Simulation game helps students understand traumatic brain injury

From a tackle in a football game to a fall on an icy sidewalk or a car accident, the dangers of traumatic brain injury are real and sometimes even fatal. To help educate students about traumatic brain injury and heighten their awareness and ability to make informed decisions, Project NEURON at the University of Illinois developed The Golden Hour.

The Golden Hour — named for the critical time period after a traumatic injury when swift and apt medical treatment has the greatest potential for saving a patient's life — is an educational computer game that immerses students in a medical case study that takes place in this decisive timeframe.

Players must save the life of a patient, Quinn Shepard, who has suffered a traumatic brain injury. To succeed, they must learn and apply neuroscience concepts and use sound reasoning skills to properly diagnose and treat the patient.

The Golden Hour is an engaging case-study-based tool that helps students learn science content and practices. As such, The Golden Hour and associated curriculum materials connect to a number of the ISTE Standards:

ISTE Standards for Students

• Use models and games to explore complex systems and issues.
• Collect and analyze data to identify solutions and/or make informed decisions.
• Exhibit a positive attitude toward using technology that supports collaboration, learning and productivity.

ISTE Standards for Teachers

• Engage students in exploring real-world issues and solving authentic problems using digital tools and resources.
• Design or adapt relevant learning experiences that incorporate digital tools and resources to promote student learning and creativity.
• Provide students with multiple and varied formative and summative assessments aligned with content and technology standards and use resulting data to inform learning and teaching.
• Address the diverse needs of all learners by using learner-centered strategies providing equitable access to appropriate digital tools and resources.

Playing the game

The Golden Hour consists of three main scenes in which players work with medical professionals to assess, diagnose and treat a patient with a traumatic brain injury.

Scene 1

Players work with an emergency medical technician (EMT) who is responding to a call about a patient who has suffered a head injury in a bicycle accident. Under the EMT's guidance, players assess the patient's vitals by checking his ABCs airway, breathing and circulation. Players then must evaluate the severity of the patient's head injury by using tests for the Glasgow Coma Scale (GCS). Using this method, players find that the patient's GCS score indicates he has a moderate brain injury.

Scene 2

After transporting the patient to the hospital, the next challenge is to correctly identify the brain injury type and location using a CT scan. Players work with a CT technician who orients them to key structures of the brain and their functions and explains how to identify different types of brain injuries on a CT scan. In studying the patient's CT scans, players identify a subdural hematoma — a pool of blood between the dura mater and the brain — on the right temporal lobe of the brain.

Scene 3

After proper diagnosis, players decide that surgery is the next step. Now they must remove the hematoma that is damaging the brain's right temporal lobe. Guided by the neurosurgeon, players prepare and disinfect the area, cut through the layers of tissue and bone around the brain to the site of the injury, and remove the pooled blood.

Assessing student learning

After each of these scenes, the game assesses students' understanding of neuroscience concepts and their ability to write sound scientific explanations. Students must complete medical reports, discuss findings with the lead physician and write medical recommendations for the patient.

The reports are based on those used in medical settings and designed to get students to think about and record the medical actions they took as well as the findings they collected. After submitting an accurate and complete report, students must discuss their findings with the lead physician, Dr. Picotte, to determine the next medical steps.

The dialogue sequences with Dr. Picotte were developed around the claim, evidence and reasoning (CER) framework for constructing scientific explanations. It works like this:

Dr. Picotte asks players variations of the following multiple-choice questions:

1. What are the next steps for the patient? (claim)
2. What findings support this decision? (evidence)
3. How does your evidence support your claim? (reasoning)

If the player selects the correct answer, the game advances. If not, the player gets feedback about why that may not be the best answer and gets another opportunity to answer the question. The focus, therefore, is not on getting the right answers but on how to think carefully and critically about the questions and on why some explanations are better than others.

In Project NEURON classrooms, the format of these dialogues with Dr. Picotte spurred thoughtful conversations among students as they worked in pairs to play the game. The right answer is not always clear, which encourages students to discuss the options with each other and articulate their reasoning as they defend their answers.

