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Spark Curiosity & Deepen Understanding Through Exploratory Learning

Posted on October 15, 2021April 5, 2023 by Eric Gantwerker, MD - Level Ex VP, Medical Director

Rote memorization and factual recall are not enough to drive deep learning of mechanisms of action and drug processes, so why do we continue to use these outdated learning techniques?

For many decades, medicine has been fairly traditional when it comes to teaching topics like molecular interactions and cell biology. Since many of these concepts cannot be seen in action with the naked eye, much of the education around them has been relegated to diagrams, cartoons, and animations to convey these complex processes.

Rote memorization of proteins and docking sites on molecules or coagulation cascades are a mainstay of medical education today. But extensive literature on the subject tells us that studying declarative facts lacks the ability to create the depth of understanding needed to apply this knowledge to novel problem-solving tasks.¹

Building a deep understanding with educational psychology

The entire corpus of medical information is doubling every 73 days,² so future medical professionals will need a learning method that encourages them to not just memorize, but also apply new information as they receive it. To effectively build on their existing knowledge and add new disease entities and different drugs’ mechanisms of action, they will need to have a deeper understanding of these processes. Factual recall is simply not enough.

Harvard professor David Perkins has written extensively on different types of knowledge, stating, “knowledge is fragile when students don’t grasp meaning and cannot apply what is studied.”³ Per Perkins, “building deep understanding entails determining students’ prior knowledge, linking new learning to previous learning, creating visual representations, and helping students move beyond acquiring knowledge to applying what they’ve learned.”⁴

In 1956, academic educational psychologist Benjamin Bloom and colleagues created the hierarchical framework we still use today for assessing a learner’s understanding of concepts. At the base of this pyramid is knowledge, and it progresses upward through comprehension, application, analysis, synthesis, evaluation, and finally creation.⁵ The more skill needed to manipulate the knowledge, the deeper the apparent understanding. When trying to understand complex molecular processes, the hope is to create a deep conceptual understanding, ascending through the higher levels in Bloom’s Taxonomy. Not only will learners be able to recall these mechanisms, but they can also evaluate and predict how certain molecules like prothrombin and factor Xa would interact in the coagulation cascade, for example.

When learners can go beyond remembering to higher levels like applying, analyzing, evaluating, and even creating, that denotes a deeper understanding of these processes and ultimately can improve the transfer of that knowledge to novel situations. Memorization only gives individuals the ability to understand discrete situations and defined examples. With deep learning, medical professionals can become more dynamic, empowering them to meet patients’ needs and manage their concerns, whether they fit perfectly into a memorized model or not.

Diagram of Bloom’s Taxonomy depicts the hierarchy of learning; Attribution: Vanderbilt University Center for Teaching

The impact of exploratory learning on medical education

Education should focus on teaching things that can’t be Googled. In a world where everyone has instant access to information, we must instead teach students how to deeply understand concepts, search out the information needed, assess the validity of that information, and apply it to unfamiliar problems. Allowing learners to interact with information in meaningful ways can create that deeper understanding.

Games can be incredibly powerful learning tools because they present players with problems and train them on the skills needed to solve them. Through rapid trial and error and near-instantaneous feedback loops, players can conceptualize and learn very complex rules and strategies. This method is superior to the rote memorization of complex pathways and complex concepts because students can manipulate the processes and explore various strings of cause and effect, ultimately achieving higher levels of learning on Bloom’s Taxonomy.

Games also naturally spark curiosity and channel intrinsic motivations. After all, they’re an opt-in experience, so players are motivated to continue engaging over time. If we can create an experience where learners achieve a deeper understanding while having fun and intrinsically feeling motivated to engage, efficient and enjoyable learning can occur.

For example, if a player were to use a video game to explore how a certain drug may interact with a given disease, they wouldn’t just apply one drug and close the game. More likely, they would return to test the other solutions, seeking to understand not only what works and what doesn’t, but also why that is the case.

This can also have an immense impact on health literacy. Patients often want to know more about their conditions and treatments but have trouble conceptualizing medical jargon and complex processes. With a deep understanding of these concepts, health care professionals can teach it themselves, sharing the information with patients in a digestible way, be it through explaining the process in simple terms, providing metaphors, or even creating educational materials of their own.

People enter the medical field because they are naturally curious and intrigued by the fast pace, complexity, and interactive experience. To enhance physician training, it’s crucial to cater to these interests, providing an opportunity to engage in exploratory learning and spark the excitement that drew them to the field in the first place. As a result, games become a huge value-add to not just medical education, but also to lifelong continuing professional development around the many varied problems that future clinicians may face.

Have we sparked your curiosity? Create a game-based solution for your brand’s MOA/MOD.

HLTH Themes: A Fireside Chat with Stefan Vilsmeier & Sam Glassenberg

Posted on October 11, 2021June 7, 2023 by The Level Ex Team

With the volume of medical knowledge increasing exponentially and the continued proliferation of technically sophisticated procedures and products, digital transformation in healthcare is more important than ever before—especially when it comes to education and training. Stefan Vilsmeier, Brainlab president and CEO, and Sam Glassenberg, Level Ex founder and CEO, discuss the changing industry and the path forward in advance of this year’s HLTH conference.

“The theoretical possibilities in healthcare are basically tenfold greater than what is currently integrated in broad clinical practice. For that reason, we need to create a whole different level of proficiency that can be rolled out faster and more broadly.”

—Stefan Vilsmeier, Brainlab president and CEO

Watch the Full Discussion

Panelists

Stefan Vilsmeier

Brainlab president and CEO

Sam Glassenberg

Level Ex founder and CEO

LinkedIn | Twitter samzg

Read the Transcript Below

Sam Glassenberg: [00:00] Hello. My name is Sam Glassenberg, founder and CEO of Level Ex. I’m here with entrepreneur, bestselling author and Brainlab president and CEO, Stefan Vilsmeier. Brainlab creates software-driven medtech, digitizing, automating, and optimizing clinical workflows. Founded back in 1989 and headquartered in Munich, where Stefan’s dialing in from now, Brainlab serves physicians, medical professionals, and patients in over 5,800 hospitals across 117 countries worldwide. Brainlab revolutionized digital medical technology back when they introduced software for radiosurgery and for surgical navigation. Today, Brainlab leads the industry in innovation with surgical navigation, precision radiotherapy, and digital operating room integration. And as of last year, Brainlab is the parent company of Level Ex.

Stefan Vilsmeier: [01:00] I imagine there were industry participants who asked themselves what a company like Brainlab would want to do with a company that makes games for doctors. For us, our ambition was always to digitize surgery.

When you think about digitizing surgery, on the one hand, you need to track surgical instruments and understand their correlation and interaction with tissue. You need perfect models, almost like a digital copy or twin of the patient, to create a link between the digital and the physical world. The element that Level Ex adds to that is the digital copy of the surgical workflow.

While every surgeon is used to practicing in the physical world, now there’s a virtual way to go through exactly the same workflow in the same learning and thought patterns. Therefore, it’s basically the digital copy of the real world when it comes to the procedure, learning, and medical practice. Then, of course, getting that synchronized with the physical world is what we really do.

For us, it was a very important strategic move, but it also gives access to adequate and accelerated learning in a number of different areas. As a technology company, the challenge is always figuring out how when we introduce a new technology, we can get it deployed quicker. So it’s really frustrating for me when we’ve got the coolest new technology, but it takes a while to get from the first doctors to the next level and to get the really broad market to adopt it. Essentially, Level Ex allows us to accelerate that process.

Sam Glassenberg: [03:07] Right. And this is a perfect segue into a number of the themes that we’re going to talk about today. We’ve talked about access, and you also mentioned adoption. This is a problem that we see not only in surgery, but across the healthcare ecosystem. The volume of medical knowledge is growing exponentially, and as everything from pharmaceutical treatments to surgical procedures becomes more complex and more technically sophisticated, the barrier to adoption can often become higher because you need to actually train on how to use these things. This takes time, and the technologies for training haven’t necessarily improved at the same rate as the technologies for genomics and pharmaceuticals and radiosurgery.

This discussion is themed around the HLTH conference, which takes place once a year. It’s focused on digital innovation in healthcare—the idea behind HLTH is that they bring thought leaders together from all facets of the industry to create a dialogue around digital transformation in healthcare. At HLTH, the people who are actually presenting are leaders and decision makers. It’s people who are moving the industry forward and people that you and I know. In addition to great talks, it makes for effective and efficient networking. In advance of the conference, they’ve actually published a few themes that they’re going to be exploring this year. So this is a bit of a sneak preview.

Theme one is called health’s tech-tonic shift. As healthcare delivery trends toward a more digital, patient-first approach, and the number of health applications continues to rise, how can we ensure that the tech we are integrating into our lives is actually making a positive difference?

So Stefan, what do you think about that? We see so much technology for technology’s sake. At Brainlab, how do you make sure that the technology that you’re creating is creating the most value for medical professionals and patients?

Stefan Vilsmeier: [05:50] It’s all a matter of training, and it goes back to when I installed the first OR systems 30 years ago at a small hospital in China. The neurosurgeon was 23 years old and had just finished medical school two weeks before I got there. I ended up having to put on the head frame, and for me, it was clear that training was really a key component in driving our technology forward. So as a small company at that time, we invested very heavily in training and education, and that became a key element.

Even in neurosurgery, where you need to find a tumor using a digital model, in 70% of cases people don’t want to go through the process of outlining the tumor. They say, “I’ll just aim, and eventually on the screen I’ll see when the tumor pops up.” I think that the theoretical possibilities in healthcare are tenfold greater than what is currently implemented in broad clinical practice. And for that reason, I think we need to add a whole different level of proficiency that can be rolled out faster and more broadly than today’s technologies.

Also, best practice guidelines and insights as to how technology is being used are changing all the time. So, even the speed at which we need to adopt a best practice or guideline and roll something out is completely shifting. For example, during the COVID crisis, the way doctors learned to intubate a patient really changed, and that’s probably something you can really talk to, Sam.

Sam Glassenberg: [07:38] Exactly. We’ve seen over the last year that there’s been a digital transformation in terms of how doctors learn, but, in many cases, it hasn’t been for the better. We’ve gone from being able to train doctors in person in groups, or potentially in the operating room, and now with COVID, a lot of that has shifted to Zoom. We’ve gone from being able to manipulate a mannequin together, or touch it, or manipulate a device together, and now we’re trying to demonstrate something using PowerPoint slides over Zoom.

In that sense, we’ve seen that digital transformation can have a negative effect. But one of the things that Level Ex has been working on, and that we’ve been employing across the industry—Brainlab has been using it, for example—is our cloud gaming platform Remote Play™ . With Remote Play™ , a surgeon and a trainer, or multiple surgeons, can get together over Zoom or Microsoft Teams or WebEx and can actually interact with a virtual patient that’s simulated in the cloud. So now what happens is that a Zoom or Teams remote learning experience is actually better, because now instead of being limited to a mannequin or a cadaver or the particular case that’s presented on the table, we can jump to a certain step in the procedure, we can rotate the angle so we can see it from the right view, and we can actually go to the particular patient scenario that matches, epitomizes, or represents the educational gap that we’re trying to close in this particular discussion.

Stefan Vilsmeier: [9:12] The main part of that is that we are now adding an interactive component to it.

Sam Glassenberg: [9:19] Yes.

Stefan Vilsmeier: [9:20] The least effective way of learning something new is lectures. And the whole world has gone to that method over the last 18 months. This is a pivot from being able to try things out, which is the most effective way of learning, almost like being in a sandbox and trying something yourself. It doesn’t matter what you learn, from little children when they take their first steps to how our ancestors learned to throw a spear. All of that is basically driven by trying things out, and with the pandemic, we’ve gone again to lecture mode, which is a lot harder but also a lot less efficient. Reading, in fact, is more effective than just being lectured at. But again, the most effective way is trying things out.

Providing a digital way of trying things out yourself, where you have your sandbox in which you can run different scenarios, different variations, and try different decisions, is really the difference. Without that, I don’t think we will be able to provide the adequate healthcare that the world needs, because we have, in most of the Western world, an aging population and patients are demanding better and better healthcare. Without digital transformation and artificial intelligence (AI), we won’t be able to meet those expectations.

But how do we make sure that we don’t leave people behind? For a successful digital transformation, I think we need three things. We need technology, we need access to data, and we need to change something in people’s mindset and readiness. Level Ex and the opportunity to use games for accelerated learning is the best thing I’ve seen in 30 years for making an impact. And making an impact not only for people that live in the Western world, where they could easily jump in a car and drive to a training center or attend some of the best medical schools, but as something that democratizes access to adequate healthcare. Everyone nowadays has a mobile device that essentially gives them access to that type of training and education, so it is something that unites us.

It helps with more quickly rolling out best practices, et cetera, but it can also be customized to different parts of the world and their access to technology, and those parts I think are very exciting prospects that I believe will make technology useful for physicians and their patients.

Sam Glassenberg: [12:18] Dare we say, the best way to learn something is to play with it?

Stefan Vilsmeier: [12:24] Yes.

Sam Glassenberg: [12:25] That is the best way to explore a topic and develop the mental model with the most rigor. Moving from lectures on one side, to reading, to watching, to actually interacting with something. What you’ve been describing actually aligns really well with theme #3 of the HLTH conference, which is health for the greater good. At HLTH 2020, Lloyd Dean said, “Healthcare is a right, not a luxury.” In our current health system, especially here in the United States, we struggle with uninsured, under-cared for, underrepresented, underwhelmed individuals. How can we close the care gaps made worse by the pandemic and remove the social and economic barriers to accessing the best care possible?

And I would extend that Stefan, in your context, to the world at whole, right? What insights do you have from a global perspective on how we can increase democratization and increase access to care?

