What's Up with Tech?
Revolutionizing Global Medical Training: LevelX’s Unique Approach
How video game technology transforms healthcare education and training; prepare to be amazed. In this episode, we chat with Sam from Level EX, who shares his incredible journey from developing Star Wars games and working at Microsoft’s DirectX graphics team to creating one of the most popular medical training tools entirely by accident. What started as a simple game for his anesthesiologist father’s colleagues has turned into a groundbreaking company, Level Ex, that aids over a million medical professionals in earning continuing education credits. Sam sheds light on how these innovative games enhance mental models of complex medical systems, ultimately advancing the field of medicine through engaging gameplay.
We'll also uncover how Level Ex is addressing health inequalities with realistic skin models in games like Top Derm, helping dermatologists diagnose and treat conditions across diverse skin tones. Learn about the fascinating use of generative AI and synthetic data to train AI models, and discover our collaboration with NASA to develop ultrasound simulators for space missions. These advancements are not just limited to space; they are making medical education more accessible globally, even in resource-constrained environments. This episode is packed with insights into how the convergence of gaming and healthcare technology is opening up new frontiers for medical training and education.
More at https://linktr.ee/EvanKirstel
How video game technology transforms healthcare education and training; prepare to be amazed. In this episode, we chat with Sam from Level EX, who shares his incredible journey from developing Star Wars games and working at Microsoft’s DirectX graphics team to creating one of the most popular medical training tools entirely by accident. What started as a simple game for his anesthesiologist father’s colleagues has turned into a groundbreaking company, Level Ex, that aids over a million medical professionals in earning continuing education credits. Sam sheds light on how these innovative games enhance mental models of complex medical systems, ultimately advancing the field of medicine through engaging gameplay.
We'll also uncover how Level Ex is addressing health inequalities with realistic skin models in games like Top Derm, helping dermatologists diagnose and treat conditions across diverse skin tones. Learn about the fascinating use of generative AI and synthetic data to train AI models, and discover our collaboration with NASA to develop ultrasound simulators for space missions. These advancements are not just limited to space; they are making medical education more accessible globally, even in resource-constrained environments. This episode is packed with insights into how the convergence of gaming and healthcare technology is opening up new frontiers for medical training and education.
More at https://linktr.ee/EvanKirstel
Hey everyone, fascinating and, frankly, amazing topic today about how video game technology yes, video games are empowering the next generation of healthcare professionals. Evan and Irma here with our amazing guest Sam from LevelX. Sam, how are you? Great, Happy to be here? Well, we're happy to have you and we're going to dive right in because we want to get on to the fun stuff, but maybe some introductions are in order. Tell us about your background, not just in video games, but your journey to developing Level X. What was the big idea and why? Healthcare and video games Not something you typically hear talked about together care and video games not something you typically hear talked about together.
Speaker 2:Well, more and more, thanks to some of the accomplishments we've had, we're slowly making. We're slowly, we say, advancing the practice of medicine through play. But yeah, happy to bring you up to speed on how this all got started. I would love to say that LevelX and making video games for doctors was some grand idea I had, but actually the company was founded by accident. Wow.
Speaker 3:That's done that way.
Speaker 2:Yeah.
Speaker 3:Tell us more.
Speaker 2:I'll tell you the story. So I've spent my career not in health care, but in video games. I started out at LucasArts making Star Wars games. Thank, you. You're welcome, thank you for your service.
Speaker 2:Station 2 on Xbox. My job? I was an animator. I was a cutscene animator. My job was literally fly spaceships for a living for episode two games. So yeah, so I started there. I worked for many years at Microsoft. I was leading the DirectX graphics team. My team's job was basically to build the matrix, figure out how to make video games look real. After that, I ran a company that did video games for major Hollywood movies like Hunger Games, mission Impossible.
Speaker 2:All of this, this impactful career in the video games business, essentially made me the disgrace of my family, because I come from a long line of doctors. My grandfather was a famous doctor. My parents are doctors, everyone's doctors. I'm the idiot who didn't go to medical school, and I have a story to show you how bad it got. So in 2006, I accepted a technical emmy on behalf of my team at microsoft for pushing the cutting edge of video game graphics. It's not like the, it's not the tv emmys they do it before but it's the same statue. There's me. There's like jensen wang accepting our emmys, uh. And so I called home to be like hey, mom and dad, I'm accepting an Emmy and my dad answers the phone he's an anesthesiologist. Without skipping a beat. He goes Sam, that's very nice, but in this family we only recognize Nobel Prizes. You're not 30 yet you can still go to medical school. So this is the universe that I come from, medicine, everything else.
