Ceylin Özgür Erzen: Journey into Medicine and XR

Faaizah Arshad speaks with Ceylin Özgür Erzen, aspiring student at the Istanbul Faculty of Medicine, about her journey into medical school, exploration of extended reality (XR), and vision for how XR can be used to improve educational outcomes for children and adolescents, including students with neurodevelopmental disorders.

The following is a transcript of the episode:

Please note that this episode was produced before IVRHA’s conference 2023, so the Psychiatry XR discount code at the end of the audio is no longer applicable.

BIO

Ceylin Özgür Erzen is an aspiring student at the Istanbul Faculty of Medicine, one of the most prestigious medical schools in Türkiye. From a young age, she has been creating educational animated videos with her own drawings, script, music, and voiceover. She intends to become a Child and Adolescent Psychiatrist and specialize in learning disorders, and thus utilize XR to help create personalized educational materials for every student at any level of education. She has completed a research internship with the ChARM (Children and Adolescent Resilience and Mental Health) team based at the University of Cambridge, Department of Psychiatry, as well as a clinical attachment within the Pediatric Liaison Service based at King’s College Hospital, South London and Maudsley NHS Foundation Trust. She is currently a freelance medical illustrator and animator, soundtrack composer, and singer of Vorticosa, a musical band based in Istanbul.

Faaizah Arshad

Welcome back to Psychiatry XR where we aim to inspire worldwide conversations around the use of extended reality in psychiatric care. I'm your host for this episode, Faaizah Arshad. I'm so happy to get to talk with Ceylin Özgür Erzen, who is an aspiring student at the Istanbul Faculty of Medicine, one of the most prestigious medical schools in Türkiye. From a young age, she has been creating educational animated videos with her own drawings, script, music and voiceover. She intends to become a Child and Adolescent Psychiatrist, and specialize in learning disorders, and thus utilize XR to help create personalized educational materials for every student at any level of education. She's currently a freelance medical illustrator and animator, soundtrack composer and singer of Vorticosa, a musical band based in Istanbul. Thank you so much for joining us Ceylin! 

Ceylin Özgür Erzen

Hi, I'm so happy to be here and be able to talk to you. Hi, Faaizah.

Faaizah Arshad

Yeah, Hello! I'm so glad that we can talk about this. So, I'd love to know how you first became interested in medicine. And if you always knew that you were going to pursue this path, and specifically if there were any people in your life who influenced you to be interested in medicine, mental health and behavioral health.

Ceylin Özgür Erzen

So, I would love to tell you more about this. I can say well since childhood, I always been interested in medicine, or maybe better to say the whole human body. I am the daughter of a physician father, so it may not sound surprising that I follow a similar path. But the first time medicine grabbed my attention was when my grandma gave me a documentary series about how the human body works in detail. Still, I can't deny the influence of my father. I enjoyed visiting his office, hearing about the surgeries he performed, and seeing the admiration of people around him. He's actually an orthopedist, but I rather used to ask questions about the human mind because it has always fascinated me the most. The interest started around the time I saw the documentary series. I think I was struck by the nervous system episode where the narrator talked excitedly about its organization and how a single defect in structure can affect us. I remember a story demonstrated in the series, a popular one actually, it was about the construction worker who survived an accident, but had his personality changed later on. His name was Phineas Gage. A large iron rod went through his head and destroyed much of his left frontal lobe and then his personality and behavior changed drastically over his remaining life. This was so profound that his friends saw him no longer as Gage. Well, I didn't know much about the brain back then. Well, I still don't, at least now. So that time, it was hard for me to grasp why Gage had ended up like that. Since then, I wondered how our brain and nervous system work to maintain our body functions and determine our personality and choices. I'm actually curious about the motive behind each action, and the emotion behind any word uttered. So, I can say that my interest about human body began when I was a child. I volunteered at Best Buddies. You may have heard a nonprofit organization dedicated to establishing a global volunteer movement that creates opportunities for one to one friendships with individuals who have intellectual and developmental disabilities. So, I made friends there, and this experience also raised awareness within me regarding the mental health. So, this also further motivated me to pursue psychiatry.

