Hybrid entry-level occupational therapy (OT) programs require innovative learning strategies to support development of clinical reasoning skills in virtual environments. Virtual education escape rooms provide an immersive, game-based approach to applying clinical knowledge. However, limited research has examined their use in hybrid OT education, particularly in neurorehabilitation-focused coursework. This pilot study examined the impact of virtual escape rooms on clinical reasoning skills among entry-level OT doctorate (EL-OTD) students. A secondary focus included the design and development of virtual escape rooms using generative artificial intelligence (AI).