Pride with a Purpose: Level Ex Pride Month 2021

“The Level Ex community helped me to not only accept myself and have pride in who I am, but also to learn about a side of my own culture that I had previously never claimed or experienced.” —Nicole Loud, Game Designer

At Level Ex, we don’t just wave flags or post rainbow logos during Pride Month, we create a safe space for dialogue, activism, education, and allyship. An open, welcoming community and secure sense of belonging are essential parts of our culture.

Last year we recognized developers and designers who are revolutionizing LGBTQIA representation in the video game industry. This year, we broadened the scope. “Our goal is to fight stigma and prejudice, provide support, educate the public, and advocate for policies that support LGBTQIA individuals and the impact they’ve made locally, nationally, and internationally…and have some fun along the way,” said Kami Bond, Head of People and Culture. Level Ex’ers from different teams across the company volunteered to be culture ambassadors and came together to plan a month of thoughtful and thought-provoking events that placed as much importance on education as they did on celebration.

Activities opened with a video documentary, Stonewall Forever, which offered an in-depth look at the LGBTQIA experience during the 60’s and 70’s in the United States, focused on the Stonewall Uprising of 1969 universally acknowledged as the catalyst of the modern queer rights movement. One Level Ex’er commented, “I am ashamed to admit how ignorant I was/am about Stonewall and all these events leading to Pride month. Thanks so much for sharing this, and I still have more to learn!”

Education, Advocacy, and Allyship

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The Pride “Lunch & Learn” featured 5 major figures in LGBTQIA history since 1900

The history lessons continued with a “Lunch & Learn” highlighting the lives and contributions of five prominent members of the LGBTQIA community in the last century: Alan L. Hart, Alan Turing, Edith Windsor, Howard Ashman, and Marsha P. Johnson. Presenters MJ Young, Associate Producer, and Charlie Strickland, HR Intern, wove these historic figures’ stories together, pointing out significant moments and places of intersection.

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Alan L Hart, born Alberta Lucille Hart, was a physician, tuberculosis researcher, and novelist.

“Most of us never got any education about LGBTQIA issues in our formal schooling unless we specifically sought it out in higher education. Even many members of the community itself haven’t learned much about the movement’s history,” MJ explained. “I think many folks were surprised both about how recently major milestones like decriminalization of homosexuality in the US were achieved, and how early community progress was wiped out by the rise of fascism in the early 20th century.” They continued, “Learning history is the only way that we can put into perspective how far we’ve come, but also remember how fragile this progress can be if we become complacent.”

Level Ex’ers encouraged one another to stay involved and connected by creating a crowdsourced internal resource page with links to LGBTQIA organizations, support networks, and sources for continued reading and education. Senior Graphic Designer Mazen Ghamlouch helped coordinate this effort. He said, “When you’re gay, bisexual, transgender, or gender-nonconforming, an average day for you is not the same for me. Some often face struggles and obstacles I can’t imagine, so I choose to speak up and advocate because it’s the human thing to do. Until the day comes when we can all live out similar ‘average’ days, I’ll continue to support LGBTQIA communities everywhere.”

Pride Voices

We also had the opportunity to hear from fellow Level Ex’ers, who shared their personal reflections and experiences. Game Design Lead – Client Success, Roxanne Splitt, echoed Nicole’s earlier sentiment about feeling a sense of belonging at Level Ex:

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Game Director Bill Sabram stressed the importance of civic involvement and engaging others in open conversation—even if the topic is uncomfortable to some.

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Nicole Loud summed up the power and impact of belonging to a community that openly shares their personal experiences: “It has inspired me to actively contribute to that same sense of pride and community so that others can feel as accepted, understood, and supported as I did.”

Swag, Games, Art, and More

It should come as no surprise that we put a Level Ex spin on our Pride Month activities. Games like trivia and bingo let Level Ex’ers learn more about how they can support the LGBTQIA community while having some laughs along the way. Trivia revealed surprising facts—some fun, some sobering. Do you know which member of the “Overwatch” roster identifies as part of the LGBTQIA community or how many states have banned conversion therapy? Blizzard and 20…our minds were blown, too.

Putting her game designer skill set to good use, Roxanne created a bingo game highlighting aspects of identity, influential figures in LGBTQIA and moments that matter in the history of Pride. Roxanne said, “My goals were to teach and inform by triggering ‘A-ha’ moments that could serve as a launchpad for future discoveries, have fun with a mix of joyful and celebratory moments —in addition to the more somber ones, and, most importantly, share the Level Ex spirit by featuring the thoughts and experiences of the people who work here.”

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The rich mosaic of voices, backgrounds, and ideas that came together in this month’s events to create one harmonious celebration serves as a reminder of the true meaning of pride: inclusivity, diversity, and unity. Thank you to our culture ambassadors for making this year’s Pride Month so memorable!

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Level Ex’ers could choose from an array of festive Zoom backgrounds created by Senior Art Designer Mazen Ghamlouch.

Want to work for a company and a cause you can be proud of? Check out our open positions.

The Airway Ex Effect: Study Shows Positive Impact on Physician Performance

 

Accuracy, by definition, is freedom from error. For a professional athlete, that may look like sinking a three-pointer or making a hole-in-one. But for a physician, accuracy could be the difference between life and death.

When intubating a patient, there is no room for error. Doctors must be prepared for every scenario that could present itself, which is why practice—and precision—are essential. So when we heard that a recent study found that less experienced physicians who played our anesthesiology-focused mobile game, Airway Ex, improved their accuracy and skill when performing intubations, we had to share the news.

This isn’t the first time that games have been proven to positively impact physician learning. We’ve seen the power of play to enhance surgical performance, laparoscopic skills, fibreoptic intubation, and more. In fact, it was an efficacy study on our CEO Sam Glassenberg’s iLarynx app he built as a favor to his physician father that inspired him to start Level Ex. We’ve been making video games for doctors, covering different medical specialties, ever since.

The Study

Skill and accuracy are critical elements for a successful intubation—especially in difficult airway scenarios. These are some of the areas that researchers measured in their study of physicians in the Emergency Department of the National University Hospital in Singapore. They focused on flexible bronchoscopic intubation (FBI), which is a specialized skill and rare form of intubation, but critical for managing difficult airways. Because FBI is not a common procedure, physicians tend to train and practice on mannequins or normal patient airways. This study introduced Airway Ex as a supplemental training to the more conventional, established methods.

Participating physicians had varying degrees of intubation experience. Both the control and intervention groups received traditional training in FBI, while the intervention group played Airway Ex for 30 minutes and attempted 6 different cases in the app. Gameplay started with the tutorial, then increased in levels of difficulty; players were required to intubate virtual patients with conditions such as a supraglottic mass causing obstruction of the airway.

The Results

Researchers then observed the participating physicians as they performed FBI on mannequins. Results from those observations showed that the ultra-realistic gameplay in Airway Ex gave physicians an edge when performing intubations on difficult airways in three main areas:

Accuracy: Failed intubations can have deadly repercussions. There were no failures to intubate among physicians who received Airway Ex training. This is especially noteworthy when considering that the first-pass success rate for FBI intubations was 51.1% according to a ten-year study referenced by the researchers, and repeated attempts can cause further complications.

