What do you really know about concussions? Can education increase self-reporting and help prevent long-term damage from brain injuries?

On this episode of School’s In, Dan and Denise are joined by Piya Sorcar, Adjunct Professor, Stanford School of Medicine and founder and CEO of TeachAids and Dr. Daniel Daneshvar, associate professor at Harvard Medical School and a concussion researcher. Together, they discuss concussion symptoms and treatment protocols, how to reach young people in ways that make them most receptive to learning about challenging health topics, and strategies for building partnerships and scaling public health initiatives about brain health for young athletes, parents, and educators. They cover several topics, including:

1. (04:25) What is a concussion? Understanding an invisible injury
2. (08:02) Creating CrashCourse: Education that engages and motivates
3. (12:04) The near-peer effect: Why kids trust other kids
4. (17:01) Proving it works: The science behind behavior change
5. (20:13) Scaling the impact
6. (23:46) Expert takeaways for parents and coaches

Piya Sorcar is an Adjunct Professor, Stanford School of Medicine and the founder and CEO of TeachAids, a nonprofit that creates research-based learning experiences to improve health outcomes. Daniel Daneshvar is an associate professor at Harvard Medical School whose research focuses on the long-term effects of traumatic brain injury and how to improve outcomes through education and intervention. CrashCourse, created by Sorcar's TeachAids with medical advisors including Daniel Daneshvar, delivers interactive concussion education for athletes, coaches, and parents.

School’s In is your go-to podcast for cutting-edge insights and fresh perspectives on the future of learning. Hosted by Stanford Graduate School of Education (GSE) Dean Dan Schwartz and Senior Lecturer Denise Pope, each episode dives into the latest research, innovations, and real-world challenges shaping education today.

Stanford GSE is at the forefront of education research and teacher preparation, dedicated to advancing equitable, accessible, and impactful learning experiences for all.

Stay connected with the latest insights—subscribe to our newsletter and follow us on Instagram, LinkedIn, and Threads.

We estimate somewhere between 1.6 to 3.4 million people get concussions every year in this country, but that estimate is so wide because we know that most people aren't coming forward with their concussions.

Welcome to School's In, your go-to podcast for cutting edge insights in learning. From early education to lifelong development, we dive into trends, innovations, and challenges facing learners of all ages. I'm Denise Pope, senior lecturer at Stanford's Graduate School of Education and co-founder of Challenge Success.

And I'm Dan Schwartz. I'm the dean of the Graduate School of Education and the faculty director of the Stanford Accelerator for Learning.

Together, we bring you expert perspectives and conversations to help you stay curious, inspired, and informed. Hi, Dan.

Well, hello "Get the information out there" Pope.

Get the information out there, Pope. That is definitely one of the themes of today's show.

Well, it's also what you do with Challenge Success.

Oh.

You try and get the information out there.

Thanks, Dan. That is true.

Yes.

That is true.

Yeah, yeah.

It is actually a big challenge in the world of education, how to get important educational information out to the world.

That's right. So, we're gonna learn about that today, and our key topic that we're gonna focus on is concussion education. And I think you have very personal experience with this, Denise.

Oh, I do. Oh, I do. I'd like to not remember it, actually, but yes, five or six years ago, I was super, super dehydrated from a stomach flu, and I passed out and hit my head on the tile floor of the bathroom. And it was bad, I had a huge shiner, I completely passed out. And I had a lot of trouble getting information from people. They said, "You have a concussion," but really different information on what I should do and how I should handle it. Like to the point of people saying, "Stay in a room with lights out and don't do anything." And literally another doctor is like, "Get out there and move and get your heart rate up." (laughs)

I mean, it couldn't have been more diametrically opposed. And it was really, really frustrating and you're sitting there with the symptoms of a concussion, with a very fuzzy head. I had vertigo, I had dizziness, I had nausea, I literally couldn't walk in a straight line for a little bit.

I'm not going to ask what your husband was doing while you're like squirming in misery. And he's like, uh, "Well, I gotta go, I gotta go walk the dog. You take care of it, Denise."

Yeah, no, he found me passed down on the floor and everyone's like-

Oh, wow.

... "Well, how long was she out for?" And, but he-

Oh, wow.

... doesn't know, right? Like, how do you know? Anyway, it was quite an ordeal. It took me about nine months to kind of feel like myself again, and I never wanna have another one. And I am really, really excited that we have experts here, not just, um, experts on concussions and what concussions are, but also experts on how to get this information out to the public because I really think it's so important and people need to know. So, it is absolutely my pleasure to introduce, we have two guests today. We have Dr. Piya Sorcar and Dr. Dan Daneshfar. And we're gonna call Dr. Dan Daneshfar Dr. Dan, just for clarity, because we have two Dans on the show, even though Dan, I know you have a doctorate as well, and you are also Dr. Dan.