Faaizah Arshad

Yeah, I think you bring up so many great points in there, like how your environment and the people around you influenced you, and especially talking about your father and I could say something similar about my mother. She was a health professional and just seeing her in scrubs and going to the hospital, that was something that first interested me to even learn about what science is. So, I definitely agree that a lot of times parents can play an important role. And then going into the story of Phineas Gage— I'm a psychology major. So that's a story that I've heard so many times and with the Broca's area and the Wernicke’s area and how all these different lesions in your brain can affect different parts of your personality and your behavior. All of that is so fascinating. So now, you're on the path to become a doctor. Is that correct?

Ceylin Özgür Erzen

Yes, I'm studying medicine. I'm a fourth year. I have two more years to complete the medical degree.

Faaizah Arshad

Okay, so what is the general path to becoming a doctor in Türkiye? For any of our listeners who are also, from there. Can you talk about like how many years of education it usually takes and when you get to choose your specialty? 

Ceylin Özgür Erzen

So medical school is six years long, of course, excluding residency and residency lasts between three to five years, depending on which field you choose to pursue. You don't need to complete a pre-medical degree unlike in the US or Canada. I hope that's correct.

Faaizah Arshad

Yes. So, we definitely have to do four years of undergraduate studies before going into medical school in the United States.

Ceylin Özgür Erzen

Ah, I see. It will be great to maybe have that in Türkiye also. You would get an idea of what interests you most. But at least this is how it works in Türkiye. So, it takes a shorter to complete, maybe something we can rejoice about. But in order to get into medical school, we need to sit an exam after graduating high school. So, after the exam, we get our score. We fill out an online application. Then we make a list of the university programs we want to get into. For example, I wrote the medical school of different universities on my list. So, you could say it’s a list of choices. If our score is high enough, we can be placed into the one we put on top of the list. So that's how everyone is enrolled in medical school in Türkiye. And I can maybe tell more about what we are taught. It should be similar in every system. But the first two years comprise basic sciences, such as anatomy, physiology, and so on. In third year, you get an introduction to the disease, both theoretical and practical, like you get pharmacology and pathology. And the fourth and fifth years consists of clinical internships like internal medicine, psychiatry, and so on. And the last year is spent as a future practitioner in the University hosptial which means you are now called as an intern, you take on duties as a regular doctor, you rotate in different clinics, and you also take night shifts, and you also get a monthly salary, which is something I'm looking forward to.

Faaizah Arshad

Awesome.

Ceylin Özgür Erzen

So that's all how the six years is planned. So, after that, you get to choose your residency. So, once you're done with the core training of six years, you can work at hospitals as general practitioner, without any further education. However, if you want to become a specialist, then you must take the medical specialty exam, abbreviated as TUS, in Turkish, if our listeners would like to read. The format is similar to the one in the university entrance exam. So, you again, get a score, make your list of choices, and the results are announced. So that's how you can become a specialist.

Faaizah Arshad

Got it. And do you think that you would want to pursue psychiatry as a specialty?

Ceylin Özgür Erzen

Actually, I haven't taken the psychiatric rotation. So, it may be too courageous for me to talk at all. But I can say that I have interest in psychiatry, and I really want to become one of them.

Faaizah Arshad

Awesome. And then since this is Psychiatry XR, what about extended reality? Is that something that interests you? Do you think that you'd want to use immersive technology in your training, and maybe you can talk about how you even first heard about the use of XR in mental and behavioral health.

Ceylin Özgür Erzen

So, telling how my interest in external reality began. Well, I'm a freelance illustrator, and animator and I have always had interest in making educational animated video series for any purposes. So, I also wanted to learn how to make games, and I guess I wanted to use all visual technologies available to make education less boring and less stressful. And also, I heard about external reality in detail in my first year in a seminar series about the new technologies that can be used in the medical field. And I also had a chance to try it myself again in second year. It was around that time that I participated. I joined a research team that were focused on developing educational VR games. I also had the opportunity to see how it is developed, which steps are required to make a game, and we had a team of microbiologic professors. So, we were focused on making an educational game featuring the foreign body associated infections. So, after that, I realized that I enjoy creating games like this. And of course, I still have a lot to learn. But so I decided that I wanted to pursue a career focused on this. I want to get better, also in the animation skills, and then continue with 3D animation. I think I was also lucky that my university was one of few universities where you can get access to extended reality. So, while immersive technologies are not mandatory yet for our training, several institutions, including our Faculty have already started this. That's also why I could try them out with those VR glasses. So, there are even lab started within universities, and they are dedicated to this— researchers, engineers, and administrators are realizing how powerful extended reality can be as an educational tool. For example, there are even centers that offer VR therapy to treat psychiatric conditions such as phobias. So, since I haven't received a rotation in psychiatry yet, I can only talk relying on what I have read or experience so far. But psychiatry is actually an area that would be perfect to use gamification to keep patients engaged or maybe lessen the stress in the therapy sessions. So, it is very open to the integration of the immersive technologies. And in them, I want to make games and I'm also interested in the human mind. So at least at the moment, I can say that I really want to be one of the researchers or clinicians that can apply that and have the patients and students enjoy the content they get.

