Sam Glassenberg, CEO of Level Ex, dodged the family business of medicine and went into video game design. But his path led him right back to the world of medicine

“All of this came to a head in 2012 when my father, who is an anesthesiologist, finally gave up and said ‘All right Sam, you’re not going to medical school. It’s too late. So at least put this game silliness to good use and make me a game to train my residents to do a fiber optic intubation.”

He made a game. And, to make it easy for his fathers’ residents to access it, he put it on the app store. A little while later his father, hoping to check in on his students, asked him how many times the game had been downloaded.

The answer was 100,000, Glassenberg revealed in a recent HIMSS20 Digital session. And not only that, a peer-reviewed paper about his game had come out demonstrating its effectiveness in training anesthesiologists on the procedure.

Decades behind

In his presentation, which included a number of informative demos, Glassenberg described how the medical simulation industry has somehow managed to find itself decades behind the commercial video game industry.

“To those of us who play video games, the renders of the eye in a physician simulator literally look like a video game out of 1992,” he said, adding that dynamic, photorealistic eyes can be found in $50 video games from Best Buy, but not in simulators that cost six or seven figures.

It’s not only the technology that’s out of date, but the form factor, Glassenberg added. He equates the current model of housing medical simulators in a physical space with the near-extinct model of video game arcades.

“Twenty to 30 years ago, video games were in the arcade because they were expensive, and expensive to maintain,” he said. “Nowadays that’s no longer the case. We have this ability to deliver incredible realism on the device we have in our pockets.”

Level Ex is one company that is attempting to bring medical training games up to speed with the video game industry through interactive simulation games that use a variety of technologies. These include augmented reality and advanced, interactive 3D modeling, as well as psychological approaches based on reward and frustration that app developers use to create engaging, even addictive, games.

“We didn’t invent this in the games industry,” he said. “This is evolutionary. This is how our ancestors learned how to throw a spear. These neuromechanics have existed in our neurons for tens of millions of years. And when you combine this, not only can you use it to drive skill development, you can use it to drive behavior change.”

Beyond gamification

Now the company is looking to see what the approach looks like beyond visual fields like surgery and intensive care. In the case of their COVID-19 release, the company came out with a game about diagnosing patients.

“If you think about the challenges doctors face, many of them are purely clinical,” he said. “You may have to diagnose or treat a difficult patient and you’re not looking at anything visual. You might be looking at test results.”

While many attempts to gamify diagnostics usually just end up being quizzes, Level Ex approached diagnosis as a puzzle game. Rather than merely being asked to find the right diagnosis, players are given a certain number of turns in which they can run tests or ask questions. Each test or question eliminates a certain number of differential diagnoses. The game is to eliminate all but one before you run out turns.

Level Ex is continuing to develop new games, some of which offer CME credits for playing them. Glassenberg urged others in the industry to embrace this technology and this approach to robust health-game design, not just quizzes, badges and leaderboards – so called "gamification."

“In my view, true game design is an art and a science that combines psychology, huge amounts of data, economics [and] a deep understanding of how the human brain works,” he said.