Skill: Scope manipulation skills were significantly better among less experienced physicians who received Airway Ex training, but the impact didn’t end there: “The difference in skill quality remained statistically significant even after adjusting for age, gender, physician rank and previous FBI experience.”1

Speed: Every second counts when treating critically ill patients. Results show potential increased speed to successful intubation with Airway Ex training.

The Impact

Airway Ex, when combined with traditional teaching methods, provides physicians with training on a “life-saving skill in a safe environment without compromising patient care.”1 Our gameplay isn’t just entertaining. It can help physicians improve their speed, accuracy, and skill so they are better prepared in real-life medical emergencies. As CEO Sam Glassenberg has said, “We trigger a similar emotional response by creating an interactive experience that will train without needing the live patient involved. So when you come in on patient one, it’s as if you’re on patient 100.”2 And these results were achieved after just 30 minutes of gameplay.

Furthermore, Airway Ex provides physicians with an easily accessible training tool. Researchers noted that “[using Airway Ex] could provide learners an opportunity for self-directed and flexible learning, anytime and anywhere, which would not be possible with a simulator.”1

For our team of video game designers, developers, and expert physicians, it’s always reaffirming to see how we, along with the 700,000 medical professionals playing our games, are working together to accomplish our mission of advancing the practice of medicine through play.

Want to learn more about how we’re using video games to advance the practice of medicine? Follow us on LinkedIn, Twitter, Facebook, and YouTube.

Interested in conducting an efficacy study with our games? Reach out to us!

References

1. Yau YW, Li Z, Chua MT, Kuan WS, Chan GWH. Virtual reality mobile application to improve videoscopic airway training: A randomised trial. Ann Acad Med Singap. 2021 Feb;50(2):141-148. doi: 10.47102/annals-acadmedsg.2020431. PMID: 33733257.

2. Coey SK. COVID-19 in the ER? Level Ex uses J&J grant to simulate infections in medical education video games. 2021. Accessed April 15, 2021. https://www.fiercepharma.com/marketing/j-j-institute-gives-education-grant-to-game-maker-level-ex-for-covid-19-specific-playing?mrkid=131465797

Are Level Ex Games Being Used to Train AI?

The answer is NO!

As doctors play our games, where we challenge them with difficult procedural, diagnostic, and treatment cases in their field, we are often asked:

“Wait a minute — are my in-game interactions and decisions being used to train medical AI?”

Or, in other words: “Is my playing this game being used to train my eventual AI replacement?”

We were taken aback by the question at first, but as we learned about the plethora of applications out there that are trying to mine physician interactions to train AI systems, we started to realize where this concern was coming from.

terminator Our upcoming dermatology game isn’t trying to create the derminator. Quite the opposite.

First off, let me just say that’s just not what we do. That’s not our mission. At Level Ex, we use game technology and design to improve physicians’ skills. We care about training *real* neural networks (the kinds inside the skulls of medical professionals) — not training artificial ones.

We are a team of over 120 people, including dozens of software engineers, biomedical engineers, and medical professionals. We do not have a single AI or machine learning engineer on staff. We simply aren’t building or training AI. Our games are not designed for that.

For example, in our upcoming dermatology game, we have all sorts of visual, diagnostic, and treatment challenges — but in all cases there’s a known right answer. In other words, these challenges are not useful for training AI, but they’re great for refreshing and expanding doctors’ knowledge.

coming soon game for humans

Sure, we’d have a lot more venture capital dollars thrown at us if we pretended that we were an “AI Company”, but we just aren’t. We’re a game company.

When I explain this to people, it sometimes leads to the next question:

“Well, OK… but if you’re not training AI, how does Level Ex make money from these apps?”

ANSWER: Advertising and sponsorship.

Just like leading medical journals and medical conferences, our games are supported by 1) industry sponsors that use our platform to help doctors better understand when and how to use their products and 2) grantors, such as medical societies that use our platform to disseminate the latest best practices. Sponsored content in our games is always obvious, so that you know what content is from your peers and what comes from the industry. It’s this sponsorship (not an AI analysis of your in-game behavior) that enables us to deliver tools to physicians for free worldwide.

Bottom line, we believe that apps should help doctors — not replace them.

Dr. Rafael Grossmann Test Drives the First Cloud Gaming Platform in Healthcare

We’re always working to improve our games and tools for doctors and other medical professionals.

Most recently, our team created the first cloud gaming platform in healthcare—a powerful way for doctors to remotely collaborate and work together on diagnosing and treating virtual patients in real time—and we’re excited to show it off to the medical community.

So we sat down for an online session with Dr. Rafael Grossmann, a world renowned trauma surgeon, medical futurist, and respected authority on tech innovation in healthcare. Our three participants were separated by thousands of miles (and even some ocean) as we explored virtual surgery and COVID-19 virtual patient cases together. See the highlights of that session in this short video:

Watch the Full Discussion

Read the Transcript Below

Level Ex Team: At Level Ex we’re a team made up of video game designers, artists, doctors, and medical professionals, all working together to capture the practice of medicine as video games. So we sat down with Dr. Rafael Grossmann, a world renowned trauma surgeon and medical futurist, whose opinion is highly sought after on the medical applications of new technologies. Our team has built the first cloud gaming platform in healthcare, and we were eager to get Dr. Grossmann’s perspective as three people in completely different parts of the country collaborate on giving medical care to virtual patients.

Sam Glassenberg [00:34]: I’m doing this here on my computer. Now I’m going to put my hands up. You open up the patient on the right. Let’s talk about what’s happening here. You and I are thousands of miles apart, and yet here we’re doing virtual surgery on a patient that’s simulated in the cloud. I’ll go ahead and bend the knee into position. Now you’ll notice you didn’t have to install anything. You just got a QR code, tapped a link, pressed play, and next thing you know, we’re doing virtual surgery together.

I, as the host, I’m in control of the camera. I can show you this knee from any angle; I can place the cut guide. Then we can show the angle relative to the femur. I can insert it to depth. Here I’ll adjust the cut guide rotation. All you have to do is click or tap on the dial and then move it to the red wedge. I’ll insert it to depth—so you and I are doing surgery together on a virtual patient. You don’t have to install anything. I think you’re probably seeing it’s pretty responsive for you.

Level Ex Team [01:47]: In addition to virtual surgery, we’ve also been working to find ways of collaborating on virtual patient cases so that doctors can discuss and internalize best practices for diagnosing and managing challenging case scenarios. Next, we had Dr. Grossmann and Dr. Eric Gantwerker, a pediatric otolaryngologist and Level Ex’s medical director, work together to secure the airways of multiple virtual patients who may have COVID-19.

Dr. Eric Gantwerker [02:14]: This is a really difficult patient. This is a 36 year old male who is COVID-19 positive, who had a motor vehicle collision, and currently has an uncleared C spine and a GCS of seven.

Dr. Rafael Grossmann [02:26]: We have no idea about the COVID-19 risk, so we’re going to don and get ready. Then we’re going to limit the standing room as we should always do. We’re going to preoxygenate this patient. This is a bit more tricky because this patient has a full stomach and has a head injury. I would say you preoxygenate. Traditionally we would do non-rebreather. I’m going to go the way of the non-rebreather, but this is a patient that has a full stomach, so this is risky to do.