Piya is founder and CEO, TeachAids, a non-profit that created CrashCourse, evidence-based interactive digital products that provide communities with the latest medical knowledge in the prevention and treatment of concussions. The CrashCourse programs are amazing. They've been adopted by the US Olympic Committee's national governing bodies, as well as hundreds of organizations, hospitals, youth sports organizations. We're so lucky to have Piya here. And we have our medical doctor, Dr. Dan, who's a professor at Harvard. He's chief of brain injury, rehabilitation, and co-director of sports concussions at Mass General Brigham.

He's a world-renowned researcher on the long-term health span effects of traumatic brain injury, including concussions, and at TeachAids, Dan is the director of the Institute for Brain Research and Innovation. So, are we lucky or what? Welcome, welcome to both of you.

Welcome.

Great to be here. Thank you.

Thanks so much for having us.

So Dr. Dan, before we talk about how we get the information out there, I think it'd be nice to know what a concussion is. Like, is, like, is a concussion an umbrella term for lots of different things or is a concussion just there's one thing. It's like brain swelling or something like that.

So, great question. A concussion is an injury to the brain that results in symptoms. So, you can have either a direct or an indirect impact to the head by direct, you know, something you'd actually traditionally consider a concussion, two heads hitting each other, for example, or a head hitting something hard like a tile floor. Or an indirect impact though could be something where your body is hit hard enough to still cause that injury to your brain. And so, it's a specific type of injury insofar as it results in symptoms or signs.

Those are evidence that your brain isn't operating the way it's supposed to be operating. Things like blurry vision, double vision, nausea, vomiting, getting knocked out. Those are all potential symptoms of a concussion and signs are actually being knocked out or stumbling, other things that someone else might observe you doing. Any issue where your brain is injured and it's not actually properly functioning, those are concussions.

I see. And, and how pervasive? Like does everybody get a concussion during their lifetime or?

Yeah. Well, fortunately not everybody gets one during their life, but a lot of us do. There's some studies have shown that, you know, up to 10% or just over 10% of every athlete that gets injured at some point during their sport, 10% of them are because of concussions. But on top of that, when you're talking about the overall number of people who get affected, the estimates are really wildly varying because we know the majority of concussions are undiagnosed. You know, so we estimate somewhere between 1.6 to 3.4 million people get concussions every year in this country, but that estimate is so wide because we know that most people aren't coming forward with their concussions.

You don't think it's urgent enough to go to urgent care or something like that? You feel a little off, but you just don't tell your doctor. Is that typical?

That's exactly right. I mean, so I, I played football in high school, I wrestled in high school and college, and there are plenty of times that I got a concussion that I didn't even know I'd gotten a concussion until afterward, right? You get hit in the head and you get what we call in football your bell rung, where, you know, your vision's a little blurry, uh, you see stars for a few seconds and you shake your head and you go back to playing. And, uh, we now realize that there are risks associated with those undiagnosed concussions and risks associated with, uh, long-term play, uh, if you get repeated brain injuries.

What are some of the risks?

So, in the short term, it's just like if you were to have an injury somewhere else in your body, right? If you, we all know that if you have an injury to your, your arm and you try to, you know, keep using that arm, it takes less of a force to re-injure it. Your brain is similar where if you're recovering from a concussion and you get another hit to the head, even if that head impact was not enough to, you know, normally give you a concussion, your threshold for getting a subsequent injury has been lowered because you're recovering.

And so, that's why it's so critically important to have the education and resources out there to let people know that, you know, getting these concussions checked out is important.

Yeah. So, Piya, you noticed this. (laughs) How did this even come to be that you decided we need to get this information out there?

Yeah. So, we had just finished our other work on HIV education, which had scaled to 82 countries and we were thinking about what is the next topic we should tackle. And, uh, no pun on the word tactical-

(laughs)

... but, um, and so in talking to a number of our experts, advisors, it turned out, uh, what people were saying was that concussions was much like cancer, that a lot of people have had one, or they know people who have had it, and yet people aren't talking about as much as they should. And so, then talking to many of the medical experts, they said it's incredible the number of parents that are coming in to see the doctor and also going into the ER, just being afraid of whether this is an issue or not. And that the education that was out there was either in PDFs where you just kinda check off a box that you received something, but you don't really understand how that's education.

Or the other extreme where you've got information that's half an hour or longer to be able to go through. So, the idea around it was, can we create effective, impactful education that's short and concise and get it out to as many people as possible?

