In the industry, designers will thankfully be creating levels in a similar environment to "engine editors". Building and adding to these engines is an immense programming effort; huge teams of talented programmers spend months and months in development before things look better than rudimentary cubes and spheres--slight exaggeration but you get the point. Obviously, designing good-looking 3D levels from scratch requires extensive programming (and often mathematical) familiarity--you have to have shadows, collision detection, and stuff which editors already include.
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