Excavo, powered by iThrive Sim

COVID-19 changed the world permanently. 

For medical students and healthcare workers specifically, it signaled a need to rethink how they prepare for the shocks and stresses that accompany the healthcare industry in an altering world.

On the frontlines contending with the illness were healthcare workers. In the United States, we lauded scenes in the media of critical care physicians and nurses in the thick of a tumultuousness that felt unfathomable to all who were tuned in. A snapshot of December 2020 shared by the U.S. Department of Health and Human Services reveals the unique stress the year posed for healthcare workers: over 100,000 patients were hospitalized with COVID-19 nationwide, and nearly 200 U.S. hospitals were at total capacity, sending patients out of state. One-third of all hospitals reported no or limited space in their ICU unit.

Overburdened by mounting cases, nearly 1 in 5 healthcare workers left the field, citing the pandemic’s strain as their primary motivator. A 2020 Healthcare Worker Survey from Mental Health America reported that 93% of healthcare workers were experiencing stress, 86% were experiencing anxiety, 77% named frustration, 76% felt burnout, 75% said they were overwhelmed, and 68% reported work-related dread over the last three months. Nearly four in every ten shared that they lacked the emotional support to feel mentally healthy enough to perform their duties effectively.

The pandemic precipitated a national shortage in health care workers still felt today. It also dramatically shifted the medical school experience, creating a pipeline of candidates with a much different training experience than their predecessors. A TMS Collaborative survey revealed that nearly 8 out of 10 students felt a shift in their learning and how prepared they were for the next stage of their training. Nearly 75% reported that their confidence in performing clinical skills was affected.

Beyond the training gap caused by the disruption to medical education, the prolonged crisis posed challenges to the psychological well-being of medical students. In a cross-sectional study of 960 medical students issued at the height of the pandemic, 40.4% screened positive for anxiety, and 21.3% met the criteria for at least one dimension of burnout. Researchers from the University of Pikeville who conducted this study echoed the need many have put forth since—more protective factors for current and future healthcare workers.

A 2021 Mercer analysis of the U.S. healthcare labor market revealed that following the tireless nearly two-year face-off against COVID-19, the nation’s demand for healthcare workers would outpace supply by 2025 with the industry experiencing up to 3.2 million job vacancies, exacerbating the fragility of the U.S.’s still recovering healthcare system.

With Elsevier Health reporting that 47% of the U.S.’s current healthcare workforce is planning to leave their positions by then, a new way of doing and providing medical education that’s supportive of healthcare professional well-being and practice is urgently needed to sustain a sector vital to our collective functioning and prepare it for the next global emergency.

Excavo is a learning management system (LMS) and simulation-authoring platform that animates scale case-based and problem-based learning approaches in medical education with play. Powered by iThrive Sim, the web-based tool allows medical experts to author content and pair it with social and emotional skill-building synergistically, creating relevant, accessible, and learner-focused educational experiences for current and future healthcare workers that support their well-being and practice.

Embodied learning, which happens when the mind and body are leveraged in the process, is one form of experiential learning. It centers the body as a source of knowledge and, therefore, deliberately enlists non-cognitive dimensions in learning to deepen it. iThrive Sim, the web-based application powering Excavo, facilitates embodied learning by leveraging the evocative power of tech-supported play to ignite social and emotional learning in any user from any sector and in any space where learning is happening.

Awarded for its inventiveness and responsiveness, iThrive Sim emerged as an ed-tech tool that powered connection-building and real-world applicable learning in virtual middle and high school classrooms at a time when young people and the educators who teach them were eager for disruption and novelty. The web-based application created a new digital space for teen collaborative learning and play in the early months of the COVID-19 pandemic and currently reaches classrooms and teens in 39 U.S. states.

