps, and applying knowledge. Students most enjoyed “teamwork” and “application of knowledge,” while suggested improvements included “group size,” allocated “time,” and the number of “stations.” Students who indicated that ER2 helped them solidify underlying fundamental concepts were more likely to succeed on their final examination. No significant difference was found in overall outcomes compared to the previous year’s cohort.

Conclusion
Integrating anatomy-themed escape rooms into the gross anatomy laboratory provided an engaging review activity, as evidenced by students' satisfaction and perceived skill application. Future studies are needed to quantify its benefits and implications on overall student outcomes.