So, what's that look like? Is there like a cartoon video of someone banging their head and then ...

There's a few different products that we have. The first one, it starts off in the middle of a football game. So, you have all these kids in the game and the learner gets hurt and it's a choose your own adventure. So, when you get hurt, they get to decide do they wanna stay in the game or pull themselves out. And so, the story unfolds from there.

Does this end with them like with dementia at like the age of 60? (laughing)

No. Fortunately, it doesn't end with dementia at the end, but what's really interesting is that the kids helped us design this content to make sure it was really, really engaging. And so that, the first product is about myths and misconceptions, just the basics. And then the second product is a brain fly through where you actually, through virtual reality and interactive technologies, you fly through the brain and you get to learn about what's happening and what the injury looks like. And then the third product is this concussion story wall that has over 4,000 stories of people who've been injured, as well as, uh, caregivers that talk about the injury and what their experiences are. And the idea behind all of it is this message of hope.

Wow.

So, why is there this issue of kids wanting to go back in the game or pretending that they're fine? What's going on? Dr. Dan, you probably have a reason here.

I think when we're talking about athletes, they wanna support their team. They want to play, that's why they're doing their sport. The difference between a concussion and an injury to somewhere else in your body, your arm, for example, has special nerve endings that let you feel pain. So, when there's an injury, when there's damage to that tissue, you feel the pain, but your brain actually doesn't have those kinds of nerve endings. And so, you can have an injury to your brain and that injury doesn't feel painful.

And the only way you know there's an injury in some of the cases is because you're experiencing these symptoms of your brain not working the way it's supposed to. And so, the issue then is that they don't feel the same kind of issues when they're playing through their injuries, when it comes to a brain injury versus a brain injury to the rest of their body. And so, because they're not feeling it and because they want to let their teammates down and because so much of their identity is often tied into their ability to play this sport.

That's why it's so critically important for them to have a bigger picture understanding of the issues with undiagnosed injuries to your brain.

And I, I know with my personal story, the really bad symptoms didn't come until like 24 to 48 hours after, to be honest. Like I was feeling kind of okay. I was like, "Uh, I'm okay. I'm a little woozy, but I'm okay." But then it kind of hits you. So, that also, I can also see how that would, would play into it. So Piya, you had this brilliant idea to use actual peers and football players, right, to help spread this message.

Yeah. So, when we were trying to figure out the best ways to teach young people about this, there were a few key elements that came out. First of all, we wanted to create something that they trusted, content that they believed. And the assumption was that that would be physicians or celebrities that would deliver that education. And initially it was students that echoed these ideas as well. But then our testing revealed that the kids actually felt that the physicians don't understand them.

No offense, Dr. Dan. (laughs)

Yeah, sorry. Sorry.

We love Dr. Dan.

We love you, Dr. Dan, but okay. For kids, yeah.

Yeah. And then with celebrities, that they're paid. And so, they're saying things because this is what they were told to do, and also that they're already famous. And so, what do they have to lose? So instead, what came back in the research was this phenomenon called the near peer effect, where the students said that they trusted peers who were just a few steps ahead of them in life. And so, you're right, Denise, the majority of all of the actors that are in our productions are near peers.

And is the theory that the kid's gonna say, "Coach, I think I have a concussion." Is that the theory of change or how's it gonna work?

Exactly. So, so part of the issue with other previous concussion education programs have been, they were so focused on just the education itself, knowledge transmission about what a concussion is. But one of the things that we try to ground this program in is the theory of plan behavior, the idea that we want to affect an actual behavior change, and education itself is not one of the main factors that influence behavior change. And so that's why we wanted to integrate factors like giving athletes the tools to be able to understand what reporting would look like, the perceived behavioral control related to reporting.

Similarly, we wanted to let them know that, uh, this view on concussion reporting is something that their peers might share as well. And so, that understanding of what peers and what their coaches might expect of them, we were hoping to influence that. And similarly, we wanted to get at the attitudes underlying the decision to report a concussion. So, we were trying to target those aspects to ultimately try to get them to involve an adult in their perceived concussion.

And it had to be fun and engaging and not boring, the way you did it, the process, right?

Uh, so there are a few things that, uh, were particularly important in this. So, the first piece was authenticity. Like you said, we needed it to resonate. And so, we worked with over 100 scientific experts to be able to come up with this content, and as we were working with the kids, they would almost immediately toss out our scripts.