Sam Glassenberg [03:00]: Dr. Gantwerker, do you want to recommend the next step?

Dr. Eric Gantwerker [03:02]: I was going to say, this is a tough situation because as an otolaryngologist and airway person, paralyzing somebody who you’re not sure you’re going to be able to intubate is very anxiety provoking for me. I know the COVID-19 recommendations are to do an RSI or rapid sequence intubation, but I would consult my trauma surgeon Dr. Grossmann to find out what he would recommend.

Dr. Rafael Grossmann [03:30]: A rapid sequence is probably the right thing to do. In a trauma patient, you’re thinking about a spine immobilization, which makes things more difficult. But you do have a low saturation, so you’ve got to bring that up. It went up as we can see on the right side to 96%, so we do have some time. We don’t really know that he has a full stomach, but he probably does. We kind of assume that all the time. Doing a rapid sequence would be the way to go, especially when you have a trauma surgeon in the room and always the option for a surgical airway.

Dr. Eric Gantwerker [04:17]: Absolutely.

Dr. Rafael Grossmann [04:18]: If you need to, you go that route. 

Dr. Eric Gantwerker [04:22]: All right, so we’re going to do RSI.

Sam Glassenberg [04:24]: We’re all interacting with it. Go ahead. There we go.

Dr. Eric Gantwerker [04:26]: Perfect, the patient’s asleep and paralyzed. Whew. All right.

Sam Glassenberg [04:32]: Dr. Gantwerker, do you want to call for assistance?

Dr. Eric Gantwerker [04:36]: That’s a really good idea. We should definitely call for an airway expert in the room. We also have our trauma surgeon who also is our airway expert, so I think we’re in a good place. We’ve definitely loaded the boat. We’re at the point now where we should probably intubate. You can see already that the patient desaturated 92%, which we know in the COVID-19 positive patient population that they actually drop very quickly upon induction. This is definitely something that we need to consider as we progress through this case, so in this particular case, what do you think, Dr. Grossmann?

Dr. Rafael Grossmann [05:18]: I stay away from this patient’s face, given the risk, so I think a video laryngoscope would be the way to go, and you always have a bougie ready. It gives you something you go through, and then you intubate over that.

Dr. Eric Gantwerker [05:33]: Absolutely.

Dr. Eric Gantwerker [05:33]: Perfect. Let’s do that. Oof.

Sam Glassenberg [05:39]: You can see that the airway is filled with blood.

Dr. Eric Gantwerker [05:44]: That’s not something we wanted.

Sam Glassenberg [05:47]: This is going to get interesting.

Dr. Rafael Grossmann [05:48]: That’s all right because we didn’t have the option to aspirate. You always have to look at the airway, the oropharynx. You’ve got suction and have everything that you need to ready. 

Sam Glassenberg [06:01]: Let’s do suction.

Dr. Eric Gantwerker [06:02]: Yeah, let’s do that. That’s a good idea. Oof.

Dr. Rafael Grossmann [06:07]: You have 83% saturation. You already called for assistance—I don’t know what type of assistance, but I’m going to hit more options to see because again this is a patient who is now with an airway, or oral pharynx, which is blocked in a way visually for safe intubation and is already hypoxic. You are getting pretty close to having to jump in and do a surgical airway like a cricothyrotomy, so let’s see what this is showing here. I’m going to hit prep surgical.

Sam Glassenberg [06:41]: Go for it.

Dr. Eric Gantwerker [06:43]: That’s where I would agree.

Dr. Rafael Grossmann [06:44]: So we’re back to, well, so we’re now at 78, and so— 

Dr. Eric Gantwerker [06:49]: My heart is pounding.

Dr. Rafael Grossmann [06:52]: To tell you the truth, with a 78% saturation, and you have an oral pharynx full of blood, I think that it depends on who is in the room. If you attempt intubation, you might choose that, but you don’t want to waste more than 15 seconds on that and then go to a surgical airway.

Dr. Eric Gantwerker [07:10]: Absolutely.

Dr. Rafael Grossmann [07:11]: I hit this to see what happens, and we can’t use a bougie unless you really are seeing. We already tried all these other three options, and the pharynx is full of blood. I’m going to go back and I’m going to see if I get the option to just go ahead and see what the surgical airway.

Sam Glassenberg [07:32]: There you go.

Dr. Rafael Grossmann [07:34]: Emergency invasive—that would mean a surgical airway?

Sam Glassenberg & Dr. Eric Gantwerker [07:37]: Yep.

Dr. Rafael Grossmann [07:39]: Big knife.

Sam Glassenberg [07:40]: Oh boy.

Dr. Rafael Grossmann [07:41]: 20 [hero points]!

Dr. Eric Gantwerker [07:41]: All right.

Sam Glassenberg [07:44]: What are your thoughts? Where should we be applying this? What are the opportunities?

Dr. Rafael Grossmann [07:49]: Like I always say, healthcare improvement is about improvement of communication and connectivity. Right now, we’re doing this virtually. We’re doing this 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 over connectivity, we can do very instructive and educational team building and skill building, lifesaving training.

Level Ex Team [08:29]: As Dr. Grossmann said, the improvement of the medical system is about advancing communication, connectivity, collaboration, and teamwork—and discovering creative ways to solve these problems is what drives us. You can learn more about us at levelex.com and don’t forget to follow Dr. Grossmann at rafaelgrossmann.com. From Level Ex, thanks for watching.

Learn more about Dr. Grossmann at his website: rafaelgrossmann.com

A Reputation of Innovation: Level Ex Wins Fast Company’s Most Innovative Company Award a Second Time

At Level Ex we love a good challenge. It’s in our DNA. Five years ago, the very idea of fusing medicine and video games to build a thriving business was a challenge that many would have considered absurd.

But we welcomed that challenge. Doctors and game developers have a lot in common. Both are driven by curiosity and the need to find solutions to difficult challenges. By working together, we’ve solved problems we could never take on alone. Our combined skills enable us to build video games that recreate tough medical scenarios, convey valuable medical information, and, as a result, transform physician learning.

Enter 2020 and COVID-19. Suddenly, best practices were turned upside down. New recommendations could not be disseminated fast enough. We strove to find innovative ways to deliver the most up-to-date medical information to clinicians on the front lines. It’s this mindset that led us to be recognized by Fast Company as one of The World’s Most Innovative Companies for the second year in a row.

Last year, we appeared in Fast Company‘s list under the Gaming category, alongside Apple, Microsoft, and Epic Games. This year, we’re in the Health category. The 463 featured businesses, hailing from 29 countries, were chosen for finding ways “to be resilient in the past year, but also turn[ing] those challenges into impact-making processes” that influenced industries and culture.

According to Fast Company, its World’s Most Innovative Companies list provides both a snapshot and a road map for the future of innovation across the most dynamic sectors of the economy. Fast Company Deputy Editor David Lidsky adds, “In a year of unprecedented challenges, the companies on this list exhibit fearlessness, ingenuity, and creativity in the face of crisis.”