After working through this question-and-answer dialogue with Dr. Picotte, players must write coherent scientific explanations that answer the question: " "What should be done next for the patient?" " Drawing on their dialogue with Dr. Picotte, they must employ the CER framework and include a clearly stated claim, evidence from their report and sound reasoning to back up their decision. The complete explanation is their medical recommendation for next steps for the patient.

By the end of the game, students will have completed three reports and written three medical recommendations, one for each scene of the game. Teachers can use these artifacts to evaluate student understanding of neuroscience concepts covered in the game as well as their ability to construct scientific explanations and arguments based in evidence.

Teaching with The Golden Hour

There are several ways to use this game in the classroom. Students can play the game with minimal instruction or it can be taught as part of either a three-lesson unit or seven-lesson unit on traumatic brain injury.

Students need no prior knowledge of neuroscience to play the game on their own because they learn about the topic as they work through the simulation. Even the individual scenes can stand alone, so teachers who want to customize the game can ask students to focus on specific sections.

To take a deeper dive into the content, educators can find curricular materials on the Project NEURON website. The three-lesson unit offers additional activities that support and expand on the concepts presented in the game. The more robust seven-lesson unit offers a full curricular unit on traumatic brain injury. Called " "Why dread a bump on the head? ," the unit covers concepts such as causes and severity of brain injuries, structure and function of brain areas, CT scans and different types of TBI, cell apoptosis and necrosis, and real-life TBI data analysis. Within the unit, students play scenes of The Golden Hour interspersed with other lesson activities and make connections between their experiences in the game and concepts covered in the lesson activities. This allows students to learn through the engaging format of a game while working within the context of a larger detailed unit on the neuroscience of TBI.

The Golden Hour in the classroom

Educators have used the game in different levels of high school biology as well as human anatomy and physiology. Feedback from teachers and students has been positive. Students reported that they enjoyed learning through doing. For example, some said that even though they had read about the Glasgow Coma Scale in the student materials, actually evaluating a patient's GCS score in the game helped them to better understand how it is used and what it indicates about the severity of a brain injury.

Within the units, teachers have incorporated the game in different ways. Some educators split up the scenes to correlate with the lessons. For example, students participated in hands-on activities in Lesson 1 and then applied and extended what they learned through playing Scene 1 of the game. Other educators had students play the three scenes in sequence as an application and review of concepts after finishing the connected lessons.

In several classrooms, The Golden Hour game was the students' first introduction to the CER framework. Even with minimal instruction on the use of CER as a framework for constructing scientific explanations, students were able to complete the reports and explain their medical recommendations. Teachers felt that the assessment sections of the game modeled the CER approach and provided a defined structure and context that supported students' first attempts at writing a scientific explanation that incorporates a claim, evidence and reasoning.

For students, The Golden Hour provides opportunities to actively learn basic neuroscience concepts connected to traumatic brain injury and how to construct scientific explanations. For teachers, The Golden Hour is an opportunity to leverage technology in the form of a computer game to teach and assess science content and practices in context.

Project NEURON is an NIH-SEPA funded curriculum development group at the University of Illinois in Urbana-Champaign. The project brings together scientists, science educators, teachers and students to develop educational materials that connect frontier science with national and state science education standards. Though the project's main focus is the development of in-class curriculum units that emphasize inquiry and active learning, they have also developed educational videos and games, such as The Golden Hour. Project NEURON is funded by the National Institutes of Health's Science Education Partnership Award (Award Number R25OD011144).

Chandana Jasti, Ed.M., is a curriculum specialist for Project NEURON at the University of Illinois, where she develops secondary science curriculum and conducts teacher professional development. She enjoys working closely with scientists, educators and students to create and share engaging ways to teach and learn science.

Barbara Hug is a clinical associate professor at the University of Illinois in the College of Education. She is interested in the design of learning environments that support teachers and students in the teaching and learning of complex scientific concepts and practices. She is the principal investigator of Project NEURON.