Speaker 2:So about a dozen years ago he gives up. He says Sam, you're too old for med school. Put all this gaming nonsense to good use. Make me a game to train my colleagues to do a fiber optic intubation Tricky procedure. We only do it on complex patients. Even experienced anesthesiologists will struggle with this. He goes can you make me a game that'll train them? But make me a game they can play on their phones. I don't want to drag anyone to a training center. So I'm busy running this big Hollywood game company, fine. So out of guilt, I sit down for three weekends and I throw together this crappy little game and I upload it to the app store. This is before test flight. So, like the only way to get a game onto someone's phone, you had to plug it in manually or put it on the store. So I put it in the store and don't think about it again.
Speaker 2:Two years later my dad calls me. Hey, sam, how many people downloaded it, dad? I don't know how many of your friends downloaded your fiber optic laryngoscopy game. But I'll check for you.
Speaker 2:So I look and I discover is you've got 100,000 doctors, nurses and airway specialists who've been playing. Ok, yes, like, ok. So I've been making games for like tens of millions of players, but like those are muggles right, these are medical professionals. Like this has never been done before. So I Google it like how did I accidentally create like one of the most popular medical training tools ever? And I discover, unbeknownst to me, they've been doing efficacy studies at institutions all over the world that shows this like game I threw together for my father is measurably improving physician performance. Wow, yeah, I would love to say that LevelX was some bent idea of it. No, it's like okay, clearly there's demand for this.
Speaker 2:So what if it wasn't just me? What if we took the top video game developers, designers, artists have worked on everything from Mortal Kombat to Words with Friends. We team them up with like hundreds of physician advisors across every major specialty in medicine to advance the practice of medicine through play, use video game design, video game technology to accelerate the adoption curve in healthcare. That's what we do. So today we have over a million medical professionals that are literally earning continuing education credit toward renewing their medical licenses while they cut, cauterize, inject, diagnose, treat patients in some of the most rare, unforeseen difficult cases in their areas. In their areas we're working with the vast majority of the top 50 med device and life science companies. We're working with major medical societies. We're working with NASA. We're having a lot of fun.
Speaker 3:This is a fascinating, fascinating story. How you stumbled into this. Clearly, you already started telling us about the need that this was addressing. Can you dive a little bit deeper into what specific needs in medical training education is this technology based on gaming is solving for?
Speaker 2:So literally any scenario where somebody needs to develop a mental model of a complex system, right, the best way, the best way to develop that mental model is to play with it. Right, like when you get a new phone. You don't go like I'm going to read the manual, nobody reads the manual. You go like, oh, I got a new phone, all right, I got to play with this. Right, you play with it.
Speaker 2:Humans learn through play and ultimately doctors learn the same way. What do you mean? Play with it? I got to try it, I got to make some mistakes and do the wrong thing. That's how doctors learn.
Speaker 2:But the challenge is the tools that we give them to. We don't really give them tools to make mistakes. We give them videos and papers and lectures, but fundamentally that trial and error process is on live human beings and that's not good for surgery. Surgery is the obvious stuff, but think about, like diagnosing a rare disease, that's, you know, in some cases where there may not be anything visual that you're looking at, that's a reductive reasoning puzzle. Or managing a difficult patient over time with multiple comorbidities. That's a strategy game. And so if you think about sort of any of the real challenges that doctors face like there are. There is a game mechanic that can be used to help you develop that mental model and, fundamentally, what this is doing is accelerating the adoption curve across healthcare.
Speaker 2:Because why are doctors hesitant to try new treatments or new devices or new techniques? It's not because they're Luddites, it's not because they're backwards, it's because, okay, well, the first hundred procedures. I've been doing this procedure 10,000 times the old way. Now you've got me a new device that does it better, but the first hundred procedures I'm not going to do as well. So who are the patients I'm going to sacrifice? We don't give them the tools and so the opportunity. With video game technology and, more important, the neuroscience of video game design, we can help. All right, sit down, grab your phone. Game design we can help. All right, sit down, grab your phone and we're going to play through, you know, five lifetimes worth of the most difficult cases to really help you develop that mental model of the system.