Here are some of the advancements that caught the attention of Fast Company and define us as a standout company.

COVID-19 Game Levels

From vaccines, to experimental drugs, to new inventions—so many pivoted in 2020 to improve the COVID-19 crisis. As a medical video game company with thousands of players on the front lines of the pandemic, we were no exception. Our goal was to use our mobile platform, played by 700,000 US medical professionals, to disseminate best practices and techniques to battle COVID-19. We added COVID-19 training content to three games: Read in depth about the levels here.

level ex covid addition levels video game app devices

The levels are designed to aid medical professionals’ emergency decision-making skills and ability to navigate pandemic medical scenarios. So, do they work? Metrics across all three games show that players improved when they played a level a second time, demonstrating their ability to retain information and apply it in their next attempt. In one of the most difficult cases in the Airway Ex COVID-19 Unit, “COVID Quandary,” players were twice as successful in intubating the patient on their second attempt. In Cardio Ex, players were, on average, ten times more likely to successfully diagnose or treat the patient on their second attempt. Now that’s what we call a win.

Cloud Gaming Enters Healthcare

COVID-19 also impacted medical professionals’ ability to learn and collaborate, as in-person options vanished and everyone struggled for effective virtual alternatives. In October we launched the first cloud gaming platform in healthcare, Level Ex Remote Play™, which allows medical professionals to seamlessly perform surgery or diagnose virtual patients together over web conferencing. Given that medical professionals now prefer a mix of virtual and in-person meetings, regardless of the pandemic, cloud gaming-based training is here to stay.

Expanding Our Brain Power

2020 became a banner year for Level Ex. We were acquired by Brainlab, which marked the first acquisition of a video game company by a major international healthcare company. At the same time that we joined this med tech superpower, we upped our talent game, bringing in some of the best from the entertainment and healthcare industries, like Tom Donnelly (Chief Revenue Officer), Andy Glaister (Chief Technology Officer), Aharon Rabinowitz (SVP, Creative Director), and Jason VandenBerghe (Design Director). These wins kicked development of our next game into high gear. Scheduled to release in 2021, this dermatology-focused game departs from any other title to date in its game mechanics and design, and we can’t wait to share it with you.

At Level Ex, we know we are stronger together, and this year put that strength to the test. Innovating during a dumpster fire (also known as 2020) was, at times, hard. But what gets us through hard is what has gotten us through since the beginning: Our passion for games and medicine, and our community of problem solvers who create in the face of challenges and believe in the power of play to advance medicine.

Follow us on LinkedIn, Twitter, Facebook, and YouTube to find out where we’re breaking new ground.

Inside the Airway Ex Tiva Challenge

It’s a busy morning at the hospital, and you’re managing a patient undergoing total intravenous anesthesia (TIVA) for a spinal fusion. You induce anesthesia, and a few seconds later, another patient is ready for operation. Then another… and another. Suddenly you’re monitoring six patients at once!

If reading that made you break out in a cold sweat, just wait until you play the TIVA Challenge in Airway Ex. Jennifer Chu, Producer, describes the level: “It’s the first type of “time management” game that we’ve added in Airway Ex. This is a classic type of video game genre in which the player needs to accomplish a particular goal (or goals) as efficiently as possible while managing limited resources (such as time).” She continues, “These types of games have been hugely successful with casual gamers because they [are] fun to play. Modern gamers are probably familiar with Overcooked or Diner Dash, which are two games that have recently found success using this type of gameplay, but older folks that grew up in the 80’s might even remember Root Beer Tapper as one of the original time management games from the arcade!”

Up for a Challenge

Instead of serving up burgers to hungry customers or root beers to thirsty patrons, Airway Ex players must use the BIS™ index value (when available), pertinent medical history, and patient vitals to titrate infusions in order to maintain adequate levels of anesthesia for each patient undergoing operation. Eric Gantwerker, MD, MMSc (MedEd), FACS) and VP, Medical Director at Level Ex discussed the purpose of the game in a recent Medtronic blog post. “The TIVA Challenge isn’t intended to replace TIVA titration or BIS™ system training; it was designed to support learning and evoke conversation. Developed using hypothetical scenarios for anesthesia professionals, the game, for example, allows application of the BIS™ system in personalizing anesthesia delivery to hypothetical patients.” The experiential learning value of this level stems in part from the act of managing multiple patients simultaneously. Sam Dreyer, Biomedical Solutions Specialist, explains: “This wrinkle adds a lot of cognitive load, where the player’s attention is forced to quickly switch between multiple inputs while reacting to the various feedback coming in across all their patients.” He adds, “Especially when an unforeseen complication arises, how does that impact your plan and ability to optimize care accordingly?”

airway ex tiva unit device screenshot

The Rush…and the Reward

This unique blend of time management and titration has been a hit with Airway Ex players. “The physicians that we brought in to playtest the game really enjoyed it,” says Sam Dreyer. “After a couple times through, one player even intentionally underdosed a virtual patient, just to observe the effects on the patient’s vitals. Much to her (and our) delight, she commented that they reacted just as she would expect in a clinical setting.” Maintaining that balance of entertainment and medical accuracy is key. “As game developers, we strive to create engaging and interesting experiences; sometimes that means pitching seemingly outlandish ideas to people that have never picked up a controller in their lives, explains Jennifer Chu. “For them to say yes to these ideas means that they trust us to deliver content that is creative and fun while maintaining a high level of professionalism and medical accuracy.” This has certainly been the case in our collaboration with Medtronic.

For more on the TIVA Challenge levels, read Dr. Gantwerker’s Medtronic blog post: Anesthesia Providers Practice Monitoring Depth of Anesthesia and Learn About BIS™ Technology with Airway Ex Video Game

What Education Can Learn From Games

Think back to the first time you ever played a video game. How did you figure out how to play? Did you read the rule book or sit through 4 hours of lectures to learn what would happen if you were to smack into the ghosts in Pacman? Or did you ever wonder why people completely lose track of time playing games? Or why your kid has a deeper understanding of Minecraft than mathematics?

The magic of games, and their ability to inspire fun, can be attributed to intentional design using cognitive psychology—the same cognitive psychology that is the key to understanding how people learn. Games and learning are deeply intertwined. We can learn a lot about education through studying games and vice versa. To better understand the connection between these concepts, we’re going to explore some of my favorite cognitive learning theories.

Experience: The Best Teacher

As James Paul Gee describes in his book What Video Games Have to Teach Us About Learning and Literacy, “game play is built on a cycle of ‘hypothesize, probe the world, get a reaction, reflect on the results, reprobe to get better results…’” [Gee, 2018]. This active experimentation is a vital element of David Kolb’s Learning Cycle, which states that “learning is the process whereby knowledge is created through transformation of experience” [Kolb, 1984, p. 38]. This experiential learning cycle starts with concrete experiences or situations followed by a period of comparative reflection to previous experiences and understanding. This is followed by a period of abstract conceptualization where the learner modifies any pre-existing conceptual models followed by cycles of active experimentation (trial and error). We see children go through this process as they throw things on the ground incessantly (only to have their parents pick it up) as they try to understand gravity and objects.

