Digital Escape Rooms as Active Learning Tools in Biomedical Sciences: A Multi-Course Evaluation in Undergraduate Biology Education

Digital escape rooms are increasingly used as active learning tools in higher education, yet evidence from preclinical biomedical subjects and comparisons across academic years remains limited. This study examined students’ perceptions of digital escape rooms implemented in four compulsory Biology courses: Cell Biology (Year 1), Histology (Year 2), General Immunology (Year 3) and Immunopathology (Year 4). A cross-sectional mixed-methods design was applied. Students completed an 11-item Likert-scale questionnaire assessing educational impact, interactivity, motivation and overall perception, together with one open-ended question. A total of 123 students participated. All dimensions received positive ratings, but differences emerged between courses. Histology obtained the highest scores across dimensions, Cell Biology the lowest, and the Immunology courses intermediate values. Significant differences were mainly observed between Histology and the other courses, and between Cell Biology and advanced subjects. Correlations between dimensions were moderate to strong (r = 0.54–0.67). Qualitative analysis identified five themes: deep but topic-specific learning, creativity and interactivity as motivational drivers, high workload relative to assessment weight, technical issues requiring clearer guidance, and variable group dynamics. Overall, digital escape rooms perceived usefulness depended on disciplinary alignment, academic level and workload. Structured scaffolding is essential for integration into biomedical curricula.