Speaker 1:Fantastic and tell us about the different areas specializations you're seeing most traction in. I guess it's sort of the popularity. You know who gets the most downloads and why and what games are being asked for. You must get a lot of requests for new games, new use cases, new applications applications.
Speaker 2:The demand is overwhelming. We started out our first game was in anesthesia, because my dad's an anesthesiologist, and then very quickly started moving into basically we're in every major therapeutic area now Gastroenterology, pulmonology, cardiology, orthopedics, robotics, eye surgery, oncology, everything In fact. It was funny I remember when we made our cardiology game. One of the reasons why we did cardiology was because we looked and we discovered we had, I think, something like 4 000 medical professionals in cardiology that were playing our like palm and gastro games. Wow, they were doing colonoscopies and diagnosing pulmonological conditions. Right, like that's. We're like clearly's demand.
Speaker 2:The entire story of the company from the very beginning was there was demand from doctors and based on that we built things and that drives everything. So, like a big area for us most recently has been dermatology and you know, there I can sort of you can almost kind of you know, know we do a lot of dermatology content now, um, you know one of the. So we asked dermatologists like what are the problems that you face? And one of the things they described was skin of color is a major challenge for dermatologists. If you are a person of color, when you go to the dermatologist you're like studies have shown you're not going to get as good an outcome and again, it's not out of malice.
Speaker 2:It's simply because your dermatologist hasn't seen your skin disease, at your severity, on your skin tone, enough to really have that model of how it's supposed to work. And so we said, all right, great, we're going to go make games to help train that. We're going to go grab a bunch of reference imagery to make the game around. And what we discovered was, when you look at the reference imagery, this is, it's patrick, this is like the number one dermatology textbook. You notice the problem. All the reference imagery like 90, some percent is all in the same skin tones, yeah.
Speaker 2:And so we're like, all right, well, video games can help here. Uh, you know, we've gotten really good at in video games at creating realistic skin. Um, you know, this is like screenshots from activision call of duty. And so we said, all right, great, let's build on top of those systems. And we built systems that allow us to create any skin disease on any part of the body uh these of these images are real.
Speaker 2:These are all like video game screenshots from Top Derm, where you know any skin tone and none of it's real. It's all just, you know, computer generated, and then we use this to create content to train doctors' brains how to diagnose and treat that disease. But it's all game tech, right. It's literally like the same tools that you might use to, like you know, I don't know design a city. You know, or create you know a you know sophisticated armor material for a video game. Like we build on top of those tools, like we build on top of video game skin technology systems that allow us again, like an artist can just go in in real time with a dermatologist and just turn dials right, oh, make that redder, make that crustier, make that wetter in the crevices, and then we have basically mathematical models of skin and it just generates infinite imagery we can use to train doctors' brains. So it's all just awesome video game tech being applied and everything from you know dermatology to space health.
Speaker 3:So you're already answering my next question here, which I wanted to learn more about how this particular technology is helping address health inequalities and any biases and serve those populations have been traditionally underserved, so obviously you showed us a great example of one way to address that. When it comes to anything in surgery or internal, is there an advantage there to approach different type of populations?
Speaker 2:Definitely so. We're doing all sorts of work and everything from vaccine hesitancy to you know all like to like. A lot of the work we're doing with NASA is around ultrasound. What's interesting about our NASA scenarios is we're building technology to train basically untrained people right, astronauts who don't have medical training just in time, how to deal with situations in a very resource constrained environment. You're on a spacecraft where you don't have access to an MRI or a CT scanner. That's very similar to remote or even like rural or underserved environments in the US or anywhere in the world. Right, like, yeah, you might. In the spacecraft they don't have a CT scanner because they can't afford the weight. But in a rural health center, yeah, you also only have ultrasound as an imaging modality because that's all you could afford. And so you know, the same, the same techniques, the same approaches apply. And let me I was going to pull up another example, but let's see here.
Speaker 3:So NASA being relevant to the underserved populations? But yes, they have constraints, just different constraints.
