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Case Study · Cookie Box · Springer Healthcare · Kern Pharma · 2019-2020
Turning a Pregabalin dosing schedule into an escape room 70 skeptical doctors couldn't stop playing
A gamified Clinical Case Room built on Cookie Box's five-layer Hamburger Model, transforming a dense neuropathic pain case into an hour of active, collaborative clinical reasoning.
MY ROLE
Learning Experience Designer & Facilitator
Learning Experience Designer & Facilitator
CLIENT
Kern Pharma (via Springer Healthcare)
Kern Pharma (via Springer Healthcare)
FRAMEWORK
Cookie Box Hamburger Model
Cookie Box Hamburger Model
SCALE
70 physicians in pilot (91+ across 3 projects) · 100% satisfaction · 2 custom Case Rooms commissioned
70 physicians in pilot (91+ across 3 projects) · 100% satisfaction · 2 custom Case Rooms commissioned
OVERVIEW
Teaching a dosing schedule to skeptical physicians, not lecturing them through it
Teaching a dosing schedule to skeptical physicians, not lecturing them through it
Springer Healthcare wanted to move continuing medical education away from the conference and slides model, where physicians receive scientific content but rarely apply it. Cookie Box's answer was the Case Room: an escape-room format that turns dense professional content into a scenario physicians have to reason through as a team, under time pressure, with the same evidence-based rigour a lecture would demand.
I was the sole designer on the first implementation, built for Kern Pharma. I designed the experience end to end (case analysis, phase structure, challenge design, physical and digital materials), tested it with Springer and the clinical case author, then implemented it with Kern Pharma. Its success led Springer to commission two additional custom Case Rooms for Daiichi Sankyo and Takeda, which I co-designed.
Co-creation session with the Springer Healthcare team, aligning the clinical case to a rigorous gamification solution before any challenge was designed.
THE CHALLENGE
A traditional sector, a dense case, and one hour to prove the format works
A traditional sector, a dense case, and one hour to prove the format works
The clinical content centered on a real-world, complex human patient case: severe neuropathic pain (lumbosacral plexopathy and alcoholic polyneuropathy). Physicians needed to evaluate symptoms, analyze diagnostic data (Altered Deep Tendon Reflexes / ROT and leg X-rays to rule out structural issues), and calculate a safe, week-by-week Pregabalin dosing schedule while managing alcohol use disorder risks. Maintaining scientific accuracy was essential, so every design decision had to protect medical rigor while remaining highly engaging.
The harder constraint was cultural. Medical education is formal and hierarchical, making physicians naturally cautious of non-traditional formats. The design had to establish credibility fast, within a single hour, with an audience that expected a standard scientific presentation.
"Doctors were initially very hesitant to play, this is a very traditional sector, even the client was nervous. But as soon as the experience started, even the hesitant ones were so immersed that they ended up running through the room looking for hidden envelopes and spying on other teams."
EXPERIENCE ARCHITECTURE
Five layers, one hamburger: the model behind every Case Room
Five layers, one hamburger: the model behind every Case Room
Every Case Room is structured on Cookie Box's proprietary Hamburger Model, five layers that separate what the story is from how it is delivered. Working this way meant scientific content (the patty) could be iterated on independently from the visual theming or the delivery technology, which mattered given how tightly the client evaluated clinical accuracy.
The Cookie Box gamification hamburger model
Narrative: The real human clinical scenario. Gives abstract pharmacology a human story to reason about and provides the emotional hook.
Aesthetics: Kern Pharma visual styling, colors, and typography aligned to the client's look and feel, lowering skepticism.
Transmedia contents: Core learning content (dosing logic, ROT findings, X-ray results) distributed across physical and digital formats so recall is active.
Game design: Time pressure, specific team roles, and progressive challenges driving clinical decisions rather than passive reading.
Technology: Interactive presentation system capturing live team responses, turning gameplay into a real-time assessment instrument.
The case was mapped into four phases: an onboarding phase introducing rules and team roles, followed by three storytelling phases of increasing complexity tied to key clinical decisions (initial presentation, diagnostic exclusion, and building the safe dosing schedule).
The empathy map built during co-creation, defining what physicians needed to think, feel and do inside the case before a single challenge was designed.
GAMIFICATION AND FEEDBACK
Every mechanic had to earn its place next to a drug dosage
Every mechanic had to earn its place next to a drug dosage
Nothing was included simply as a novelty. Each mechanic directly supported a specific clinical behavior, making the design easy to defend to a scientifically focused client and SME.
