DSSH congress program 2016

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Medical Simulation

-Tough (T)issues in Medical Simulation8th Congress Dutch Society for Simulation in Healthcare 16th March 2016, Delft, the Netherlands

8th DSSH Congress, Medical Simulation ‘Tough (T)issues in Medical Simulation’ Dear colleagues and friends, The 8th Annual Congress of the Dutch Society for Simulation and Healthcare will take place at the Cultural Centre TU Delft, The Netherlands. Delft is a beautiful city with traditional architecture, canals and home to the world famous blue and white ceramics and the painter Johannes Vermeer who left his mark throughout Delft’s historic centre. Just out of the city, the Delft University of Technology was founded on 8 January 1842 by King William II of the Netherlands as a Royal Academy. The school rapidly expanded its research and education curriculum, becoming first a Polytechnic School in 1864 and finally changing its name to Delft University of Technology in 1986. Our conference venue, the Cultural Centre of TU Delft is located near the big TU Delft’s red tower and is easy to reach by car or public transport. As one of TU Delft’s four researched-based initiatives is the Delft Health Initiative focusing on developments in medical technology, makes a natural bridge to being this year’s host of the annual DSSH conference. This year’s theme of the conference is “Tough (t)issues in medical simulation” Simulation is used by almost every healthcare discipline and is included in most training programs. Unfortunately, a lot of (t)issues still remain to make it more widely accessible, cost-effective and mandatory in training and certifying healthcare workers. To address these (t)issues, we want to invite every professional involved in healthcare to present their research or innovative ideas, to network and to become actively involved: nurses, midwives, engineers, psychologists, designers, physicians, human factor managers, healthcare managers, insurances, government and the industry. The congress is in Dutch, all presentations and workshops will be supported by English language slides but some international presenters may present in English.

The exhibition hall will also allow attendees to interact with developers, the industry and others. Finally, we are planning some site visits to different types of simulators developed at TU Delft. So, are you actively involved in creating new tissues or tools to simulate the human body? Do you evaluate the impact of fidelity of simulators or serious games on training, skills acquisition and patient outcomes? What about issues such as team performances, curriculum design, quality outcomes, costs and implementation of simulation or gaming in daily training programs? Do you train, assess or debrief using any type of simulation or games? Are you active in E-health? Then, do not miss the DSSH congress in Delft, March 16th 2016. We hope to meet you soon in Delft and increase our network! Gabrielle Tuijthof, PhD, congress president Isabelle Van Herzeele, MD, PhD, president DSSH

DSSH Board President I. (Isabelle) Van Herzeele, MD PhD Vascular Surgeon | Ghent University Hospital, Ghent, Belgium Isabelle.vanherzeele@ugent.be Vice President R. (Ralf) Krage, MD PhD Anesthesiologist | Free University Medical Center Amsterdam, the Netherlands r.krage@vumc.nl Treasurer H.W.R. (Henk) Schreuder, MD PhD Gynecologist | Universitary Medical Center Utrecht, the Netherlands hwrschreuder@hetnet.nl Secretary C. (Carla) de Jong Secretary of Board St. Anna Hospital | Geldrop, the Netherlands secretariaat@dssh.nl Board Members A.M. (Alma) Schaafstal, PhD Senior Lecturer Serious Gaming | Windesheim University of Applied Sciences the Netherlands alma.schaafstal@gmail.com J.M. (Joya) Smit, MSc Lecturer and Researcher Research Group Nursing Diagnostics School of Nursing Hanze University of Applied Sciences, Groningen, the Netherlands Joya1@hetnet.nl L.E. (Ludmilla) Garmers, MD Anesthesiologist | Medical Center Alkmaar, the Netherlands l.e.garmers@mca.nl G.J.M. (GabriĂŤlle) Tuijthof, PhD Faculty 3ME, dept. of BioMechanical Engineering | Delft University, the Netherlands g.j.m.tuijthof@tudelft.nl L. (Lex) van Loon Teacher Technical healthcare, University Twente, PhD candidate, Radboud University Mecical Center l.m.vanloon@utwente.nl Board Member - Manager Social Media E.Z. (Esther) Barsom, B.Sc. Medical Student | Academic Medical Center Amsterdam, the Netherlands e.z.barsom@amc.nl

DSSH The Dutch Society for Simulation in Healthcare The Dutch Society for Simulation in Healthcare - DSSH- was founded in June 2007; and aims to: Support the development and implementation of Simulation and ‘Serious Gaming’ in Healthcare; and improve evidence-based education, team training, quality in healthcare and ultimately patient safety. The Society aims to achieve this goal by: • Facilitating, exchanging and improving the use of simulation technology and its appropriate application in Belgium and the Netherlands and with the affiliated foreign Societies (networking function); • Development and promotion of standards for evidence-based simulation training in healthcare and its associated research trough the Society’s Commission activities, newsletters and annual Congress; • Supporting a global Dutch network for, by and trough all professionals involved with Simulation and ‘Serious Gaming’ in Healthcare.

To accomplish this goal, the DSSH has a number of committees: Committee on Accreditation and Standardization: To promote and facilitate (inter-) disciplinary standards for accreditation, standardization and certification for professionals in Healthcare. To stimulate scientific activities and establish collaboration between various professionals and professions involved in accreditation and standardization for medical simulation. Chair: a.i. Mw. M. (Joya) Smit, MSc; j.m.smit@pl.hanze.nl Committee on Serious Gaming: To promote and facilitate initiatives contributing to the development and implementation of ‘Serious Gaming’ in Healthcare by facilitating collaboration between soft- and hardware developers, game designers, ICT professionals and medical professionals in daily healthcare. Chair: Dr. A. (Alma) Schaafstal; alma.schaafstal@gmail.com Committee on Education: To promote and facilitate the quality of medical teaching and -education within the DSSH, and to offer a platform for educational activities and improve the collaboration between various professionals and professions involved in educational activities including any type of medical simulation. Chair: Mr. drs. L.E. (Ludmilla) Garmers; l.e.garmers@mca.nl Committee on Scientific Research: To promote and facilitate research activities within DSSH. To establish a network between various professionals and professions active in research focusing on the use and implementation of medical simulation in daily practice. Chair: Dr. ir. G.J.M. (Gabrielle) Tuijthof; g.j.m.tuijthof@tudelft.nl

Quality Label for Serious Games Last year, the DSSH introduced the Quality Label for Serious Games to bridge the gap between game developers and medical practitioners internationally. Everyone is welcome to submit his or her serious game via the DSSH Website. Further information about the Quality Label is available in: Graafland M, Dankbaar M, Mert A, Lagro J, De WitZuurendonk L, Schuit S, Schaafstal A, Schijven M. How to Systematically Assess Serious Games Applied to Health Care. JMIR Serious Games 2014;2(2):e11 DOI: 10.2196/games.3825 The DSSH welcomes and encourages new input! Not only physicians or medical students but all healthcare professionals (e.g. nurse practitioners, physician assistants, obstetricians, anesthesiology assistants and OR assistants‌) are cordially and actively invited to join and participate within our Society. We are also looking for motivated soft- and hardware developers, game designers, ICT professionals who would like to work in close collaboration with medical professionals. Are you interested to join the activities of one of these Committees? Please send an email to the DSSH board via secretariaat@dssh.nl Twitter: @dutchsimulation

Program Wednesday March 16th 2016 The conference program consists of a main program which takes place in the ‘Theaterzaal’. During some main sessions, a parallel program is available consisting of workshops or tours to simulators on the TU Delft campus. These parallel sessions can be found after the main program. Notice that you need to sign up to participate. 08.30-09.00 Entry Hall

Registration & coffee

09.00-09.10 Theaterzaal

Congress opening – Gabriëlle Tuijthof, Congress president Welcome in Delft – Prof. Theun Baller, TU Delft

Main sessions in the Theaterzaal 09.10-09.25 Theaterzaal 09.25-09.35 Theaterzaal

Moderators Jan Maarten Luursema & Henk Schreuder “Anaesthetic needle insertion simulation” Dennis van Gerwen, TU Delft