Speaker 2:Yeah, if we think about you know, historically, we think about medical training and simulation. It was you know. I like to show these examples and kind of show the gaps. So we think about medical training and simulation. There are only 200 simulations, some simulation centers in the United States that's the United States right, forget the rest of the world which are you know. They're in the basements of big academic training centers so they're inaccessible to 90% of practicing doctors, let alone nurses and other folks. I say like we're very familiar with this model in the video games business because we abandoned it 30 years ago.
Speaker 2:Nobody plays video games at the arcade anymore. You have more compute power in your pocket than you had in all of the video arcades and sim centers combined in 19.
Speaker 1:I beg to differ. I still go to the arcade now and then, but I'm an old school geek, so but please continue, probably because you're drinking right.
Speaker 2:The arcades are there, they're in bars, they're for grownups.
Speaker 1:They're for us, they're not for kids.
Speaker 2:There was playing on their phones. And so now what we can do, because you have all this compute power, we can make this accessible. So a medic in Ukraine can train how to do a trauma procedure, be trained remotely from someone in London, you can have someone train how to do OBGYN, or a nurse in Sub-Saharan Africa can train how to use a handheld ultrasound device, all using their phone, because we're able to leverage video game tech.
Speaker 1:Wonderful Wow Mic drop moment. I almost dare not to ask this, because you're doing such great work in healthcare and you've gotten such great adoption and engagement from the healthcare industry. But are there other industries you've thought about, have ideas for next, or you have your hands full for the foreseeable future?
Speaker 2:Okay, so in health, level X is always going to be focused on healthcare. Okay, we are scratching the surface. We are scratching the surface.
Speaker 2:There is. The demand is endless in terms of just think like this is the thing that is preventing. You know that is preventing acceleration in healthcare. And adoption right Is, like every therapeutic area, has so many things that medical professionals need to understand. From managing a ventilator, everything we are just scratching the surface. There's room for 10 level Xs in healthcare. Is there application for what we're doing outside of healthcare? Definitely no-transcript.
Speaker 3:Let's talk about a little bit of underlying technology. Obviously, it's gaming technology that you've worked in for so many years. What about AI? Are you using generative AI or AI in general to fuel some of your use cases? If so, we'd love to learn more.
Speaker 2:Sure. So there we're really kind of following. I think the video games industry actually has the most healthy approach to generative AI of almost any industry, and I think there's actually a lot that health care can learn from games and a lot that everyone else can. Um, you know, we think about. You know, when we think about video games, right, for the last 30 years, every font like everyone's thinking jenny I like, oh my gosh, jenny I my job, it's going to replace me in the video games industry. For the last 30 years, every five years, the game engines support an order of magnitude more content at an order of magnitude greater detail. This is what I used to do. This is what we were working on in DirectX, like how to make video games look real, writing Moore's Law. Every five years, an order of magnitude more content, an order of magnitude greater detail, magnitude, greater detail.
Speaker 2:If you're an artist in the video games business, you can't make this using the tools you used five or 10 years ago. So the expectation is you are always going to be reinventing how you make things, and if you're making things the same way you were making them five years ago, something's wrong. Whatever you were doing five years ago should be automated already. And so the video games industry has just had multiples of these steps. We move from like pixel art to 3d tools, to clay modeling tools, to procedural tools where an artist can just kind of draw a street or the outline of a building. It just fills in all the rest of the detail. For you, and in the video games industry, we're just, we view generative ai as just like the next logical step and we we're like, yeah, we've seen, you know, we've kind of seen this movie before. But what's interesting is not only is that a healthy approach, we're actually using the output of the last generation of tools to now train generative ai systems. So this, like we're using, you know, we're using the old simulation systems to train gen ai. I mean, I can show you cool examples like we, you know, you know we're using the old simulation systems to train Gen AI. I mean, I can show you cool examples like we, you know they're all of these Like this is an example from like Unreal Engine 5, next generation video game characters, where it's Gen AI based but trained on simulated data, right Trained, what we call synthetic data, unsimulated data, right Trained, what we call synthetic data.
