Using video gaming to improve education in medicine, Part 1

Gamification is a big buzzword in the tech and business worlds – adding gaming features like badges and progress markers to tasks, to make them more enjoyable and get jobs done in a faster timescale. But real, immersive video game technology is rarely used to deliver the bonuses it could in terms of training, skill optimization, and dealing with edge cases that would otherwise be complicated or costly to predictably arrange.

That kind of gaming technology is being developed for use in the medical world, though, and its development, use, and not least its funding model, is both innovative in its own right, and could hold lessons for training, knowledge retention, and instinct-development across the business world.

We sat down with Dr Eric Gantwerker and Dr Peter Lio, Director and Lead Physician Adviser respectively at Level Ex, a leading company in the field, to explore the potential of training in arcane knowledge through the full video gaming experience.

The path to where we are

THQ:

You’re both respected physicians. Why are you involved in a games company?

PL:

I’m a clinical assistant professor of dermatology and pediatrics at Northwestern University in Chicago. I’ve been a dermatologist for almost 18 years. And I love video games. In fact, on the side, I have a side gig where we have a podcast all about video games in the 80s. And a friend point out that Level Ex was in my very building, and they said you should talk to these guys. They are doing some really creative things with games and education. And maybe you could do something with them. So I emailed them about five or six years ago. And we’ve really been on this exciting journey, we’ve launched Top Derm, the dermatology game, but I’m hoping this is just the beginning – we have all sorts of new ideas and places to go.

EG:

I’m a pediatric otolaryngologist, not a dermatologist, and after I finished my clinical training, I got a Master’s in medical education, with a special focus on the cognitive science of learning, educational technology, educational research, and game-based learning. Around the time that I finished my Master’s, I found out about Level Ex, and I came on as a subject matter expert, because they were developing an airway app and my niche is airway surgery. And eventually, they started going into other specialties, including gastroenterology and pulmonology, and they asked me to be a lead advisor, so basically, advisor of the advisors. And I’ve been the Vice President, Medical Director since March of 2018.

The upsides of medical gaming

THQ:

What are the fundamental benefits that gaming can bring to the identification and treatment of conditions and diseases?

PL:

I think there are a few. The first one is that in the context of a game, we can bring something to the forefront that might be actually fairly rare in real life. So if you’re trying to see a scenario, a condition, or even a common condition, but an uncommon location, or a less common presentation, sometimes you go through the textbooks and they all kind of have the same setup, or even if you spend a week or a month in clinic, you might see the usual, but how do you get the unusual on demand? That’s a big advantage to a gaming setup – you can have the unusual on demand, any time you like. We can actually contrive it in a way that makes sense to bring it to the person so that they get learning just in time.

The second advantage for me is that we can then leverage the concept of repetition.

I love the idea that people go through again and say, “Oh, I missed that! Let me go back. Let me try that again. Let me do it again.” That’s a natural way to emulate what you might have to use flashcards for in real life. And certainly, it doesn’t happen in a lecture or in a textbook. Usually, you read a textbook and you’re not getting quizzed on it. But here, the idea that you get challenged and then have to go back, that’s really special for me as a learner. I’ve always been a flashcard person, and I tortured my parents when I was a little kid, “Can you please quiz me? Take me through again?” My poor parents said “Why don’t you just do it yourself?” I’ll tell you why – because when I was challenged, that’s when I really learned.

The importance of active learning

THQ:

So video games are a pathway to active learning?

EG:
Exactly. That idea of active learning versus passive learning is crucial. In medical education, there’s been a lot of discussion around the engagement – or rather, the disengagement – of our trainees as they’re going through medical education. That’s because we’re using a lot of antiquated methodology that obviously our faculty learned by seeing other people. Now we know much more about how people learn, and we know that people learn much better through active learning. And that’s literally what games are designed for – engagement and active learning.

The other thing is that gaming makes knowledge stickier, because you’re getting challenged, and you’re going through these things, and it makes it very memorable and stickier because of that repetition factor – you miss things, you can go back and do them again until you understand why the situation you’re in works the way it does.

The only other thing I’ll add is the idea of self-assessment. When you go through a traditional education, you get a quiz, and that’s how people retain that knowledge. Games are constant assessment with immediate feedback. And that is a great model for how people learn, that just in time learning, that instantaneous feedback for how you’re applying your knowledge, and you don’t realize that it’s going on. In games, that’s just part of the game. But in education, it feels like this other added thing that you have to deal with.

Built intuition?

THQ:

Traditional education builds a knowledge-bank, but gaming education builds instincts and intuitive understanding?

EG:

Yes, and that transfers then into the real world. You’re not thinking back to where you read a thing, or wondering if it’s right. You’re remembering doing a thing. You’re going through the experience again, and remembering how to do the thing. It’s built intuition.

PL:

Can I add a controversial point? The relationship between educators and industry is tenuous. There is this push in the US towards the blocking out of industry influences, which on its face is a good idea. You don’t want companies shilling their product and swaying young learners. On the other hand, a lot of what we do though, is we have to learn about new medicines. And you’ll have this bizarre thing where some of the residents or medical students will come and rotate and they’ll say, “Oh, wow, I’ve never seen anyone use this medicine. I don’t know anything about it.”

And I think ultimately, like it or not, that is a disservice to our patients. In the Chicago Museum of Science and Industry, there’s a big rotunda, and on the inscription of the rotunda, it says “Science discerns the laws of nature, industry applies them to the needs of man.” So we kind of need both, right?

And that’s what Level Ex is trying to do – weave the two together in a productive way.

Having established the place that exists for video gaming in education and training – in both medicine and other disciplines – in Part 2 of this article, we’ll get into the significant leaps forward in gaming technology that allow Level Ex to use it for in-depth medical education, and the funding model that makes it distinct.