09.35-09.45 Theaterzaal

Nursing student’s perception of the educational efficiency of two strategies of education: Problem Based Learning and the High-Fidelity Simulation Véronique Gerard (Paramedical Department Henallux)

09.45-09.55 Theaterzaal

E-Learning for Surgical Training: A Systematic Review Heidi Maertens, Ghent University Hospital

09.55-10.05 Theaterzaal

A new 3-dimensional method to automatically analyze the deformed human face Marinka Hol, Academic Medical Centre

10.05-10.15 Theaterzaal

Training Basic Laparoscopic Surgical Skills: Face- and Content Validity of the Nintendo Wii-U™ Laparoscopic Simulator Evelien Overtoom, UMC Utrecht

Development and evaluation of the Taxonomy of Trauma Leadership Skills (TTLS) as an assessment tool for leadership performance Nico Leenstra, UMC Groningen

10.15-10.25 Theaterzaal

Transfer validity of arthroscopic skills from simulated training: a pilot study Jonah Stunt, Academic Medical Centre

10.25-10.30 Theaterzaal

Moderator Willem Brinkman Company pitches

10.30-11.00 Entry Hall

Coffee break, time to visit Expo and posters

11.00-11.45 Theaterzaal

Moderator Ralf Krage Keynote “Effective implementation of different simulation modalities” Prof. Antoine Tesniere, Paris Descartes University, Paris, France

11.45-12.45 Theaterzaal

Moderators Alma Schaafstal & Esther Barsom Ceremony Quality Label Serious Games

12.45-14.00 Entry Hall

Lunch, time to visit Expo and posters

13.30-14.00 Theaterzaal

General Assembly DSSH Henk Schreuder & Isabelle Van Herzeele

14.00-14.30 Theaterzaal

Moderator Gabriëlle Tuijthof Keynote “Tough tissues in arthroscopic simulation” Prof. Mustafa Karahan, Acibadem University, Istanbul, Turkey

14.30-14.40 Theaterzaal

Moderators Ludmilla Garmers & Lex van Loon ReValidate! Development and validation of a serious game for wrist rehabilitation Riëtte Meijer, Academic Medical Centre

14.40-14.50 Theaterzaal

Improving ABC training in the nicu using novel neonatal manikin design Mark Thielen, TU Eindhoven

14.50-15.00 Theaterzaal

Ultrasound in the curriculum of technical medicine: combining theory, simulator training and hands-on skills Anique Bellos-Grob, University Twente

Program Wednesday March 16th 2016 15.00-15.10 Theaterzaal

Onaangekondigde multispecialisme acute trauma simulatie training Raymond van den Broek, Radboud UMC

15.10-15.20 Theaterzaal

Training high-precision dental procedures with virtual reality simulation and 3d feedback Dirk Bakker, Academisch Centrum Tandheelkunde Amsterdam

15.20-15.30 Theaterzaal

E-simulatie klinisch redeneren: oefenen voor de klinische praktijk Fiona Slond, UMC Utrecht

15.30-15.45 Entry Hall

Coffee break, time to visit Expo and posters

15.45-16.50 Theaterzaal

Moderators: Joya Smit, Ralf Krage & Peter van der Heijden Special session ‘Though Steps in Teamwork Training’ Fidelity level of simulated environment during team training Micha Erwteman, VUMC HartslagNU Anton van Veldhuijzen, Veiligheidsregio Gelderland-Zuid Evaluation of HartslagNU Ruud Koster, Veiligheidsregio Gelderland-Zuid Translation of HartslagNU into training programs Peter van der Heijden, Veiligheidsregio Gelderland-Zuid

16.50-17.00 Theaterzaal

Award session and closing remarks Congress president Gabriëlle Tuijthof and president DSSH Isabelle van Herzeele

17.00-18.00 Entry hall

Drinks en visiting expo

Workshops in Balletzaal Workshop 1 (p.16) 09.25-10.25 Blind debriefing Balletzaal Peter Bennik, Medical Training & Simulation. Max 20 persons. Workshop 2 (p.17) 11.45-12.45 Creation of training scenarios (tips & tricks) Balletzaal Ralf Krage, Ludmilla Garmers & Ada van den Bos-Boon. Max 20 persons. Workshop 3 (p.18) 14.30-15.30 How to choose a game or a sim Balletzaal Evert Hoogendoorn, IJsfontein. Max 10 persons. Parallel session different locations There are 3 chances to visit the TU Delft simulators. Max 10 persons per Demo. 09.10-10.30

TU Delft Simulators Demo 1 Haptic master Tricia Gibo Proprio Winfred Mugge


TU Delft Simulators Demo 2 Simulator for NOTES training Ewout van Arkenbout Needle steering simulator Teun Hoevenaars & Jeroen Wilderbeest


TU Delft Simulators Demo 3 Epidural Needle simulator Dennis van Gerwen PASSPORT en ForceSence Tim Horeman & Willem Nerkens

Registration for the workshops and TU Delft Demo’s will only be possible on site. First come, first serve!

Keynote Speakers Tesniere (Antoine) Pr Tesniere, MD, PhD, is specialized in Anesthesiology and Intensive care, and has a full time position at Cochin Hospital, APHP, Paris. He is also the Director of iLumens simulation center, Université Paris Descartes, and vice director of the Doctoral School « Frontiers in life sciences », Center for Interdisciplinary Research, Université Paris Descartes. He holds an MD, obtained in 2007 from Université Paris Descartes, and a Phd, obtained in 2009 from Université Paris Sud. He is also Dean for medical education at Université Paris Descartes Medical School, is working as special advisor for simulation in healthcare for Health Institution (Haute Autorité de Santé), and is the current President of the European Society for Simulation in Healthcare SESAM, and the current secretary for the French society for simulation in Healthcare (SoFraSims). Antoine Tesniere is the co founder of iLumens, an innovative Simulation Department that develops new training and research programs using all simulation modalities, and virtual environments (serious games), for every healthcare professionals. Through all these activities, Antoine Tesniere has developed a renowned expertise in the field of new technologies for information and communication, and of new approaches around learning and teaching, especially for healthcare professionals. Karahan (Mustafa) Professor Mustafa Karahan is an internationally active Orthopedic Surgeon working mainly on Sports Traumatology, Knee Surgery, Shoulder Surgery and Arthroscopy. He is currently Adjunct Professor of Orthopedics in Acibadem University, Istanbul where he is actively involved in CASE (Center for Advance Simulation and Training) After his graduation from Hacettepe University in Ankara, Dr. Karahan completed his residency in Marmara University in Istanbul, Turkey. He worked in Marmara University from 1988 to 2012 until achieving full Professorship of Orthopedics. He has founded Marmara University Sports Sciences and Health Research Center in Istanbul in 2004. He implemented a teaching method on Arthroscopic Surgery on bovine knee. Currently, the center is working mainly on Sports Prevention and Return to Sports issues. Dr. Karahan is an Executive Board Member of ESSKA and is the Editor of ESSKA Academy, the online teaching portal of ESSKA. He is the vice Chair of the Publication Committee of ISAKOS.

Invited Speakers He has published more than 70 scientific articles in peer-reviewed journals, has over 150 scientific presentations. He has authored in book chapters led by “Effective Training of Arthroscopic Skills”. He is an Editorial Board Member of American Journal of Sports Medicine (AJSM), Journal of Arthroscopy and KSSTA. Van Gerwen (Dennis) Dennis van Gerwen received the M.Sc. degree in aerospace engineering, and the Ph.D. degree, focusing on experimental methods for the study of needletissue interaction mechanics, from Delft University of Technology in the Netherlands. He is currently a postdoc at the department of Biomechanical Engineering in Delft, working on the measurement of blood flow using laser speckle techniques. He has been involved in the development of the Delft Epidural Needle Simulator and related research since 2009.