Speaker 2:Well, if you think about that in healthcare. One of the major problems we have in healthcare is we'll have, you know, all of these. Like there's a new melanoma detector but it doesn't work on darker skin tones. So instead of using you know, our skin system just to train doctors' brains, theoretically you could be using all of this stuff to train unbiased AI systems. So I think that there's also at LevelX, we're using Gen AI across the board to generate game content to help solve tough engineering problems. Like we're using it. But the reason we are is because we're a game studio, and I think what's interesting is there's a lot of things, both in terms of philosophy and approach, that both healthcare and the rest of the Fantastic.
Speaker 1:I have to go back to one thing you mentioned about NASA and deep space. We went over that way too quickly. What's the scenario there? How are you being used to support this research and what's the big idea moving forward? How will you be deployed one day as we go into deep space?
Speaker 2:We're actually being deployed next month on the space. Oh, okay.
Speaker 1:Science fiction the future has arrived.
Speaker 2:Science fiction. This is crazy cool. So okay, we were. We've been working with nasa for years, um, through their translational research institute for space health. Uh, there's basically a group that's responsible for finding terrestrial technologies that can help solve problems in space. Uh, it was originally funded by the mars mission. Why is that? Like? You're nine months into the Mars mission, all of a sudden, one of the astronauts grabs his chest and rolls over unconscious in zero gravity. It's going to be the flight surgeon. It's always the flight surgeon. You've seen movies. What do you do? So there's a bunch of interesting problems.
Speaker 2:We kind of started talking about so one is we talk about resource constrained environment. The only imaging modality you have under ultrasound is normal, or you know astronaut evan, who's been in space for nine months, or abnormal. The next challenge is there are no experts. So today there is an ultrasound rig on the international space station, um, and there's a radiologist on the ground in houston. We work with him. He's super smart, who can read the result in real time and he can give them direction.
Speaker 2:Give me a little to the left, push in, he can read it. But if you're nine months into the Mars mission, it can be 40 minutes for the speed of light to make the round trip. So you have all of these problems that actually are kind of parallel to the problems that we have in a lot of areas here on Earth, that actually are kind of parallel to the problems that we have in a lot of areas here on Earth. So for years, like we've been doing, you know, using basically tricking video game hardware to simulate things like X-rays, and so we have this. You know we've been working with NASA basically to create the world's most realistic interactive ultrasound simulator where instead of simulating light or X-rays, we're simulating sound. I don't know if you know like sound casts a shadow, like you can see an echo it has, it's called ring down, they're like all of these effects, and so we're basically building the most realistic ultrasound simulator to train astronauts how to deal with these different scenarios. Um, let me actually fire something up. Maybe let's see here I'll load up one of the examples. So, basically, what's happening here and I'm just doing this sort of on my computer, it actually runs on the clouds, it runs on a phone. I'm, you know, manipulating this virtual probe. We actually have a version. You can use your phone and we're simulating ultrasound. So you're literally like I don't know if you can notice it there's actually you can see the heartbeat in the jugular vein. We're bombarding, like we this is real patient data. We're bombarding it with virtual ultrasound waves to train you how to do a range of procedures.
Speaker 2:The version of this game is going up on the next SpaceX mission, polaris Dawn. That's currently scheduled for July. It's been delayed a couple of times and there the astronauts are going to be doing a series of experiments. Like medical experiments is what they do. They're contributing, you know. So one of the things they're actually measuring is they're measuring the jugular vein to see how blood flow changes in microgravity, why SpaceX and Polaris Dawn wants to help prepare us for these deep space missions. But one of the other things that we're testing is we're testing the effectiveness of just in time training in zero gravity. We're not going to learn like we're going to have folks that aren't going to learn on the ground how to use the device. They're going to train just-in-time in space to test the effectiveness of the training. So it's like a double win. These are all just examples about how SpaceX and Polaristan and these missions that are happening today are all helping us collect information and knowledge that we can use to prepare for Mars and, you know, future missions in the solar system.
Speaker 1:Fantastic, wow, mind-blowing.
Speaker 3:I know Really really fascinating. So it's probably going to be an obvious answer. I'm curious about the feedback for this technology from medical schools, from physicians, from hospitals, from regulatory bodies. Is absolutely everybody embracing this technology and giving you positive feedback and requesting features and et cetera?
Speaker 2:Non-stop. I mean you check the app store, it's everything's five stars. Of course, like in development, it's not all positive feedback as we're developing stuff. Doctors are, like you know can be some of the most critical gamers which you want, right you want right, that doesn't look real.