An example in action would be to imagine you’re playing Mike Tyson’s Punch Out and you find a perfect strategy for Glass Joe on the first level, but then you face Von Kaiser on level 2 and attempt those same strategies, only to find out that they no longer work. You must sit and watch the idiosyncrasies of that new opponent, change your strategy, and experiment with new strategies until you are able to win the round. This is amplified when you rematch those previous opponents later in the game, and now they have evolved new strategies to evade your skills. The identical process happens with learning. As learners, we are constantly going through this cycle as we continually refine our conceptual understanding of the world and phenomena around us. Games accelerate this process by finely tuning these experiences to maximize your learning and growth of skill throughout the game.

dr-eric-gantwerker-bangkok-thailand
Photo of me in Bangkok, Thailand giving an invited presentation on the future of technology and games in medical education at the 20th Annual Thai Medical Education Conference.

The Goldilocks Zone

That process of maximal growth is based on the principles of skill attainment. In games, a perfect match of challenge in lock step with skill development leads to the best experience. Imagine you were again playing Mike Tyson’s Punch Out and were dropped into challenging Mike Tyson after beating Glass Joe. You wouldn’t stand a chance and would get so frustrated that you would end up quitting prematurely. A similar example in the education sphere would be your professor giving a final exam on the second day of class. These are stark examples, but in games, designers keep players at the edge of their abilities in what is referred to as the Regime of Competence (ROC).

In education there is a very similar concept described by Lev Vygotsky called the Zone of Proximal Development (ZPD). The ZPD is essentially the sweet spot, or what I call the Goldilocks zone, where students (and players) will be optimally challenged and advance the furthest along their learning path. This also involves scaffolding during which you get slight assistance from a teacher or the game that allows you to achieve tasks just above your ability level; these are termed desirably difficult tasks. Tasks that are too easy are often not interesting and, in games, would result in a player exiting the experience or a learner disengaging (imagine someone giving you directions back to your own house). Challenges that are too difficult lead to frustration and ultimately to the player dropping out or the learner getting overly discouraged. This is why level design (and curriculum) design is so important throughout the experience [See Vygotsky (1978, 1987) for more on ZPD or DiSessa (2000) on ROC]. Keeping challenges that constantly test your skills fall into this Desirably Difficult realm and lead to the most efficient and best learning experiences.

Practice Makes Perfect

On the road to mastery in both games and education, it is commonly understood that practice makes perfect. In education we call this Deliberate Practice, colloquially known as the 10,000-hour rule (even though this is a misrepresentation). This is not the typical kind of practicing we think about. These are the years of daily practice that are typified by violin players and olympic athletes where each session is a highly focused attempt at improving performance. Ericsson described this as repetition with very specific targeted goals and immediate feedback [Ericsson, 2008].

Imagine in Guitar Hero when you come to the “Cliffs of Dover” level and realize that it is way too difficult. You go back in the game and practice and practice until you are able to face that challenge again with renewed confidence and ability and imagine the rewards when you do! This is the same in the game as in education. Surgical trainees work for years trying to perfect their skills to the point of mastery. As an ENT resident, we were required to practice a highly difficult surgery, a stapedectomy, at least 50 times the day prior to being guided through the surgery by our attending the next day. The goal is always to improve your performance and advance knowledge and skills. In education we hope that studying achieves the same goal, but oftentimes low stakes testing, termed retrieval practice, can help inform and drive your learning. This is actually why flashcards and quizzes can improve your learning much more than rereading and highlighting.

Go with the Flow

When players and learners are fully engaged in challenges, they may enter something termed the Flow State. Flow is a concept described by Mihaly Csíkszentmihályi that is a period of intense concentration and learning where all external factors (like time and distractions) are ignored. Many have experienced these flow states during games and/or education when you totally lose track of time and are completely engrossed in a task [Csíkszentmihályi, 2014].

This period provides maximally efficient learning and is often achieved in games with certain criteria such as very specific and obvious goals and progress, clear and immediate feedback on performance, and a sense of confidence in a player’s ability to complete the task. In games, flow is achieved in games like Candy Crush during which the user immediately knows what the goal is (match and clear tiles) and immediately knows how they are doing (tiles disappear or don’t), and players get into this zone of clearing tiles and lose all sense of time. In Cardio Ex, we present the player with very clear goals (fix the stenosis) and give them immediate feedback as they navigate the level, trying to achieve that flow state.

dr-eric-gantwerker-speaking-virtual-vr-conference
Photo of me speaking at the virtual VR/AR Chicago conference.

As you can see, there is an endless list of theories that apply both in education and games. The way games use the cognitive psychology of how people learn and neuroscience of reward and frustration provide an elegant learning experience that all disciplines can lean on. I have readily adapted these concepts into my teaching of medical students and surgical residents with great effect and will continue to teach other faculty and trainees to do the same. Together we can integrate these principles and powerful techniques to supplement more antiquated ones such as didactics and lectures.

About Eric Gantwerker, MD, MMSc (MedEd), FACS

dr-eric-gantwerker-200px

Eric Gantwerker, MD, MMSc (MedEd), FACS is a practicing academic pediatric otolaryngologist and Vice President, Medical Director at Level Ex. At Level Ex, he leads the company’s medical and educational strategy, directs CME and product development, oversees efficacy studies, and manages the company’s robust physician advisory board as well as relationships with hospitals, institutions, societies and organizations. He holds a Master’s of Medical Science (MMSc) in Medical Education from Harvard Medical School and a Master’s of Physiology and Biophysics from Georgetown University. He specializes in applying the cognitive science of learning, motivational theory, and educational technology to medical education and speaks both nationally and internationally on these topics.

To learn more about how we use video games to advance the practice of medicine, visit our website.

References

Csikszentmihalyi, M. (2014). Flow and the foundations of positive psychology. Netherlands: Springer.

DiSessa, A. (2001). Changing minds: Computers, learning, and literacy. Cambridge, MA: MIT Press, A Bradford Book.

Ericsson, K. A. (2008). Deliberate practice and acquisition of expert performance: A general overview. Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine, 15(11), 988–994. https://doi.org/10.1111/j.1553-2712.2008.00227.x

Gee, J. P. (2008). What video games have to teach us about learning and literacy (2nd ed.). Gordonsville, VA: Palgrave Macmillan.

Kolb, D. A. (1984). Experiential learning: Experience as the source of learning and development. Englewood Cliffs, NJ: Prentice-Hall. as cited in Smith, M. K. (2010). David A. Kolb on experiential learning. In The encyclopedia of pedagogy and informal education.
https://infed.org/mobi/david-a-kolb-on-experiential-learning

Kumar, J. M., Herger, M., & Dam, R. F. (2019). A brief history of games. https://www.interaction-design.org/literature/article/a-brief-history-of-games

Vygotsky, L. S. (1978). Mind in society: The development of higher psychological processes (Revised ed.). Cambridge, MA: Harvard University Press.

Vygotsky, L. S. (1987). Cognition and language. The collected works of L. S. Vygotsky, Vol. 1. Problems of general psychology (R. W. Rieber & A. S. Carton, Eds.). New York City, NY: Plenum Press.