On the backend of iThrive Sim is an authoring system that enables any subject matter expert to import rich content (text, graphics, videos, audio files, stand-alone resources, and third-party links) and create an engaging single-player or multiplayer role-playing simulation that’s tailored to the audience’s needs (i.e., reading level, preferred learning modality, language preferences, etc.). Using iThrive Sim’s synchronous and asynchronous information delivery mechanisms, admins individualize the information each end-user receives and personalize their learning journey, simulating the stress providers experience while making real-time decisions.

Excavo brings iThrive Sim’s tech to the medical education space, facilitating the development of immersive, personalized learning experiences that are scaffolded with interactive opportunities that support self-regulation and self-management and have real-world applications in the shifting and fragile world healthcare workers navigate. The software captures in-game behaviors and improvised interactions shared with users and admins at the end of each simulation experience. An additive feature in the works will expand the software’s data collection and assessment capabilities, enabling more comprehensive reporting of users’ learning outcomes, real-time social and emotional functioning, and skill development.

The challenges impacting today's U.S. healthcare industry give us cues on what will be needed to support the impactful change that'll sustain it. Our tech-based solution seeks to meaningfully improve outcomes for current and future healthcare workers, the individuals and institutions tasked with training them, and the patients who benefit from a healthcare system that is protective of its professionals' social and emotional functioning.

According to the U.S. Census Bureau's 2019 American Community Survey (ACS), the most recent count of the U.S. healthcare industry estimated 22 million workers, accounting for 14% of all workers in the country's labor force.

This number dropped during the pandemic, with many physicians, nurse practitioners, physician assistants, and other healthcare workers quitting their jobs. COVID-19's impact on their psychological well-being and emotional functioning was named as a core motivator for leaving the profession. Stress remains the top reason why almost half of U.S. healthcare workers plan to go too by 2025. Thirty-nine percent said in a Mental Health America-administered survey that they did not feel they had adequate emotional support. 

Excavo, powered by iThrive Sim, addresses current health workers' need for more protective factors while on the job. Continuing medical education (CME) efforts will forever be a vital cog in bettering healthcare quality and improving patient outcomes. Our tech-based solution provides medical institutions and for-profit medical education a way to integrate the building of core, wellness-supporting social and emotional skills, like emotional regulation and stress management, meaningfully.

In states like New York, where the need for immediate care during the pandemic strained the training capacity of medical institutions, Excavo presents a new and innovative way to support meaningful self-directed learning in healthcare workers' continuing medical education, scaffolding their learning with practices supportive of their self-care, shown in a 2020 literature review to bolster healthcare professionals' well-being when integrated directly into clinical training programs and into the quality assurance processes of professional organizations. (Posluns & Gall. 2020)

Students at medical schools also benefit from a real-world applicable and inventive way of learning about the field that honors their wholeness as people and their social-emotional needs as future healthcare workers. Data published in the BMC Medical Education in 2021 reported that of the first- to sixth-year students surveyed, many named classes without a didactic approach as a factor that worsened their quality of life. Conductors of the study went on to recommend medical schools' design curricula that connects their students with responsive psychological and pedagogical support (Tempski et al., 2012). Interventional studies have affirmed the same thing showing that social and emotional supports show promising effects on the self-care and academic adjustment of first-year medical students. However, more is needed to support them with long-term stressors. (Ball & Bax, 2002)

Positive patient outcomes are inevitable when the ones tasked with caring for them are supported holistically in their practice. Integral to a healthy world is healthy and prepared healthcare workers.

As mothers, daughters, siblings, colleagues, and friends, each of us was affected by the COVID-19 pandemic—the abrupt disruption of life and the massive loss of it. Our proximity to healthcare workers starts with the simple truth that we are members of the same society, their labor sustained throughout this health emergency. Their work is vital, they are vital, and their health and well-being will always matter to us.

As social and emotional learning and mental health experts, we know the value of social and emotional skills in today's world, which is prone to shock and stress. We also recognize social and emotional skill development's role in its continued functioning and in supporting our collective well-being. Over the last six years, our team has built nuanced understandings in community with young people about what they need to thrive and integrated them, along with what we know about teen brain development, into compelling games, tools, and experiences, engineered with museums, nonprofits, and libraries that help teens question, shape, and explore new possibilities in themselves and the world. Each of these support their inquiry, imagination, meaning-making, resultantly—their social and emotional skills—factors proven to be protective of teen mental health. 