Stefan Vilsmeier: [13:22] When I started building my company 30 years ago, what really caught my mind was the idea of software being something that you can scale and replicate in a way that we couldn’t have imagined 30, 40 years ago. Now, mobile devices and other technologies, like cloud computing, are taking that to an entirely different level. Having started a company, what I always wanted to do from day one was have an impact with what I do, and I always found healthcare to be exactly that area.

Having grown up in Europe, we have the mindset where education and many other things are free, and the expectation to give back to society is also different. What really drives employees today is not necessarily just maximizing their income, but also working for a company that is engaged in projects. We provided technology in countries that otherwise couldn’t afford it a long time ago. Now, all of the sudden, something like Level Ex is the technology that really will virtualize education. I think that the next step is also to virtualize those expansive navigation systems, and mixed reality and Magic Leap is a way of doing that. Instead of a $250,000 hardware device that you need to wheel into the operating room, you’ll be able to put on a $5,000 headset and you will be able to see the patient with X-ray eyes and immediately capture anatomical problems, trauma, et cetera. Finally, we will also find cheaper ways of turning operating rooms digital. So instead of being something that only the first world is able to afford, I think that digital technology is about to shift gears.

The way cell phone technology has allowed some of the merchant countries to leap frog what is implemented in the first world—you find better cell phone coverage throughout most parts of India than you find in Manhattan—is another reason why I think there’s hope for better access in those countries. It starts with training, so Level Ex in my opinion is really a critical component of that. But also, the technology is more accessible and so is the data.

We need to build a more powerful system that’s based on sharing information and data. I think that a lot of the business models in healthcare are built around selling a disposable that may cost $5 to make for $1,000 and building a complex hardware infrastructure around that. So software is not used for what it is meant to be used for, like this universal, intro-optical, scalable concept, but something that is used as a proprietary system to maximize lock-in effects of certain hardware.

I think those business models will be a thing of the past, and I think patients should really demand increased access to adequate healthcare. We as a company want to do everything to really facilitate that by also coming up with more flexible and software driven business models and concepts. That will definitely be data-driven. The question of where technology development will take place in five or 10 years from now is also going to be dependent on data. I think that there are certainly emerging markets that can lead the way regarding how they capture their data, how they make the data accessible, and how they become an interesting place for developing the next generation of healthcare technology.

Those developments will also be driven by AI and software developers. I find entrepreneurship in a number of places around the world that you wouldn’t really expect, and the ability to shape healthcare through AI and other technologies is no longer a privilege of Europe, the US, and Japan. It’s a number of other markets like Malaysia and China that are still developing, that all of the sudden are coming up with lots of innovation and a fresh new mindset. Not being entrenched in those structural contingencies that result in a gridlocked system is sometimes an opportunity to even out-innovate the Western world.

Sam Glassenberg: [19:03] I think that the point that you made, getting back to AR headsets, was actually intriguing, because we think about the opportunity and potential of AR, right? We think about having a Magic Leap headset and the benefit for the surgeon and the patient of being able to project the MRI or the CT scan or the ultrasound view on top of the patient that you’re looking at, so you don’t have to register in your brain what you see on the screen. And then from there, we can look at the educational benefits. Now we can take that same headset and project a virtual patient over here and practice doing the procedure beforehand.

The point that you made is really interesting, because as we do this, we’re actually democratizing access to the broader suite of technologies. With an AR headset, instead of needing a million dollars of equipment and screens and all the complexity, you put it on, you push a button, and you can create a virtual endoscopy suite, cath lab, or OR. The screens are all placed correctly, and you have all the tools you need and all the visualizations, and you could also project the training material on top of it.

What this would do is not just improve the situation in developed countries, but lower the barrier to entry for developing countries to be able to build out this infrastructure because so much of it exists in software. And really, what’s enabling that is a headset that costs a few thousand dollars and the software on top of it. So I think that’s an interesting way to think about it.

Stefan Vilsmeier: [20:36] And you would be able to press a button, and at the push of a button, you could get an expert to be available online in a different corner of the world, who may be a teacher for a new procedure or a new concept. Maybe helping you take care of a very rare case or special situation—it could be a clinical support group, or it could also be technical support. This is something that will be important for rural areas in the developed world, but also something that really is equally applicable anywhere.

It may also involve several different services—maybe reading CT scans for a radiology report could be done equally well but less expensively by other countries, and so I think that there’s also going to be a different level of competition for services and quality around the world. That quality needs to be measured and characterized, which I think takes us to another important topic, which is how we can create a data ecosystem that really would be patient-centric and patient-determined, where patients are basically in charge of their own destiny. Where it’s not a matter of big platform companies having everything from life insurance to an activity tracker coupled with your health insurance and a drone that then delivers your 3D printed track.

It’s a great new world, but I don’t think, for me as a patient, that that would meet my own values in terms of privacy. For that reason, I think we need to put a patient in the center and give the patient control over their own data in a very privacy-preserving and secure way. This is, in fact, where we believe that being a European company is of tremendous value, because Europe—and Germany in particular—has the highest interpretation of the European General Data Protection Regulation (GDPR) laws. Brainlab has picked the toughest market as a home for developing a data-driven system.

However, I think we’ve started to really look at how we can build a data ecosystem that would also need broad, societal consensus. It’s becoming pretty clear that it wouldn’t fly if we were more or less taking over the toll both and controlling access to data. We need to do that in a very liberal and broad way, which still makes it open and accessible to others as long as something is covered by the patient consent. Then we are more or less just a contractually committed execution entity of the patient’s will, so to speak.

We also think that patient consent should be standardized, and it should be given once and then applicable to all the data. And if we are more or less helping to consolidate the data, we should be privileged in our access to the data over other users. Whether patients want to really improve healthcare through their clinical resources or through science and fundamental research, that research should be at the patient’s discretion.

In Europe, we have this mindset that sometimes, “Oh, it should be just research.” But a scientific paper can never really provide products that serve a broad majority of patients. For that reason, it’s important that there’s really a broader discussion, and also trusted infrastructure that enables it.

A lot of times, people think that if we just made all data available, things would be great. But even if you had it over the hard-disks of all the hospitals in, let’s say, the U.S. or Germany, it’s just garbage that you wouldn’t be able to process in a meaningful way (with a few exceptions). If you were to actually structure the data in a more careful way, you could capture it at the point of care in a structured way and not just as text that somebody typed in that is really difficult to make sense of, because of a lot of biases and the way the data has been processed. Innovation needs to be encouraged, and the entire data value chain is what we’re focusing on recently.

We’re looking at doing that across a number of clinical subspecialties and also doing that in different countries. With registries worldwide, nothing scales—these are two- or three- person companies each, and they hardly scale on a national level and certainly not on an international level. Today in a data ecosystem, you should have structured radiology reports and patient-reported outcome measures and images that can be processed with AI, along with special clinical data and everything that’s coming from information systems. To bring all that together in a trusted way is tough, so we’re doing something that hopefully will work in Germany. And if it works in Germany and Europe, what works in Europe is also something that can be adopted globally considering that even some states in the US, such as California, are adopting several concepts from the GDPR.

There is an ongoing debate about the power that Amazon should really have. I think it’s a wonderful company that we use as well, but I think that using it, or Microsoft, in basic cloud computing is the role those companies should play. I’m not sure that they should also be providing consumer services that are for building customer profiles with mapping services and tracking and speech control, et cetera. And also, on the other hand, be processing our most private data—they should be doing one of the two. So for that reason, we’re trying to build an ecosystem that will have to do with providing better healthcare to a broad area of the world.

Today at Brainlab, we’re hosting a craniomaxillofacial symposium. It’s probably one of the most technically sophisticated subspecialties, but also one of the smallest surgical subspecialties. Unless you really pool all the data globally, you’re unlikely to collect enough data to further the practice. It’s also a subspecialty where almost every single patient is custom, all the way to even custom implants. Therefore, collecting data and finding better ways for training, because the cases are so rare, is essential. It’s an exciting moment where Brainlab together with Level Ex can really shape the future of digital health.

Sam Glassenberg: [28:09] One of the interesting areas that you started touching on was Brainlab’s work in standardizing and structuring data, and creating standardized registries so that data can be more broadly available and be used for all of these broad beneficial purposes, but obviously while respecting the privacy of the individual patient. Theme two is life sciences game-changers. You had alluded to some of the disciplines and specialties that you’re working in. So the theme is basically that—throughout 2021, there have been incredible advancements in fields such as genomics and oncology, and these are catapulting us into a new era of science. How is this changing the game?

And you started to talk about these registries. Can you talk a little bit about what Brainlab is doing specifically around oncology to help accelerate the development of new treatments?

Stefan Vilsmeier: [29:10] We’re seeing a couple of important trends. First of all, there’s always a distinction between what is a clinical study and what is routine care. They are two distinct areas, but I think the distinction will go away, and it’s really crucial and an important step that that all becomes one and that every patient will get the data collected and processed at the same level as if it were a clinical study.

That will also move us from doing only prospective clinical trials to retrospective and continuous analysis of what people call real-world data, including basic patient reported outcome measures and continuous data that may be collected from activity trackers and the like. So that can build a more complete understanding of how patients are doing.

For an oncology patient, for example, it all starts with how you even capture the diagnosis in the first place, which is of course for many patients devastating news. If you’re diagnosed with cancer, basically you’re getting, more or less, a written report. Most clinical oncologists look at a report and then from there drive their decisions.

But there are two things, too, that I think are important. One is that all those patients are followed, and you’re developing a number of longitudinal data so that the radiology report is not generated by copying and pasting, but is generated from the same tools that are able to quantify any subtle change in the tumor volume using, maybe in the background, 50 radiometrics that analyze subtle changes in tissue and composition and patterns of the tumor. Then you get a lot of valuable data that allows you to quantify the change in tissue.

This way, for every cancerous disease, you get much more detailed and valuable data so you’ll be able to recognize a change in the body’s reaction to a drug, et cetera, much earlier. You might be able to develop much better predictors as to whether therapy is working. The same thing would also be applicable to degenerative diseases where you can detect patterns much earlier.

Starting with a structured radiology report is an important part, but then also, most patients are not just treated with a clinical oncology approach. Twenty years ago, I remember the discussion was that the decoding of the human genome was going to be the silver bullet that would cure every type of cancer. While a lot of progress has been made and several types of cancer have turned into chronic diseases, it makes it more important to follow the subtle changes in the composition of, or the change in size and shape of, the tumor. Most patients also end up getting a number of different treatments, from surgery to radiotherapy, to immunotherapies, et cetera.

If you’re trying to determine whether a particular track was successful or how it impacted the patient’s journey, every patient is different, so we must capture the entire journey. We need to collect the data along the way in a structured format and compose it in registries so we can better personalize treatments.

The data we collect from patients today is setting the standard for cancer treatments in our children and grandchildren. Therefore, not collecting data is basically killing patients at scale. I think it’s a moral obligation today, for all of us, to contribute with our own data to the future of healthcare. It’s even more dramatic and even more important—and it’s already pretty important to be donating your organs—but I think it’s even more critical to do that with data because the data isn’t gone; it’s still yours, and you can still use it—you just have to share it with others. Not sharing data, I think, is really a problem. Therefore, creating the ecosystem that allows you to do that in a systematic way is important.

I see more and more pharmaceutical companies starting to insource some of their clinical research, for instance. Providing better data is important for that reason, but it’s also important for hospitals. Hospitals today have information systems that are, more or less, collecting data from billing, and you can probably still search them, but it almost stops there. They don’t capture the whole wealth of clinical data. On top of that, you need to have a layer for clinical searching, but also for research and studies. When it comes to personalizing each patient’s treatment, you need to be able to capture the clinical information with a whole different level of granularity.

Since it’s difficult for many players to engage in that area, we have also created a spin-off called Snke OS, which embodies the idea of providing access to the fundamental software tools for taking the data, aggregating it, and putting that all in a cloud repository. If every company needs to do that from scratch, it doesn’t scale, it’s hard to share, and it’s hard to ensure that it’s interoperable—and there may be a lot of medical device companies that have innovative solutions that are dependent on better access to data.

For example, to optimize the parameters or setting of a treatment, we’re working very closely with Boston Scientific for deep-brain simulations of Parkinson’s treatment. We are helping with the data that’s being collected for the individual adjustments of the patient’s brain pace-maker, so to speak. Even the settings for that can be really fine-tuned around the specific requirements for each patient, and that is dependent on data. It’s dependent on data from healthy patients as well as patients that suffer from exactly that disease. I believe that we are at the beginning of a very exciting journey, and as bad as it is to be diagnosed with a life-threatening disease, there’s never been a better time than today, or a more encouraging time, to be provided with the best treatment. There isn’t anything that would deserve the name good old times, I don’t think.

Sam Glassenberg: [36:35] Right. You make an intriguing point here about the degree to which the technologies that you’ve developed for acute challenges in surgical oncology are now proving to be incredibly relevant and helpful in medical oncology. It’s not like one is superseding the other—quite the opposite. The technologies that you’ve been developing at Brainlab in order to identify tumors, to size them, to understand their position, and to be able to take that data and present it in a structured way are highly relevant to be able to measure the outcomes of either clinical studies or ongoing patient treatment with clinical treatment. That’s very exciting and probably not something that most are aware of.

Stefan Vilsmeier: [37:23] I think that we bring all the different elements together, considering that Brainlab has been in the business for 30 years. Thirty years ago, you were not a good neurosurgeon if you needed certain software. Today, you’re not a good neurosurgeon if you do most of your procedures without the proper software. Fortunately, times have changed, and I think the technology will end up with a lot of investment—potentially about $700 million cumulatively.