Faaizah Arshad

Yeah, it's definitely like really interdisciplinary, where you can combine both. You're interested in the human body and like, you know, the biological aspect, the very science aspect of medicine, with technology and developing games and making these 3D visualizations. And I think it's very interesting that you see it as an innovative tool for learning, like using it as this new modality for improving education. And I'd love to hear more about that. And maybe, in what ways you think that you can use it for children and adolescents in particular and their education. What factors about that demographic really fascinates you? Like, why do you think that children and adolescents could benefit, in particular by using XR in medicine?

Ceylin Özgür Erzen

So as far as Child and Adolescent Psychiatry, I can again, start with why I'm also interested in this demographic. I said my father is a physician, but my mother is a classroom teacher. So, she spends a lot of time talking to the parents of her students either face to face or on the phone. And as an educator, she knows the strengths and weaknesses of her students and informs, again, students and parents about their learning style. So as her daughter, I have an idea about how can a technology like this help students because I can also remember from my own childhood and adolescence that you are given a big amount of information, and you need to adapt to any situation. And if you are also preparing for an exam, you have opponents. So, the traditional education system comes very stressful to me, and I still don't like, and I really want to change this. And I think we can use the power of extended reality, and we can still teach and help the child to get through this in an enjoyable way. Because I learned a lot from games, like the basic example could be you learn any language with the help of games, so why not use this with even the most serious lectures? So, I want to change the traditional nature of education. Again, college is a revolutionary resource. I'm still a student, but that's the main idea in my mind, and this motivates me.

Faaizah Arshad

Yeah, so really keeping students engaged while they're learning.

Ceylin Özgür Erzen

Yes. I think we will accomplish this with extended reality and also in adolescence, there are many learning disabilities and they are spotted in this in childhood and adolescence again. So, I actually don't like the fact that the general education materials are only advantages toward some learning methods, and they don't appeal to all senses like seeing, hearing, and so on. So also with the help of AI, I thought why not we adapt the same content to all learning styles. So I think this technology is very needed for the education and it will help people from all levels of education.

Faaizah Arshad

Yeah, I think you bring up a really good point about how we can personalize XR. I think that's really what you're saying, where we can individualize our technology to help children who have specific learning disorders, and who might need a different method to retain the same material as their peers. Because you're right, a lot of younger aged children are diagnosed with neurodevelopmental disorders, and learning can definitely be a challenge. So, using these game-like technologies that we have to help them enhance what they're learning, I can see how that is a promising avenue for using XR in mental health. Do you have ideas about ways that psychiatrists and medical schools can use XR specifically for learning disorders? Or are you thinking of specific kinds of disorders when you are thinking about, you know, this topic, or maybe like challenges that you think would be applicable?

Ceylin Özgür Erzen

So I will start telling you about the parts of the traditional approach that we could improve. So like, I'm somewhat dissatisfied with the traditional teaching methods. In them, you are mostly only the receiver like you can take a note in the lecture, you follow a course from reference book, and in lab classes, you repeat what you see. But when you're done with the class, then you are all alone. You have to find your own way to review or practice or repeat the same thing. At least for me, extended reality is very, it would be very useful to fill this gap. When I'm done with my class, I could go home, or maybe I could go to the library or any VR lab in my Faculty, I could open the same experiment that, let's say, my instructor showed me at play. Let's say there are some parts that I don't think I learned. I would open the game, and I would review it. For me, I'm not convinced until I repeat the same experience several times. And I really want to get feedback from either an instructor or in the case of XR, the software. I mean, a feedback could appear on some corner of my screen. So that, something like that is what I really desire. And I really wish everyone could get an access to this. So, it would make the learning more engaging. So actually, we have an opportunity to do some of this in our Faculty, like we have a lab and we can practice open surgeries. And there are both education and exam modules. But for now, at least, it's not mandatory in our curriculum. So maybe it will be next level. So, I kind of imagine a model that combines the best parts of XR, it could be VR, or augmented reality based on the topic and also artificial intelligence because it will be, it would be time consuming to optimize the same content for all kinds of learning styles. It doesn't have to be a disorder, but learning preferences. And with the help of GPT, the learning models, those algorithms are also becoming stronger. So, we can introduce the content, whatever we would like to teach and the software could turn it into a teaching tool by itself.

