The Future of Gastroenterology Training: GAMING

The Future of Gastroenterology Training: Gaming!

The discussion surrounding endoscopic simulation has been a prevalent topic for many years, but now the industry is seeing even further advancements for gastroenterologists, with the evolution of gaming as a training basis.

The word ‘gaming’ a lines with many connotations, but one that might not be so synonymous is ‘medical training’… Living in the 21st century, means the presence of digital advancements is inevitable, however innovation never ceases to amaze, and proof is in the pudding with the latest training technology emerging in the form of an app-based game! – Welcome Gastro Ex…

The medical video game concept:

The market leading medical education video game is created by Level Ex. The CEO, Sam Glassenberg, has a whole back catalogue of success’ and career related history which has led him to curate the brainchild. It all started when Glassenberg designed a video game for his anaesthetist father to train colleagues on a fiberoptic intubation procedure. “It’s a tricky procedure that even an experienced anaesthesiologist can mess up, so [my father] said, ‘Make something that can run on their iPads. I don’t want to drag anybody to a simulation or training center.’” [1] – And there we have it, the deciding comment, that unknowingly instigated the latest development in medical training!

Fast forward two years, Glassenberg’ father was curious as to how many people had downloaded the free app. The figure was roughly 100,000; made up of doctors, nurses and healthcare specialists worldwide. – Appearing to prove as one of the best medical video games for doctors. From two industry specialists colloquially collaborating on an initiative for no more than a personal solution, the figures highlighted a viable product addressing a need… Cue the birth of Level Ex!


Each game has varying levels, progressing in difficulty, that clinicians play through; choosing your surgical tools and medications, to practice the techniques you’ll later put to use in real-life procedures. Every level is played against the clock, with a set number of attempts, leading to scores being awarded on completion! – In the US, as you play the game you earn CME credits via the difficult cases, taking the boring out of ongoing training.

Due to the games niche fields of practice they are designed, just like at conception, with the input of both industry specialists; medical professionals and games designers. The key ingredient is the art of translating the medical experience into virtual form… with the most challenging obstacle being able to understand and define the tricky portion of the case, and to interpret said challenge into the game mechanics. – For example, If it’s a really challenging decision about how to remove [a foreign body], there are ways we can create a puzzle game to try and recreate that, says Dr Eric Gantwerker, a paediatric ENT surgeon and Level Ex’s medical director.[2]

The business has 150 clinician advisors to assist in emulating the medical realities, as well as the all-important UAT (User Acceptance Testing) contributors who play the products and share their feedback. The medical games are free for doctors and paid for by medical companies’ sponsorship. To elaborate, clinicians can play levels using virtual medical devices sponsored by the companies that make the real-life versions!

Exciting prospects of medical video games:

While the companies current focus remains on mobile due to the infrequent nature of VR tech in medical education, they do occasionally curate content using virtual and augmented reality – often at request of clients. “Our model is mobile, accessible in your pocket at all time, and free. The second you have to have a physical device, it limits all of those things,” Gantwerker said.[3]

Currently, cases are aimed at senior doctors, however Level Ex has had frequented requests for more junior material. It has been discussed that more junior based content would need to be created as part of a curriculum, which would extend the existing training basis to include video games for medical students. – Providing the scope and capability to be the best video game for medical learners.

Discussions are being held with medical institutions, societies, and hospitals around adapting existing content, as well as creating new material. A comment made by Glassenberg explains how content progression a lines with learning and the fun this creates… “We start with real cases, this is how doctors learn… now when you encounter a difficult or interesting case, you can submit it to a journal or conference, or you can submit it to us and, within weeks, hundreds of thousands of your colleagues can be playing it and competing to get the best outcomes”.

Level Ex’s medical video game success:

Throughout the following years, Level Ex has exceeded and surpassed figural expectations, with over 3 million cases played in 2018, while also capturing clinician attention for upwards of 10 minutes per session. There is now an established suite of games designed for four different areas of medicine: cardiology, gastroenterology, respiratory, and airway management, with the aim in their own words to “capture the challenges of practicing medicine: from puzzling diagnoses to rare surgical complications.” [4]

When we question why the platform is a success, it revolves around simple human behaviour principles… With the theory of empiricism in mind; a user plays a video game, they experience reward and frustration, in this instance trial and success! – Several times they will fail, but when they succeed, they are rewarded by the game; triggering a release of dopamine which reinforces neural pathways used on the successful attempt! For a collective constantly striving to be the best in their profession, gaming is positioned as an authoritative tool for clinician learning.

** The medical benefits of clinical video games are still relatively unknown, however Glassenberg cites efficacy studies conducted by third parties, which establishes playing ‘fiberoptic intubation procedure’ helped improve physician performance. Level Ex are conducting their own efficacy studies, though the release date is still pending.


At present this new, innovative, dopamine releasing training technology only seems to harbour positivity; who doesn’t love to have fun when learning! However, many questions still pose surrounding the hot topic… Are video games in the medical field advanced enough to supplement longstanding training forms? Can they replace expensive and often outdated tools? Do they have an impact on reducing mistake rates in real-life patient procedures? Will they continue to drive positive behaviour change to improve patient care?

While the US adoption of the gaming technology appears to be paving the way in clinical training, we are still wondering if the UK will embrace and follow suit… Only time will tell, it’s safe to say our eyes are firmly focussed on the much anticipated, and long-awaited data.


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