Comparison of the effects of online escape room games and case-based learning on critical thinking among nursing students: A randomized controlled trial.

BACKGROUND: Case-based learning (CBL) and online escape room games (ERGs) are two active learning strategies that cultivate critical thinking. Case-based learning promotes analytical reasoning through structured scenarios and guided discussions, whereas escape room games employ gamified challenges to enhance engagement and problem-solving. Although both methods are gaining popularity, they are based on different pedagogical principles. To inform evidence-based instructional decisions, we compared the effects of CBL and online ERGs in this study on nursing students' critical thinking disposition, critical thinking skills, critical care nursing knowledge, learning motivation, and learning satisfaction. SETTING: A university in Vietnam. PARTICIPANTS: Seventy-two senior nursing students were randomly assigned to an intervention group (ERGs; n = 36) or a comparison group (CBL; n = 36). METHODS: This was a two-arm randomized controlled trial. The intervention group participated in online ERGs following each of six weekly lectures, while the comparison group engaged in case-based discussions. Data were collected at the baseline, immediately after the intervention (T1), and 1 month later (T2). Students' critical-thinking disposition and skills, critical care knowledge, learning motivation, learning satisfaction, and perceptions of the escape room experience were assessed. RESULTS: Critical thinking skills improved in both groups at T1, while critical thinking disposition showed no significant change at either T1 or T2. No significant between-group differences were found in changes in critical thinking skills over time. Both groups demonstrated improvements in critical care knowledge, with no significant differences between them. Similarly, no significant between-group differences were found in learning motivation or learning satisfaction. CONCLUSIONS: Online ERGs and CBL were both associated with improvements in nursing students' critical thinking skills, knowledge, and learning motivation, with no statistically significant between-group differences observed over time. Both approaches can serve as useful instructional strategies in nursing education, and educators can consider selecting either approach based on instructional goals and available resources. REGISTRATION: The study was registered at ClinicalTrials.gov (ID: NCT05999305).