GlasgowSim - Glasgow Coma Scale Simulation
Authors: Correia Deoliveira Dominique , Rekik Yassin , Malandain Stéphane 
Published: August 2024

The training of healthcare professionals is a tough and prolonged process that requires deep understanding of theoretical concepts as well as technical, non-technical skills. Commonly, during the early stages of medical education instructional techniques involve static and unrealistic learning materials, based on the old philosophies. Nowadays, traditional approaches are being replaced by novel methods focused on the use of the new technologies and advanced simulators. The use of serious games and VR simulation can contribute to the training and improvement of the skills of healthcare professionals, thereby contributing to the quality of care, increasing patient safety and reducing costs of training programs. In this project, we developed a simulation-based serious game allowing students and professionals to practice on the evaluation of the patients’ state of consciousness according to the Glasgow scale. The Glasgow Coma Scale (GCS) is a neurological instrument that measures the “severity” and extent of impaired consciousness. The GCS has become the most used tool in the world to document alterations in the level of consciousness caused by brain damage. In combination with other neurological examinations, the scale is used to estimate the vital prognosis of patients with a severe brain injury. Because of its ease of use for all health professionals in all care settings, the scale has become an essential tool in all training programs. The neu-rological evaluation requires frequent simulation-based education to improve the cognitive, psychomotor and communication skills of the health students. However, current simulation approach¬es are resource-intensive and not routinely offered in all healthcare schools. Also, alternative approaches are needed to improve working memory, decision-making skills and teamwork per-formance. Serious games may be effective and more accessible alternatives if they use active, experiential and problem-based learning. They are indeed likely to solicit the student motivation and allow them to develop knowledge in complex learning situations. A multidisciplinary team including experts from healthcare, education and engineering ensure a coherent interaction between the game, content and pedagogical features. The GlasgowSim project aims to develop a pedagogical innovation that meets the requirements of the curriculum and extends the teaching options for the Glasgow Assessment Scale. The user is invited to interact with a computer-based device that combines teaching aspects with playful elements derived from video games. Theoretical and simulation workshops are currently being organized, but straight neurological assessment needs to be made more accessible to health students who will be applying ECS daily as future clinicians. When used for demonstration purposes, these approaches are resource-intensive (mannequins, technicians, teachers, etc....) In addition, through the various satisfaction evaluations, students express their wish to have access to different teaching tools to identify the future challenges of the practice sites. On the one hand, the teachers in the HESAV nursing care stream have developed clinical vignettes that promote the integration of knowledge and student learning, and on the other, the teachers in the HEPIA IT stream have developed a virtual environment that allows users to immerse themselves in a real-life neurological assessment situation. In this way, we will encourage the participants' reflective practice by optimizing their clinical judgement in the assessment and management of patients with neurological disorders. The trainers are convinced that simultaneous learning of Why and How the Glasgow Coma Scale is administered would optimize the clinical judgment of health professionals in the neurological assessment of brain-injured patients. Based on the design decisions, we have broken down the GlasgowSim solution into three essential components. The first component is the simulation tool, which allows the learner to interact with the patient, make diagnosis, and deliver assessments and recommendations. This tool creates the complete simulation environment based on a description of the scenario in JSON format and aggregates the necessary objects with the right configuration. The second component is the interactive patient. We considered this element to be essential given the importance of the patient in the diagnosis to be made by the learner. This patient has been developed to enable realistic GSC diagnosis. Finally, the last component is the interactive scenario creation tool. This tool will enable teachers to define all the parameterizable elements of a scenario and to export the scenario in JSON format to the simulation tool. To be able to create new scenarios and new clinical situations simply and easily, a scenario generator has been developed in the form of a web application connected to the simulator.