We build on 30+ years of combined instructional and game design experience and an evidence-based, impact-oriented, accessibility-forward, and iterative approach to create these social and emotional health interventions. Core to our process is our co-design model with users, which is care in action. Recognizing that people are often defined by their vulnerabilities rather than the strengths they embody every day, our strength-based model of UX research makes clear that we cannot get to a world where every person  is valued, protected, proactively challenged, and cared for, without their unique needs centered and genius leading the way. 

Titled 'Game Design Studio,' our UX research model creatively combines game design and design thinking activities with social and emotional ones. It revolutionizes the typical focus group with strategies that create a supportive context for discovery where everyone at the table feels safe, seen, and heard in relation to the issues they care about. Used so far with over 2,000 individuals and counting, it effectively gives the end-users of our wellness-supporting experiences a new modality for expressing their needs, concerns, and preferences before, during, and after the design process.

We know from our experiences with our UX research model  that the nuance that comes from co-creating elevates the efficacy of a solution, and the process itself is affirming for all who join in. Our team intends to take our co-design model and method to healthcare workers, past, current, and future ones, as well as the medical institutions tasked with training them, to arrive at a community-driven product. We have deliberately expanded our team to help us widen the net of healthcare professionals nationwide and extend the invitation to join in on the co-designing. We will use our UX research model, co-designing with at least 100 healthcare professionals and medical students, as we optimize Excavo.

We have a working technology for a different market segment (secondary education); with this proposal we aim to adapt its content and functionality for the health care segment, a segment we are not currently serving.

3000+

iThrive Sim, the core technology that powers Excavo, has successfully scaffolded learning with social and emotional skill-building. Its first iteration launched in September 2020 as a free tool accessible to any high school educator or a teen-serving adult looking to bring any of the 35- to 60-minute multiplayer simulation games in our core civics library to the in-person and remote spaces they share with young people. Optimized to respond to the shift and disruption to education caused by the pandemic, the tech is personalized to respond to the pain points educators identified, like lack of student engagement and the needs teens expressed (i.e., connection, fun, and novelty). Since then, the tool has effectively done this for young people and educators not just in 38 states across the United States but for groups in nine other additional countries across six continents.

Our team is clear on how to build on iThrive Sim’s core tech to optimize Excavo and personalize it to address the pain points and UX/UI preferences shared by healthcare workers, medical students, and individuals at healthcare facilities tasked with supporting their medical education, new and continuing,

From this Solve MIT Global Challenge, we hope to gain strategic guidance and partnership to support our ongoing efforts to commercialize iThrive Sim’s technology in this sector and others where learning and training are happening. Mentorship from experts at Solve and MIT who are familiar with technological disruption and what it takes to bring forth new ways of doing and being in the world would greatly benefit our team. As a nonprofit, we hope to get to a licensing model that allows us to offset the costs of providing this valuable tool to educators for free and expanding it specifically for the benefit of the teens they teach.

As Solvers, we also hope to be in community with people across sectors who are thinking critically and consciously about the problems in tomorrow’s world and the solutions we can envision today to address them. From our experience working with museums, presidential libraries, youth programs and nonprofits, and colleges/universities, we know that inspiration, partnership, knowledge-building, and knowledge-sharing await in any generative space attended by those eager to broaden their horizons. 

Access to community-building activities, funding and in-kind services, namely legal support and access to helpful software licenses, will allow us to streamline our design process, optimize our tech-based solution to be as impactful as possible, and bring it to healthcare workers, present and future, who need it.

Excavo supports a new way of addressing the stress healthcare workers experience. The health emergency of 2020 made clear how their stress leads to burnout and how that burnout directly assaults and exacerbates the fragility of the U.S. healthcare system.