Orzone provides advanced simulation technology to support and facilitate clinical training and assessment world-wide.




Examples of ORCAMP procedures: • • • •

Endovascular (EVAR, TAVI, Stroke, etc.) Team training MIS (Hysterectomy, Nephrectomy, etc.) Orthopedics (Hip, Spinal, Trauma, etc.) Emergency Medicine (Hemodynamics, CPR, Intubation, etc.)


Invited Speakers Horeman (Tim) In 2005, Tim received his MSc degree in Biomedical engineering from the Delft University of Technology with a specialization in BioMechatronics and minimally invasive surgery and medical safety in 2008. Tim did his PhD research in the Minimally Invasive Surgery and Interventional Technology (MISIT) group of the department of Biomechanical Engineering of the TUDelft and Gynaecology department of the Leiden medical Centre. During his PhD research he developed novel training systems equipped with force and motion tracking systems that provide feedback to the user. In May 2014, Tim started as project leader on the Steerable Punch project, a collaboration between universities, international and national operating manufacturers. Erwteman (Micha) Ik ben geboren en opgegroeid in Amsterdam. Het VWO volgde ik aan het Maimonides lyceum. Na een jaar in Israël te hebben gewoond begon ik in 1997 aan de studie geneeskunde aan de Vrije Universiteit waarna ik in 2005 startte met mijn opleiding tot anesthesioloog in het VU Medisch Centrum waar ik sinds 2010 werk als staflid. Sinds 2008 ben ik actief betrokken bij het simulatieonderwijs in het VUMC, zowel voor de eigen afdeling als voor trainingen voor de rest van de specialismen. Buiten het werk in het ziekenhuis heb ik een grote passie voor muziek, zowel actief als passief en houd ik van sport. Van Veldhuijzen (Anton) - Directeur bestuurder HartslagNu (Stichting Hartslag voor Nederland) - Docent Instructeur Nederlandse Reanimatie Raad - Lokaal Opleidings Coordinator Veiligheidsregio Gelderland Zuid - Docent/instructeur Veiligheidsregio Gelderland Zuid - Ambulance verpleegkundige en Rapid Responder Veiligheidsregio Gelderland Zuid - Spreker op DSSH congres 2014 met als onderwerp “Ketentraining”

Van der Heijden (Peter) Master advanced Nurse practitioner at the regional ambulance services Gelderland-South. After working as a anesthesiology nurse in the hospital, he made a switch over to the ambulance emergency services and helicopter emergency services in the Netherlands. Peter van der Heijden also practices in the field of pré-hospital care and cure as a ambulance rapid responder. One of his professional competence and tasks is to organize and support innovative and targeted educational multidisciplinary training at a regional level. This multidisciplinary chain training within the EMS Gelderland South involves firefighters, police, midwives, ER doctors and nurses and general home doctors. Innovation in hands-on training, interactive blended learning are key concepts in the teaching programs of the emergency services in Gelderland-south.

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Workshops Blind debriefing P. Bennik, M. Kuiters, M. Schouten, R. Brendel METS Center Content: Voor deze actieve workshop worden 1-2 facilitators en 4 rolspelers (het team) uit het publiek gevraagd. Na uitleg gaan de facilitators het lokaal uit. Het team wordt ingedeeld in de verschillende disciplines en rollen. Er wordt een video vertoond van een scenario. Het team kan zich daarbij inleven in hun rol. De debriefing start zodra de facilitators terug zijn. De workshop wordt afgesloten met een debriefing van de debriefing. Tijdsindeling 10 minuten 5 minuten 20 minuten 15 minuten 10 minuten

introductie en uitleg workshop vertonen scenario op video debriefing debriefing van de debriefing afsluiting en gelegenheid tot vragen stellen.

Learning goal(s): “How to get the picture clear”. In deze workshop wordt een appèl gedaan op de luistervaardigheid van de facilitators. Door het ontbreken van het visuele deel, is de facilitator afhankelijk van de output van het team. Hier ligt de uitdaging voor de facilitators. Het beeld van de situatie wordt duidelijk, door middel van het stellen van vragen en actief luisteren krijgt men het plaatje duidelijk. Deze auditieve werkvorm ondersteunt het niet hebben van een agenda als debriefer en kan daarmee de instructeur helpen bij zijn rol als facilitator. Target audience: Enige ervaring met debriefing/nabespreking van simulatiescenario’s is wenselijk. Interaction: De overige deelnemers van de workshop zien het scenario en de debriefing. Zij kunnen de facilitators volgen die zich een beeld moeten vormen van de situatie en hoe zij de debriefing vormgeven. Tevens kunnen zij direct de reactive zien van het team op de gestelde vragen. Tijdens de debriefing van de debriefing zal hun observatie een onderdeel van het gesprek zijn. Daarbij wordt vanzelfsprekend rekening gehouden met de veilige leeromgeving van de facilitators en rolspelers. Ruimte voor minimaal 20 personen.

Scenario design – the importance of the learning goals R. Krage1, L. Garmers2 VU University Medical Center, Amsterdam, the Netherlands 2 Medical Center Alkmaar, Alkmaar, the Netherlands


Content: Simulation-based education has become very popular over the last years. Although it is quite ‘chic’ to use simulation in various circumstances and for various target groups there is still the debate on ‘what should we simulate’ and more importantly ‘how should we simulate’. This workshop will focus on Scenario Design. How can we translate a ‘clinical need’ into an effective ‘simulation-based learning experience’. The workshop will start with a short introduction presentation. Subsequently the learners will be asked to design their own scenario based on a ‘clinical need’ and specific learning goals that have been given to them from the faculty. Learning goal(s): At the end of the workshop 1. The learner will realize about the importance of creating specific learning goals for each simulation-based scenario 2. The learner will have designed a scenario based on a clinical need Target audience: Healthcare Professionals interested in Simulation-based Education (mannekin-based, SP-based). Interaction: The workshop will be highly interactive. Number of participants: Max 20 persons.

Workshops How to choose a game or a sim. E. Hoogendoorn Strategist and Gamedesigner, IJsfontein, the Netherlands. Content: It is said that every game is a simulation, although most games don’t simulate reality very accurately. In entertainment games the simulation gives the player a very clear idea of the situation at hand, but further it is completely tuned towards the players’ experience. In other words: things that are very hard in real life, like driving a formula 1 car or martial arts are made suitable for “pick up and play” use. In the medical domain a simulation means a specific kind of training that is aimed at learning in a situation that is as close to the real thing; things are as hard and as complicated as in real life. To make a complex and accurate simulation of real life is very hard (real life does not fit well in a computer) and therefor expensive. So to make a good SIM worth it, you should ask yourself if the learning aims actually need this level of complexity. Because this same complexity can also get in the way of the actual intended learnings of the student. Therefore in some cases it is better to simplify the simulation and design more towards the experience of the player and the learning goals of the course. Learning goal(s): As a gamestudio with experience in making both simulations (abcdeSIM) and games (Delirium Experience) for training medical personnel, we have developed a Playful learning Canvas for clarifying this process and making the right choices early on in the process of developing a digital training app. In this hands-on workshop you will learn how to effectively use a Playful Learning Canvas as a starting point to create a game. Target audience: Health care professionals interested in developing a serious game. Number of participants: Maximum of 10 persons.