Oh. (laughs)

And they would redo the language and, because the metaphors had to be right, the music had to be right, the slang had to be right, the clothing had to be right. It really needed to feel like it was something that was made for them by them. And so, the challenge was how do we translate the science into their language? And the secret was that near peer effect, not just in the productions that we created, but we worked with college students who were then working with high school students and middle, middle school kids to be able to design the content. And we went through over 500 iterations to come up with the final productions.

So, I'm dying to know in the choose your own adventure, like, what's my first choice?

Your first choice is whether you wanna stay in the game or take yourself out.

Okay. I, I've decided to stay in the game. What happens next? Ooh, I don't-

You get another hit to the head.

Oh.

I know it.

Or you get another hit. We don't actually, you know-

Yeah, yeah.

... show that it's, it's to the head.

And we just heard how bad the double hit is. And people would-

Correct.

... say that to me like, "When you're recovering, do not get another concussion whenever you do." And then if they take themselves out of the game, do you give them like a script or something to say to the coach or what, how, what happens then?

In both scenarios, they end up in the doctor's office and have a conversation with the doctor. And then from there, they get transported onto Stadium, which was actually filmed here at Stanford. And so, from there, they're talking to their near peers about what's happened and what do they think happened versus what actually happened.

Sweet. I like it. I like it a lot. So, this is really interesting. There's a lot of people who want to get educational interventions out the door and, uh, there, there's kind of two things they need. One is they need to demonstrate impact, so efficacy, and one is they need to find someone to help them scale. So, I wanna hear both of these, how you went about this, because you're very good at this, you're very successful with TeachAids. How do you know if this program is working, if it's a positive impact?

Well, so Piya was, uh, brilliant enough to involve dorks like me, uh, early on in the process.

We love dorks.

Uh, and-

Dr. Dork. (laughs) Sorry, sorry.

And so, uh, you know, basically everything that we put together, we wanted to make sure that it was scientifically validated, that we ensured that it was working. And so, we conducted a number of studies amongst which actually is the largest study of concussion education to date. Because this program was mandated across the state of North Carolina, we enrolled tens of thousands of, of athletes and evaluated the efficacy of the program in that context. But really what we wanted to do was take a look and see whether or not this program worked in the near term and whether it worked in the long term.

And we looked at it in a couple different ways, you know, ways that other studies have looked at things have been tracking intent to report behavior changes, but that's not the best marker. The problem with concussion research really is that we're trying to track a moving target. We're trying to identify individuals reporting undiagnosed concussions, but the problem, the very issue with undiagnosed concussions is that they're not identified. So, if concussion numbers change, is it because practice changed, rules changed, culture changed around the sport? Is it because reporting changed?

We don't know what, what, what's actually going on. So, we looked at it under traditional ways looking at intent to report behavior change, but what we also identified was another interesting factor. We identified that, that first, uh, decision point that Piya outlined, the virtual con... simulated concussion and the reported, you, you, the- there's a decision tree there of whether or not you'd report that initial injury. And what we found in a few different ways was that that was indicative of someone's likelihood of reporting a concussion in the real world.

And so now that's interesting then because we're actually able to capture these undiagnosed concussions in a way that we can't do in the real world because we're simulating the concussion, we're showing them the symptoms, and then we're giving them the decision tree. And so, that's something that we're now hoping to do going forward.

So, let me make sure I've got this. So, your, your measure of effectiveness is actually occurring through the instructional manipulation. You're putting them through this environment and then you see the choice they make.

Exactly. In, in that context for those studies, yes.

Yeah.

We also did the traditional studies where we looked at reporting, uh, intent to report behavior change, and then we also did another study where we looked at, we checked in with individuals a year later and we asked them, "Retrospectively, did you have a concussion? Did you report that concussion?" And we looked for individuals who experienced crash course and for individuals who didn't, what they said.

And then you're looking for a correlation between their choices in the game and do they report concussions later?

And that was the remarkable thing. We found that, that there was a relationship between their re... decision in the game and whether or not they reported a concussion.

That's a good assessment.

Yeah, that's awesome. And Dan loves that because he likes to create those kinds of assessments and games too, so.

Yeah, yeah.

But then they had to scale it, right? So, you, you said the whole state of, was it North Carolina?

Yeah, that's correct.

So, I, I know, I know how this happens.

Oh.

Piya goes to the legislative house and stands in the front (laughing) with a large poster shouting at people.

Use our intervention. Piya, how did, what did you do?

So, you're right that, uh, the key to our work has been partnerships. So, all the crash course products developed by TeachAids are available on our website, but the true impact has been collaborating with these highly trusted partners that have vast networks. So, as you said, it's used, uh, in schools across the country. Arkansas and Colorado have launched it state wide. North Carolina mandates it for high school athletes, but beyond schools, we partnered with a lot of other different kinds of organizations that work in informal learning environments, so outside of school.

