Motivation and perceived learning in serious games: Reflexive thematic analysis of educational escape room experiences

INTRODUCTION: Serious games represent an innovative and engaging method for teaching procedural skills, but educators lack sufficient data on optimal design and implementation strategies for enhancing learning and motivation. The purpose of this study was to explore learners' perceptions of how core design features of an educational escape room affected their motivation and learning during procedural skills training. METHODS: We conducted individual interviews in 2023 with anesthesia residents and student nurse anesthetists who concurrently participated in a randomized controlled trial examining the effects of time pressure in a procedural skills escape room. We analyzed interview transcripts using reflexive thematic analysis within a constructivist paradigm. RESULTS: We reached thematic sufficiency after interviewing 13 participants across 13 escape room sessions. We identified 7 themes: 1) competition with self and others is motivating and improves cognitive engagement, 2) time pressure enhances simulation fidelity and affects participants' goals, 3) group dynamics impact participants' motivation and learning, 4) psychological safety within teams enhances motivation and learning, 5) pre- and post-escape room activities enhance participant motivation, 6) struggling in a task promotes learning, and 7) relevant and memorable tasks enhance motivation and learning. DISCUSSION: Competition, time pressure, social dynamics (e.g. social cues, team learning), and active effort contributed to the educational success of serious games. Immediate feedback embedded in the design of escape room puzzles may benefit learners by improving their self-efficacy. Findings suggest productive avenues for advancing understanding of how motivation and performance intersect in other types of serious games and for identifying effective ways to incorporate struggle or failure.