Working with Level Ex: An Interview with Medtronic

“Video games are something we’re supposed to grow out of, but I bet if you were to pick up the phone of any anesthesiologist, they have at least one game on there. We’re adults, we’re still playing games, and that’s OK.”

—Miles Curro, Medtronic Senior Director of Global Marketing for Airway Management

In 2016, Miles Curro was searching for new and different ways to accelerate the adoption of the McGRATH™ MAC video laryngoscope among anesthesiologists. Level Ex was breaking new ground as well: harnessing video game technology and design to capture the challenges of practicing medicine. With a shared mindset and bold aspirations for the future of medicine, Level Ex and Medtronic teamed up. Miles reflects on the journey below:

Q: Medtronic was one of our first clients at Level Ex. Why did you decide to work with Level Ex initially?

A: When I met Level Ex, you were a small startup. It was at the American Society of Anesthesiologists (ASA) 2016 annual meeting in Chicago. You had a big screen at your booth and it looked like people were playing video games in front of it. Aircraft Medical had just been acquired by Medtronic, so we had a kind of a startup mentality as well. We were looking at how to do things differently from an integration standpoint, but equally how we would commercialize the video laryngoscope.

What caught my eye about Level Ex was that you brought a certain entertainment aspect to medical education and technical training and the fidelity was at such a high level.

Q: Medtronic has worked with Level Ex in a few different ways since 2017. Can you tell us about the projects you’ve worked with Level Ex on?

A: In a fun way, it’s evolved. When we met, we were early in our journey with the McGRATH™ MAC video laryngoscope, and Level Ex was finding its way, too. So some of our baby steps were around virtual reality simulation. A lot of airway management training and exhibits tend to be with plastic mannequins that may lack situational realism. We saw an opportunity with Level Ex to create a virtual environment where you could perform an intubation. No one had ever done that before. So first, we redefined how you could experience an airway product at a convention or conference.

2018-medtronic-show Level Ex showcasing the McGRATH™ MAC video laryngoscope virtual reality experience in the Medtronic booth at a medical conference in 2018.

Then that led us into some work around augmented reality. The relationship between Level Ex and Apple created an opportunity to do an augmented reality experience on iOS 11.

mcgrath-ar Image from the McGRATH™ MAC video laryngoscope augmented reality experience that Level Ex created in collaboration with Medtronic.

Ultimately, it brought us to Airway Ex, which was the high watermark of the relationship where we had app-based training and access to third-party content. It wasn’t a Medtronic platform or app. It was something that Level Ex created that offered an entire ecosystem of relevant airway management content.

Q: What did the development process with Level Ex look like when you were developing the McGRATH™ MAC video laryngoscope levels in Airway Ex?

A: What struck me was how consultative it was. When I first came back to some of my colleagues and said, “Hey, we’re going to do virtual reality and we’re going to do app-based gaming to help educate on the McGRATH™ MAC video laryngoscope,” I got a lot of “You’re going to do what?” I think the concern was we were going to be making video games, rather than medical science content.

But from the beginning, Level Ex did a nice job of blending exceptional game development with the right amount of medical guidance and industry input so that what we were creating was exceptionally authentic. It was entertaining, but it was equally realistic. There was a lot of learning from Level Ex given by Medtronic and vice versa. And when it was appropriate, we would pull in physician experts for an objective perspective on the accuracy of the content we developed.

Q: Why do you think video games are an impactful way for physicians to learn?

A: I think at the beginning of this journey, people would have said it was not. Video games are something we’re supposed to grow out of, but I bet if you were to pick up the phone of any anesthesiologist, they have at least one game on there. We’re adults, we’re still playing games, and that’s OK.

It’s a format that we’ve become more comfortable with, to the credit of Level Ex and other companies. The nature of that content is no longer viewed as just a video game. We’re comfortable steering things with our thumbs. We’re comfortable playing games and then being able to put something in our pocket or use that same device to make a phone call. I think it’s just become a natural extension that a video game or a gaming platform can be equally valuable for medical education.

Q: How do the levels in the Medtronic Airway Unit benefit anesthesiologists and healthcare professionals?

A: What I would hope is that many times they don’t even realize they’re being taught something. They’re experiencing something in these apps or in these virtual reality experiences that is entertaining, but at the same time they’re learning subtle skills when it comes to the McGRATH™ MAC video laryngoscope—things such as the placement of the device, the range of articulation, elements that are subtle, yet inherently critical to the successful use of the device in a real patient.

I would also hope that they feel entertained and view this experience as fun and engaging. We’ve moved into a new dynamic where medical training can be every bit as exciting as playing a game if it maintains that balance of high fidelity with highly engaging content and environments.

“What I would hope is that many times they don’t even realize they’re being taught something. They’re experiencing something in these apps or in these virtual reality experiences that is entertaining, but at the same time they’re learning subtle skills when it comes to the McGRATH™ MAC video laryngoscope.”

Q: As you refocus the McGRATH™ MAC video laryngoscope towards routine use, how do the Airway Ex games help reiterate that this product should be used for every intubation?

A: There are two aspects to the current content we have on Airway Ex. One is a pure tutorial, and the other introduces this gamified concept of risk. In real life, you don’t always know what type of patient you’re going to experience. One of the things that we historically struggled with is the perception that video laryngoscopy was only for a difficult intubation, one that you knew in advance was going to be more challenging. However, we’ve seen from the clinical literature that it’s unpredictable when an intubation will actually be difficult.

So within our cases, we added an element of randomization so “players” wouldn’t know what type of airway they were going to encounter. The idea was to reinforce the use of the McGRATH™ MAC video laryngoscope regardless of the patient. If you’re performing laryngoscopy, you should lead with video laryngoscopy. With those two cases we could demonstrate the advantages of using the video laryngoscope on the first attempt.

mcgrath-airway-screenshot Image from the McGRATH™ MAC video laryngoscope experience in Airway Ex.

Q: How has our collaboration benefited your marketing efforts and Medtronic overall?

A: I think it helps us do more. I never saw Level Ex as replacing our traditional marketing efforts. They augmented them. It was in addition to and I think that was important because we had a bold aspiration to redefine a clinical practice that goes back to 1943. To do that, you have to simultaneously encourage adoption of this new technique with the thought leaders of today, but you also have to influence the thought leaders of tomorrow.

Airway Ex gave us a chance to introduce the McGRATH™ MAC video laryngoscope and the potential for a safer intubation through universal video laryngoscopy early in physicians’ careers so that they become comfortable with video laryngoscopy and view it as their ‘routine-use’ device. But we tend to focus on the primary decision makers who are well into their clinical tenure, so Airway Ex expands the reach of our message to broader & often younger audiences.

Q: How does the program meet your specific product education needs?

A: First, it helps to highlight the technical use of the product. One of the McGRATH™ MAC video laryngoscope cases functions as a basic tutorial. The McGRATH™ MAC video laryngoscope, by design, should be intuitive to an anesthesiologist. It should look and feel like a traditional Macintosh laryngoscope, but there are subtle steps that we think can help you achieve the best result with that device. The nature of Airway Ex really does enable a new user, or even an experienced user, to effectively master those steps.