Therefore, a lot of core technology has been put together that we’re now going to be able to utilize. There are going to be a number of startups for those bigger companies that have an ecosystem in place and just need a way to anonymize the patient data. Or, if you want to develop a Magic Leap application, you don’t really have to start from scratch on the patient model, and you can answer questions like, “how do you do the tracking, where do you transfer the data, how we can securely have a cloud, and how do you build a 3D model from the 2D data?” That’s something that everybody would otherwise have to do from scratch.

All of a sudden, you’ll put on the headset, and everything will be taken care of so that in the future, with two or three software engineers, you can develop in 18 months a clinical application that otherwise you probably would have needed to hire 100 people to develop. That’s the idea, making advanced technology accessible in a much broader way. Again, it’s the access to data and the access to training to make sure that people get the best out of the technology and are fully able to utilize the technology, which we will do through Level Ex.

Sam Glassenberg: [39:11] And through democratizing the technology and democratizing the data, it’s not just increasing access to care for patients or increasing access to technology for the healthcare providers, but what you’re describing is also increasing access and democratizing healthcare innovation itself. The barrier to entry to innovate in healthcare, if you’re a new healthcare startup, is now much lower because you don’t have to develop your own registration, you don’t need to develop your own tracking system, you don’t need to develop your own tumor measurement system—you can use the state of the art and then build on top of that, and as such, it’s just another layer in accelerating the creation and adoption curve of new technologies in the healthcare ecosystem.

Sam Glassenberg: [39:57] We just covered a broad range of topics—a lot of food for thought here. Stefan, thank you so much for sitting down with me today to share thoughts and chat about these topics. We’ve definitely got to find an excuse to do this again soon. To our viewers, thanks again for tuning in. For those that are going to be participating in the HLTH conference, Level Ex would love to continue the conversation with you during the event. Please reach out if you’d be interested in meeting with us. As always, for more information or to request a demo of any cool Level Ex technologies, please visit us at www.levelex.com. For more information about Brainlab, please visit www.brainlab.com. Thank you.

Reducing Barriers to Entry in Medical Device & Surgical Training

Posted on September 8, 2021May 24, 2023 by The Level Ex Team

Have you ever invited surgeons to a training session that could have gone better? These stories are all too familiar in the world of medical device and surgical training.

You’re in a virtual meeting, and after 3 tries and 10 minutes, you still can’t get your presentation to screen share correctly.
You’ve launched a learning management system (LMS) on your website that is packed with valuable information, but medical professionals bounce almost immediately.
Physicians arrive at your training session, and the simulator that you have dragged hundreds of miles isn’t working. By the time you get it running, you’ve lost half your audience.

These examples highlight the importance of reducing barriers to entry, such as fragile equipment, confusing interfaces, or tricky software. Requiring an instructor and learner to be in the same physical location can also become a barrier, as evidenced by the COVID-19 pandemic. When learners are extremely busy physicians, smooth and time-efficient training is even more essential. The bottom line: the more complicated and the longer it takes to get into an experience, learners’ motivation and commitment plummets. The following blog post explores reasons behind this falloff rate and offers solutions to reduce barriers to entry, accelerate learners’ access to training, and increase the reach and scale of surgical and medical device training.

Examining Technological Barriers and Human Frustration

When training a physician or surgeon on something inherently complex, like a surgical procedure or medical device, straightforward and effective training methods can aid in adoption. Multiple studies have demonstrated that “the more complex an innovation or the setting in which it is introduced, the less likely it is to be successfully adopted, scaled up, spread, and sustained.”¹ Researchers have tested theories (i.e., technology acceptance model, innovation diffusion theory, and the unified technology acceptance and use of technology model) and defined factors that influence one’s willingness to adopt technologies. Some of the factors identified in these models are utility and ease. Technology is more likely to be adopted when it is perceived to be valuable and simple to use. Other influences for uptake include relative advantage, compatibility, complexity, opportunity for a trial, and observability (see figure below).²

On the positive side, this indicates that when new technology is perceived as important to learn, due to its value or advantages, people may tolerate inconvenience and will be motivated to learn it (eventually). In a crowded market place, however, it could mean that healthcare professionals (HCPs) go with the most user-friendly and convenient option to learn.

HCP-specific data supports these claims. One study reviewed 74 journal articles and identified barriers to entry and technology adoption. Major takeaways from the study related to design and technical concerns: technologies should be intuitive, easy to use, and compatible with existing systems.³

When glitches happen, we must also consider the larger context: how much are learners feeling frustrated, emotionally drained, and impatient—and how is that impacting their learning? Faulty technology influences mood: a survey of over 2,000 US adults revealed that 36% had recently reacted to technology challenges by resorting to “profanity, screaming and shouting, or by striking [technology] with a fist or other object.”⁴ In another study of working adults, 30% of whom worked in healthcare, researchers investigated how technological issues impacted productivity, mood, and even interactions with coworkers. On a scale of 1-9 (with 9 meaning the most frustrating), 71% of technological problems caused frustration levels of 7-9, and 34% were rated at level 9.⁵ Neurologically, frustration, boredom, and even surprise can negatively affect learning, attention, perception, and memory, and lead learners to give up.⁶ The solution is not to return to luddite ways but to assure that remote training is well-designed and minimizes frustrating, unanticipated barriers.

Another important consideration is that HCPs may experience worse hesitancy and frustration because of already tolerating other clunky, mandated technologies like EMRs in everyday practice.⁷ For example, one study of 15,505 HCPs showed that they experienced frustration with technology on at least 3-5 days per week; researchers concluded that the experience is “common but not ubiquitous among healthcare workers, and it is one of several work-life integration factors associated with emotional exhaustion. Minimizing frustration with healthcare technology may be an effective approach in reducing burnout among healthcare workers.”⁸ With this in mind, a smooth and HCP-centered medical device and surgical training approach is paramount.

Reducing Barriers to Entry with Remote, Cloud-based Training

Physician testimonial by Rohin Francis for Virtual Technique Guides

One way to ensure that training experiences run more smoothly from the onset is with remote, internet-based training. Remote surgical training has gained traction, especially as the COVID-19 pandemic encouraged the healthcare industry to adapt and innovate.¹⁰ Such training removes the need for the learner and teacher to be in the same physical location. Additionally, utilizing the cloud for surgical and medical device training increases reach and scale. With a cloud-based training solution, HCPs in rural areas, and in any country with an internet connection, can participate. Trainers can also reach far more surgeons in the same amount of time with greater convenience because myriad learners can access and engage the same content in the cloud.

Level Ex offers a remote solution to address barrier-to-entry pain points. Virtual Technique Guides by Level Ex allow HCPs to explore and master how a medical device is used through interactive virtual training that streams over the internet and is constantly accessible. Learners do not have to worry about logins, special downloads, or particular equipment/hardware. They use technology that they are already familiar with: their own computer or phone, a web browser, and a web conferencing tool like Zoom, Webex, or Microsoft Teams. Inside the guide, users can go through the steps alone or with another surgeon or sales rep. The two can use the experience together and collaborate in real time. This technology utilizes the first ever cloud-based platform for multi-user remote HCP engagement.

Virtual Techniques Guides Solve the Barrier-to-Entry Issue

Convenient for HCPs. Respect HCPs’ limited time with a training method that allows immediate, seamless entry. Virtual Techniques Guides can be used on demand with any web conferencing platform. It can also be integrated on your website or in your LMS.

Global reach. Learners anywhere can access your content. You can have several people in the same experience at the same time on any device with internet access and a browser.

Stress-free coordination. If you are organizing training, you only need to provide a link or QR code to get your learners into the experience. You do not have to worry about the devices of your participants, who can use their desktop computers, phones, or tablets. Level Ex’s solution is device agnostic. Similar to a platform like Netflix, they only need internet access and a web browser—but even better, there is no login required.

Reliable, high-fidelity training. Level Ex’s platform runs on high performance graphics processing units (GPUs) that allow complex real-time computing in the cloud. This enables two or more surgeons to operate on the same virtual patient or use the same device in real time from different cities or countries.

In an instant gratification culture, with little tolerance for technological hiccups, Level Ex solutions can help you stand out as customer-centric and forward-looking. Reducing barriers to training also brings the medical community closer together to exchange vital information. As Rafael Grossmann, MD, FACS, trauma surgeon and medical futurist, shared while using Virtual Technique Guides, advancing healthcare “is about improving communication and connectivity, and right now we’re doing this virtually with no boundaries. It happens instantaneously; it happens collaboratively. Healthcare is about teamwork. The beauty of this is that we are on a laptop computer. With a regular smartphone and connectivity we can [facilitate] team-building, skill-building, and lifesaving training.”¹¹

To get your medical device or training on Level Ex’s platform, or to learn more, contact us today.

Written by Bethany Brownholtz, Senior Copywriter of the Level Ex Team

Top Derm Hits the Dermasphere

Posted on August 24, 2021May 24, 2023 by The Level Ex Team

Dr. Peter Lio, renowned dermatologist and physician advisor, and Dr. Eric Gantwerker, Vice President, Medical Director for Level Ex, discuss our new dermatology game, Top Derm, on the Dermasphere podcast. Co-hosts Dr. Michelle Tarbox and Dr. Luke Johnson ask them about the game development process, dermatology trends, and the future of the field as the hosts share their reactions to playing the game.

“One thing that I loved about [Top Derm] is that it lets you make decisions… These are the decisions we make all day in clinic… It lets you practice that decision tree and then gives you feedback immediately after, which is one of the most powerful ways to learn.”

—Michelle Tarbox, MD, Co-host of the Dermasphere podcast, Assistant Professor of Dermatology at Texas Tech University Health Sciences Center

Listen to the Episode

Contributors

Michelle Tarbox, MD

Co-host of the Dermasphere Podcast, Assistant Professor of Dermatology at Texas Tech University Health Sciences Center, fellowship-trained in dermatopathology

Luke Johnson, MD

Co-host of the Dermasphere Podcast, Assistant Professor of Dermatology at the University of Utah School of Medicine, fellowship-trained in pediatric dermatology

Peter Lio, MD, FAAD

Medical Dermatology Associates of Chicago, Clinical Assistant Professor of Dermatology & Pediatrics at Northwestern University Feinberg School of Medicine, atopic dermatitis expert, Lead Physician Advisor for *Top Derm*

Eric Gantwerker, MD, MMSC (MEDED), FACS

Vice President, Medical Director at Level Ex, Pediatric Otolaryngologist at Cohen Children’s Hospital Northwell Health/Hofstra, Holds a MMSc in Medical Education from Harvard Medical School and an MS in Physiology and Biophysics from Georgetown University

Read the Transcript Below

Dr. Johnson: Hello, friends and colleagues, and welcome to Dermasphere, the podcast by dermatologists for dermatologists and for the dermatologically curious. I’m one of your hosts. My name is Luke Johnson. I’m a pediatric dermatologist and general dermatologist with the University of Utah. And my co-host, of course, is—

Dr. Tarbox: This is Michelle Tarbox. I am an Associate Professor of Dermatology and Dermatopathology at Texas Tech University Health Sciences Center in beautiful, sunny Lubbock, Texas.

Dr. Johnson: This is a bonus episode of Dermasphere. Normally we come to your ears every two weeks with discussions with some of the latest, and we like to think, most relevant research in the world of clinical dermatology. Today we’re going to do something a bit different. We’re going to discuss not an article and not an area of research, but a new dermatology app that is available. It’s called Top Derm and get ready for this: It is a dermatology game published by a studio called Level Ex. To help us discuss it, we have two members of the Level Ex team here with us today, Dr. Gantwerker and Dr. Lio, thanks so much for joining us. Do you want to start by introducing yourselves?

Dr. Lio: Wonderful. Thank you so much for having us. My name is Peter Lio. I’m a clinical Assistant Professor of Dermatology and Pediatrics at Northwestern University in Chicago. I am excited to be in the position of lead advisor for the Top Derm game. I’m the dermatology representative among a group of dermatologists who have helped put together the game.

Dr. Gantwerker: Thank you so much for having me. I’m a pediatric otolaryngologist, Dr. Eric Gantwerker, and I’m not a dermatologist, so I apologize. But I also wear a hat. I’m in academic practice in New York at a tertiary care center and Associate Professor of Otolaryngology and the Vice President, Medical Director of Level Ex. I started as an advisor and now oversee everything from a strategy, education, and medical standpoint. I have a master’s in medical education, which is my background.

Dr. Johnson: Super excited to have you here today to discuss this. By way of full disclosure, this episode does represent a partnership between Dermasphere and Level Ex. No money changed hands, listeners, but Level Ex did put out some advertising for this episode. Maybe you guys saw it. We thought that a collaboration between Dermasphere and Level Ex would be great for a lot of reasons. One, it allows us to get Peter Lio back on the show. He did join us in episode 47 to discuss topical steroid withdrawal syndrome. Also, I feel that Level Ex’s, especially this Top Derm game, and Dermasphere’s missions are really aligned. We all are trying to get people better at dermatology using various forms of technology that are out right now—podcasting and apps, etc. By the way, I should say that the Top Derm app is free, and also I love dermatology and I love games, and this is a dermatology game! Finally, peanut butter, meet chocolate! Dr. Lio, Dr. Gantwerker, I’d love to hear a summary of the game. We’ll start with that. Tell us about it.

Dr. Gantwerker: Dr. Lio, take it away, you’re integrally involved, so—

Dr. Lio: I will tell you a little bit from my perspective. One of the exciting things about Level Ex and this project is that it is something that continues to evolve and develop. I am hopeful that what we have today is going to be pretty different than what we have in a couple of years—that we’re going to be adding and developing and continuing to explore what we can do with this medium.