Speaker 2:It wouldn't bleed like that. Why did you take 10 points away for me for choosing that treatment that treatment's's fine, like constant, to make the content better and then we launch it, and then that just creates demand for more and more content. They say so. I mean we're working now with, you know, most of the top med device and life science companies to accelerate products we're you know, we're working with, like I said, like Um, we're you know we're working with. Uh, like I said, like you know, we and and there, you know, when we do things that sponsored by industry, it all goes through regulatory, a regulatory review process to make sure that you know, not only is the game medically accurate, but you got to make sure that it's not making any claims that are off label, like you don't want to be able to like have in the game. You can, you know, use the thing in a way that you're not actually allowed to use it, so you have to apply those constraints. That's just part of you know, games are made of rules and that just adds more rules.
Speaker 1:Fantastic. What about the other constituency out there? Kids, you know typical consumers of video games. What sort of feedback do you get from kids who happen just to play the games for fun? Is this a growing audience? Are there future doctors and nurses and scientists being developed through these channels?
Speaker 2:We have a million medical professionals who play. We have 3 million downloads. We know that there are some non-medical professionals playing A lot of it is actually doctors using it to explain things to patients.
Speaker 2:I mean it's freely available, and if you don't, we have ways to validate folks who are medical professionals, and if not, we just don't count you against our metrics. So the kids can remove as many nails from patients' throats and misdiagnose patients as much as they want, and that's fine. We are starting to do more and more of actually use this to train patients. So we're starting to work with customers where and, and and partners where, where you know where the patient needs to have a mental model to understand how to use a device or how to manage their disease, and so we're starting the same methodologies apply, the same neuroscience-based techniques. We're starting to build games that are still medical, but for patients.
Speaker 3:This is fascinating and I would love to learn more as a patient advocate on myself. So would this be direct patient access? So would this be through their doctor, where doctor can use it directly in interaction with the patient or advise them to go and play this game to learn more, or patients can find it on their own?
Speaker 2:Yes and yes. So we've started with things where it's through the doctor, you actually play first in the clinic and then you get an email like we're doing some of that. But we're eventually going to be launching things into the app store and making them publicly available as well. There actually is not. I think about it. We actually do have a game for patients in radiation oncology.
Speaker 2:That's just available on the web so you can understand the benefits of, you know 4DCT and you know new techniques for you know for treating cancer. So it's just sort of kind of purely educational. We're starting to do more and more of that.
Speaker 1:Fantastic. Well, thanks so much for sharing that quite tour de force of you know. Interactive medical education so amazing. What are you looking forward to this summer, the next few weeks, any travel or trips or team in the heads down just delivering amazing new solutions we are.
Speaker 2:We're not going to space, but we are sending, so that's, that's great, and um, yeah, let's see this summer. I mean, there's just a lot of you know medical conferences and you know, industry conferences and so forth.
Speaker 2:We really like level x is kind of you know, there's a lot of a lot of talk about generative ai but there's not a lot in healthcare of practical examples.
Speaker 2:But because at LevelX we've been using it so heavily, we're sitting on just dozens of examples of using it to create medical content, using it to solve really hard technical R&D problems, things like we talked about, like the examples I was showing you with skin, of where you can use it to make better, unbiased AI systems. So we've now started sharing like we don't we don't sell AI products, we sell medical video games but we found that like we've been pulled in more and more to share those examples. Just, hey, everybody, you know we're learning great things about ways to use generative AI, also what happens when the generative AI hallucinates in healthcare and what the implications are, how to prevent that. So we're learning a lot. Hey, healthcare, here are lessons we're learning. Please use these in your own exploration in generative AI. So it's not for us, it's not like a money-making thing, but it's just a great way for us to share the experience and knowledge that we've gleaned.
Speaker 1:Well, we appreciate the work you're doing, and just onwards and upwards. Thanks so much for taking the time, sam, and look forward to seeing you in person soon.
Speaker 2:Take care, looking forward. Thank you, sam, thank you All right. Thanks for watching.
Speaker 1:Thanks for watching Reach out on the App Store. These games are fantastic. Take a look. Thanks everyone, Take care Bye.