Abstracts Development and evaluation of the taxonomy of trauma leadership skills (ttls) as an assessment tool for leadership performance. N.F. Leenstra1, O.C. Jung2, A. Johnson3, J.E. Tulleken4 1 Department of Traumatology, University of Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands. 2 Department of Anesthesiology, University of Groningen, UMCG, Groningen, the Netherlands. 3 Department of Psychology, University of Groningen, Groningen, the Netherlands. 4 Department of Critical Care, University of Groningen, UMCG, Groningen, the Netherlands. Introduction: Leadership is a critical non-technical skill in acute trauma care. Targeted training and feedback is necessary to achieve team leaders’ optimal proficiency at leading the team. However, for trauma care only global teamwork assessment tools are available, which offer a too limited set of items on leadership performance to facilitate in-depth evaluations during training and post-event debriefings. In this study-in-progress we aim to address this gap by developing an assessment tool for trauma team leaders’ non-technical performance across 3 phases of trauma care (ie, team briefing, patient handover and actual patient handling) and to evaluate its inter-rater reliability. Methods: An initial draft of the tool was developed based on the skill elements as previously identified in our Taxonomy of Trauma Leadership Skills (TTLS). After three rounds of pilottesting by two surgeons, one anesthetist and three CRM medical team instructors, a final version was achieved. This version is currently being evaluated for the inter-rater reliability with which skill elements are recognized (Cohen’s Kappa), as well as with which skills are being rated (intra-class correlations: ICC’s) using videotaped, simulated trauma scenarios. Results: Preliminary analysis of raters’ recognition of skill elements shows an average reliability between rater pairs of 1.00 (Cohen’s Kappa) for skill elements for the team briefing and .92 for the handover, which is considered very good on a scale from poor (<.20) to very good (.81-1.00). Good inter-rater reliability is found for skill elements of the patient handling phase (k=.63). Data collection for the reliability of ratings on the skill elements is scheduled. Conclusion: Preliminary analysis shows that raters can observe and identify leadership skill elements with good to very good inter-rater reliability. With this study, we address a need of valid tools that facilitate in-depth evaluations of the trauma team leaders’ non-technical skills. Further data collection is scheduled.

Abstracts Nursing student’s perception of the educational efficiency between two strategies of education: problem based learning and the high-fidelity simulation. J.C. Servotte1, L. van Simoneau², M. Guillaume3, V. Gérard4 1 Paramedical Department Henallux, Belgium. ²Cegep Sherbrooke, Canada. 3 Public Health Université de Liège, Liège, Belgium. 4 Emergency Department CHU UCL, Namur, Belgium. Introduction: The teaching’s evolution in nursing education has to answer the challenge to stimulate the student’s skills development. According to literature review, it’s necessary to compare Hig h-FidelitySimulation (HFS) with other pedagogical methods. Furthermore, the comparison with Problem Based Learning (PBL) was not studied yet. Methods: Two indicators were evaluated: student satisfaction self-confidence. For this, two validated scales were used: Student Satisfaction Learning Scale and Self-Confidence in Learning Using Simulations Scale. 141 nursing’s students were involved in the study. They were exposed to the two pedagogical methods (PBL and HFS). The experience was organized according a complete cross plan. Results: The results demonstrated a higher level of the student’s confidence and the student’s satisfaction in learning for the HFS compare to PBL. Carry-over effects were study. It was concerning the teaching style (questions 3 and 5) as well as the varieties of educational tools (questions 2 and 4). The perception of the value of the PBL during the second period was systematically lower while the score obtained for the HFS for the two periods remains almost identical. Conclusion: A clear superiority of the HFS compared with the PBL is perceived by the students. This result seems to open new opportunities with the HFS method in the education nursing student. Nevertheless, research must be conducted in order to better understand the value of this new pedagogic approach.

E-Learning for Surgical Training: A Systematic Review. H. Maertens1, A. Madani2, T. Landry3, F. Vermassen1, I. Van Herzeele1, R.Aggarwal2,4 1 Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium 2 Department of Surgery, McGill University, Montreal, Canada 3 Montreal General Hospital Medical Library, McGill University Health Centre, Montreal, Canada 4 Arnold &Blema Steinberg Medical Simulation Centre, Faculty of Medicine, McGill University, Montreal, Canada Introduction This study aimed to evaluate the effectiveness of e-learning as a teaching tool compared to no intervention and other methods of surgical training. Internet and software-based platforms (e-learning) have gained popularity as teaching tools in medical education. However, despite their abundance and widespread use, there is limited evidence to support their effectiveness for surgical training. Method A systematic literature search of bibliographic databases (MEDLINE, EMBASE, BIOSISPreviews, ERIC, The Cochrane Library, PubMed, Web of Science and Scopus), conference proceedings and grey literature was performed up to August 2015. Studies were included if they were randomized-controlled trials assessing the effectiveness of an e-learning platform for teaching any surgical skill, compared to no intervention or another method of training. Results From 4704 studies screened, 87 were included with 7871 participants enrolled, comprising of medical students (52 studies), residents and fellows (51 studies), attending physicians (2 studies), and nurses (6 studies). E-learning tools were used for teaching cognitive (71 studies), psychomotor (36 studies), and non-technical skills (8studies). Tool features included multimedia (84 studies), interactive learning (57studies), feedback (27 studies), assessment (26 studies), virtual patients (22 studies), virtual reality environment (11 studies), spaced education (7 studies), community discussions (2 studies), and gaming (2 studies). Overall, e-learning showed either greater or similar effectiveness compared to no intervention (29 and 4 studies, respectively), or compared to non-e-learning interventions (29 and 22 studies, respectively). Discussion/Conclusion Despite significant heterogeneity amongst platforms, e-learning is at least as effective as other methods of training and can be a powerful tool for surgical curricula. Nevertheless, the effectiveness of this technology remains contingent on adherence to best practices in education.

Abstracts A new 3-dimensional method to automatically analyze the deformed human face. M.L.F. Hol¹, J.W. Meulstee², T.J.J. Maal², A.G. Becking¹, L.E. Smeele¹ ¹Department of Oral- and Maxillofacial Surgery, Amsterdam Medical Centre, Amsterdam, the Netherlands 2 3D lab, Department of Oral- and Maxillofacial Surgery, Radboud UMC, Nijmegen, the Netherlands Introduction: Surgery and radiation for childhood cancer are known to result in severe deformities in later life. The aim of this study was to develop a method to accurately and objectively measure facial deformities. Method: A three-dimensional (3D) stereophotograph of a patient’s face was compared to a reference face. This reference was composed of 80 3D stereophotographs of healthy individuals matched for racial background, sex and age. An algorithm was designed in MATLAB to automatically segment the reference face into 33 facial aesthetic units. The reference face underwent a non-rigid transformation to automatically subdivide the 3D stereophotograph of the patient into the same facial aesthetic units. As an example one patient was analysed, she suffered from a rhabdomyosarcoma at the age of 9 months and was treated with surgery and external beam radiotherapy. Results: For each specific aesthetic unit of the face an analysis of the amount of facial deformity compared to the average face can now be calculated and within each patient symmetry can be evaluated. In the patient the deformation of the radiated(left) and nonradiated side(right) of the orbit, zygomatic area, chin and forehead were 2.7cm/1.9cm, 1.9cm/1.2cm, 7.2cm/ 5.9cm and 0.4cm/0.4 cm respectively. Discussion/Conclusion: The radiated side, as expected, shows more deformations. But, the non-radiated side is not average as well. Therefore, the conventional left-right comparisons within the patient him/herself are not accurate for the evaluation of growth disruption. This new method is, after a validation study, highly valuable in order to analyse facial deformities caused by different surgical and/or radiotherapy treatments.