The basic impetus for the vision, Luke, is just like you: I love dermatology, I love games, and I love learning. What an amazing way to take some of the addictive quality of mobile games, which we know can work against us sometimes. You’re sitting there and you find yourself 20, 30 minutes have passed while you’re playing with some kind of coin game or jewel game, and you go, “Boy, I didn’t really get anything out of that.” What if we could leverage that to do some educational things, to practice some of the things that many of us already know—or we’re supposed to know when we studied for our boards—but we can review them?

For me, the part that’s particularly interesting is that, very much like the Dermasphere podcast, there are certain things you can do very well in a lecture. At a lecture, you can show certain slides; you can take an audience through a certain set of principles and instructions. Then there’s a lot you can’t do. So on a long form podcast like this, I love it because I love listening to you guys not only tell me about the article. That’s awesome. That by itself is worth the price of admission. I love when you guys digest it, discuss it, think about it, and put it to use because that’s what I remember when I’m actually in a clinic. I’m like, “Oh, yes. Michelle said this is how she likes to use this, or this is what she thought of it.” That extra bit of editorial, obviously very sophisticated editorial, helps me put it in place.

There are even additional things we can do in the context of a game. Within a game, we can now create scenarios to challenge you. We can present experiences where you might try something and then go, “Whoa, I don’t like what happened there.” Go back and try something different and then learn from those experiences—both the good and the bad. So from a general standpoint, I love this idea. We know that the secret of learning is repetition, and nothing lets us do more repetition than in a game. Then those subtle changes that we’re able to show you in a game—I mean, I could go on for a while and I’ll shut up in just a moment.

They have the most incredible art team doing specific renders of skin disease. We have lots of great photo atlases. We’re blessed that dermatology is very visual, but here we have a team of artists who can then tweak those images. They can enhance those images. The word I like to use—I don’t think the artists talk about it this way, but I love saying it—it’s hyper-real. You look at it, and it feels like that 8K image where everything’s crystal clear and they’re showing you the key pieces that we want you to see and minimizing some of the other pieces. It also allows us to show it in different skin types. You can show it across different skin tones, on more richly pigmented skin. You can see things that maybe you don’t get to see normally because you can render it. Then finally, it lets you play with some of the other aspects of disease: the type, the shape, the arrangement in the distribution, where maybe every photograph that you’ve ever seen is always on the back of somebody’s hand. That’s the most commonplace. Now we can move it to a different location to challenge our learners to think about it in a different way. So for all of these reasons, I think this is in some ways the future of education. It allows us to take a deep dive into how people learn and to reinforce strategies, but also to create novel and exciting clinical scenarios to challenge people.

Dr. Tarbox: That’s awesome. One thing that I loved about it is it lets you make decisions. That’s what we do in clinic all day long. I have never used Tinder because I’ve been married to Mr. Dr. Tarbox for a very long time, but I understand that there’s a lot of swiping right or left or something like that. Some of the game is a binary choice: infectious or noninfectious. These are the decisions we make all day in clinic. I’m looking at this rash: “Is it going to get better with antibiotics? Do I need an anti-inflammatory?” It lets you practice that decision tree and then gives you feedback immediately after, which is one of the most powerful ways to learn. I always tell my residents, if you commit to an answer and you’re right, you’ll get a little shot of serotonin. You’re going to remember it pretty well. If you commit to an answer and you’re wrong, it’s like “Not again, Satan,” and you will remember it forever.

Dr. Lio: Exactly.

Dr. Gantwerker: I couldn’t have described that better. I’d like to borrow that. Taking a step back to give it some historical context, Level Ex was built on the idea that we can use the technology of games and the mechanics and psychology of games to create medically relevant content. Historically, we’ve done a lot of procedure-based games. We started introducing some medical decision-making games, critical thinking, and judgment. This is a new genre for us where we’re creating challenges and knowledge-based challenges of diagnosis, treatment, judgment, clinical decision making, and all the things that Peter and Michelle, we’re talking about—all in one game.

The best thing about it is there’s so much agency for the players. If you want to work on some adult dermatology, oncology, or pediatric dermatology, you can self-select the types of things that you’re in a mood for. If you want to do some quick hit binary sort, you can choose that. If you want to do some more deep thinking, you can do some more of the ”sticker situation” where you’re matching different things to decide the next steps.

This game was built to be whatever it is you want it to be. If you want it to be more fun and lightning, if you want to do stuff that has a little bit more challenge and may be harder that simulates some of the Boards type of stuff, you can. It’s there for you, and it’s your choice to do what you want with it.

Dr. Johnson: For any of our listeners who doubt that Peter Lio likes games, I know this is a podcast and you can’t see him, but I can. On the wall behind him is what seems to be a complete map of the original Legend of Zelda from the Nintendo entertainment system. Is that correct, Dr. Lio?

Dr. Lio: That is absolutely correct. Bravo. Not everybody knows what it is. Many people call attention to it and say, “Is that a microchip? What are we looking at?” But that is an eight-foot by four-foot, huge, beautifully printed fabric map of the original Legend of Zelda overworld.

Dr. Gantwerker: I don’t know if I’m more impressed that you have it or more impressed that he knew what it was.

Dr. Tarbox: I’m not surprised Luke has an epic level of nerdom that I have great respect for. Speaking of nerdom, I am a self-proclaimed dermoscopy nerd, and there is a dermoscopy game that is a part of Top Derm, and I really appreciated that. It’s teaching the three-point checklist, which is one of the more simple, usable formats for dermoscopy. I thought that the images were really good and that the feedback that you get after you play the round is really helpful. So super excited to see that.

Dr. Johnson: Do you want to ring our bell and tell us what the three-point checklist is?

Dr. Tarbox: I don’t have the bell. So this is a candle. [dings candle]

Dr. Johnson: Come on. We sent you two of them.

Dr. Tarbox: I had to switch offices at the last second because I changed my password in Microsoft and now I can’t remember what it is. So the three-point checklist. Ding. I’m so sorry about this. So it includes having an atypical network, having asymmetry, and having blue veil structures or blue-white veil structures—people describe this a little bit differently. A lesion gets one point for each one of those things. Any score of two or three is going to be more of a worrisome lesion. Three is very worrisome. Two is you probably need a biopsy. Normal lesions can have a score of one or zero. I thought that was a great way to reinforce that teaching and the way that you describe each little photograph underneath—very helpful. I also love the playfulness of some of the games. So there’s a rock and roll game that is hilarious and has had me singing “Come together right now” all day. So when are you guys going to explain that one?

Dr. Gantwerker: That was one more of my favorites. We like to have a little bit of fun when we’re creating these games. One of the creative opportunities that we have is the names and how we label things. That was one of the binary sorts that you’re trying to decide to either “Let It Be,” or I can’t even remember what the other option—

Dr. Tarbox: If it’s infectious, they’re supposed to “Get Back.” So that’s the Beatles song, [singing] “Get back to where you once belonged.” Then if they’re noninfectious, they can “Come Together.” So if it’s mycosis fungoides, they can come together and look for a medical treatment. If it’s herpes, then they can get back and not transfer it to other band members, which I thought was hilarious.

Dr. Gantwerker: There’s also another Beatles reference where there is a binary sort, whether you should biopsy or not. All I remember is if you don’t want to biopsy, it’s “Let It Be.” Peter, do you remember what the biopsy one is?

Dr. Johnson: It’s “Ticket to slice.”

Dr. Lio: Yes, that’s it. I love it.

Dr. Johnson: Listeners, I presume that you’re already convinced that you should check out this game. But I just want to give you an idea of what the experience is like. This might be incorrect, but the experience that I felt I had was like flashcards turned into a game show. I originally was going to say “flashcards made fun,” but we’re all nerds. Flashcards are already fun! There are these different categories. You have lots of pictures. I think every question that I looked at had a photograph associated with it. Then there are different versions. There is matching and then what you refer to as “binary sort”; you say “Let It Be” or “Come Together” and stuff like that. It has the feel of an old-school question bank, which I love, but in a much more fun way. It tracks your progress and lets you select different categories and different ways that you want to experience your education.

Dr. Tarbox: To me, it felt like You Don’t Know Jack, but for dermatology. If you ever played the game You Don’t Know Jack, there’s “dis or dat,” which is like the binary sort. Then there’s the matching and the questions. I just love it.

There are definitely little serotonin bells built in there to reinforce your learning. I always think that makes your brain work better, too. That’s why I’m very reinforcing when I teach my residents. You get little experience points, which I love. You have levels up and you unlock challenges. It’s very encouraging to move along and progress in the game, which is super fun.

Dr. Gantwerker: You hit on something important and that’s the strong tie between emotion and memory. We know things that are activating are always going to be stronger in your memory, whether it be negative or positive, which is why people always think pimping actually works. Pimping does work because you’re activating them, but you’re activating them in the negative zone. Games try to activate you in the positive zone. And that’s why Sam, our CEO, used to always say that your kids remember a hundred Pokemon characters, but not 40 US presidents. That has to do with the emotion—that strong tie between emotion and memory.

Dr. Johnson: Again, if everybody is convinced that they should go out and check out this game, since we’ve got medical education experts, I’d like to discuss topics relevant to that. How can our listeners who are interested in learning more, or who are educators themselves, leverage what you guys know, that we might not, to help teach both themselves and their learners?

Dr. Gantwerker: I’ll say that you all might be dermatology nerds, but I’m a cognitive science of learning nerd. If that doesn’t come across, I’ll tell you upfront that that’s my bag. I’m interested in motivational theory and in what motivates people. One of the things that attracted me to games as a learning platform was the fact that games are an opt-in experience. You are intrinsically motivated to play games. The way the games create environments in which you are intrinsically motivated to not only start the game but persist through challenges. I’m sure there were very many challenges in Legend of Zelda where you were ready to give up, so how do games create this motivational pattern to have you persist through challenges?

The way that medicine is trying to teach our future clinicians of tomorrow is we’re trying to teach them to face challenges. We’re trying to teach them to problem-solve. We’re trying to teach them all the different ways and patterns of things and how they can be presented in a clinical environment and understand those patterns and make decisions and judgments. That’s literally what games do in an intrinsically motivated pattern. It was so exciting for me when I started working for Level Ex back in 2016. It’s been solidified for me that games are the right way to do this.

Dr. Tarbox: One of the great things, too, that I found exciting about the app is that you’re touching on neglected areas of dermatology. There’s a focus on the treatment of patients who are pregnant and medications that are appropriate or not. There are lots of images of skin of color, which I think is very important for us to be able to provide complete healthcare to all of the patients that we take care of. Then there are operational guidelines that we need to have cold as dermatologists, but those things are just so hard to learn by rote. There’s a really fun game that’s helping you understand the NCCN Guidelines for squamous cell carcinoma and which treatment is appropriate for what? Which one’s a high-risk lesion? These are all things that will help people to practice more efficiently and also more effectively.

Dr. Lio: It’s so true, you know, I’m a medical derm almost exclusively, and about half my practice is pediatric. Early on in the discussion a couple of years ago, we were saying, “What’s easy and what’s hard?” I learned quickly that that depends on your point of view. If you are mostly doing Mohs surgery, then even some basic pediatric dermatology is not so basic. It’s like, “I don’t really see kids anymore.” We tried to get a gradient for each of these things so that people can dabble. We don’t want you to go in and be like, “Oh my gosh, it’s all crazy genodermatoses that are super rare, and I don’t want to do this anymore.” We want to have some easier stuff. People say, “Oh, yeah, I remember this. OK, right.” Then they can build up and strengthen.

I love that you brought up, Michelle, the idea of strengthening your own. We have that radar plot, that spider chart, where you can strengthen on all those different forms to become a well-rounded “Top Derm,” if you wish. Maybe you’ll just pick your own area to just practice and kind of test your might, or maybe you’ll pick your weak point and say, “I just want to spend time just focusing on this area.” I love that there’s all that flexibility and again, potentially for the future, to even add more modules and more new experiences, because this is a great way to learn. I don’t love reading journals anymore. Right now, we have all these other awesome ways to do things. So journals can be the springboard, but this is a way to really bring it to life.

Dr. Johnson: Podcasts. Another good example.

Dr. Tarbox: Exactly. One other thing I want to clarify, just if anybody who’s listening has any questions about this. Sometimes whenever a computer is involved and decisions are being made, people get concerned, in the days of artificial intelligence (AI), that we’re training our replacement overlords of robots. There’s no way this game could do that because this is not using us to say, “Is this bad?” It’s telling us, “You said this about this lesion, and this is what’s correct.” So the game already knows. We’re not teaching it anything it doesn’t know. This is not us training our robot overlords. It is us making our brains, which are a little computer-like, kind of a mushy biological computer, work better. I think that’s amazing. If anybody’s concerned about that, you can allow yourself to take a deep breath and realize that you are just making yourself better. You’re not helping out the AI.

Dr. Lio: Yes, I know people were kind of nervous. Whenever they see sorting, it’s like, “Are we training it?” But here, these are all known quantities. They’re all hand-done now. The computer didn’t organize them. These are all hand-done by humans. So the right answer is what we put in. Now, of course, there may be mistakes. In that case, we want our users to say, “Hey I’m flagging this. You’re wrong on this,” because this is truly hand done. The AI discussion is interesting. It just, fortunately, does not apply to this setup right now in any way, shape, or form.

Dr. Gantwerker: Peter hit on it. Something interesting in this game that’s different from our other games is the ability of players to give us feedback. Oftentimes when people are playing our games and they want to give us feedback, they send us an email or go to our website. This is feedback integrated into the game because we want to hear from people to say, “Hey, this is what I want to do. This is what I’m interested in. This is what I’m motivated to do.” Having that explicit communication with our player base is something completely new in Top Derm that I’m excited about.

Dr. Tarbox: I saw that feedback button right at the bottom of every game. After you’re done playing, you can leave feedback for any question that you have. You could leave like, “Hey, great job.” Or you could say, “I think this question might be better written this way.”