Faaizah Arshad

Right, so really using XR as more of a complement to existing education in the classroom. And I think what you were saying with where you take the technology home after class, and you can simulate what you learned in class and use it as a way to kind of re-immerse in what you had learned when you're on your own. So, I think you're bringing up a really good point about how it can be an extension to the in class academics. Is that right?

Ceylin Özgür Erzen

Oh, yes, that was what I was trying to say.

Faaizah Arshad

Yeah. And so, do you see any challenges that might make it hard to adopt XR in educational systems?

Ceylin Özgür Erzen

Well, there are indeed some challenges and maybe establishing the infrastructure and providing the equipment seem to be the most challenging parts for starters, at least to me. For an institution to use XR widely, there should be enough headsets, powerful computers for higher resolutions, and so on. And other VR accessorized for each person, so that we can work on the same material as a classroom or some research groups. So, it will be costly at first to provide this, as well as to upgrade and repair the equipment periodically. And also, we need more content and their development will also require time and money for institutions. Even if, let's say all of these are ready, they're all done, then educators must be trained to use them. And while they are already functioning learning methods at hand, institutions will be reluctant to incorporate a costly time consuming and relatively uncertain teaching style into the program. So, everyone needs to want this and cooperate because I haven't experienced it myself yet. But I think bureaucracy will be, can be a problem as we are introducing something new. And it will even take longer if you try to use it as a therapy method, then they will look for some other experiments, and phase two, phase three researchers and it will even take longer to introduce this and make all administer bodies to accept and be willing to use this technology. So, we all need to cooperate and be willing to work together to increase the use of XR from developers to administer bodies.

Faaizah Arshad

Right. Yeah, and especially, you know, if we want to use XR, and so many different topics are being taught in medical classrooms that you know, XR technologies, like you said, have to have all that content. And then on top of that, because it's so hands on and it's interactive, the providers and the teachers that are going to be using this to teach medicine or science or whatever topic they're teaching need to also be educated on how to provide that. So, I think it's a really interesting point and that hopefully, there will be more data that will be collected on this in the future and that when prices drop, and XR becomes more available to different institutions, then we'll see more widespread use of it for classroom education.

Ceylin Özgür Erzen

Of course.

Faaizah Arshad

I think one thing that comes to mind, though, is you know, we can personalize VR and all these immersive technologies and we can create individualized environments. Do you think though, that it'll be a challenge to address the wide range of learning disorders that exist like autism and memory challenges and attention deficits, and just like differences in students spatial abilities and their reasoning skills, especially across ages as well, from childhood to adolescent to when someone is maybe doing medical school, and they also want to use VR to learn? How do you think that VR developers should be working with psychiatrists or other providers to really address these wide ranges of learning disorders that different students have?

Ceylin Özgür Erzen

So being able to develop something that can address to the whole variety of learning preferences, it may seem impossible at the moment, because as the content covered by VR software is limited as we talked. So first, we need the primary material to build on like, let's say, there's enough content accumulated, that can replace the traditional education. So, we say we have enough content, we can now customize this. Even though if he can come to this level, once enough content has accumulated to teach the whole elementary, high school curriculum or medical school or any program taught at universities, I believe we can, and we should design games for different groups, different combined needs and personalize them further with the help of artificial intelligence. I think that's the only option to help us gain time and to reach everyone and offer solutions to everyone in a relatively shorter time. So again, with the powerful language models, and with the help of, of course, the professionals like psychiatrist, so we should be able to combine XR with powerful language models. And on the other hand, psychiatrists can provide the developers with the detailed information of what specific learning groups need depending on their mental structure. And we also know that we know very little about mechanisms of different mental conditions. But AI is also used in researches that are aimed to reveal the underlying mechanisms of these diseases. This will take some time, at least first few steps, but then I doubt it will be impossible because technology is also rapidly developing. I hope I will be able to tell more as I maybe as I'm involved in one of the studies.

Faaizah Arshad

Yeah, I think what you're bringing up is how it might seem like a very massive step in the short term. But in the long run, they're likely so many benefits if this can actually be implemented in a variety of disciplines, and if psychiatrists can help VR developers be involved in the ways that we can transform classroom education, and really make it effective for students to learn. 