A meta-analysis showed that healthcare workplace interventions designed to support well-being lead to significant improvements in burnout (Panagioti et al., 2017). Additional research supports this finding adding that interventions that made workers feel in control and gave them meaningful opportunities to be heard yielded more reliable improvements in wellness. One rigorous meta-analysis showed that interventions that utilized team-based interventions, coping and communication skills training, and e-mental health approaches positively affected burnout reduction, however not all interventions showed impact (Fox et al., 2020).

The variance in the impact of these interventions reflects the myriad of factors, often localized to the workplace, that influence healthcare workers’ psychological well-being. It also serves as a reminder that while the additive wellness-supporting effects of one-time interventions support healthcare workers in the short term, achieving well-being sustainability throughout the healthcare workforce requires a prolonged effort. A task that is colossal and important to societal functioning requires a deliberate integration of the social and emotional into the culture of healthcare in the U.S. so that the wellness support of healthcare workers is never called an ‘intervention’ or an add-on, but rather viewed as a fundamental consideration in the industry. Medical education presents a viable means of ensuring that. 

We see Excavo as a tool supportive of that necessary culture shift, hosting the learning vital to bettering healthcare professional practice in the same engine as the protective, social, and emotional skill-building needed to support healthcare workers’ capacity to recover from stressful and emotional events and innovate in their daily work. 

Our tech-based solution, optimized in partnership with medical educators, will change how medical students and healthcare workers learn and train through their professional journey.

The tool enables the authoring of new medical education simulations, giving institutions, facilities, and schools ready to embrace participatory approaches with their personnel or student body a direct lever for co-creating with them. Responses solicited from a question like “How does stress typically show up in this medical case, in and outside the workplace?” are brought to life in each of the dynamic, media-rich simulations Excavo enables admins to create, allowing end-users to contend with educational content in a simulated context that mirrors the triggers, shocks, and stressors they see in their profession. By supporting social and emotional skill-building—an evidence-based factor supportive of mental health through embodied learning, Excavo directly addresses a pervasive underlying cause for healthcare worker turnout. This, in turn, supports positive impacts on patient outcomes and alleviates the operational costs that accompany the turnover that often follows healthcare worker burnout and currently costs the average U.S. hospital $5.2 million and $9 million per year for the loss of registered nurses (RN) alone (NSI National Health Care Retention & RN Staffing Report, 2023).

Our team is focused on product optimization over the next year. We aim to engage a diverse group of more than 100 healthcare professionals and medical students in optimizing Excavo, iteratively testing and fine-tuning the tech-based solution to reflect their feedback and wisdom. To reach this goal, we have onboarded two new consultants to our team to support our network-building efforts. Each has been trained in our values, co-design approach, and design principles, collectively supportive of active listening, knowledge-building, and knowledge-sharing. 

On the impact end, we aim to have our co-designing with healthcare workers culminate with the development of a social and emotional skill-building learning management system (LMS) that meaningfully supports the training of healthcare workers at medical institutions and students at medical schools across the country. Excavo presents a new medical education method by scaffolding educational content with social and emotional skill-building activities and facilitating immersive experiences that build on practical case-based and problem-based learning approaches. With the tool optimized to effectively support the development of social and emotional skills proven to help mental health outcomes, we hope to see an increase in social and emotional learning outcomes at medical institutions across the country. To reach this goal, our team intends to scale the impact of Excavo through partnership with companies already well-positioned in the medical education space, namely the ones already thinking innovatively about how to best deliver high-quality educational programming that elicits demonstrable outcomes and supports workers’ well-being.