The images are amazing, so I’m glad you brought up the tuning of the images because I was like, “Oh, wow,” because there was a port-wine stain, and I was like, “That is the port-wine-iest port wine stain that I have ever seen.” This is just a good way to sort of imprint the chief characteristics of what you’re looking for. It’s almost like how Netter images are the way that we learn basic anatomy when we’re going through medical school, because the structures are hyper-real in a way, in that they can be more classified into the boundaries of the lesion and the defining characteristics. It’s just easier to learn that way. I used to make dermatopathology cartoons for the same reason.

Dr. Gantwerker: It’s really interesting because all those images were peer-reviewed by Peter Lio and all of our dermatology advisors. Some of them were completely fooled as to whether they were real or not. You point out that some of them are hyper-realistic where it’s the quintessential picture of what that is, but the good news about our ability to create these images is that we can make them less discerning. We can make them more ambiguous. We can make them however we want. That’s the power. What Peter really believed in was our ability to create these images of any disease on any skin type and be able to create those so that it’s challenging. It’s interesting. We don’t have to rely on the images that exist out in the ecosystem, which we know aren’t representative of all the diseases we see, especially in skin color, like you brought up earlier.

Dr. Tarbox: I love the atypical locations, too. Like the bullous lesions, which were almost always shown on trunks. They were on acral surfaces, so you have to think about them a little bit differently. They teach you the right way to do the proper biopsy, which as a dermatopathologist, I absolutely love. I was like, “Yes, scream it to the mountains.” That was very nice to see.

Dr. Johnson: This is fascinating. Let me make sure I understand: The photographs that we see in the game are not just “somebody took a picture and uploaded it.” They’re somehow modified by graphic artists?

Dr. Gantwerker: We have a mixture. We have ones that we’ve sourced from either dermatologists or atlases. We have some that we’ve gotten through partnerships. Then we have the ones we create. The ones that we create are in instances where there aren’t a lot of good examples or there’s something we don’t have really good examples of this skin condition on this location, on this skin type. If they don’t exist, then we’ll create them.

That’s one of the hardest things and why I’m so proud of our team. They’re making images that don’t have reference images. Just think about creating something, drawing something, that never had anything for you to reference, and you’re not medical, so you don’t know what you’re even looking at. That’s where our advisors come in. That’s where Peter Lio has been invaluable in this, and all of our derm advisors, to say, “You know what? I’d make it a little bit redder. You know, subsurface scattering is a little bit different. The lighting is a little bit different. I would extend this a little bit.” That’s where it comes to life.

Dr. Lio: It was so cool because they’re rendering the skin in this sophisticated way. It has depth, moisture, and all these different qualities. It’s not just a sketch. Sometimes they would show me an image and I’d be like, “Ah! I don’t know! Something’s wrong about this. It feels too dry or it feels like the texture is wrong.” You’re trying to explain it to the artist. It was so cool. They understood that language, too. It was just uncanny. You’re like, “What you’ve just shown me is really wild. It looks good, but this doesn’t exist. This is wrong.” Then they’d spend a day or two, and you would get this new image like, “Yes, that’s right. That feels correct. That looks right.” It was a whole new level of language processing for what we’re seeing because they can defy the laws of biology. They can make whatever they want. They can make a wet lesion in the context of dry scale or something crazy like, “Whoa, this shouldn’t exist.” It was so fun to fine-tune that. I think that’s something that’s going to keep happening. It allows us to paint a particular situation for any kind of clinical scenario we want to bring up.

Dr. Tarbox: That’s really cool.

Dr. Johnson: That’s really innovative. Now there are two innovative things about this. There’s the gamification. Plus there’s this very fascinating graphic art rendering of dermatologic disease. As somebody who is a dermatologist and would use the game, I could be assured that even though the image was created rather than actually photographed on a patient, I can trust that that’s what it would really look like in person because smart dermatologists like Peter Lio have agreed that that’s what it should look like. Is that fair?

Dr. Tarbox: And actually give the feedback to shape, it sounds like?

Dr. Gantwerker: Yeah. They worked literally side by side, as Peter Lio talked about. We do have a lot of images that are photographs taken by dermatologists or that are available that we sourced as well. It’s not all computer-generated. We source it. We focus on the computer generation of things that there aren’t a lot of reference images for. Everything else—the typical atopic dermatitis, the typical acne, all those types of things—is usually available. It’s the hard-to-find ones that we’re trying to focus on.

Dr. Tarbox: Well, there are some things that I feel like we all were trained on the same five images of—

Dr. Gantwerker: We always saw the same Wartenberg picture as an ENT. Every single one knows that one kid with Wartenberg’s.

Dr. Tarbox: Everyone knows the young lady that had chickenpox. We all trained on that one picture of that one young lady with chickenpox. It’s just like, “Wow, you’ve seen it once!” I think that having the ability to diversify that and build our visual library is very beneficial. We were talking about the AI bots, but that kind of learning is based on the way humans learn. Every time we see an image and we understand and know what it is, we add to our own visual library, and that increases our sophistication as we diagnose and treat patients. That’s awesome.

Dr. Gantwerker: Yeah. And that strong imprinting of how you learned changes the way that you practice. If you only saw chickenpox on somebody who was fair-skinned, Fitzpatrick skin type 1, then seeing chickenpox and somebody who’s a different Fitzpatrick skin type is going to be very difficult for you. One of the things we’ve tried to focus on with this technology is creating those images so we can change your imprinting.

Dr. Tarbox: It’s awesome.

Dr. Johnson: So we mentioned this AI thing. I think another aspect that people might have a question about is if this game doesn’t cost anything to download, then how do you guys keep remaining a business?

Dr. Gantwerker: I work really hard. No, just kidding. When Sam and everybody created the company, the goal was to democratize this type of content and use games for good and for a purpose to try and bring everybody up to the same level within their specialties. In that, he wants to democratize it and give access to everybody. He always wanted it to be free. He didn’t want to have doctors or institutions pay for it. He wanted to have access, which is why it’s mobile.

The way that we monetize is similar to any other free platform. We work with societies and organizations. We do some grant work, and we work with industry partners and clients to help get content that is specific to them or trying to work on specific challenges that would be applicable.

The example I always give is in our anesthesia game, Airway Ex; we worked with the American Society of Anesthesiology. They were very specific about some of the needs that they were seeing based on malpractice insurance claims showing that doctors weren’t getting the difficult airway algorithm. We recreated the difficult airway algorithm within our game and helped them to solve some of the problems that they were having in a creative way. I think that’s the way that I look at it. We work with these partners and clients to solve problems in a creative way that otherwise didn’t have good solutions.

Dr. Tarbox: One of the amazing things about democratizing education is that you’re not just elevating the state of practice of the physicians that play the game, you’re elevating the state of healthcare of the patients they take care of. That helps improve the entire quality of healthcare across our very diverse and very unique country. And so it’s really a noble mission. I’m very impressed by that.

Dr. Johnson: Dr. Gantwerker, you just alluded to this, but Top Derm is not the only game that Level Ex makes. Some of our listeners might be or know people who practice in other fields. What else do you have out there?

Dr. Gantwerker: Top Derm is our fifth title. Our first title was Airway Ex. After that, we had Gastro Ex, Pulm Ex, and then Cardio Ex. So we have four different specialties: anesthesia, cardiology, gastroenterology, and pulmonology. Top Derm is our fifth and newest title, but we continue to try and change the way the different specialties can consume content. Dermatology we’re very excited to be working on next.

Dr. Johnson: How come it’s not called Derm Ex?

Dr. Gantwerker: That is a great question, I think Peter had a small hand in this as well. There are a lot of things that we were thinking about, and we talked to our dermatology advisors and felt that Derm Ex didn’t capture what we’re trying to do. I don’t know if Peter has any comments on it either.

Dr. Lio: The underpinning for pushing this forward is to make you better. In the back of our mind, the goal we’re going towards is by doing this game, by playing and practicing, you’re going to be able to become a “Top Derm.” That was the concept. We really liked it. I thought it was unique and different and also gave us a little bit of a new space to start thinking about. Like when Apple switched from “i” everything to switching things out.

Dr. Gantwerker: We also didn’t want people to think that this was some kind of medical therapy. Right? Derm Ex, you know, get over the counter for your psoriasis, but—

Dr. Tarbox: It sounds like a medicine. That’s what I was going to say. It kind of sounds like it could be a drug.

Speaking of drugs, I did notice that you’re using the generic names. For any educational purists in the sphere, it is absolutely fine to recommend this for resident use. It teaches really important points about those medications that our residents need to be familiar with, like if it’s appropriate to use in the state of pregnancy or something like that. I thought that that was a lovely point to emphasize so that people feel comfortable.

Dr. Gantwerker: Absolutely. To build on that, all of our games have CME. CME content is coming to Top Derm. Not only do we believe that we should use generics and keep it unbiased, but we also have to for CME purposes. Any of our sponsored content has to live separately from our CME content, so we just by principle do that. That’s one of the things that we strongly believe in.

Dr. Johnson: Again, I want to dip into your unique expertise as technological innovators and medical education experts. Where do you project the future of medical education to be and how it combines with technology, not just in games and excellent podcasts, but over the next 10 to 20 years?

Dr. Lio: The future is podcasting. I’m pretty sure you guys are the tip of the spear. I do think that with improved technology, we’re going to see the sim movement. Simulation is such an important part of medicine. It has been for a long time, but it is, so far, synonymous with big clunky mannequins and getting up at five o’clock in the morning to do a surgical trauma sim with everybody in the room. It’s pretty cumbersome, although I think there are some amazing outcome changes.

What if we could bring some concepts and learning down, distill them into your mobile app, or, who knows, maybe in the next couple of years we’re going to have augmented reality and virtual reality that everyone will be having with them all the time? That’s my guiding light. If we can bring some of these same principles to everybody, we are going to see the best education in the history of medical education.

We come from a generation—all of us are old enough before there were work hours—so we put in a lot more time. As we cut down on that for our younger learners, and even for us, you can’t see everything in a given amount of time, no matter how good your training is. So we can augment and expand upon that in a way that will change everything.

Dr. Gantwerker: Building on that, you’re never going to come out of medical school or any kind of training knowing everything you need to know. We need to focus on teaching people how to learn. The doubling time of medical information is 73 days. The entire corpus of medical education is doubling—medical content is doubling—every 73 days. But, we take advantage of technology and how technology has advanced.

Simulation has been a great area for medical education. The problem is, as Peter told you, a lot of hardware-based solutions were always destined to have a problem. When COVID-19 hit, it shone a bright light on the fact that now these hardware simulations that are hundreds of thousands of dollars are locked behind doors, and nobody had access to it. One of the things that we saw explode was asynchronous learning. We saw synchronous remote learning and synchronous in-person learning diminish. And I think the future is: how do we leverage asynchronous learning and synchronous remote learning and then save synchronous in-person learning only when necessary. Software-based simulation and software-based solutions are going to be the answer.

Dr. Johnson: I also think that AI is going to play a big role. I know we touched on that briefly. My personal feeling is that it’s not going to replace us. It is going to assist us in some ways with decision support. So, for example, if you take a dermoscopic image, the computer might say, “Hey, this has a blue-white veil and an atypical pigment network, that’s two points, dummy. Maybe you should biopsy it.” But also people will be able to take pictures of stuff on their phones and they’re going to come in and see us for stuff that their phones don’t have a good answer to. It’s going to be like the equivocal lesions and then it’s going to be our job to figure it out. Those are the hard things that we do. So, I see that kind of thing coming too, even though maybe it’s not directly related to medical education.

Dr. Lio: I really like that. I like that so much because sometimes people will say, “Oh, derm, you guys are doomed because everything you do is just diagnostic and the computer is going to do it.” But it’s like, “Really?” The diagnosis for 90% of my patients or more happens in the first 10 seconds, or even when they walk down the hall. I know what they’re here for. Sometimes it’s in the current complaint. If the computer can take that over, OK, that doesn’t affect us too much.

I think you’re totally right—that decision support and augmentation of knowledge. What’s the current best therapy for when a patient fails something? You can read the textbook and the evidence tells you maybe one, maybe two. What if they fail both? Now what? It’d be cool to have a little decision support that says, “OK, well, there’s a little bit of literature here. This might help us here in this context.” Especially as we get towards more personalized medicine, which is my goal—to look at a patient and to understand specifically what is their genetic background and what is their phenotypic background. We can customize a treatment protocol for them that not only is the best therapy for them, but also has the least side effects.

We’re learning about this right now with some of the new medicines. My area is atopic derm, and we’re seeing scenarios like, “Whoa, this side effect only happens in one group of people. What if we could figure out who that is and exclude them?” We might be able to use the medicine a lot more safely, but this is going to become an exponential amount of data. I think we’re going to need peripheral brains to help us digest all this and bring it up to the forefront.

Dr. Gantwerker: Absolutely. Radiology was probably the first area that felt threatened by AI. Bertalan Mesko is a medical futurist who said that radiologists who use AI will replace those who don’t. It’s the idea that resisting it is futile. No, I’m just kidding. Resisting the ability to focus on what you can do as a clinician: the medical decision making, the judgment, and the amount that we can do with the external brain. Again, with the 73 days turnover time for doubling of medical content, you as a clinician can never know everything that’s out there. Why not offload that onto a computer? You already do. We Google things all the time. We look things up. We’re always using computers, imagining. Twenty years ago if they said: “You can be a doctor, but we don’t want you to use the Internet.” How would you have responded then? This is the new evolution, the new industrial revolution, of bringing AI into all aspects of our lives.

Dr. Johnson: As long as we’re off on this digression, something else that I think might be important in the future is more computer modeling. I remember being a medical student, and I was kind of offended when I discovered that the placebo-controlled, randomized trial was the gold standard. “Why do we need to spend millions of dollars and get five thousand people to figure this out? Can’t we, like, draw blood on a bunch of people and chug it through some fancy computer system to measure six hundred different micromolecules and then see what happens to different people when they take particular medicines?” My hope is that something like that can come as well.