Ceylin Özgür Erzen

Yes.

Faaizah Arshad

So, it seems you're really excited about the ways that XR can be used in education, and training and in medicine in the future. Can you elaborate on maybe what your vision is, in 20 years from now? Where do you think you'd want to see XR being used in psychiatry, and what do you think is the greatest challenge that we need to solve to get there?

Ceylin Özgür Erzen

So I think the interest in extended reality will increase even more and more as our generation and future generations complete their training in this field and more universities start relevant degree programs, and also the government supports startups and projects. As more 3D artists, software and hardware developers emerge, and medical students and practitioners realize that this tool has a feature, the sector will rise even more. And so, I hope that in 20 years, we will be able to go home after the whole day of lectures and clinical practice, access the university's XR library through our headsets and type in whatever subject we have a hard time comprehending. As the relevant game is loaded, we interact with the tissue, a laboratory or a patient. We will even have the opportunity to enter the same practice with our classmates. And we could even study at a shared lab with our lecture. So, the same technology can be applied to any sector starting from primary and elementary schools. As for medical education, I'm not sure if we can leave out the hands-on practice, hands-on classes by the side of patient, because in the end, we will need to experience how it feels in real. But still, XR will be a very strong tool because we can go to the practice prepared. We can study and review ourselves once our classes are done. And as for treatment options in psychiatry, again, it's our headsets or glasses, the glasses we use, may be used by patients with learning disorders to tailor the content they engage with based on their needs. Also, the virtual environments can also simulate real situations like it could be social interactions. You can walk in the forest, you can also find yourself on a plane, you can simulate anything. This way, it can also be incorporated into treating and managing various mental disorders such as phobias, or anxiety, depression, or even schizophrenia. And there are already many studies that are testing that. And, in 20 years, all of these studies will be proven and they will find their place and these technologies will become more common. They will be more accessible. So, at the end of 20 years, we can find ourselves in a clinic in which your doctor follows your progress through the data collected by the VR glasses. So, this will save us time, and the patients will get better results or we will realize sooner if something is wrong. So, we will change the treatment. And both education and struggling with the problems you have will be hopefully more fun and maybe easier. So, I imagine a world and a setting like this for the future.

Faaizah Arshad

Yeah, I think it'll change everyday life. And I absolutely agree. Like it's such an amazing emerging technology. And in the future, I hope that we can really implement it in all these different disciplines and in education and see the widespread use especially, and improvements for students as well. Is there anything else that you'd want to share with our listeners today? Any final thoughts?

Ceylin Özgür Erzen

First, I would like to thank you very much for inviting me, to be serious. And it is my first time as a speaker on the podcast and I haven't even done my psychiatry internship. So, what I have said so far are merely ideas of a student with an interest in immersive technology. So, I may not be able to reflect the exact needs and the best possible ways to use XR in the field of psychiatry. But regardless, it was lovely talking to you. And I hope our roads will cross with audience someday as we develop enjoyable games for young people from all education levels together.

Faaizah Arshad

Thank you so much, Ceylin! It's such a pleasure to talk to you and to hear your ideas. And I hope that we can also make this vision come true. And I can't wait to see how you use your expertise and what you learn and your passion for medical illustration and your interest in child and adolescent psychiatry. I can't wait to see how you use all of that to really make a change in the XR industry and in medicine. So thank you so much for joining us!

Ceylin Özgür Erzen

Thank you likewise.

Faaizah Arshad

That's it for this episode of Psychiatry XR. We hope you gained a new perspective on the use of extended reality in health care. And thank you all so much for listening. This episode was brought to you by Psychiatry XR, the psychiatry podcast about immersive technology and mental health. For more information about Psychiatry XR, visit our website at psychiatryxr.com. Be sure to subscribe to the podcast and tune in again next month to hear from another guest about XR’s use in psychiatric care. You can join us monthly on Apple podcasts, Twitter, Spotify, or wherever you get your podcast. Psychiatry XR was produced by Dr. Kim Bullock, Faaizah Arshad and Jessica Hagen. Please note that it's distinct from Dr. Bullock's clinical teaching and research roles at Stanford University. And the information provided is not medical advice and shouldn't be considered or taken as a replacement for medical advice. We credit and are very, very grateful to David Bell for audio editing and Austin Hagen for music production. See you all next time.