In the next five years, we hope to see Excavo widely distributed across the country and support patient outcomes in underserved areas currently experiencing the most intensive effects of healthcare workforce turnover. The 2022 NSI National Health Care Retention & RN Staffing Report, which assessed over 730,000 healthcare workers and registered nurses from 272 facilities in 32 states, estimated the national hospital turnover rate to be 22.7%. Research has long established that higher rates of healthcare workforce turnover are associated with higher patient mortality, lower patient satisfaction, and adverse patient outcomes (Aboagye et al., 2014; Geno Tai et al., 2021; Hall, 2005; Vaughan & Edwards, 2020; Vikas et al., 2015). One study has even shared that with the loss of one nurse, patient infections increase by roughly 30 percent. As a tool that supports healthcare workers in building emotional resilience and managing shocks and stress, Excavo will meaningfully add to the ecosystem of support healthcare workers deserve and require to provide ongoing patient-centered care.

Tangentially, since the revenue generated from the licensed use of Excavo will offset the cost of developing iThrive Sim-powered simulations for teens, the uptake of this product will help facilitate the authoring of more dynamic social and emotional learning experiences for young people in schools and in teen-serving spaces across the U.S., connecting them with a tool that helps them sharpen a protective factor vital to teen mental health.

Over the next nine months, progress for our team will be measured by the number of co-design sessions with representative groups of healthcare workers and medical students and the survey responses they share afterward. 

In addition to collecting user input through design artifacts and field notes through the co-design session, at the end of our co-design sessions with end users, we ask participants to share their reflections using qualitative surveys methodologies. Devised to be as much of a social and emotional learning experience as a UX research-centered one, our co-design model facilitates a wellness-supporting experience that enables active listening and affirms participants' strengths. We intend to assess the data they share through surveys to track and measure the impact of this vital process that will get us to a community-driven product. Our team, skilled in outcome and process evaluation, will use affinity mapping to assess this aggregate data for common themes to report on the impact of the participatory process.

Data collection capabilities on the back end of Excavo through its core iThrive Sim tech allow us to gather essential demographics and outcome data to measure progress toward our impact goals. 

Excavo will assign each user registered on the platform a unique identifier that allows us to measure uptake and use. Users will also be able to share vital information about their affiliated medical institution or medical school, including zip codes, academic year, or profession (title, number of years teaching, etc.). Pursuant of the tool's goal to meaningfully support healthcare worker well-being, Excavo will collect indicators of each end user's real-time social and emotional functioning, measuring and reporting their improvement with each simulation they interface. A personalized report of this data will be accessible on each user's dashboard.

Vital demographic data coupled with outcome data on healthcare workers' social and emotional learning enables us to compare the geographical density of Excavo’s use with patient outcomes in zip codes nationwide.

With the tool's ability to quickly generate reports of social and emotional learning outcomes at the individual user, hospital-wide, and at the zip code level, our team will be able to share valuable insights with relevant state institutions thinking critically on how to personalize solutions to the healthcare worker burnout and turnover challenge that's exacerbating the United States' already fragile health infrastructure.

With the uptake of Excavo directly supporting teen social and emotional learning by offsetting the cost of an expanded free simulation library, we intend to continue leveraging iThrive Sim's tech to help young people's social and emotional skill development in all academic and recreational contexts. Our tech currently measures progress toward this goal by gauging real-time social and emotional functioning and guiding teen-serving adults as simulation facilitators through pre- and post-simulation activities and assessments.

Elevating the importance of social and emotional learning in the U.S. healthcare sector has immense potential to support it in confronting a pervasive factor underscoring workover turnover—burnout caused by psychological stress. 

Healthcare workers have always been vital to the functioning of society and are leaving the sector at such an alarming rate that demand for healthcare workers will outpace supply by 2025 (Mercer, US Healthcare Labor Market, 2021). Studies report that the poor mental health experienced by healthcare workers is underlying much of this turnover (Willard-Grace et al., 2019; Bae, 2023).

The impact this has had on patients' health outcomes has been felt in U.S. states experiencing the highest turnover rates. It has restrained healthcare access and patient choice and elevated the incidence of patient infections and mortality (Bae et al., 2010; Warshawsky et al., 2013; Castle, 2010; Luther, 2017). An estimated 6.5 million healthcare workers plan to leave by 2026, exacerbating the sector's current fragility (Mercer, US Healthcare Labor Market, 2021). The 2021 GHS Index estimates that the United States ranks the U.S. healthcare system's medical countermeasures and personnel deployment at 50, indicating that the country's healthcare sector's workforce is dangerously unprepared for future epidemic and pandemic threats. 