Nederlandse Vereniging voor Medisch Onderwijs: Word Lid! De NVMO is met meer dan 1300 leden de grootste vereniging voor alle betrokkenen in het onderwijs in de gezondheidszorg in Nederland. Actief in de artsopleiding, de medisch-specialistische opleiding, de diergeneeskundige opleiding, en andere opleidingen in de gezondheidszorg. Het jaarlijkse congres in november wordt zeer goed bezocht door docenten en studenten. Het tijdschrift van de vereniging “Perspectives on Medical Education” is een on line tijdschrift en verschijnt vijf- tot zesmaal per jaar. De vereniging heeft 14 landelijke werkgroepen, van Professioneel Gedrag tot Skills & Simulatie, van E-learning tot Docentprofessionalisering. De NVMO stimuleert onderzoek en ontwikkeling van onderwijs in de gezondheidszorg, ondersteunt promovendi op dit gebied met een jaarlijks symposium en verzorgt ethische toetsing van onderwijsonderzoek. De NVMO nodigt studenten en docenten en of zij die dat willen worden van harte uit lid te worden. De kosten zijn € 85,- per jaar (studenten € 30,-) en geeft korting op het jaarlijkse congres én op het congres van de Association for Medical Education in Europe, uitnodigingen voor landelijke werkgroepbijeenkomsten en voor al een stimulerend netwerk van contacten met andere onderwijs-geïnteresseerden uit Nederland en Vlaanderen. Heb je interesse voor onderwijs in de gezondheidszorg? Meld je aan bij de secretariaat@nvmo.nl of bekijk de website www.NVMO.nl

Abstracts Training Basic Laparoscopic Surgical Skills: Face- and Content Validity of the Nintendo Wii-U™ Laparoscopic Simulator. Evelien M. Overtoom1, Frank-Willem Jansen2, Evert van Santbrink EJP3, Steven E. Schraffordt4, Sebastiaan Veersema1, Henk W.R. Schreuder1 1 Department of Gynaecology and Reproductive Medicine and UMC Utrecht Cancer Center, Division of Surgical Oncology, Department of Gynaecologic Oncology, University Medical Center Utrecht, Utrecht, the Netherlands 2 Department of Gynaecology, Leiden University Medical Center, Leiden, the Netherlands 3 Department of Obstetrics & Gynaecology, Reinier de Graaf Gasthuis, Delft, the Netherlands 4 Department of Obstetrics & Gynaecology, Meander Medical Center, Amersfoort, the Netherlands Introduction: Simulators have become important training tools for teaching laparoscopic skills. Residents are required to practice regularly on simulators to improve or maintain their skills. This has been reported challenging. Serious games might be valuable to overcome this problem. The primary goal of these games is to teach a specific skill, while entertaining the user. A serious game called ‘Underground’ has been designed for the Nintendo Wii UTM platform. This game is individually played and is set in a cave. Specially designed laparoscopic tool shells in which the Wii controllers are inserted are used to control the video game. The virtual laparoscopic instruments can be used to create a path through the cave by for example building roads and removing obstacles. The objective of this study is to evaluate face and content validity. We assess the response to this serious game of OBGYN residents and consulting gynaecologists. The realism of the game and movements in the game are compared with actual laparoscopic surgery (face validity) while the participants’ opinion of the didactic value of the game for learning laparoscopic skills is also investigated (content validity). Method: OBGYN residents PGY 1-6 and consulting gynaecologists (n=63) from several European countries were included in this study. The subjects were divided into two groups: beginner (n=38) and experienced (n=25) based on their laparoscopic experience. Participants received a standardized introduction and completed level 3 and 4 of the game ‘Underground’. Afterwards, they filled out a questionnaire concerning demographics and their opinion on the realism, usefulness, suitability, haptic feedback and home training-use of the game. The answers to the questionnaire were assessed and compared using SPSS. Results:The realism of different aspects of the game received mean scores around three on a 5-point Likert scale. The hand-eye coordination was regarded most useful for training with a mean of 3.89 (0.92SD) and the game was considered most suitable for residents in the first part of their post-graduate training with a mean of 3.69 (0.99SD). Beginners and experienced

differed significantly in their opinion of three statements, two of which concerned the usefulness of the game as a training tool. Discussion/Conclusion: The potential value of serious games is to be used complementary to VR and box trainers and diversify current training options. The game setting is thought to enthuse residents to train their basic laparoscopic skills on a regular basis as well as at home. This study demonstrates good face validity and shows that the game has potential didactic value, especially for gynaecological residents at the beginning of their post-graduate training and particularly in teaching hand-eye coordination. However, the game does require some major improvements before it can be incorporated in training curricula. Enhancement of the accuracy and sensibility of the game as well as the incorporation of a scoring system for example are necessary improvements. With an improved version of the game it would be interesting to assess the development of laparoscopic skills after training with this serious game compared to training on a VR or box trainer.

Abstracts Transfer validity of arthroscopic skills from simulated training: a pilot study. J.J. Stunt1, G.M.M.J. Kerkhoffs1, T.M.J. Pahlplatz1, M.M. Maas1, G. J. M. Tuijthof1,2 1 Orthopedic Research Center Amsterdam, Academic Medical Centre, the Netherlands 2 Department of Biomechanical Engineering, Faculty of Mechanical, Materials and Maritime Engineering, Delft University of Technology, Delft, the Netherlands Introduction: Simulators have become more important in the education of orthopaedic residents, as a consequence of reductions in the training time and increasing demands for patient safety and quality control. Although the feasibility, face -and construct validity of simulators have been evaluated, transfer validity is key to proof that simulator technology has progressed to the level that they truly contribute to acquire proficiency in arthroscopic skills. The aim of this randomized controlled pilot study is to investigate the effects of simulator training, and to evaluate the study design and investigate the feasibility of the used methods and procedures for later use in a large multi-center transfer validity study. Method: A randomized controlled trial was conducted in the Academic Medical Centre in Amsterdam. Thirty-one medical students were randomly classified to the investigational Group A or the control Group B. All subjects received three one-hour sessions, for three consecutive weeks. Group A was given training on three different arthroscopic knee simulators. Group B was exposed to theoretical and attended a life knee arthroscopy. Both groups performed a knowledge quiz and an arthroscopic skill proficiency test on a cadaver knee to evaluate the transfer validity of simulator training. Outcome measures were quiz-scores, ASSET scores and navigation time. Results: Preliminary results show that there is a trend towards improved knowledge and performance by the simulator-trained group, compared to the conventionally-trained group. Quiz scores, ASSET scores and navigation scores are higher for the simulator group (52 vs 45, 13 vs 12, 7 vs 6 respectively (n.s.)). Discussion/Conclusion: The results provide preliminary evidence for the effectiveness and presence of transfer validity of knee simulator training for training arthroscopic skills. Evaluation of the design indicates that it is necessary to conduct transfer validity study on a larger scale to further investigate important trends and associations.

ReValidate! Development and validation of a serious game for wrist rehabilitation. H.A.W. Meijer1, M. Graafland2, J.C. Goslings1, M.P. Schijven1 1 Academic Medical Center, Amsterdam, the Netherlands 2 Flevoziekenhuis, Almere, the Netherlands Context: Wrist injuries are common in emergency departments, with 50,000 – 60,000 patients per year suffering a wrist fracture in the Netherlands. These injuries lead to a large personal, societal and financial burden. There is no standardized protocol for wrist rehabilitation, moreover, only 35% of exercises in a physiotherapy regimen are executed as prescribed. Goal: The goal of this study is to develop a serious game for wrist rehabilitation. The serious game is controlled by a wearable motion sensor in combination with the patients’ own smartphone, using movements of the wrist as a controller for the game. We hypothesize that by making exercises more fun and providing patients with an extra motivation, treatment outcomes will improve and duration of recovery will decrease. Target Users: The focus of our study is on patients recovering from a distal radius fracture. The game will primarily be tested in both conservatively and operatively treated patients, but can in the future also be used for other wrist injuries or conditions such as rheumatoid arthritis. Description: The game uses smartphones as a platform and will contain different levels that the patient can achieve as recovery progresses. We hereby aim to make rehabilitation easily accessible and more fun, leading to higher motivation and better adherence in patients. The game will be able to give patients extra support during the exercises, but will also send them reminders of their exercise sessions. Evaluation: During development the game will be validated by a team of experts including trauma- and hand surgeons, physiotherapists and game designers. The effects of the game on range of motion and duration of recovery will be tested in a randomized controlled trial.