Equally, there’s an obvious degree of promotional value with this and other digital formats. Airway Ex lives in an ecosystem that doesn’t sleep. So we can drive awareness of these technologies and their applications in the way that we think is most beneficial to patients.

Q: How does the data you receive from your Level Ex program support your business?

A: We have received a high level of detail around the number of users, where those users come from, and what their background is. We know, for example, what type of physician plays these cases. Seeing this distribution of user type is helpful. We also get a good impression of how much time users spend engaged with the content. We can measure how long we have someone’s attention, relative to a traditional sales call.

Within both the tutorial and the randomized cases in Airway Ex, we see at various stages how users perform. That’s been a pleasant surprise for us.

More broadly, it is possible to see how often someone replays content, not to relearn something, but to refine their skill and hone that expertise.

Q: What is one of your favorite memories from working with Level Ex?

A: There is, and probably always will be, a unique tension within Level Ex. You have people who designed first-person shooter and sporting games working with chiefs of anesthesia and surgeons. Those two groups historically don’t hang out together. The nature of Level Ex brings them together in one company and for one common cause.

selfie-japan-medtronic Level Ex’ers Rosie Hale and Ryan Blake (center) with the Medtronic Japan team (far left) and Miles Curro (far right).

Some of the funniest memories for me was watching that interaction. When we had some support from Level Ex in Japan, we were doing one of our virtual reality demonstrations and there were individuals from Level Ex who were game designers and artists interacting with people who’d spent careers in operating rooms and caring for patients. I like watching each learn from the other—watching a physician or an anesthesiologist in Japan learn something from a 20-something year old video game designer. Equally, that video game designer hearing things, seeing things, and how the physician was interacting with their experience and learning from that. There were moments of comedy and there were moments of humanity where you saw, despite such different backgrounds, we weren’t so different and something like a video game or virtual reality could bring us a bit closer.

mcgrath-jsca-demo Level Ex team demoing the McGRATH™ MAC video laryngoscope augmented reality experience at the Japan Society for Clinical Anesthesia (JSCA) Annual Meeting in Tokyo.

Do you have bold aspirations for the future of healthcare? Consider partnering with us.

Minds Behind the Games: Victoria Perizes

Welcome to our next edition of Minds Behind the Games! We’re shining a spotlight on Senior Biomedical Solutions Specialist Victoria Perizes, whose contributions to science, from developing assistive technology for stroke victims to helping astronauts handle medical emergencies in space, are nothing short of stellar.

Q: What is your role at Level Ex?

A: I am a Senior Biomedical Solutions Specialist, which says little about what I actually do. For the newcomers (in a nutshell): I am responsible for communicating highly complex scientific and medical topics with the goal of enabling and guiding the game dev team to design and create amazing products that our audience will enjoy. By extension of this, I am also responsible for ensuring medical credibility and plausibility across all aspects of any project I work on—for the last year and a half I have largely been overseeing all biomedical aspects for the work we are doing with NASA.

Victoria discusses our continued work with NASA and TRISH in an interview from the 2020 Human Research Program Investigators Workshop Meeting.

Q: How did you get your start in science?

A: I chose degrees in STEM because they offered me the most flexibility and opportunity to be creative and have a meaningful impact on people’s lives. However, there was no eureka/defining moment that really drove me to science. When I was graduating high school, I essentially gave myself three options: (1) Become a pilot (I come from a family of pilots), (2) become a chef (I LOVE cooking), or (3) go into the sciences and/or medically related field. I somehow decided I wanted to become a physical therapist only to completely change my mind my senior year of undergrad (majoring in Kinesiology). At that moment, I really thought hard about graduate programs that complemented the BSc I was about to receive…long story short, I decided to get a master’s in Biomedical Engineering. How the hell did a non-engineer go and get a master’s in an engineering discipline? That’s a whole other story.

victoria at launch party Victoria at Level Ex’s Pulm Ex launch party in 2017.

Q: Before joining Level Ex, you spent some time in the robotics lab at the Shirley Ryan Ability Lab. Tell us about your work there.

A: In my life previous to Level Ex, I was merely a grad student doing research at the Rehabilitation Institute of Chicago (now the Shirley Ryan Ability Lab). I specifically focused on biomechanics and found an opportunity to work on soft robotics and exoskeletons. The purpose of my research was to improve the stroke rehabilitation process through modulating movement/providing movement assistance. It was the first time I was involved in translational research and really opened my eyes to the difficulties of creating real-world solutions. It was also the first time I got to work with non-engineers (i.e. physical therapists) and really forced me to learn how to communicate technical concepts using non-technical language.

Q: What discoveries did you make during your time at the Shirley Ryan Ability Lab?

A: I helped to design the second generation of the MARIONET (Moment Arm Adjustment for Remote Induction of Net Effective Torque). Let me first start by addressing what it actually is: The MARIONET is a type of passive exoskeleton that is actuated through diagonally orientated cables (tension elements) and moment arm manipulation (see schematic below) to produce a single sinusoidal torque profile about a single joint. Moment arm manipulation is achieved by shifting the line of action of the cable by rotating its attachment along a circular path. I was specifically responsible for proving, through mathematical and empirical means, that such a device is viable and can be realistically optimized (given real world measurements of anthropometry) to approximate various torque profiles to provide assistance in movement.

The image below was one of the very early physical concepts created by the students that continued my research and showcases a single, simplified MARIONET. The image was taken from the paper that we recently published. marionet concept cropped

The concept of the MARIONET was used as a mathematical proving ground to show that moment arm adjustment can provide both stable and unstable torques to modulate or assist movement, which are critical to gravity assistance to enhance mobility in an industrial setting, or therapy post accident. This empirical success allowed us to “stack” or add multiple MARIONETs to each other to create multi-joint springs that can approximate any desired torque profile. We call this “stacked MARIONET,” the ExoNET (Exoskeletal Network for Elastic Torque).

Q: What is the broader impact of your discovery?

A: Mathematically we’ve shown that a multi-joint ExoNET system has the ability to provide a number of assistive forces to match a desired torque profile across multiple joints. For example, if a patient is relearning how to extend their arm following a stroke, the ExoNET would be able to “fill in” the torque that the patient can not produce and assist in arm extension. This added torque from the ExoNET can be fine tuned, increased, or decreased by a physical therapist based on patient needs.

The broader impact is the ability to provide more cost effective and impactful rehabilitation to recovering stroke patients, or assistance to a factory worker, through a user-friendly, highly adjustable, safe, and low cost device.

Q: What do you enjoy about working at Level Ex?

A: I personally really enjoy the highly interdisciplinary aspect of Level Ex. There is not a day that goes by where I do not learn something new and that is a direct impact of working with people outside of my discipline and specialty. It also has been really fun and enlightening to see how we apply all of our collective knowledge (as a company) to make truly unique products.

nasa-oct-19 Level Ex’ers Erik Funkhouser (far left) and Victoria Perizes (third from left) meet with veteran astronauts and NASA stakeholders at the Johnson Space Center in October, 2019.

Q: What do you hope to accomplish in the future with Level Ex?