Dr. Gantwerker: I think there’s a lot of opportunity in big data. We had talked with a company that is using CT scan images of lungs to predict best ventilation plans for patients in the ICU. They use the big data from all the CT scans of the chest of patients with different diseases. They could create a computer model that can tell clinicians at the front end, “Based on this patient’s CT scan, this is the recommended ventilation that’s going to be best and most optimal and best survival for this patient.” Why would you not want to be able to use that type of technology?

Dr. Johnson: Especially if I was reallocated to some kind of COVID-19 unit.

Dr. Lio: Definitely.

Dr. Gantwerker: Absolutely.

Dr. Johnson: Well, guys, as we wrap up here since Top Derm is kind of like a game show, I want to give the two of you some game-show style questions.

Dr. Gantwerker: Do we have a theme song? Yes, that was it.

Dr. Johnson: I’m going to start with fill in the blank. You can each answer. So “The thing that I am most proud of about Top Derm is blank.”

Dr. Lio: For me, it’s that it is accessible to learners of a huge range. It’s not just designed for somebody who’s an expert in one particular field. Lots of people from many different specialties, potentially, could play around and learn some basic dermatology from it.

Dr. Gantwerker: I will say I’m most proud of our team for bringing so many different elements of games into a totally new genre for us and using these computer-generated graphics, which is, I think, groundbreaking. If anybody looks at them, they’ll realize the power that this technology has. But using those game technologies, using those designs to create a really one-of-a-kind type of experience.

Dr. Johnson: All right, good answers. One more fill-in-the-blank. “In terms of the future of technology and medical education, maybe we already discussed this, I am most excited about blank.”

Dr. Lio: I’m most excited about personalized medicine coming in, as you described beautifully, where we’re going to be able to instead of doing randomized controlled trials, we’re going to be able to give a specific patient, with the power of technology, exactly what they need, just in time. That’s going to change. It’s going to change everything for the better.

Dr. Gantwerker: I’m most excited about the power of adaptive learning and dynamic content-serving—the idea that you can train during your medical education residency on the things that you need to train on instead of just saying, “You need to be here for four years, and whatever we can teach you in those four years is what you get.” Whereas, “We want you to be the best thing we can be in four years.” Trying to say, “You know what, you’re really good at dermatopathology, but you’re really bad at this. Let’s focus more time on this.” Once we do more adaptive learning and really specific personalized learning experiences, I think we’re going to make much better clinicians.

Dr. Johnson: I, as a parent of young children, would also be excited about that stuff for my young children. So here’s to hoping that that comes around while they’re still in school. All right. Two more questions for you guys. Both multiple-choice: most physically attractive Dermasphere co-host is A, Luke, B, Michelle, or C, all of the above.

Dr. Tarbox: The pimping bell, which I don’t have. It’s gorgeous. You’re going to have to take my word for it.

Dr. Gantwerker: Can I get a write-in for the Legend of Zelda map? That’s really the—

Dr. Johnson: Man. I lost the attractiveness contest to Legend of Zelda map? There’s a first time for everything. OK, finally, the funniest Dermasphere co-host is A, Luke, or B, all of the above. I’ll just let listeners make their own judgments on that one. As a reminder, you can write notes in the margins of your test, but they won’t count for scoring purposes.

Dr. Gantwerker and Dr. Lio, thanks again so much for being here and for making this cool game. So tell us where people can find out more about it, more about Level Ex, Twitter handles, and other social media, so we can put it in the show notes.

Dr. Gantwerker: For sure. They can find us on the interweb at www.levelex.com. You can find us on Twitter @LevelEx. We’re also on LinkedIn as Level Ex Inc. They can also find me @DrEricGant on Twitter and Eric Gantwerker on LinkedIn.

Dr. Lio: I’m most active on our Twitter, which is @ChiEczema, for the Chicago Integrative Eczema Center. And then that’s also our website: ChicagoEczema.com.

Dr. Johnson: Perfect, we’ll put those in the notes, guys.

Dr. Gantwerker: You can download all of our content for free in the App Store and Google Play. You can find Top Derm under that, as well as links to our Airway Ex, Gastro Ex, Pulm Ex, and Cardio Ex games.

Dr. Johnson: And listeners, thanks to you guys for joining us today. If you are new to Dermasphere, welcome aboard. Happy to have you. If you want to keep riding the Dermasphere train, here are good cars you can head out to keep it rolling. So of course, episode 47 with Peter Lio. Our two most popular episodes are episode 44 (we talk about over-the-counter hair supplements, among other things) and episode 49. We talk about environmental causes of skin aging, among other things. So a lot of people like those.

If you’re new to us, you might want to check those out. A nice Dermasphere sampler is a recent bonus episode that we put out called Pearls Floating in the Dermasphere, where we touch on some of the highlights from our first two years. Dr. Lio and Dr. Gantwerker, any final comments before we bid you adieu for now?

Dr. Lio: Thank you so much for having us. It’s so much fun, and I can’t wait to hear the next episode of Dermasphere.

Dr. Gantwerker: Yes, and I thank you again on behalf of myself and Level Ex. We really appreciate it and we’re super excited about this game. Thank you so much for having us on.

Dr. Johnson: We are excited as well. And listeners, you know where to find it. If you would like to find more Dermasphere here, you can find every episode, including the topics we cover on each on our website, DermaspherePodcast.com. You can also find our entire archive on Apple podcast or wherever you get your podcasts. And you can find us on social media, too. We are on Twitter, Facebook, and Instagram. That’s the other one. I’m too old. Thanks to young person, Ryan Carlisle, a medical student and member of our team who keeps those moving along. We will see you guys next time for our regularly scheduled stuff.

Thank you to Dermasphere co-hosts Michelle Tarbox and Luke Johnson for having us on the show. If you enjoyed listening, you’ll love playing. Download Top Derm now.

Using Video Game Technology to Create a Memorable AAD Summer Meeting

Posted on August 16, 2021May 24, 2023 by The Level Ex Team

In an exhibition hall, amidst the hustle and bustle of a medical conference, how do you forge meaningful connections with physicians? When attendees aim to learn, and catch up with colleagues who they have not seen for over a year, how can you become an attraction instead of an unwelcome distraction?

Game technology. These interactive and visually compelling experiences are where Level Ex turns to generate impactful educational solutions for doctors and healthcare industry partners—and it’s where we turn when thinking about how to build an effective conference experience.

Step into our American Academy of Dermatology Association (AAD) Summer Meeting booth. This year we were ecstatic to premier Top Derm, our dermatology mobile game, in its natural habitat. Dermatologists stopped by to learn more and play, intrigued by a knowledge-building game in their speciality and the opportunity to dive right in:

Attendees could grab a tablet and start exploring the wide range of topics covered in Top Derm: skin cancer, pediatric dermatology, adult dermatology, cosmetic dermatology, surgical dermatology, and more. Dermatologists also appreciated Top Derm’s high-resolution imagery, embedded in each challenge, including images of Fitzpatrick types IV-VI that are hard to access or unavailable elsewhere. As one dermatologist shared with us, “I always struggle with skin of color diagnosis, so having it in a game to practice is helpful.” Our goal is to include well above the industry average of darker skin tones in Top Derm to continue to address representation disparities in dermatology education.

Other visitors to our booth included pharmaceutical industry leaders who were interested in learning about how to incorporate video game technology into their brand planning to better engage and educate dermatologists. We were glad to observe that, despite a slightly lower attendance than previous years, pharmaceutical companies of all sizes were present (such as Boehringer Ingelheim, Pfizer, and Galderma), and they were able to have meaningful conversations with dermatologists about new products and exciting developments on the horizon.

event booth crowd

Both healthcare industry partners and dermatologists alike were drawn in by our Top Derm contest, specially created for the event. Conference moderator and speaker, and renowned dermatologist, Dr. Peter Lio, developed a challenge pack for Top Derm. Dermatologists who answered all questions correctly in “Derm Hero: The Dr. Lio Pack” were entered into a contest to win a chance to be featured in their own challenge pack. This allowed dermatologists already familiar with Top Derm to re-engage with the game and learn more about one of Dr. Lio’s expertise areas, atopic dermatitis. Best of all, dermatologists across the world—whether attending AAD or not—could participate.

dr-peter-lio

We ran a special contest during the AAD Summer Meeting that featured Peter Lio, MD, FAAD, pictured above.

The beauty of a mobile platform is that many attendees had already played Top Derm since its US release in June, having heard it discussed on the Dermasphere Podcast and elsewhere. We even met a dermatologist who playtested the original prototype and visited the booth to see how the game had progressed since the beta version. Being on mobile also meant that attendees could keep the fun going outside of the booth. They would grab a tote bag and a postcard and compete on their phone later at their leisure. One dermatologist admitted, “I’ll play it tonight and maybe during some of the talks if they get boring.” (Hopefully, no conference talks were harmed in the promotion of Top Derm, but we can’t make any promises.)

To all those who visited the booth, it was great to meet you in person (!!!). Dermatologists, we hope to see you in the game. Keep leaving your feedback inside of Top Derm. To our partners and prospective partners, we enjoyed syncing up with you at AAD and look forward to advancing the practice of dermatology through game technology, together.

Let us help you build a memorable interactive experience at your next physician event—or from anywhere. And try Top Derm for free, a mobile game that takes the fun to wherever dermatologists are.

Asynchronous and Synchronous Options for Remote Surgical Training

Posted on August 16, 2021June 7, 2023 by The Level Ex Team

Surgical training is a constantly evolving and dynamic process. This versatility makes it impossible to master a single and static set of skills that could last and be useful for the duration of a 21st-century surgical career. Innovation in surgical techniques is radically coupled with technology, hence its pace of change is exponentially accelerating. How we learn and how we teach must adapt to this reality.

—Rafael J. Grossmann, MD, FACS, trauma surgeon, medical futurist, and first doctor to ever use Google Glass during live surgery

Given the pace of surgical advancements, training is necessary for even seasoned surgeons to master new medical devices and techniques.¹ In the pre-pandemic days, surgical training occurred through in-person apprenticeship, sometimes requiring cadavers, mannequins,² or lugging equipment on site. With the pandemic’s detrimental effects on surgical training,³ institutions expanded their teaching modalities,⁴ and companies tried to adapt. The developments over that period have inspired remote surgical training trends that will only continue and evolve.⁵

Remote Synchronous and Asynchronous Learning

Even before the pandemic, distance learning enticed researchers who saw increases in online programs and wanted to explore the merits of various platforms and delivery types.⁶ One topic of discourse focuses on synchronous learning versus asynchronous learning.⁷ A core difference between the two is engagement: being present and interacting with another/others, or not, in real time. Asynchronous-style learning gives one “complete control,” offering time flexibility and maximum convenience,⁸ while synchronous-style learning allows for immediate feedback/responses and can expose learners to many perspectives through dynamic real-time discussions.⁹

Chart: What is the difference between asynchronous and synchronous learning?

Research has shown that a blend of synchronous and asynchronous learning modes are useful and can positively impact learners’ experience and performance.¹¹ In a study of physicians performing flexible bronchoscopic intubations—a procedure with a “steep learning curve”—a combination of in-person training supplemented with asynchronous interactive training using Level Ex mobile game Airway Ex yielded higher ratings for the quality of scope manipulation skills.¹² Another study explored the synchronous and asynchronous learning preferences of adult learners to discover how much synchronous instruction, if any, to include in an online curriculum. 57% of participants reported that they preferred online courses with synchronous sessions, but the research suggested that synchronous sessions be voluntary wherein the instructor addresses key points. Data showed that 39% of participants wanted synchronous sessions as needed, as compared to 30% once per week, and only 7% of participants desired no synchronous instruction. Students also preferred the option to watch videos of the synchronous sessions later due to potential schedule conflicts.¹³ This study highlights the importance of adult learners’ agency.

With surgeons in particular, having web-based and self-directed learning (asynchronous) as an option is helpful due to their busy and restrictive schedules.¹⁴ Some studies have shown that “web-based teaching modalities for residents and medical students may be equally as effective as in-person teaching modalities in various situations, including simulated patient encounters, ultrasound training, and procedural training”¹⁵; for experienced surgeons, then, how much more should medical device companies be utilizing remote surgical training?

Trends in Remote Surgical Training

A review of literature addressing emerging remote surgical training technologies shows a mix of synchronous and asynchronous options, with room to improve, expand—and merge—technologies.

AUGMENTED REALITY AND VIRTUAL REALITY (AR/VR)

In practice, VR/AR surgical training can involve “scrubbing into” a real operating room from a remote location,¹⁶ practicing procedures on virtual patients or 3D scans of patients,¹⁷ utilizing a headset overlaying AR graphics on what is actually present, such as a rubber model¹⁸ to guide the learner, and more. Studies have demonstrated VR training’s efficacy in ensuring patient safety,¹⁹ increased procedural accuracy and completion, and overall improvement in users’ overall surgical performance.²⁰

The pandemic fueled interest in adopting and developing new applications for AR and VR in healthcare²¹; however, our internal team at Level Ex has observed that AR/VR equipment, which some medical device sales representatives use for training, remained unused because of the safety concerns around COVID-19. Adoption in the consumer space has increased,²² and this has the potential to create an adoption trend among medical professionals—similar to the way that “consumer adoption of powerful smartphones paved the way for high-fidelity medical training on mobile,” said our CEO, Sam Glassenberg. He forecasts, “In the short term, we see the opportunity for the 3D medical content being developed for touchscreens, web, and PCs eventually being adapted for a headset environment.”