Abstracts Improving abc training in the nicu using novel neonatal manikin design. M. Thielen IMPULS program, Designed Intelligence group, Eindhoven University of Technology, the Netherlands Context: Our main research goal is to increase the quality of ABC skill training in the NICU. By improving the tactile realism of our new manikin design, which is being developed, we hope to improve the suspension of disbelief during training sessions. Next to this, internal monitoring of our new manikin design is expected to benefit the debriefing stage of training. Goal: The goal of the new manikin design is to improve the physical learning space of the simulation setting in terms of having a more realistic patient. Also it will provide a method to improve the quality of debriefing after training. Target Users: NICU neonatologists and nursing staff. Description: Our manikin design is based on a 40 week old real patient. From a full body MRI dataset of this patient, we are reconstructing body parts using 3D printing. Due to the wide variety of materials available for 3D printing, the mimicking of a realistic patient body has become plausible. We are currently reconstructing: a complete skeletal structure, rib cage, major airways, lungs, simplified cardiac system, oral- and nasal caveties, and surrounding tissues. Within the reconstructed body we plan to embed sensor systems to monitor parameters such as: airway opening, tracheal angle, airflow during ventilation, and blood flow during chest compressions. These parameters will be the input for a mathematical physiological model to determine patient response with respect to the quality of skill performance. This information will be used in a feedback system where video monitoring, physiological changes, as well as skill performance will be displayed. This can be used in debriefing to pinpoint cause and result. Evaluation: Our aimed improvements focus on increasing tactile and visual realism, as well as embedding internal datamining for determining patient response and clinical skill assessment. Through combining MRI imaging with 3D printing we believe this will be possible.

Ultrasound in the curriculum of technical medicine: combining theory, simulator training and hands-on skills. J.K. van Zandwijk, A.T.M. Bellos-Grob, E.Groot Jebbink, M. Groenier, R. Burie, H.A.T. Miedema University Twente, Enschede, the Netherlands Context: Worldwide the application of ultrasound (US) is increasing in both medical research and diagnostics. Technical Medical students from the University of Twente are educated in the background and mechanisms of ultrasound. This enables them to advance patient care by safe use of this technology and to further improve diagnostic and therapeutic procedures. However, we observed a gap between theoretical knowledge and hands-on clinical use of the technique during internships. Goal: Combining different educational methods during the curriculum to teach technical medicine students and alumni the technology and use of ultrasound imaging, to obtain a thorough understanding. Target Users: Technical Medicine students, from bachelor till master, and postgraduates. Description: During the curriculum of Technical Medicine, knowledge and insight in medical ultrasound is taught through a combination of different learning methods. Theoretical education, lectures, are given to provide students with the basic insight and limitations of ultrasound. Phantom based and regular simulator training sessions are incorporated in the curriculum to let the student experience live scanning and device handling without the complexity of the human anatomy. To complement the learning experience and link to the medical field of work, hands-on scanning on fellow-students is taught. An overview of the courses implemented in ultrasound imaging during the curriculum. Each course has its own focus (e.g. cardiology, abdomen, etc.), to ensure a diversity in clinical cases. The current curriculum has recently been complemented with a (basic) Massive Open Online Course (MOOC) and (advanced) hands-on ultrasound courses for alumni. Evaluation: We acquired our goal in combining different teaching methods in relation to ultrasound education throughout and beyond the Technical Medicine curriculum. Additional research on ultrasound knowledge and appreciation for our students and alumni in the field should quantify whether the gap between technology and hands-on use has been closed.

Abstracts Onaangekondigde multispecialisme acute trauma simulatie training. R. van den Broek, T. Eikendal, A. Vos SEH, Radboud UMC, Nijmegen, the Netherlands Context: Binnen het Radboudumc vindt iedere maand een onaangekondigde Multi– disciplinaire en Multi-Specialisme Acute Training plaats op een Traumakamer op de SEH. Goal: Vergroten patiëntveiligheid, werkprocessen optimaliseren/standaardiseren, optimaliseren crew resource management in ad hoc samengestelde multidisciplinaire teams, samenwerking en begrip vergroten, met als kader geen verstoring reguliere patiëntenprocessen. Target users: Iedereen werkzaam in de acute zorgketen. Description: Voordat de training start vindt een check plaats bij de verschillende disciplines, zodat zeker is dat patiëntveiligheid voor andere patiënten is gewaarborgd, indien dit niet het geval is wordt dit later in de evaluatie duidelijk benoemd en meegenomen. Tijdens de realtimesimulatie worden deelnemers geobserveerd. Het initiatief is geïnitieerd, ontwikkeld en uitgevoerd vanuit medewerkers zelf. Het kernteam wordt gevormd door vertegenwoordigers van de cardiologie, traumachirurgie, anesthesie, SEH, pediatrische zorg en het interne CRM trainingsbureau. Bij een go van de verschillende specialismen wordt de “Acute knop” ingeduwd en wordt het corresponderende team ad-hoc opgeroepen, zij weten vooraf niet dat zij in een training belanden. Bij aankomst vindt een korte casuistiekbriefing plaats, waarna het team start met de simulatie. Tijdens de simulatie komen elementen van samenwerking, leiderschap, communicatie, klinisch redeneren, besluitvorming aan bod. Uit onderzoek blijkt dat vermijdbare fouten vaak ontstaan als gevolg van onduidelijke samenwerking, leiderschap, communicatie en taakverdeling. Tijdens de nabespreking reproduceren deelnemers de casus chronologisch. Op deze wijze ontstaat gezamenlijke Situational Awarness en worden deelnemers in staat gesteld leerpunten te formuleren. Daarnaast wordt het werkproces geëvalueerd en worden hiervoor verbeterpunten aangedragen. De totale trainingstijd voor deelnemers is max 45 minuten. Het geheel aan leerpunten wordt aan deelnemende afdelingen aangeboden. Evaluation: Gezien de onbekendheid van deze vormen van trainen vindt evaluatie plaats na zes maanden, momenteel wordt het evaluatiekader verder ontwikkeld.

Training high-precision dental procedures with virtual reality simulation and 3D feedback. C. Serrano, P. Koopman, N. Egmond, L. Sczaniecki, D. Bakker, J. Vervoorn Academisch Centrum Tandheelkunde Amsterdam, Amsterdam, the Netherlands Context: Traditionally in Dentistry, phantom heads (mannequins) with either plastic or the increasingly less available extracted teeth, are used to train clinical skills. However, these do not provide the opportunity to develop a more comprehensive clinical training that includes decision making, problem solving or personal competences improvement. The Moog Simodont速 Dental Trainer provides a learning experience for the students in an immersive virtual reality environment with 3D vision, haptics along with audio sensory information. By incorporating pathology and complete case information, within the attached courseware, the simulator aims for a problem based contextualized training. Goal: Partial crown preparation is a high precision non reversible dental procedure, recently introduced in undergraduate dental training at ACTA. Safety and ethical foundations led to develop a virtual reality training program, enabling students to achieve satisfactory levels of competence and confidence before performing the procedure in real life patients. Target users: The Simodont Dental Trainer partial crown exercise has been implemented in the program of approximately 120 Master 2 students. It offers the opportunity of countless applications in undergraduate and postgraduate training in Dentistry. Description: After discussing a clinical case and the related theoretical content, students are required to design and cut partial crowns in virtual reality, using the self-assessment tools available in the system for convergence, depth and adjacent teeth safety. An interactive 3D model of the preparation is generated and sent to each student with individual feedback, which can be opened from any computer or mobile device. Evaluation: Competence, self-confidence perception and satisfaction were measured, as part of ongoing research. This experience will be part of coming training modules, which will provide more research data.