As social and emotional learning experts, our team is uniquely positioned to strengthen the social and emotional skills healthcare workers need. Studies have long proven that the continual practice of these skills protects well-being and supports emotional resilience. 

To understand the social and emotional skill gaps that exist in the healthcare workforce and the way it shows up in their practice and profession, our team is working toward engaging a representative sample of healthcare professionals and medical students in a co-design process that will thoughtfully explore their lived experiences and pain points. Affinity mapping the insights from these trauma-informed co-design sessions will support us in developing an optimized output—Excavo. Studies show that participatory models similar to our co-design one directly support the efficacy of interventions and programs (Quinlan, 2009; Shire et al., 2019; Gray et al., 2016).

As a lever for dynamic medical education, Excavo will help healthcare workers sharpen wellness-supporting skills, like stress management and responsible decision-making, while learning content vital to their practice. We plan to scale the impact of Excavo through partnerships with companies and institutions already well-positioned in the healthcare sector to reach as many workers as possible.

Research shows that when adults consistently practice social and emotional skills, they experience better mental health. When they have these protective factors, they are less likely to experience burnout—a widely reported cause of healthcare workforce turnover (Gabriel & Aguinis, 2022; Görgens-Ekermans & Brand, 2012). Less burned-out healthcare workers translate to a better-staffed healthcare sector equipped to handle the next health emergency. 

Our theory of change is more than a product. It disrupts medical education with the reminder that emotions have a place in learning and that by supporting social and emotional skill development at all entry points for learning in the healthcare sector, we fortify it as a whole.

The iThrive Sim platform at the core of Excavo leverages the transformative power of social and emotional learning—an evidence-based practice proven to support emotional resilience to stress and positive mental health outcomes. 

These skills are all buildable ones and iThrive Sim supports the deliberate practice of them while healthcare workers and medical students contend with educational content, so they are always actively strengthening a factor protective to their psychological well-being while they learn.

iThrive Sim is written in AWS Lambda and uses a GraphQL API. Front-end development was done using HTML, CSS and the VueJS framework and backend development was done with Python 3.7 and MySQL enabling easy and streamlined creation and customization of new simulations. The tech specs support the creation of interactive learning experiences that offer dynamic opportunities to engage deeply with learning materials typically folded into the online modular approaches embraced by many medical education and continuing medical education programs. 

Through the tool’s dynamic authoring platform, admins can personalize simulations to the needs of  in-person, online, and hybrid environments (i.e., reading level, preferred learning modality, language preferences, etc.). Using iThrive Sim’s synchronous and asynchronous information delivery mechanisms, admins individualize the information each end-user receives and personalize their learning journey, simulating the stress healthcare workers experience when making decisions in their practice while leveraging the merits of case-based and problem-based learning approaches.

Designed to be universalized and user-friendly, the iThrive Sim utilizes HTTP requests to allow anyone to immediately begin using the software despite firewalls, supporting its accessibility by learners everywhere. Building on this current version, we are tailoring the iThrive Sim platform in community with those it will serve and support, optimizing it to be future compatible. 

The simulations built with Excavo via the iThrive Sim platform support immersive role-play that’s synergistic with the best way healthcare professionals learn, prompting them on the user end to engage in critical, urgent decision-making with timed decisions, weighted voting, and consequences. The ability to create single-player or multiplayer ones also gives admins the power to create connection-building, tech-supported learning experiences, or self-directed ones that workers’ can engage with on their own time. 

User-created content and decisions are captured on admin, facilitator, and user-facing dashboards, as well as metrics that measure learning progress. Assessment and data collection features to come will enable more robust data collection and allow for the quick exporting of outcomes.