INTERACTIVE WEB-BASED OPTIONS

One recent study focused on ways to train at home during the pandemic. Authors discovered over 20 computer-based platforms, available online, ranging over 9 surgical specialties. The learning tools granted access to operating room simulations, intraoperative video clips, and other interactive surgical platforms. Phone-based programs, such as Level Ex mobile games, were also included. The authors noted that these “applications are widely available and have the potential to satisfy and supplement the learning needs of surgical trainees as defined by surgical education governing bodies.”²³

Massive open online courses that enable experts to teach at scale are another option, as well as video sharing platforms that allow learners to watch surgical procedures; vendors are exploring how to make video-based learning less passive by integrating 3D and allowing users to adjust their point of view.²⁴

Whether phone-based, computer-based, AR, or VR, surgical simulations are an important tool that could be used to not only improve outcomes (see Figure 2) but allow medical professionals to explore safely: “Surgical simulation enhances surgical skills by allowing repeated practice and to maintain an acquired level of competence. Current high fidelity simulators offer the opportunity for safe, repeated practice and objective measurement of performance. Furthermore, it is a more efficient and cost-effective modality that poses no risk to patients and avoids many ethical and legal complications.”²⁵ Adding remote, asynchronous capabilities to such a tool only broadens its positive reach.

Visual: What are the benefits of surgical simulation?

VIDEO CONFERENCING AND TELEMENTORING

Telementoring through web conferencing is an effective synchronous remote learning option for sales representatives, trainees, and practicing surgeons. Video conferencing has been used for decades as a clinical and educational tool for telementoring surgical procedures and in trauma and emergency medicine; this mode allows colleagues to share best practices and techniques regardless of distance, which can be helpful to collaborate with those in rural areas.²⁷ What became a standard as a means to overcome restrictions during COVID-19 can now be used to save on time and travel expenses in our “new normal.”

Johnson & Johnson Institute in particular created a telementoring pilot program that allows surgeons to enhance their surgical skills through educational activities that include real-time, intra-operative access to experts through multiple camera feeds, telestration, and two-way audio: their technology enables users to “virtually collaborate across regions, expanding access to experts and opportunities for learning, and empowering them to break down educational barriers.”²⁸ Johnson & Johnson Institute has also found other ways to promote remote learning among medical professionals during the COVID-19 pandemic by providing educational grants to aid physicians on the front lines of COVID-19.²⁹ Level Ex used a Johnson & Johnson Institute grant to launch COVID-19 training levels in its existing mobile games that allowed medical professionals to navigate COVID-19 diagnosis and patient management scenarios and internalize clinical guidelines.

Telementoring combined with AR/VR is being investigated as well. In a recent experiment, academic researchers developed a system that included asynchronous video clips, remote surgical mentorship, and AR to help expert surgeons train novice surgeons.³⁰

Synchronous and Asynchronous Cloud-based Remote Surgical Training

Virtual Technique Guides, a remote surgical training tool by Level Ex, was also released in 2020—not only to address challenges surrounding in-person medical device training but to make quality virtual surgical training more accessible overall. Virtual Technique Guides run over Level Ex Remote Play™ , the first cloud-based gaming technology to be used in healthcare. It hosts both synchronous and asynchronous training. On this platform, surgeons can train with each other or with medical device sales representatives in real time without any special equipment. Using a phone, tablet, or desktop computer they can perform high-fidelity virtual surgery together over standard web conferencing. Access starts with a QR code or link allowing the users to enter the experience immediately. This same technology can also be used asynchronously if a surgeon would like to go through steps on their own or refresh on what they learned in a former session.

Medical device companies can work with Level Ex to create detailed replicas of their device that their sales reps or surgeons can try out and master in the virtual space. Use of Virtual Technique Guides has been shown to improve product competency: The first medical device company to use Virtual Technique Guides reported a 28% increase in information recall by medical professionals.³¹ Active learning, such as discussing the medical scenario or engaging with a simulation, is a key component of learning because it promotes retention.³²

Visual: Level Ex Virtual Technique Guides increased HCP recall by 28%

Virtual Technique Guides at a Glance

IMMEDIATE ACCESS

Sales reps can instantly schedule a training and invite a surgeon with a simple link or QR code. Share, click, and enter a virtual world: One link allows multiple users to perform virtual surgery collaboratively on their phones, tablets, or desktop web browsers. There’s no app to download, software to install, or special hardware requirements.

UNMATCHED VISUAL QUALITY

Users experience each procedural step in spectacular detail and explore lifelike anatomy in true 3D—whether under visible light, X-ray, ultrasound, CT, or MRI. High-fidelity device simulations showcase device functionality down to the micrometer.

EXPERIENTIAL LEARNING

This is no YouTube video or PDF instruction manual. Elevate surgical training through real-time interaction. Skill-building sequences, based on the proven neuroscience of game design, keep surgeons engaged, challenged, and actively learning.

Anytime, anywhere training is here to stay—and benefit all. As stated by physicians in the International Journal of Surgery: Global Health, “The future of global surgical training resides in blended learning with a strong virtual learning component. While we do not have a clear idea of what the post-pandemic world will look like, our hope is that those platforms continue to grow and become integral parts of global surgical education, both for the surgeon-in-training and for the trained surgeon looking for continuing professional development.”³³

Let us help you meet your training goals. To equip your sales reps with Virtual Technique Guides or to add Level Ex Remote Play™ to your medical device website, please contact us.

References

Written by Bethany Brownholtz, Senior Copywriter of the Level Ex Team

Win a Chance to be in Top Derm! Play the Dr. Lio Challenge

Posted on August 5, 2021May 24, 2023 by The Level Ex Team

Atopic dermatitis expert Peter Lio, MD, FAAD has designed the ultimate challenge for Top Derms. Play Derm Hero: The Dr. Lio Pack and get a perfect score to win your own Challenge Pack and appear in the game, too!

How to Enter

Download Top Derm FREE and create your account (also free!).
Log into Top Derm any time between 8/5 11am ET/10am CT and 8/9 11am ET/10am CT.
Get 100% of the questions correct in Derm Hero: The Dr. Lio Pack and be automatically entered into the contest.*
Return Friday 8/13 at 1pm ET/12pm CT when we’ll announce the winner in game and on social media!

* One 100% completion entry per person

top derm hero contest faq terms

FAQs and Contest Terms

Q: What is the Challenge Pack called? A: The Challenge Pack to play is called Derm Hero: The Dr. Lio Pack.

Q: What are dates you can play the Pack to be entered into the Challenge? A: The challenge will be live from Thursday, August 5th at 11am ET/10am CT to Monday, August 9th at 11am ET/10am CT.

Q: How can I be entered into the drawing? A: To enter the Challenge’s drawing for the Grand Prize of appearing in your own Top Derm Challenge Pack, you must create a free account to unlock Derm Hero: The Dr. Lio Pack, and earn a 100% on the pack’s questions by Monday 10am CT.

Q: What if I do not get a 100% on the Pack on the first time I play? Can I play again? A: Yes! You can play as many times as you would like until you get a 100%.

Q: What if I play multiple times and earn a 100% score multiple times? Will I receive multiple entries into the drawing of the Grand Prize? A: You may play Derm Hero: The Dr. Lio Pack as many times as you would like. However, you will only receive 1 entry into the Grand Prize drawing, no matter how many times you earn a 100% on the pack.

Q: What exactly is the Grand Prize? A: The winner of the Challenge will receive the opportunity to appear in a Top Derm Challenge Pack: The winner’s name and photo will go in the game as the face of a new Challenge Pack. The winner will earn the option of selecting the imagery for the pack’s icon and the opportunity to select the pack’s title. The pack will consist of 5 questions total. If the winner would like to be further involved, the winner will be given the option of creating their own content or choosing the topics they would like showcased in the pack. The winner’s challenge pack will be playable for all Top Derm members!

Q: How will the winner get the prize? A: Once the winner is chosen, contacted, and accepts the prize, the winner and Level Ex will work together to schedule the winner’s appearance in Top Derm!

Q: When will the winner be announced? A: The winner will be announced in-game on Friday, August 13th at approximately 12pm CT/1pm ET

Q: If I am attending the AAD Summer Event, can I play the Challenge in person? A: Yes! Level Ex will have a booth at the AAD Summer Event (booth #1008 under “Top Derm by Level Ex”). You may play Top Derm and participate in The Dr. Lio Challenge at our booth. You can download Top Derm, create a free account, and play the pack. If and when you score a 100% on the Challenge, you will then be automatically entered for the Grand Prize. You can also discuss the Challenge and Top Derm with Level Ex employees at our booth.

Q: If I win the Grand Prize, will I receive a monetary prize? A: No. The prize is a virtual prize and no money will be awarded or exchanged. Your chosen Pack image and name (and if you so choose, content) will be featured front and center in Top Derm, reaching thousands of fellow dermatologists and HCPs. Your Pack image and name will also be promoted across various media channels for additional exposure.

Q: If I win the Grand Prize and opt not to accept the prize, will I receive an alternate prize? A: No. Should the winner opt to not accept the prize, Level Ex reserves the right to choose another winner. No alternative prize will be awarded.

Q: Must I reside in the U.S. to win the Grand Prize? A: No. Anyone can participate in the Challenge, U.S. domestic and international.

Download Top Derm to play!

For Derms, By Derms: Top Derm from the Physician Advisors’ Point of View

Posted on August 4, 2021May 24, 2023 by The Level Ex Team

“When you’re working outside of your industry in something that I think of as an incredibly exciting space—the video game space and technology space—you’re interacting with a whole different group of people: game creators, artists, people who really deeply understand the technology. It has been so interesting to me and really has pushed me and stretched me in ways I didn’t even think about before. In a way, it’s kind of my dream to use the skills that I’ve acquired in one area and be able to apply them to other areas to make something bigger.” —Peter Lio, MD, FAAD, Dermatology, Medical Dermatology Associates of Chicago

Over the past few years, Level Ex artists, designers, developers, and over 140 dermatology experts have pushed, stretched, and enriched one another as they collaborated to create our newest game, Top Derm. The result of their hard work is a fast-paced, fun, and challenging dermatology game unlike any other medical resource available—and the journey from concept to launch is just as unique and exciting as the app itself. Four of our physician advisors share their experiences.

Teaming Up with Top Derm

Prior to Top Derm, the Level Ex team of designers, developers, and medical experts has collaborated with hundreds of physician advisors to create games for cardiology, gastroenterology, anesthesiology, and pulmonology. Dermatologists were downloading and playing these games, so we knew there was both an interest and need present. We also recognized that a dermatology game would differ from previous titles in style, content, and mechanics due to the nature of the field. Shraddha Desai, MD, FAAD, Director of Cosmetic and Laser Surgery, Dupage Medical explains, “A lot of us, especially in dermatology, are very visually oriented.” In addition to being a highly visual field, dermatology also has high clinic volume and is relatively fast-paced. Top Derm’s gameplay strives to mimic that environment.

Supporting Images Gameplay Skin Renders V1C

Not only did we consider how dermatologists work, but we also paid attention to how they like to learn. For Dr. Desai, Top Derm’s departure from traditional methods of learning and review was a big draw. “I am more of an interactive learner in general. So for me, reading a journal is not very exciting and can be kind of boring. More often than not, I tend to skim things. So having a visual product as well as one that is entertaining and fun, people get a lot of stimulation in different ways and then they end up learning more as well as retaining that knowledge moving forward,” she explains. The game takes important topics in dermatology and transforms them into short, rapid-fire challenges that educate while they entertain. Sara Hogan, MD, Dermatology, Laser Skin Care Center Dermatology Associates, learned about Top Derm through an ad looking for reviewers to playtest Top Derm before its official release. “I had so much fun and [enjoyed providing feedback during playtesting] that I became an advisor,” she remarks. Like Dr. Desai, Dr. Hogan appreciates having a new and different mode for obtaining information: “It compliments our readings that we do in journals and the continuing medical education that we do through conferences. It’s a new way to see information and to learn.” Fabrizio Galimberti, MD, PhD, Dermatology, University of Miami, calls it “the next level of learning.” As one of the newest advisors to join the team, he attributes some of his interest in Top Derm to the pandemic, which he believes has made everyone more comfortable with technology and open to bigger changes in how we live, work, learn, and connect with one another.

DermCollab Blog Quote + Headshot Hogan

As a Clinical Assistant Professor of Dermatology and Pediatrics at Northwestern University Feinberg School of Medicine in Chicago, Peter Lio, MD, FAAD, Dermatology, Medical Dermatology Associates of Chicago, has particular interest in the educational value of Top Derm with regard to the broader impact it will have on patient outcomes: “Part of my work is thinking about how we can bring some of the key educational experiences that are really high value in terms of knowledge, but also improving clinical practice. The dream, ultimately, is to have an impact on patient outcomes using the power of technology and gaming, which really captivates the audience and brings people back for more.” Dr. Lio was so passionate about sharing his own expertise with the broader derm world that he collaborated with our team to curate his own challenge pack on atopic dermatitis.

Collaboration: Just What the Doctor Ordered

When creating a video game for physicians, the level of collaboration is unlike anything most contributors have ever experienced. “I would say that in my career, this has been one of the most interesting and exciting things I’ve ever done,” remarks Dr. Lio. “Working with Level Ex has been this incredible give and take and a growth experience for me… iterating, changing, sharing ideas and then building things out to get feedback on it has been incredibly inspiring to me.” Level Ex Senior Artist Colin Joyce says the feeling of inspiration and admiration was mutual. “Five minutes worth of feedback from a derm could save a week of making adjustments,” he explains. Colin created much of the clinical imagery in Top Derm by working closely with physician advisors to perfect each and every detail—to the point that most dermatologists could not discern the renders from the real images.