Abstracts E-simulatie klinisch redeneren: oefenen voor de klinische praktijk. F. Slond1, Y. de Jong1, S. van der Werf1, L. van der Plank1, B. van der Klis2 1 Centre for Research and Development of Education, UMC Utrecht, Utrecht, the Netherlands 2 Faculty of Medicine Utrecht, Utrecht, the Netherlands Context: De e-simulatie klinisch redeneren is ontwikkeld voor coassistenten als oefenmateriaal klinisch redeneren. Het gaat om veelvoorkomende, acute of zeldzame ziektebeelden die een coassistent mogelijk niet ziet in de praktijk, maar wel belangrijk zijn. Goal: Coassistenten worden vaardig in het klinisch redeneren door veel met casuïstiek te oefenen, patiënten te zien en verschillende situaties te beoordelen. Ze krijgen hier tijdens hun coschap de mogelijkheid voor. Deze e-simulatie biedt studenten een veilige omgeving om het klinisch redeneren zelfstandig, in eigen tempo te oefenen. Het denkproces staat centraal en wordt aangestuurd door verdiepingsvragen en structurele feedback met als doel het bewust redeneren te stimuleren. Target users: Het simulatiemodel coschappen (gaan) lopen.

is ontwikkeld voor alle geneeskunde studenten die

Description: Met de e-simulatie oefenen studenten de vaardigheid van het klinisch redeneren op analytische wijze als een lineair proces: vanaf de verwijsbrief tot aan de (werk)diagnose en behandeling. Het doel is om vanaf het begin patiëntinformatie te koppelen aan de differentiaal diagnose aan de hand van interactieve vraagtypes. De DD staat in beeld en kan ieder moment worden bijgesteld op basis van nieuwe bevindingen. Op iedere keuze die de student maakt, volgt feedback van een virtuele supervisor. Deze richt zich op belangrijke informatie herkennen, welke vragen te stellen, waarom deze vragen en doelgericht keuzes maken. Evaluation: De pilot die van 1 september tot 1 maart loopt, zal uitwijzen hoe bepaalde studenten deze e-simulatie waarderen. De evaluatie gebeurt aan de hand van een digitale vragenlijst gekoppeld aan de simulatie in combinatie met een focusgroep of individuele gesprekken afhankelijk van de haalbaarheid. Studenten lijken de regelmatige feedback, het stapsgewijs doorlopen en het koppelen van gegevens aan de DD nu het meest te waarderen. Op basis van de uitkomsten van de evaluatie is de intentie het model aan te passen ter verbetering en standaard op te nemen in het curriculum op basis van meerdere casus. Studentquote: “Deze simulatie gaat verder dan de andere leermodules om Klinisch redeneren te leren”.

Implementeren “a tough issue”. D. Bakker, M. Vervoorn Onderwijsinstituut, R&D Simodont, Academisch Centrum Tandheelkunde Amsterdam, Amsterdam, the Netherlands Context: Binnen de opleiding tandheelkunde wordt veel geoefend in de prekliniek op fantoommodellen. Sinds 2010 heeft ACTA de beschikking, naast deze prekliniek, over de Simodont Dental Trainer. De Simodont is een virtual reality trainer. Nu de simodont door de early adapters in het onderwijs wordt gebruikt, is de vraag hoe het beste aan de verdere implementatie richting kan worden gegeven. Goal: Balans vinden tussen de verschillende invalshoeken van de stakeholders bij de ontwikkeling van een virtuele leeromgeving binnen de beperkingen van geld en kennis. Target users: De Simodont wordt in de eerste plaats gebruikt door studenten tandheelkunde, die via oefeningen op virtuele patiënten worden getraind ter voorbereiding op de behandeling van echte patiënten. Op termijn zal de Simodont ook een plaats krijgen in nascholing van praktiserende tandartsen. Description: Bij de verdere ontwikkeling van de Simodont dient voortdurend een balans te worden gevonden tussen uit drie invalshoeken: 1. Meer deelgebieden opnemen in het programma, dwz meer aanbod voor de gebruiker 2. Betere haptiek bij bestaande programma, dwz een betere ervaring voor de gebruiker 3. Presentatie van het huidige programma verbeteren, dwz een mooiere aankleding Voor studenten is een verdere ontwikkeling in richting 1 het nuttigst, voor de praktiserende tandartsen is richting 2 en 3 belangrijker. Zij hebben moeite om via de nieuwe (virtuele) wereld hun skills te verbeteren en worden belemmerd door de verschillen in de virtuele wereld en de echte wereld. Evaluation: Bij verdere implementatie is een afweging noodzakelijk tussen de twee doelgroepen. De beslissers zijn vaak deel van de groep tandartsen.

Abstracts A human factors perspective on simulation-based surgical skill assessment. M. Groenier1, E. Groot Jebbink1,2, F.R. Halfwerk3,4 Department of Technical Medicine, University of Twente, Enschede, The Netherlands 2 Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands 3 Department of Cardio-Thoracic Surgery, Thoraxcentrum Twente, Medisch Spectrum Twente Hospital, Enschede, the Netherlands 4 Department of Biomechanical Engineering, University of Twente, Enschede, the Netherlands 1

Context: Several years ago, international reports on surgical safety revealed major deficiencies in worldwide surgical skill training and assessment. Currently, surgical skill training is moving towards objective, outcome-based performance assessment and simulation-based assessment is increasingly used for that goal. At the University of Twente’s Experimental Centre for Technical Medicine, we revised our current Surgical Skills master course to further improve surgical skill assessment. Insights from human factors research were taken into account during course re-design. Goal: The aim of this study is to provide valid and reliable simulation-based assessment of surgical skill based on a human factors approach. Target users: Medical educators. Description: Human factors is the scientific discipline that investigates how humans and systems interact and aims at improving both system and human performance. Human factors approaches in medicine have mainly focused on incident analysis and error reduction, however, performance assessment is integral to these approaches. In our new course design, knowledge from cognitive psychology and psychometrics is applied within a human factors approach to develop a state-of-the-art assessment procedure. We developed a flow diagram representing major decision points in the design process. Evaluation: Currently, the revised surgical skill course is running. The results of a study investigating the feasibility and effectiveness of a human factors approach for surgical skill assessment are expected in February.

Meldkamer Control game. P.H. ten Hacken, J. van Nigtevegt Veiligheid Regio Gelderland-Midden i.s.m. Flavour Context: Meldkamer control is een game ontwikkeld voor centralisten. De game is ontwikkeld om kwaliteit te kunnen meten en verhogen. Daarnaast werkt het kosten besparend. Door het uitlezen van de statistieken is het mogelijk om individuele scholingstrajecten op te stellen en beter te sturen op het zeer moeilijke logistieke meldkamer proces. Goal: Doel van het spel is om centralisten te kunnen trainen in het logistieke proces om de uiteindelijke performance te kunnen verbeteren. Target users: Het spel brengt de speler in de dagelijkse praktijk van de centralist. Description: In een hectische omgeving moet de centralist meldingen verwerken, ambulances aansturen, het regiogebied voldoende gedekt houden voor incidenten etc. Meldkamer control neemt je mee in een spannende wereld waar keuzes maken van levensbelang is. Evaluation: Graag delen we de eerste resultaten van het inzetten van de Meldkamer Control game in Gelderland-Midden. Gaming inzetten om centralisten te trainen en toetsen op individueel niveau.