We take pride in being a diverse team that centers equity and inclusion in all parts of our work and process. 

The core iThrive Games team—the iThrive Sim platform's producers—comprises four women from diverse communities: Newton, Massachusetts, Atlanta, Georgia, and New York City. Each of us comes from diverse cultural backgrounds, namely, white, Nigerian-American, and Singaporean-Australian, and each of us are equally committed to elevating the profile of social and emotional learning across the country and in the world. Our work reflects the cultural knowledge we collectively harbor. We leverage our team's unique genius to think expansively about best supporting and promoting well-being in all spaces where learning and gathering happen. We intend to expand our team's sales and business development capacities soon and look forward to expanding the shared genius of our team with more wisdom and lived experiences.

Inherent to the co-design model we enlist to create meaningful games, tools, programs, and experiences is a power-with approach instead of the power-over one, favored in the aspects of our culture that champion hierarchy. This model is an extension of our organizational value system, which values equity and inclusion. We've equalized power and normed participative decision-making across departments helping us facilitate the trust that supports organizational efficacy and efficiency. Conscious of how unconscious bias shows up in each of our lives, our team often engages racial equity consultants who review our products with a decolonizing lens, carefully assessing their cultural responsiveness and relevance, and accessibility ones who nudge us toward those who help us think dynamically about how to universalize and engage as many people as possible meaningfully. Collectively, these measures help us ensure that the intention we embody in our daily work and amplify in the way we create with and for end users is reflected in the products and experiences we share with the world, Excavo included.

iThrive Sim's tech powers Excavo and creates customized interactive role-playing simulations and game-based learning scenarios designed to help current and future U.S. healthcare workers develop the critical social and emotional learning (SEL) skills they need to navigate and manage the work-related stress underlying the burnout driving turnover at medical institutions across the country. 

As a nonprofit partially funded by donations, our business model is B2B and B2G, with sales deriving primarily from fee-for-service contracts. On the B2B side, private foundations and for-profit educational companies contract us to design or co-design customized game-based solutions that respond to identified pain points and challenges, attune to defined learning objectives/standards, and help attain desired learning outcomes as they build core social and emotional skills. Similarly, our B2G government customers contract us to create digital learning experiences designed to amplify life-saving education while developing and measuring skills needed in real-world contexts, such as crisis-related decision-making, self-advocacy, and bias recognition. 

Since launching in June 2020, our award-winning iThrive Sim platform has powered collaborative and single or multiplayer online gameplay and immersive learning simulations that are flexible, engaging, and deliver measurable impact. Customers like High Resolves and the Middlebury Institute Center on Terrorism, Extremism, and Counterterrorism have leveraged the tool's embodied learning approach to drive measurable outcomes and invest in their audience's social and emotional skill-building.

Excavo brings this same learning management system (LMS) and simulation authoring tech to the healthcare sector and, in doing so, brings significant value to medical education companies, medical schools, and medical institutions.

For medical education companies, enlisted by 00% of U.S. healthcare facilities as their continuing medical education (CME) provider, Excavo provides a solution that responds to the tension between balancing educational activities with accrediting institutions' standards with the desire for inventiveness and novelty. By presenting a new immersive and SEL-rich way of doing medical training, medical education companies adding Excavo to their library better prepare the healthcare professionals they reach with a dynamic tool and real-world applicable learning experiences.

Medical schools looking to remain competitive can also rely on the tool to support them in differentiating their curricula and learning journeys from other educational institutions.

Effective learning comes from medical education that deliberately centers social and emotional learning—a practice proven to support healthcare workers' well-being. Medical institutions at the helm of healthcare delivery with employees trained with Excavo effectively have a protective measure proven to mitigate burnout and support emotional resilience.

iThrive Games is currently structured as a 501(c)(3) organization. Historically, our team’s revenue has come from a combination of grants from private foundations, fee-for-service contracts from government agencies, foundations, and co-creation contracts with other educational companies.

