"The serious game Underwater is a fun and useful way to learn Point of Care Ultrasound"
- Dr. Tycho Olgers

Underwater is a serious game that makes it possible to perform an ultrasound examination in a playful environment. The game has been developed in close cooperation with UMCG and experienced sonographers.

Research papers

What is Underwater

Underwater is developed to measure and practice the fine mobility of echoing. The game allows the player to improve his or her skills in performing ultrasound examinations.

The game uses a self developed controller that resembles a real ultrasound probe to provide internists, sonographers, other ultrasound experts and students a fun, challenging and realistic training module.

Underwater is developed in collaboration with UMCG, tested with students and sonographers and played at medical fairs.

What are the benefits of Underwater?

The use of Underwater brings a number of advantages in terms of time, motivation, money and measurability.

Time saving

Players are able to practice without a person's supervision, The intelligent software will provide them useful feedback.

Money saving

It is possible to save on expenses by reducing instruction time. In addition, the game provides more insights into the progress of the players.

Increased motivation

Through the clever use of game elements in combination with real echo examinations, the game increases the intrinsic motivation of the player. The immediate feedback keeps the player's attention and rewards the player for achievements in the game.

Measuring values

The so-called 'gold standard' is a system that compares a user to ultrasound experts. The system assesses a player on his handling of a transducer in game parts inspired by real ultrasound guided examinations and procedures.

Underwater compared to traditional learning methods

Use of intrinsic motivation

Intrisic motivation is not used in the traditional training sessions. The intrinsic motivation of the player is reinforced by the use of the game elements in Underwater. It ensures that the player wants to practice more often and ultimately gets better in handling the transducer.

Fun and challenging

Underwater makes practicing more fun and challenging by using clever puzzles and game mechanics. This makes it possible for the players to train the required skills, without them immediately noticing this during the game.

Direct Feedback

By providing players with clear and direct feedback, they know exactly what went wrong, how it went wrong and how they can improve their skills. Due to the objective feedback provided by the game, no interventions by a doctor are needed during a training session.

What are the learning goals

  • Measuring hand-eye coordination with a transducer

  • Measuring classroom proficiency

  • Adaptively set the option per person

  • Immediate feedback on the exact action and possible improvements to it

  • The gold standard is a computer-calculated 'ultimate' movement

Research papers and publications

Within the development and use of Underwater, we value research. An overview of recent research papers and publications can be found below:

The validation of a serious game for teaching ultrasound skills

This study shows solid content- and face validity of the serious game “UnderWater” for training ultrasound skills.The game is appreciated as a promising serious game for training eye–hand coordination and learning ultrasound, which may reduce expensive bed-side teaching.

Sonography students try ‘Underwater’ ultrasound game to practice imaging technique

20 December 2023
Cat Pastoor

College of DuPage Sonography students recently had the opportunity to test their skills using a new, gameified training tool in development called “Underwater,” a simulator where students use an ultrasound probe to navigate an underwater world.

Teaching point-of-care ultrasound using a serious game: a randomized controlled trial

Point-of-care ultrasound (POCUS) is an important diagnostic tool for internists. However, there are important barriers in learning POCUS, including lack of practice time and lack of experts for supervision. Alternative learning tools may assist in overcoming these barriers. A serious game is being developed specifically for teaching ultrasound. In this study, we assessed the use of a serious game in learning POCUS.

Point-of-care ultrasound for internists: a serious game!

24 april 2024
Tycho Olgers

Point-of-care ultrasound (POCUS) is a crucial skill for internists, both in the emergency department and in the outpatient clinic and inpatient wards. The strength of POCUS lies in several aspects. First, the performing of the ultrasound is done by the treating physician at the patient's bedside. This ensures immediate access to relevant information without any time delay. Moreover, POCUS is characterized by a relatively limited scope of questions. This means that the examination is focused on specific clinical questions, which promotes efficiency. Additionally, the results are immediately available, allowing them to be used right away in the clinical reasoning process.

About Sfinx Games

Sfinx Games is a company specialized in developing games, with the focus on serious games. These games offer more than just entertainment value. Their main goal is to teach, convince or change the target group's view.

The mission of Sfinx Games is to develop each of their games with a good distribution of serious and fun elements.

Robert Mertens


Tony Fial


Jan Timmerman


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