SunSet: Scrub Nurse Non-technical Skills Training System

The SunSet project aimed at developing a software suite based on immersive and collaborative virtual reality technology for training and evaluating non-technical skills. The project is implemented in the context of the training of scrub nurses specialized in neurosurgery. It integrates methods and systems developed in the S3PM project on procedural knowledge. By relying on Human Factors approaches, it addresses training and evaluation of interpersonal skills. Whereas the developed technologies and approaches are generic and adaptable to any surgical specialty, the project focuses on the evaluation of the developed system within training sessions performed with scrub nurses. The ambition of the project is double: to propose novel approaches for surgical non-technical skill learning and assessment, and to implement and install the developed training factory at the University Hospital of Rennes, and evaluate it with real scale user experiments. This was ensured by:

  1. involving medical professionals from the early design stage of the project and for specifying the pedagogical content of the system, and
  2. developing a prototype of a surgical simulation system result from a strong engineering effort

According to the Haute Autorité en Santé, there are between 6 and 8 millions of surgical procedures per year in France (250 millions worldwide). The quality of their performance has a direct and strong impact on patient’s morbidity and mortality. A reference report from the Institute of Medicine in the US estimated that between 40.000 and 100.000 serious adverse events appeared every year with mortality consequences. In France, it is estimated that yearly between 60 000 and 95 000 adverse events (1%) occur in the peri-operative process, from which the half is considered to be avoidable and coming from non-technical errors, specifically related to interpersonal non-technical skills such as teamwork and communication issues. From them, a third is considered to be serious events. To ensure patient safety and reduce serious adverse events, several strategies have to be implemented. In its report on simulation in healthcare, the Haute Autorité en Santé (HAS) outlined the need for better teaching and evaluation of surgeons using simulation systems, covering the different required surgical skills.

The SunSET project specified, developed and assessed a new generation of virtual reality based surgical training systems covering non-technical skills (NTS), known to be responsible for a majority of adverse events in surgery [3]. For demonstrating the feasibility and added value of the approach, we studied, implemented and evaluated methods, as a proof of concept, in the context of neurosurgical scrub nurse training.

Limitations of existing systems include costly and subjective human based training in sensitive clinical environments or non-realistic simulated environments, assessment of technical skills only, lack of quantitative metrics, lack of realistic scenarios, and lack of flexibility. To overcome these limitations, the SunSet project aims at proposing a new paradigm in surgical teaching and assessment of non-technical skills, at the same time it aims at reducing costs of teaching as well as improving quality of teaching.



  • MediCIS team from LTSI (UMR 1099 Inserm) has an extensive experience in Image Guided and Computer Assisted Neurosurgery, Augmented Reality, and Surgical Process Modeling. With additional expertise on ontologies and study of surgical skills, MediCIS provides to the project data and methods for studying and modeling surgical skills, and for specifying pedagogical content with SunSet Author. It also developes Sunset Eval tools and uses them in the evaluation of the training sessions.
  • The department of neurosurgery at the University Hospital of Rennes (CHU) has a long history in research on computer-assisted surgery. The CHU brings to the project the mandatory support on pedagogical content as well as on clinical relevance of all developed methods and systems.As partners of the SunSet project they also participate in the creation of a future university degree on "Simulation Teaching" with their expertise on surgical skill teaching and evaluation.
  • LP3C (E.A. 1285) is a multi-site research institute (Université Rennes 2, Université Bretagne-Sud et Université Bretagne Occidentale). With expertise on humanities approaches for studying environmental, organizational, job factors and human and individual characteristics which influence behavior at work in a way which affect health and safety, LP3C will bring to the project an important highlight on understanding and modeling the non-technical surgical skills within training environments.
  • Hycomes team from Inria is specialized in hybrid systems modelling and contract-based design. In this project, Hycomes brings its expertises to study methods for computing and representing generic surgical process models from a population of individual descriptions of surgical procedures. These methods are used to construct scenarios embedded in the Virtual Reality (VR) based training system.
  • IRISA - Institute for Research in Computer Science and Random Systems: field of computer science and information technology. It covers all the themes of these fields, from computer and network architecture to artificial intelligence, software engineering, distributed systems and virtual reality.