Going forward, we will continue to generate revenue for the nonprofit’s impact goals through grants, design service contracts, and co-creation contracts as we restructure iThrive Games as more of a hybrid. We will continue operating the nonprofit to support its work with foundations and other youth-serving nonprofits and to house the intellectual property living within the iThrive Sim platform. We intend to create a separate, independent for-profit corporation that will operate as our primary operating company and be responsible for executing fees for service contracts, housing employees, and licensing iThrive Sim’s intellectual property. 

This structure will allow our team the flexibility to continue generating revenue through grants and contracts for our game design services and products, as well as our thought leadership to foundations and grantors making philanthropic contributions while growing our for-profit customer base. The for-profit arm of our organization will generate recurring revenue with design and co-design contracts with larger companies, as well as contract revenue for design and product delivery and recurring iThrive Sim platform fees from adjacent market customers such as workforce development and professional certification curriculum providers seeking engaging simulation tools to deliver measurable outcomes for their users in areas such as social and emotional skill development and well-being. We are also investigating the feasibility of earning recurring revenue where we could charge a small platform maintenance fee each time the simulations are utilized by licensees. Creating a for-profit arm will enable us to grow our organization by raising capital from the numerous investors who have inquired about investing after seeing iThrive Sim in the market.

Since our inception in 2017, we have received a total of $4.55 million in philanthropic gifts, $1.69 million in grant revenue and $1 million in design contract revenue for a total of $7.24 million in revenue. 

iThrive Games' revenue has been generated primarily through grants. We were created through a financial partnership with DN Batten Foundation, whose focus on adolescent well-being and innovation dovetailed with iThrive Games' expertise in adolescent wellness and gaming. The synergy led to the building of iThrive Sim as a lever for supporting young people at a time when social distancing orders limited how remote learning was done. 

In addition, iThrive has successfully generated grant revenue from the William T Grant Foundation, who awarded us a $394,133 grant to use design thinking with Black youth in the juvenile justice system to address mental health inequities; the National Endowment for the Humanities, who awarded us a $250,022 grant to develop game-based humanities education for distance learning for high school students; The Reagan Foundation and The National Archives, who collectively awarded us $191,000 to develop Civics simulations, and the XQ Institute, who awarded us a $26,000 grant to support design and planning of new transformational learning experiences for high school students. 

Through these grants, iThrive Games has been able to build award-winning immersive learning experiences that have delivered outstanding measurable outcomes.  

We have also successfully generated revenue from contracts with federal government agencies, other educational non-profits, and foundations. In 2021, the Federal Emergency Management Agency contracted our team to co-design a role-playing scenario on the iThrive Sim platform that promotes teen emergency preparedness. The goal was to increase FEMA Region VIII's reach in underserved and rural communities and to enable a greater understanding of the crucial role teens can play in supporting the preparedness and resilience of their communities.

The same year, the Middlebury Institute of International Studies contracted iThrive Games with funding from the Department of Homeland Security (DHS) to support them in co-developing a new iThrive Sim scenario to support teens in recognizing and resisting online radicalization efforts. Part of the work allowed us to co-design the simulation with teens to ensure authenticity. Because of this co-design, participatory process, our funders and users reported exponentially higher teen buy-in, engagement, and impact than existing tools and learning approaches.

Fellow non-profit, High Resolves, contracted iThrive Games to help digitize and increase the impact of its existing role-playing game, CO2. iThrive Games successfully re-designed the game, weaving in social and emotional learning and expanding the game's delivery method into the digital space with the iThrive Sim platform. High Resolves' CEO remarked that the collaboration enables them "to retain the deeply engaging feel of the simulation while allowing us to run the simulation remotely online." 

We will continue assessing pain points iThrive Sim offers a solution and, with an expanded outbound marketing strategy, seek opportunities to create value for others using its core social and emotional skill-building software. We will be pursuing more partnerships, design, and co-design contracts with government and foundation customers in the future and are currently in talks with professional education and workforce development organizations about designing new immersive learning experiences with iThrive Sim's tech.