Training doctors and nurses for emergency situations is a vital part in medical education. Using the latest online gaming technology and a proprietary physiological model of the human body, we created a new and innovative program to teach emergency skills to doctors and nurses,  according to the internationally known and used ABCDE-method: abcdeSIM. 

This prize-winning serious game has since seen the introduction of additional programs (e.g. severe burns treatment) and is used in hospitals in Europe and the US. Together with Erasmus Medical Centre, the game will be further developed to become the medical flight simulator for training emergency departments.

AbcdeSIM is successfully used by medical and nurse students, residents as well as doctors and nurses as part of their continuing education. AbcdeSIM is the first serious game that was awarded a 5-star quality label from the Dutch Society for Simulation in Health (DSSH), based on the scientific validation study proving the value of AbcdeSIM for the training of residents.

AbcdeSIM is an online simulated emergency department with virtual patients. In an online realistic and immersive emergency department environment doctors and nurses are challenged to care for the sickest patients. Mistakes made in online patients are not fatal as in real-life, but important learning points, thereby improving everyday patient care. Doctors learn to accurately assess the medical condition of each patient, recognize life threatening illnesses and injuries, and resuscitate and stabilize in ordered priority.

The following versions of abcdeSIM are currently available:

AbcdeSIM was developed by and on initiative of Erasmus University Medical Center. The initial idea came from dr. Stephanie Klein Nagelvoort-Schuit, currently head of Internal Medicine at Erasmus MC.

AbcdeSIM includes a high-fidelity physiological model that contains more than 200 parameters for circulation, respiration and consciousness. This model creates a very realistic and immersive experience in which the trainee can see the direct results of their chosen diagnostics and treatment. Just like flight-simulators have increased airline safety, abcdeSIM aims to cost-effectively increase patient safety.

For any additional information please contact:

Ronald Nanninga, CEO VirtualMedSchool
nanninga@virtualmedschool.com

Training in emergency medicine is an essential part of medical education. Around the world every doctor and nurse working in a hospital or primary care is required to be trained in emergency skills. Expertise usually comes with experience. However, doctors and nurses must be prepared for all types of medical emergencies even when they lack extensive experience.

Using gaming and simulation technology and a high fidelity model of human physiology abcdeSIM, Erasmus University Medical Center, Technical University of Twente, IJsfontein and the Dutch national primary care residency program are improving training in emergency medicine in a cost-efficient manner.

In an online realistic and immersive emergency department environment doctors are challenged to care for the sickest patients. Mistakes made in online patients are not fatal as in real-life, but important learning points, thereby improving everyday patient care. By using the program doctors learn to accurately assess the medical condition of each patient, recognize life threatening illnesses and injuries, and to resuscitate and stabilize in ordered priority. They can train lifelike patient scenarios without putting patients at unnecessary risk. Just like flight-simulators have increased airline safety, abcdeSIM aims to increase patient safety.

AbcdeSIM is a mandatory part of training for residents and medical students at Erasmus University and has already reduced costs while improving skills. Since the implantation of abcdeSIM within standard ABCDE training for residents, the face-to-face training time has been reduced by 50% while maintaining the same learning objectives.

As an example the abcdeSIM Emergency Physician module consists of 3 parts:

1. The e-learning consisting of 7 chapters (the ABCDE-method, communication and in-hospitaltransportation of critically ill patients)
2. A test for which the student must receive a score of 75% or higher to be able to enter the Virtual Emergency Department (the game part of the module)
3. The Virtual Emergency Department where the student must attend to 6 seriously ill patients. Four patients are treated separately and the 5th and 6th patient are treated at the same time (the learning objective here is triaging the severely of illness)

The other abcdeSIM versions are built up in a similar manner.

AbcdeSIM has recently become the first serious game in The Netherlands to be accredited with 6 hours of Continuing Medical Education (CME) credit by a number of medical specialist organizations such as the Dutch Societies of Internal Medicine, Anaesthesiology, Neurology, Pulmonology and Family Practice.

Currently the following versions are available online:

The abcdeSIM modules include a learning management system (LMS) where the student and teacher can track progress and scores.

The abcdeSIM website includes a high-score server where the top 10 scores are placed

AbcdeSIM has users in over 40% hospitals in The Netherlands, including all academic centers. Furthermore abcdeSIM joined a partnership with the British Royal College of Physician to use abcdeSIM in 60 training centers in the UK.

