The doors fly open as an ashen- faced little boy on a gurney is wheeled in. You immediately feel a knot in your stomach. His upper body is bright red and in some places the skin is peeling off. There’s barely time to think about what you need to do. You’re a medical student and right now you’re the only one responsible for this patient in the accident and emergency department.

While the adrenaline races through your body, you go through the checklist that’s been discussed so many times during lectures. You start with the checklist, choose the medications and order tests. You make your choice, push some buttons and suddenly there’s a notification on your screen: Your patient is recovering. Satisfied, you lean back and close the page; the simulation went well.


How you react in life and death situations can’t be learned from a book, you’ll simply have to experience it and do it. However, that is rather difficult if it involves people in specific situations. With financial support from Erasmus MC and the SBOH general practitioner programme, Stephanie Klein Nagelvoort- Schuit (Acute Medicine internist) and entrepreneur Ronald Nanninga were able to develop the abcdeSIM simulation game. The game can be played on a computer and trains staff in the emergency and accident department in the abcde approach: This is a structural approach used by medical staff to assess and treat a patient.

AbcdeSIM is an example of a serious game, a game where the primary goal is to teach the user something. Look at it as the operation game for advanced players. There are endless possibilities within this genre. The simulation game abcdeSIM is just one example, but there’s also the game Darfur is dying, in which the player learns more about the situation of refugees from Darfur.

Digital EUR

Erasmus University has committed significant resources to the digital environment over the past few years. The purpose of this investment is to make digital normal to the same degree that nominal is now. This also includes, for example, Massive Open Online Courses (MOOCs), and of course, serious games. Preliminary research findings obtained from studying abcdeSIM show that a well-designed game can help in attaining better study results in a shorter period of time. In that research, two study methods were compared to each other. In the first study method, medical interns were asked to read a book on the abcde approach, then attend a lecture, and finally practice a number of medical scenarios on the simulation mannequin. In the second method, the book and the lecture were replaced by the EducaabcdeSIM serious game. The comparison revealed that the second method was more effective with the medical interns able to more quickly grasp the subject matter. This allowed them to act more quickly when practicing with the mannequin and that in turn meant they were able to cover more scenarios in less time.

For the programme, omitting the lecture means savings in terms of time and money, says Ronald Nanninga. He is CEO of Virtualmedschool, the company that developed abcdeSIM. That makes it a win-win situation. The game is not just for medical interns in training. According to Nanninga, there are currently six thousand users. “Students, doctors, and nursing staff – they can all benefit from the game.”

Campus-wide gaming

According to Mijke Slot, there are a number of reasons why serious games have not yet been developed for every programme, in spite of the good results demonstrated at the medical faculty. Slot is a researcher in the Media and Communication department at Erasmus School of History, Culture and Communication. Her field of research includes new media and serious games.

Serious games are not a quick fix, says Slot. It looks quite easy: simply come up with a game and then students can use the game to learn everything. But that’s not how it works. There has to be a connection between the curriculum and the other modes of study offered by EUR. The level structure also has to be properly considered and, for example, you have to think about how you’ll motivate students who aren’t competitive by nature to play the game. Development costs can mount considerably, and the question is whether that is needed for every programme.

‘It looks quite easy: simply come up with a game and then students can use the game to learn everything. But that’s not how it works.’

Onderwijs Medfac Serious Gaming 0114-21
Mijke Slot

Slot predicts that online resources such as serious games or MOOCs will be used more and more as a supplement to a programme. “With the emphasis on supplement. It can’t replace the face-to-face interaction between student and professor.”

AbcdeSIM is a promising example of the added value of serious gaming, believes Slot. “There hasn’t been much research done on the impact of serious games. That is also difficult to assess in practice because in addition to the game there’s the lecture, tutorial or research class where the student also learns the subject matter. How do you distil the results that are based solely on the game? That was possible with the Erasmus MC game because there you had two separate cases – studying using a textbook or studying using the game – that could be compared. We need more studies like this. I think that would then convince other programmes.

Legal battle app

If it’s up to Farshida Zafar, Erasmus School of Law is following close on Erasmus MC’s heels when it comes to serious games. In addition to holding the position of lecturer, she is also the project manager for Online Education and Innovation at the law faculty. Last year, the law faculty introduced ESL Legal battle, an app that allows students to test their knowledge. In the app, students are presented with questions with multiple-choice possibilities. Every question is equipped with feedback. To date, the app has been downloaded 500 times. App users can first practice on their own with the subject matter, and then challenge other students to play in a competition. “The game is still in the developmental phase but I’ve already received a lot of positive feedback,” says Zafar.

She’s proud of the fact that it’s the law faculty that developed this app. “In the past years, ESL has made a great effort to innovate. These enriching educational tools are a part of these innovations. I’ve received a lot of enthusiastic comments from students who are using this app to prepare for examinations as another way to test themselves.”

Making studying fun again

Studying should be more fun and more challenging, according to Zafar. “I’m a lecturer and I see that students these days face a lot of difficulties. You have to get high grades, you have to distinguish yourself and make sure you pass the first time around. And then you have the student loan system. For many students, this means having to spend their time on a job on the side so they don’t have to borrow as much. It’s a positive development to bring in fun tools like the Legal app to give a bit of panache to the programme again. Educational tools which are better compatible with the perception of students are barely available,” according to Zafar. “There are some apps with educational content, but they don’t link with the classes we offer at our faculty.”

‘It’s a positive development to bring in fun tools like the Legal app’

Farshida Zafar

Zafar believes these extra study options should be available for all students. To this end she, together with a number of professors from different faculties and the IT development department, submitted a project proposal to develop a EUR app. Lecturers from different programmes would be able to upload their study materials in the app. “Students would then be able to test themselves and also play in competitions against students from other programmes; a format similar to the Dutch tv-programme ‘de slimste mens’.” The proposal will be sent to the Executive Board.

AbcdeSIM AbcdeSIM uses the abcde approach. ‘A’ is for Airway Maintenance with Cervical Spine Protection; ‘B’ is for Breathing; ‘C’stands for Circulation, ‘D’for Disability, and ‘E’for Exposure/ Environment. This method is used across the world by emergency service providers to assess and treat patients.

Interested in finding out more? Mijke Slot is organising an evening on the 3rd of November on the subject of serious games in the Rotterdamse Schouwburg. The evening will feature game developers and researchers who will speak on the subject.