Abstracts Ludovita: Gaming voor Vitaliteit. S. Kattenberg, N. Degens Lectoraat User-Centered Design, Hanzehogeschool, Groningen Context: Uit cijfers van het onderzoek van Stichting IZZ en de Erasmus Universiteit Rotterdam blijkt dat 85% van de medewerkers in de Nederlandse zorg te kampen heeft met fysieke klachten. In samenwerking met Lerenophetweb, ErgoEnzo en Impuls ontwikkelt het lectoraat User-Centered Design speloplossingen voor het verminderen van fysieke klachten ten gevolg van werkdruk en stress in de zorg. Het tweeĂŤnhalf jaar durende onderzoeksproject is gericht op het stimuleren van de duurzame en gezonde inzetbaarheid van het zorgpersoneel door middel van adaptieve games. Goal: Huidige face-to-face trainingen voor het verminderen van fysieke klachten zijn kostbaar en duren een aantal dagen. Daarnaast is het rendement van deze trainingen te laag vanwege de tijdsdruk, variĂŤrende startniveaus en weinig persoonlijke diepgang. Hierdoor sluit de training niet aan bij de behoefte van de cursist en valt men terug in oude gedragspatronen. Door middel van het inzetten van langdurige gepersonaliseerde game-oplossingen wordt het mogelijk werknemers over een langere termijn te stimuleren en te helpen om gezond gedrag aan te leren en daardoor werkdruk te verminderen. Target users: De game(s) worden ontwikkeld voor verplegers en verzorgers in de thuiszorg, het ziekenhuis en de gehandicaptenzorg. Description: LudoVita is slechts een aantal maanden gestart, echter zijn er in het voortraject al meerdere prototypes ontworpen door studenten van de opleiding Game Design & Development aan de Hanzehogeschool. In het komende half jaar zullen nog meer gameconcepten ontwikkeld en geĂŤvalueerd worden. Uiteindelijk zal dit leiden tot een selectie van games, gebaseerd op individuele leerdoelen, die in staat zijn zorg medewerkers op meerdere fysieke en mentale aspecten te helpen met het verbeteren en behouden van een goede vitaliteit. Evaluation: De effectiviteit en validiteit van de uiteindelijke game(s) zal getoetst worden bij meerdere Nederlandse zorginstellingen in Noord-Nederland. Daarnaast is het de intentie van LudoVita dat verschillende zorginstellingen nauw betrokken zullen zijn bij het ontwikkelproces zodat de uiteindelijke game-oplossing beter zal aansluiten bij praktijksituaties.

Simulation based teaching of physiology. E. Oppersma, L. M. van Loon Department of Technical Medicine, University of Twente, Enschede, The Netherlands Context: Knowledge of physiological processes in the human body is essential for quick and adequate diagnosis and treatment, but also in development and implementation of new medical technologies. In the educational program of Technical Medicine at the University of Twente not only extensive attention is paid to theoretical education but also to more practical methods to both teach and test physiological understanding. Goal: Detailed knowledge and thorough understanding of the complex human physiology, to improve and apply to medical practice and technology. Target users: Medical and technical-medical students learning about physiology. Description: Throughout the curriculum of the Bachelor’s program and the Master’s program as well as in postgraduate courses, a whole range of computer simulation, modeling tools and high fidelity simulators is used. Modeling and simulation is used with increasing difficulty of the physiology, tools and applications during the educational program. In the bachelor this starts with basic Matlab and Simulink but also other more specialized cardio-physiological modeling tools, as ECGsim. High fidelity simulators are used to show physiological interactions like the Frank-Starling curve and its effect on patients. Towards the Master phase the used tools become more sophisticated and students work with advanced modeling and simulation, increasing their advanced Matlab skills, and use the high fidelity simulators in small groups and even write their own scenario’s. Evaluation: Achieving detailed knowledge of complex human physiology and applying this to daily medical practice and improvement of medical technology shows the value of using simulation during the whole curriculum. Feedback from clinical supervisors show that this educational program provides the students with a flexible way of learning and applying their skills in medical technology in the practical situation.

Abstracts eSolv, a CellML-based simulation front-end for online teaching. T.P. de Boer1, B. Hennekam2, D.P. Nickerson4, A. Garny4, M. Gerbrands2, A.-P. Rozendal2, E. Torfs2, H.V.M. van Rijen3 1 Department of Medical Physiology, UMC Utrecht, Utrecht, The Netherlands 2 Educational ICT programme ‘Learning without Limits’, UMC Utrecht, Utrecht, The Netherlands 3 Biomedical Sciences, Education Center UMC Utrecht, Utrecht, The Netherlands 4 The University of Auckland, Auckland, New-Zealand Context: Simulation of physiological processes is a powerful tool to help students integrate the knowledge they gain during traditional forms of teaching. While there are excellent tools available for researchers to use simulations to answer research questions, these tools are not always suitable for teaching. The flexibility of such tools that is useful for researchers is a drawback for students since it will be difficult for them to make the distinction between the parameters of a model, and know to which extent a specific parameter may be altered without destabilising the model. Goal: To create an online tool that can present CellML-based simulations, and allows a teacher to define which model parameters can be manipulated by the students. Target users: (PhD) Students from (Bio)Medical, Biological, Chemical and Pharmacological sciences. Description: Using the C# .NET framework, we built a graphical user interface (GUI; called eSolv) that interacts with CSim to run CellML models. More than 600 models are freely available. Model results can be presented in line charts or used to drive an animation of cardiac cell. Model input parameters can be altered using standard GUI elements or a representation of a real experiment (e.g. neuron with several electrodes). The performance of eSolv was tested by groups of students doing exercises with eSolv simultaneously. Student level ranged from high school to PhD candidates. Afterwards, students were surveyed about their experience with eSolv. Evaluation: eSolv functions are as expected and are appreciated by students. The performance of eSolv is good, and scales linearly with student number. Based on CellML models, teachers can define a ‘lab’ and specify exactly how the model is presented. Students can run eSolv using modern browsers on desktop computers and tablets. eSolv is now being implemented in the biomedical curricula of the University Medical Center Utrecht.

Use of the Eyesi® simulator in training ophthalmology residents: Results of a pilot study on self-efficacy, motivation, mental effort and performance. T. Coster1, M. van der Schaaf2, O. ten Cate1, R. Wisse1 1 UMC Utrecht, 2Utrecht University Introduction: To describe the development of motivation, self-efficacy and mental effort during cataract surgery training in ophthalmology residents. Secondly, to assess the relationship of self-efficacy, motivation and mental effort on both simulator (Eyesi®) and real-life surgical performance. Methods: Prospective cohort study using a within subject design. Eight residents were asked to fill out questionnaires on self-efficacy, mental effort and motivation towards the Eyesi® simulator and real-life cataract surgery at three different moments: prior to any simulator or surgical experience, after completing the simulator training with a standardized examination, and after three months of real-life cataract surgery. Simulator performance was derived from the instrument’s output. Patient charts were reviewed to assess real life surgical performance. Results: Comparative analysis showed a significant increase in self-efficacy towards real life cataract surgery after completing the cataract training on the simulator (p=0.005). Furthermore, we found a significant correlation between total tasks to complete the cataract training and self-efficacy scored after working with the simulator (p=0.038). Motivation towards the simulator remained stable over time and seemed not to be influenced by simulator or real-life performance. Conclusions: Cataract surgery simulation seems to increase the self-efficacy beliefs in performing cataract surgery in ophthalmology residents. Furthermore, we found evidence that performance on the simulator correlates with self-efficacy scored after the simulator training, thereby supporting prior theories on self-efficacy being determined by prior performances. By including more residents over time, this study might provide better insight in the role of self-efficacy and motivation in training complex surgical skills.

Exposition and Innovation Center Innovation area and Exposition Center Come and experience the latest developments. The DSSH offers young innovators / startups the opportunity to showcase and reflect on their ideas at the Innovation Center. The large Exposition provides a selection of simulation companies, serious and applied gaming companies and institutes / initiatives focusing on training the medical professional.


Delft University of Technology Delft University of Technology A fascination for science, design and engineering is the common denominator driving the 16,500 bachelor and master students and the 4,700 employees of TU Delft. Delft University of Technology is not only the oldest, but also the largest university of technology of the Netherlands: a university constantly seeking outstanding talent to keep the research and education of this unique institution top-ranked. Delft Health Initiative Changing the healthcare system requires a multi-disciplinary approach involving science, engineering and medicine in close collaboration with practitioners in hospitals, first-line care, nursing homes, the healthcare industry and policy makers. There is a demand for highly skilled engineers who are trained to collaborate in multi-disciplinary research teams and who use their strong engineering background for innovative solutions in the medical field. Together with medical doctors and industrial parties the Delft Health Initiative will apply its expertise to solve the health engineering challenges of the future. Minimally Invasive Surgery and Interventional Techniques MISIT conducts research on tissue-instrument-human interaction with the goal to improve diagnostic and therapeutic performance during minimally invasive interventions. The focus is on the mechanical interaction with instruments, the design of new instruments and the design of simulators to improve surgical skills.



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