AbcdeSIM has received very enthusiastic reviews from users and experts in- and outside the field of emergency medicine. In 2013 abcdeSIM won the Dutch national E-learning Award. The jury was highly impressed by;

AbcdeSIM won the Accenture Innovation award in the section Health after a competition between 100 innovative health ventures.

The total list of awards includes

There are many considerations when deciding on which training methods to use for Emergency Medicine education. This paragraph will provide some of the educational advantages of serious gaming in emergency medicine and abcdeSIM in particular.

For the optimal training efficacy it is essential that the students feel the stress and time pressure that is an important part of real-life patient care. Serious gaming technology not only gives us the tools to create such an immersive environment, it also allows us to train various clinical situations in a relatively short period of time. To ensure the highest quality learning experience, skilled clinicians at Erasmus University Medical Center and other institutions worked together with serious game developers at abcdeSIM and Dutch software developer IJsfontein. To allow students to take on the roles of doctors and nurses a number of key elements in the simulated emergency department must be extremely lifelike. Panels of experienced clinicians, end-users and educationalists worked together to this end with game developers in order to obtain the feeling of immersion for minimal costs.

The physiological model that sits at the core of abcdeSIM allows for a very flexible platform on which an endless variety of clinical scenarios, also outside the emergency room, can be played out. At the moment one simulation is specifically tailored to nursing skills, one featuring patients in a primary care (home/ambulance) setting and another one paediatric patients (including a paediatric physiological model). Additionally the graphics of abcdeSIM can be adjusted to correspond with local medication names and dosages, as well as medical equipment if needed.

Using gaming technology students can learn specific skills online prior to the training course. Students are therefore better prepared and the existing training time can be used to teach additional skills. Furthermore, acquired skills can be better maintained by the ability to continuously train online, even months or years after the training course.

Doctors and nurses are naturally competitive individuals. The serious game element in abcdeSIM makes it fun to learn and gain skills. Game competitions with doctors and nurses at 4 national healthcare conferences in The Netherlands showed abcdeSIM to be highly engaging.

To aid in creating a realistic and immersive experience the Technical Medicine department at the University of Twente worked with Erasmus University Medical Center to develop a high-fidelity physiological model that is based on years of extensive research. This physiological model contains more than 200 parameters for circulation, respiration and consciousness. An extensive physiological model of this kind has never been part of an online simulation. Implementation of this extremely complex model required teamwork between programmers, clinicians and researchers. This collaboration resulted in a virtual emergency department where clinical parameters react to illnesses, injuries, medication, infusion and other therapies the way that real life patients would. Learning objectives are obtained by the virtual patients’ reaction to medical treatments and therapies and a complex scoring and feedback system.

Low operating costs and easy online access with minimal computer hardware requirements mean that there are significant (financial) advantages for the user. But even more important is the increase in knowledge and skills for doctors and nurses treating patients. This way healthcare workers can now train emergency skills on a computer connected to the internet from anywhere in the world without exposing real patients to unnecessary risks.

Using gaming technology students can learn specific skills online prior to the training course. Students are therefore better prepared and the existing training time can be used to teach additional skills. Furthermore, acquired skills can be better maintained by the ability to continuously train online, even months or years after the training course.

Evaluation of the training “Treat first what kills first: the deteriorating patient” by management of Admiraal De Ruijter Ziekenhuis (ADRZ) in Goes (NL) and trainers of Erasmus Medical Center Academy in Rotterdam (NL):

• AbcdeSIM leads to a reduction of errors.
• By deliberately trying out other interventions and reflecting on your actions in AbcdeSIM, you learn more and the knowledge based on simulated patient experience is better preserved.
• AbcdeSIM ensures an increase in the quality of collaboration between nurses and doctors

With the use of AbcdeSIM, the communication between doctors and nurses has been synchronized since, information is based on the same criteria and equivalent level when the ABCDE method is applied. For example,  at ADRZ, a conversation between a nurse and a doctor about a patient initially admitted under a suspicion of problem D, led to the conclusion that patient had problem A.

Testimonial UK – Royal College of Physicians

Testimonial NL (English subtitled)

AbcdeSIM is a realistic online simulated emergency department and is proven to have a positive effect on emergency medicine education, while reducing costs at the same time. Thanks to an innovative high-fidelity physiological model that contains more than 200 parameters it provides a flexible platform for medical education that can be tailored to different learning objectives. This allows students and medical professionals to acquire new, or hone existing skills by treating different patients in a virtual environment thereby helping to improve overall patient safety.

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