The 25 US Olympic committee national governing bodies, so that's like USA football or USA baseball, US soccer, and they made the content available for kids, parents, coaches throughout their networks. Then there's also organizations like the National Council of Youth Sports, which works with the Boys and Girls Clubs across the United States and hospitals, clinics. So, partnerships was one piece, the second piece I think is just as important, which is understanding the technical capabilities of these different partners and how we can build content to fit their models.

So, we had actually done a systematic study of the use of their technology, and that's what led us to building the 22 different packages. So, we have video versions of the content, we have interactive versions of the content that fit straight into their learning management systems. We've got versions where you take tests and get certified, and we've got VR versions of that content. And so, creating and adapting the versions of what we created such that they, it's like a plug and play for them was incredibly important.

And you had mentioned to me too, it has to be short, people are busy, people don't have the time. So, tell me, the current length of a basic one, I know they, they kind of vary. Is what 10-

So, the first production is 12 minutes long.

12 minutes.

And the second production is six minutes long. And the third is our, the concussion story while you can stay on there for a few minutes to hours if you'd like.

So, I love that. And Dr. Dan, because I know you can do this in a very short amount of time, I know there are parents and educators and coaches out there who want the right information. So, if you're, you know, if you have advice for people on concussions and concussion education, what would that be?

Yeah, well, the landscape for management of concussion has changed dramatically in the last 10 to 15 years. It used to be that, uh, like you, you were advised you should stay in a dark room and avoid anything that might exacerbate your symptoms, but we now know that that's not the case. So, the first and foremost important thing is to make sure you're going to a concussion specialist because the way they're teaching management concussions when I was in medical school is very different than what we know now to be the case. That's the general overarching principle.

So, make sure you're being guided by a physician. But, uh, in general, we encourage supervised return to activities independent of exacerbation of symptoms. So, even if your symptoms are getting worse, it's actually okay as long as you're in a supervised setting and as long as your activities are being regulated in a way to make sure you're not getting at risk of another head impact.

So, if you are concerned, if you bumped your head, if your kid bumped their head or whatever, first step is find a doctor.

100% correct.

Very, very good. So, uh, I think it's time to get our final takeaways. I'll go first.

Okay.

So, two things really stood out in what Piya said. One was you really want quality content that's important and the second is you need to sort of understand the context where it's gonna be used, right? And so, you don't wanna design something that's sort of unusable at home or perhaps at school.

Yeah.

So, those were my two takeaways for all the people who wanna bring great ideas to the world in the education space.

Yeah. And I love that they got the students involved, right? Uh, which is obviously, I say that tune over and over again, but go to your audience. They're the audience, they're the ones who you need to bring in not just to educate them about the content, but also bring them in to be part of the solution and be the designers. I think the near peer effect is so cool. I think we see that all the time trying to, getting kids to say, uh, uh, it's actually cool to report that you have a concussion, right? The cool factor and social norming. So, um, I thought that that was really brilliant.

And of course, Dr. Dan, I love that the content is gonna be consistent and short and research based and you've tested it out and it actually works. So, thank you for that. Last words from both of you. Let's hear from Dr. Dan and then we'll hear from Piya.

I think that the most important thing when it comes to understanding concussions and their, their long-term effects is that we wanna avoid playing through symptomatic injuries because concussions and concussion recovery, as you know, Denise, it can be incredibly isolating.

Mm-hmm.

You can look normal, but not feel like yourself, and that can be incredibly disconcerting to recover, especially in isolation, especially on your own. And so, that's where bringing in others, bringing in parents, coaches, teammates to help understand the process is what you need going for.

I love that, so important. Piya.

You know, it really bothered me when I learned that three out of five high school students don't report. And so, I'd say the takeaways for me, the first one is to educate yourself and make sure that you know the signs and symptoms that teachers and parents know this. And then it would be to educate the kids because it's so important to know that symptoms like sleep and concentration, disorientation, depression, these can be related to concussion. And the last piece is to have a discussion with the kids about who they could go to for help and just giving that a label so that when something happens, they can find someone that's trusted because they've already had that discussion.

Such an important show, such important work. I am so excited that we had you both on, so thank you, thank you both for being here, and thank all of you for joining this episode of School's Inn. Be sure to subscribe to the show on Spotify, Apple Podcasts, or wherever you tune in. I am Denise Pope, and I no longer suffer from my concussion symptoms. Yay.

And I'm Dan Schwartz, and I'm reclaiming the title of doctor.