60-minute timer: Simulated real clinical urgency, prevented fatigue, and forced the team to prioritise rather than deliberate on every detail.
Hidden envelopes: Scattered under tables, chairs and behind walls, they acted as optional scaffolding, redirecting stuck teams to the right research paper without handing over the answer.
Magnifying glass, UV torch, red cellophane, dose spin wheel: Physical proxies for diagnostic investigation, used to manually work through the week-by-week Pregabalin titration scheme.
Digital submission: The interactive PowerPoint required teams to commit to definitive diagnoses and doses in real time, generating the dataset later used in debrief.
Role allocation: Roles such as Resource Researcher, Envelope Inspector, and Clue Hunter, plus team identities named after Kern Pharma products, structured collaboration and prevented passive participation.
Diagnostic tools hidden inside the table's mini chest of drawers, replicating clinical investigation.
Materials to solve challenges.
Materials experimentation.
TESTING AND ITERATIONBuilding trust one prototype at a time
Development progressed through three structured testing cycles with the clinical SME and Springer Healthcare:
Low-Fidelity Testing: Raw PowerPoint storyboards validated whether the clinical questions were accurate and meaningful before physical assets were produced.
Medium-Fidelity Testing: Testing with printed challenge materials revealed that participants struggled to extract complex dosage and complication data solely from printed papers. This observation led directly to the hidden-envelope mechanic, a scaffolding tool added to keep learning momentum going.
High-Fidelity Testing: Replicated the complete event setup: interactive presentation software, physical drawer units, hidden clues, and scientific research documents before final sign-off.
Team role badges and phase boxes with clues prepared ahead of a testing session, structuring collaboration before the first team ever sat down.
The physical kit for each phase: research papers, phase markers and the drawer unit holding the diagnostic tools.
IMPLEMENTATION70 doctors, 2 hotel event rooms, and a timer that never stopped
I facilitated the live event, guiding 70 physicians divided across two hotel event rooms (35 doctors in my room arranged into 5 teams of 7). Teams played against the projected countdown timer, and searched the room for hidden envelopes. I walked the room throughout, monitoring progress and providing light guidance if a team hit a wall.
Initial hesitation quickly shifted into active focus: doctors collaborated intensely, searched for clues, and compared progress with neighboring tables. The clinical case author closed the session with a structured debrief, addressing the exact misconceptions identified by the digital system during gameplay.
The room set for implementation: phase tables with drawer units and research papers, countdown projected at the front.
The room set for implementation: phase tables with drawer units and research papers, countdown projected at the front.
EVALUATION AND IMPACTWhat the data and the debrief showed
Evaluation focused on measurable session outcomes, learning signals, and organizational impact:
70Physicians reached
100%
Satisfaction (Level 1 - Learner Reaction)
Satisfaction (Level 1 - Learner Reaction)
2–3
Recurring misconceptions surfaced (Level 2)
Recurring misconceptions surfaced (Level 2)
2
Further editions commissioned
Further editions commissioned
Real-time response data from the interactive presentation showed strong overall accuracy, with teams consistently converging on the same 2 to 3 complex dosing and diagnostic questions as misconceptions, giving the SME a precise, evidence-based debrief agenda rather than a generic knowledge recap. Qualitatively, a physician cohort that started visibly hesitant shifted into active, competitive engagement, an early signal that the format can convert passive CME attendees into 3 Further editions commissionedactive participants. The pilot's success led Springer to commission two further Case Rooms, for Daiichi Sankyo and Takeda.
WHAT I WOULD DO DIFFERENTLY
Three things this project changed about how I design
Three things this project changed about how I design
Include a Lightweight Pre/Post Knowledge Check: While in-session accuracy provided a strong real-time learning signal, a brief assessment before and after the session would offer clearer proof of overall knowledge gain (Level 2 learning evaluation).
Create a Remote Pre-Onboarding Teaser: To address hesitation early, I would design a short, interactive pre-event digital preview or video highlight of a previous session. Sending this to participants ahead of time builds curiosity and sets expectations before they enter the room.
Formalize Misconception Data into a Client Insights Report: The live error data was valuable during the debrief but wasn't compiled into a permanent report. Packaging these insights into a summary document would give the client clear proof of learning gaps to address in future training programs.
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