How do you stimulate trainee surgeons to train their skills more often?

By making their training just as much fun as the games they enjoy playing on their smartphones!

A trainee surgeon must practice on a simulator for a least 200 hours per year to optimise his or her surgery skills. University Medical Centre Groningen, in the Netherlands, has a skills lab full of simulators – but trainees were making too little use of them.


The fun of Angry Birds

Henk ten Cate Hoedemaker, a surgeon at UMCG, noticed that his colleagues were spending too little time in front of the simulator screens, but played games such as Angry Birds enthusiastically on their smartphones. He decided to investigate whether he could combine the educational aspect of the simulator with the fun of these games.



“I didn’t know anything about serious games, so I started looking online for someone to help me,” he says. “After a bit of Googling I came across a news item about Grendel Games winning an award for their serious games. I gave them a call, and a week later I was standing on their doorstep. They showed me a range of games, and the more I learnt, the more enthusiastic I became. We decided to embark on this adventure together. It was truly pioneering, as we had to still find everything out, from organising the funding to making a sales plan.”

The game: Underground

“We wanted a game that would challenge trainee surgeons and encourage them to complete the necessary amount of training hours. We involved an education specialist who supported us with the teaching elements of the game. The Grendel Games team came up with a wonderful idea.”


The story of Underground

Underground is about a brave little girl called Sari and her robot friend Sw4nk. Sari’s father is dissatisfied with Sw4nk and sends him to the mines. Sari can’t accept this and tries to free him. Sari and Sw4nk run into problems in the caves, and only you can help them…

The making of Underground

Tailor-made controller

The advantage of Underground is that the hospital doesn’t have to make a major investment in a simulator. It can be played on the Wii U Game Pad, but Grendel Games developed a tailor-made laparoscopic controller for surgeons who want to train their motor skills. A regular simulator costs between € 50,000 and € 100,000, while Underground costs € 19.95 and the controller € 249.



The collaboration between UMCG and Grendel Games brought two cultures together.
Henk: “During the process we realised that we were dealing with two different areas of expertise, and we had to learn each other’s language. The casual, men-with-ponytails culture of a game company is quite different to the more formal environment of a hospital. But we were united in our commitment and professionalism.”



Underground has won two Dutch Game Awards, and has been named by Forbes as a ‘game that can change the world’. To learn more about Underground, go to

cups of coffee were consumed by the team when they made Underground
time winner of a Dutch Game Award: Underground!
euros can be saved in comparison to a conventional simulator

Awards & nominations

Dutch Game Award 2013 ‘Best Serious Game’


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something awesome!