Dr. Hogan worked closely with artists like Colin to review computer generated imagery for the game. In this process, she would provide feedback on aspects such as features, morphology, coloring, and distribution. “One thing that I thought was really important was the team at Level Ex really wanted to make sure that different dermatologic conditions were visible or captured on different skin types,” she shares. Specifically, she remembers working with the team to perfect a particular shade of purple used in the clinical imagery depicting lichen planus in someone who is Fitzpatrick phototype five, giving feedback on the type of micaceous scale you see on psoriasis or what dyshidrotic eczema looks like on the palms. The attention to detail was appreciated by Dr. Desai, as well. “The artistic renderers know I’m a stickler for color and texture and shape,” she laughs. “I’m like, ‘No, no, it’s baby pink, not pastel pink.’ And they have not been annoyed with me at all. They’ve actually been very appreciative about that.” The time and careful consideration taken by the team, from start to finish, really impressed her.

Going through this process not only creates a better game, but builds incredible bonds as well. Dr. Desai explains, “What’s unique about Level Ex is that it kind of feels like a family. It’s not really just like you’re working. There’s a lot of camaraderie, there’s feedback, and there’s been a lot of input, which you don’t get a lot of when you partner with other games or groups.”

DermCollab Blog Quote + Headshot Desai

While the collaborative process was long and thorough, the Level Ex’ers made every effort to work within the physicians’ busy schedules. “We know how few and far between their free time is. And to know that in between seeing patients, during their commute, or a ten minute lunch break that they would give us feedback was immensely appreciated by the whole team. Their investment and expertise propelled us to get Top Derm to the condition it’s in now,” says Elsa Varghese, Manager, Medical Team. Dr. Lio speaks to the ease in which he is able to fit working with Level Ex into his schedule. “My days are fairly complex and pretty busy. They often go late into the evening, often seeing patients during the day and then fielding calls and follow ups and pathology reports in the late afternoon. But much of my work [on Top Derm] has actually been asynchronous. We’ll have a list of things that we want to check over. I can fill in some spreadsheets, we can give some feedback. And what’s really nice about that is we can continue the dialogue in those free moments in the late evening or even in between patients.” He adds that these are the moments when he can see himself playing Top Derm as well.

Play with Lasting Impact

With the launch of Top Derm, Level Ex’ers and physician advisors alike are seeing years of hard work and close collaboration finally come to life. The game is now in the hands of dermatologists around the world, and featured in publications like Healio and The Dermatologist, and on Dermasphere – The Dermatology Podcast.

For Dr. Lio, it’s not just a job well done, but a dream come true: “I’ve been interested in video games my entire life and always dreamed about bringing together the ability to have some fun, but also to teach in the same concept. And that’s really for me, what Top Derm represents— this opportunity that has never before existed and really is only made possible by the right people, the right technology and the right timing.” Speaking of “right people, right timing,” we met Dr. Lio years ago because his office was located on the floor below ours! His enthusiasm and encouragement were major motivators in the making of Top Derm.

DermCollab Blog Quote + Headshot Lio

Working on a video game gave Dr. Galimberti a level of reach and influence that he could not have achieved on his own. He says, “I was actually helping the next generation of dermatologists. I was able to reach an incredibly large number of people that I wouldn’t have been able to do by publishing a paper.” In fact, he already has future plans for collaboration. He would like to see Top Derm used on an international level to bring higher quality medical education to countries with less robust residency programs.

DermCollab Blog Quote + Headshot Galimberti

And this is just the beginning. A major feature of Top Derm is the ability to rate and leave feedback on challenges. In doing so, physician players can help better the game and advance the state of the art in dermatology. Game Design Director, Jason VandenBerghe, reflects on the development of this feature: “When we were doing the first public playtest for Top Derm, we had included this feature…Normally in video games, we put in a feature like this, you get one percent or two percent, five percent participation. We got seventy five percent participation. Three quarters of people who played the Top Derm beta had something to say to us about the questions they were playing…We had never seen anything like this before and I’ve never heard of anything like that before. I can’t tell you how fun it is working with the audience that really wants to tell you what they think.” Both sides of this collaboration have benefited greatly from the other and we are excited to see that continue in the game. Thank you to all our physician advisors for their tremendous contributions.

We’d love to know what you think, too! Download Top Derm and leave feedback on the challenges you play. Want to do more? Become a physician advisor!

Level Ex Makes Mental Health Top of Mind

Posted on July 27, 2021May 24, 2023 by The Level Ex Team

“An initiative like this brings mental health to the forefront and out into the open, so it is safer to feel like you can be yourself. You may also be able to connect with others who are struggling with similar issues. I connected with at least two coworkers about mental illness with whom I had never discussed that issue before.” – Bethany Brownholtz, Senior Copywriter

At Level Ex, the overall health of our community and our world is of utmost importance to us. “Mental health is all too often ignored, dismissed, and trivialized and mental health is stigmatized by society with disastrous consequences,” Sam Glassenberg, our CEO and founder, shared in a message to the team. He has witnessed this on a very personal level and recognizes that many of us and our loved ones struggle with mental health, anxiety, and depression. So in an effort to raise awareness, provide support, and fight the stigma associated with the mental health continuum, we dedicated the month of May to mental health awareness. The Level Ex community came together to create and participate in activities and content for every day of the month providing resources, tools, and a safe space for everyone to be their authentic selves.

“Mental health issues are stigmatized and yet are prevalent. Approximately 1 in 5 adults in the U.S. experience mental illness in a given year. This means at a company of our size, there are probably at least 30 people experiencing mental illness,” explains Senior Copywriter Bethany Brownholtz, a culture ambassador for the event. Because of this stigma, many people who suffer feel forced to do so in silence—afraid to reach out for help or ashamed to be seen struggling. Bill Sabram, Game Director, reflects on this sentiment: “40+ years ago, my Mother had breast cancer and it was just not something you talked about back then. There was a lot of shame. You could not even say the word ‘breast’ in public! Contrast that with today, where people go on fundraising walks to raise money for breast cancer research, and people rally around a friend or loved one that is battling breast cancer. I believe one day we will be able to openly talk about our mental health issues, and get that community support that makes so much of a difference in our treatment and recovery. I just hope it does not take 40+ years to reach that point!”

Creating a Safe Space

Kicking off a month-long series of events, Head of People and Culture Kami Bond shared a video to remind anyone experiencing stress, loneliness, anxiety, loss or depression: You are not alone.

Following that were activities for each day of the week:

Mindful Mondays led Level Ex’ers in meditation and gratitude practices.

Tasty Tuesdays consisted of “Lunch & Learns” discussing topics such as resiliency and the art of letting go.

Wellness Wednesdays encouraged healthy habits like hydrating and getting more sleep.

Thoughtful Thursdays offered methods and tools for overcoming obstacles and dealing with stress.

Fact Fridays shared ideas for continued support and education, including crowdsourced resources from the Level Ex community.

Cheers to hydration! Level Ex’ers started each meeting by raising a glass of H20 during the “Wellness Water Challenge.”

Game Designer Jacob Mooney and Director of Information Technology Colette Custin led a “Lunch & Learn” introducing 8 habits of resilient people. “Everyone who attended had great tips on how to overcome even the most intense stressors. It was an awesome opportunity to hear from members of the Level Ex community. It opened my eyes to the fact that our community here at Level Ex is one that is truly caring and thoughtful,” Colette shared. Jacob added, “Level Ex’ers surprised me with their willingness to come forward and talk about things that bother them or that help them in times when staying resilient is key.”

Many Level Ex’ers commented on the usefulness of the practices and resources that were shared throughout the month. “The resources Level Ex’ers came up with could really help you make time for your wellness on a daily or weekly basis without it feeling like a burden. You have everything from crafting/baking, to reading powerful books, to yoga,” explained Bethany. She continued, “The different levels of resources inspire me to invest in my wellness more. You tend to forget things like drinking more water, taking walks, and getting enough sleep can improve your quality of life. There were so many good reminders. I haven’t made habits of all of them yet, but awareness is always the first step!”

Continuing the Conversation

May was a great opportunity for us to recommit to mental health—especially in light of the added stress this last year caused for so many of us. Working from home can make it difficult to feel connected with your team, but coming together to plan and execute events like this has the added benefit of building community and closer bonds. Colette reflected, “The planning process for Mental Health Awareness month was an excellent opportunity for me as a new employee to connect with other Level Ex’ers that I don’t normally get to interact with. That was my favorite part of the whole experience.”

Studies show that employees who see nature from their office spaces like their jobs more, enjoy better health, and report greater life satisfaction. Level Ex’ers wear green to remind one another of the color’s positive effects on mental health.

We are committed to continuing to look for ways we can support all facets of wellness in our community. Level Ex’ers crowdsourced many great ideas to keep the momentum of mental health awareness month going throughout the rest of the year, and we are putting structures in place to see that it happens. We also have a wealth of resources currently available to employees that some of us may not be using to our full advantage. “We should remind people every quarter that there are mental health resources available through our benefits programs. It’s easy to hear about these benefits at the end of the year, and then forget them when you really need them,” Jacob said.

“This initiative was especially important to us because we wanted to respond directly to the needs of our team. Earlier this year, Level Ex’ers had indicated heightened levels of stress as the effects of the pandemic continued to take their toll. Many of our events, resources, and conversations were a direct response to this identified need,” explained Kami Bond, Head of People and Culture. She continued, “We want our employees to genuinely feel that Level Ex is a safe place where they can be their authentic selves, build trusted relationships, and access the right resources when they need help.”

Want to be part of a team that makes mental health a priority? Check out our open positions.

Accelerating IVUS Adoption with the Philips Peripheral Vascular Levels in Cardio Ex

Posted on June 30, 2021May 24, 2023 by The Level Ex Team

IVUS is a powerful diagnostic tool. It has been shown to change treatment plans in 79% of arterial cases, 76% of AV access grafts, and 57% of venous cases vs angiography alone. A cutting-edge product with this level of impact on patient outcomes needs to be in the hands of as many physicians as possible.

By using IVUS, physicians can unlock the ability to assess the presence and extent of disease, plaque geometry and morphology, and guiding wire position during lesion crossing. This technology is just as important post-stent placement to confirm apposition and treatment effectiveness. Recognizing the power of IVUS to improve patient care and treatment plans, Philips sought out Level Ex to help accelerate its education and adoption among peripheral physicians.

Jude Wimberger, Head of Peripheral Vascular Commercial Marketing, Philips, explains: “Creating an interactive experience with the portfolio of products we offer is critical to engaging physicians; enhancing education and knowledge. Our goal was to tell the story of how our products come together. That’s where Level Ex came in. The uniqueness and interactive nature of their platform allows physicians to build on their understanding of IVUS (and the broader Philips product portfolio) in a risk-free and engaging environment.”

Enhance Your Peripheral Vision

The Philips Vascular unit allows peripheral physicians to explore the Philips IGTD Product Portfolio in a low stakes environment. First, Morphology Quiz tests players’ IVUS interpretation skills. Then, five interventional cases place Philips tools directly into the hands of peripheral interventionalists. Levels like SFA Investigation and Serial Stenosis provide a dynamic environment in which players can identify and treat ATK (above-the-knee) lesions and use IVUS to determine the percent and stenosis of the lesion, and products needed to prep and treat the area. The Long Dark, Compression Conundrum, and IVC Imperilment present unique challenges specific to the targeted anatomical areas of each level.

The Morphology Quiz in the Philips Vascular Unit in Cardio Ex

Dr. Mahesh Raju, Director Cardiac Cath Lab, EndoVascular, is an interventional cardiologist who specializes in peripheral vascular procedures. When describing his experience with the unit, he recognizes one of his professional challenges addressed by the gameplay: “I feel that we undersize most of our treatment options. The peripheral vascular levels allow me to use varying balloons and stents with more confidence when sizing appropriately for the vessel size.” He continues, “I would recommend [this unit] to any physician who does endovascular procedures in order to expand their skill set in a safe manner to improve patient outcomes.”

Play the Philips Vascular Unit in Cardio Ex! For more information on how our games can help physicians build confidence in using your tools, check out our partnerships page.

Category: Uncategorized

Spark Curiosity & Deepen Understanding Through Exploratory Learning

Building a deep understanding with educational psychology

The impact of exploratory learning on medical education

HLTH Themes: A Fireside Chat with Stefan Vilsmeier & Sam Glassenberg

Panelists

Stefan Vilsmeier

Sam Glassenberg

Read the Transcript Below

Reducing Barriers to Entry in Medical Device & Surgical Training

Examining Technological Barriers and Human Frustration

Reducing Barriers to Entry with Remote, Cloud-based Training

Virtual Techniques Guides Solve the Barrier-to-Entry Issue

Top Derm Hits the Dermasphere

Listen to the Episode

Contributors

Michelle Tarbox, MD

Luke Johnson, MD

Peter Lio, MD, FAAD

Eric Gantwerker, MD, MMSC (MEDED), FACS

Read the Transcript Below

Using Video Game Technology to Create a Memorable AAD Summer Meeting

Asynchronous and Synchronous Options for Remote Surgical Training

Remote Synchronous and Asynchronous Learning

Trends in Remote Surgical Training

Synchronous and Asynchronous Cloud-based Remote Surgical Training

Virtual Technique Guides at a Glance

Win a Chance to be in Top Derm! Play the Dr. Lio Challenge

How to Enter

FAQs and Contest Terms

For Derms, By Derms: Top Derm from the Physician Advisors’ Point of View

Teaming Up with Top Derm

Collaboration: Just What the Doctor Ordered

Play with Lasting Impact

Level Ex Makes Mental Health Top of Mind

Creating a Safe Space

Continuing the Conversation

Accelerating IVUS Adoption with the Philips Peripheral Vascular Levels in Cardio Ex

Enhance Your Peripheral Vision

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