A: I’d love to see a Level Ex product end up in space and used by astronauts on their way to the moon, or even Mars.

victoria-nasa Victoria visiting the Johnson Space Center in Houston, TX. The behemoth you see behind her is actually part of the second stage of a resorted Saturn V rocket.

Interested in solving complex problems in healthcare? Come work with us! Check out our open positions.

#PlayApartTogether for the Holidays

From team bonding with a virtual game jam to combating the COVID-19 pandemic by developing critical new levels, video games have taken on an even greater significance in our lives and work over the last year. This holiday season, continuing our commitment to #PlayApartTogether, we crowdsourced our team’s recommendations for games that they have been using to connect to friends and family while physical distancing:

playapart collage

TABLETOP SIMULATOR AND ROLL 20

Submitted by: Curtis Schmidt, Director of Video Production; Erik Funkhouser, Senior Producer; Maggie Xing, Biomedical Solutions Specialist

If your board games have been collecting dust since March, maybe it’s time to try the digital versions. Tabletop Simulator (TTS) is a popular choice among Level Ex’ers for its endless possibilities: play popular board games, create your own, or even flip the table when you’re losing! Senior Producer Erik Funkhouser adds, “The game is built with basic interactions and physics handling, so you are moving pieces in a 3D environment, just as you would on a table. This does create some usability quirks here and there, but after a while it’s easy to get used to playing.” Curtis Schmidt, Director of Video Production, lists Gloomhaven, Arkham Horror Living Card game, and Cosmic Encounter among his favorite games to play on TTS. “My biggest focus is always on story and theme first, but great game mechanics a tight second. I love board games that play through like a great choose your own adventure book,” he explains.

Biomedical Solutions Specialist Maggie Xing plays a traditional pen and paper RPG game, Earthdawn, on Roll 20. She says, “Having a great game master and a group of people with a similar sense of humor are major reasons I enjoy any tabletop role-playing games. It’s like having a virtual hangout with everyone’s alternative personalities.”

maggie-xing

“Having a great game master and a group of people with a similar sense of humor are major reasons I enjoy any tabletop role-playing games. It’s like having a virtual hangout with everyone’s alternative personalities.”

Maggie Xing, Biomedical Solutions Specialist

JACKBOX GAMES

Submitted by Joel Villegas, QA Analyst; Steven Eanet, Senior Marketing Specialist; Erik Funkhouser, Senior Producer

For games that even your Grandma can get in on, our team recommends Jackbox Games. Jackbox takes classic social games like charades to the next level with their fun and phone-friendly format. Whether you’re on a Zoom call or a Twitch stream, you can bring friends and family together with their Party Packs. QA Analyst Joel Villegas says this is his favorite because “your phone’s web browser is the controller, and no one has to install any other apps.” Quiplash is Senior Marketing Specialist Steven Eanet’s game of choice. “It’s a good reminder that my sister and I are in our 30s but still have the sense of humor of 7th graders,” he says.

DON’T STARVE

Submitted by Brynne Clippard, Executive Assistant to the CEO

Unlike 2020, Don’t Starve is a survival challenge that we wouldn’t mind repeating. Brynne Clippard, Executive Assistant to the CEO, says, “I’m a huge fan of the game. Besides loving the Tim-Burton-esque aesthetics of the game, I thoroughly enjoy that the game is about strategy over the long-term. Yes, there are a few adrenaline-rush battles with wild dogs here and there, but the goal is essentially to collect and ration your food and supplies so that you don’t run out before the land runs out of resources.” She adds, “It sounds tedious, but you blink and three hours have gone by. I’ve made it to 13 days (13 day-to-night-to-day cycles in the world of the game) a few times by myself, and I’m hoping that playing Don’t Starve Together with my friends across the country will help us get even further in the game.”

bryne-clippard

“I’m a huge fan of the game. Besides loving the Tim-Burton-esque aesthetics of the game, I thoroughly enjoy that the game is about strategy over the long-term.”

Brynne Clippard, Executive Assistant to the CEO

MINECRAFT

Submitted by Jason VandenBerghe, VP, Studio Creative Director; Ernesto Rodriguez, Senior Product Manager

This is a great option for imaginative gamers of all generations. VP, Studio Creative Director Jason VandenBerghe loves to play Minecraft for the “total creative freedom and joy of accomplishment” it provides. Ernesto Rodriguez, Senior Product Manager, adds, “My son and nephew play throughout the week, and I sometimes join the fun on our Xbox myself. I like the ‘pick up and play’ aspect of it so that we can join, make some building progress, and hop off at any time.”

ernesto-rodriguez

I like the ‘pick up and play’ aspect of it so that we can join, make some building progress, and hop off at any time.”

Ernesto Rodriguez, Senior Product Manager

WORDS WITH FRIENDS

Submitted by Sangita Sarkar, VP, Marketing

Don’t forget the classics! Sangita Sarkar, VP, Marketing, recommends Words With Friends. She says, “I’m a bit biased because I worked on that beloved ten year old franchise. It’s such a great way to connect and reconnect with loved ones with some witty words and friendly chat rooms.”

SETTLERS OF CATAN

Submitted by Sam Dreyer, Biomedical Solutions Specialist

Biomedical Solutions Specialist Sam Dreyer recommends finding your favorite game online: “My brothers and I really enjoyed breaking out a game of Catan when we were home during the holidays over the last few years. When the pandemic hit, we quickly found the online version. It was pretty buggy and had awful UI/UX issues, but we powered through because it was so much fun to be able to steal each other’s resources and block roads together again.” He continues, “They’ve since made a bunch of QOL improvements, and we’ve settled into a rhythm of playing a few games together every weekend! Does anybody have wheat they’d be willing to trade?”

JUST DANCE

Submitted by Maggie Xing, Biomedical Solutions Specialist

Socialize and work up a sweat at the same time with Just Dance. Maggie Xing, Biomedical Solutions Specialist, explains, “You can complete a dance routine together no matter where you are.” Given Maggie’s past dance training, it gets a little competitive among her crew. “My family always receives the greatest joy by watching me score lower than them,” she jokes.

CALL OF DUTY

Submitted by Todday Gaither, Assistant Production Manager; Mazen Ghamlouch, Senior Graphic Designer

Who doesn’t need to blow off a little steam these days? Assistant Production Manager, Todday Gaither, plays Call of Duty Warzone because “working with friends and strangers to complete goals is fun.” He adds, “Sometimes you build a new relationship with people you don’t even know from a distance. That’s a long-distance relationship and I love it.” Mazen Ghamlouch, Senior Graphic Artist, agrees: “It’s all about the hang. The game brings us together, but it’s the hang that keeps us all connected and having a good time with one another.”

mazen-ghamlouch

“It’s all about the hang. The game brings us together, but it’s the hang that keeps us all connected and having a good time with one another.”

Mazen Ghamlouch, Creative Lead

STAY SAFE, STAY HEALTHY, AND GET GAMING!

We hope these recommendations help you make happy memories with friends and family this holiday season. Here’s to an even happier and healthier 2021!

Are you ready to challenge Level Ex’ers to a round of Gloomhaven in Tabletop Simulator? Check out our open positions.