Co-authored by Lily Pestel
Simulations for lifesaving procedures
How do you save a patient from a heart attack on the surgical table? What are the right steps to take, while dealing with mounting pressure? Currently, healthcare education does not adequately prepare students to perform lifesaving care during such emergencies. Neth-ER visited Leiden University Medical Center (LUMC) to speak about the Erasmus+ project tackling such complex challenges: Virtual Reality SIMulator and digital PORTfolio in CardioThoracic Surgery. We spoke with Cardiothoracic Surgeon Dr. Edris Mahtab and Physician & PhD Candidate Samuel Max, who are leading the LAIXR group. Together with many international partners, the consortium is building innovative AI and extended reality (XR) technologies to improve healthcare education. Now in 2026, LAIXR submitted another project proposal for EU-funding to further develop these tools.
Bringing real-life scenarios into classrooms
Dr. Mahtab had a very clear goal in mind: bringing real-life scenarios into classrooms to better prepare healthcare professionals. “During all my years of training to become a surgeon, I received few chances to prepare for high-pressure scenarios”, Dr. Mahtab explains. The current curricula do not yet allow for adequate practice of the specific resuscitation protocol for patients after heart surgery. “When emergencies occur, you, as a surgeon, are responsible for saving someone's family member and friend.” This is why Dr. Mahtab decided to apply for Erasmus+ funding with a group of international experts at Erasmus Medical Centre in 2022. The proposal was granted, with support from the EMC Grant Office and the Dutch National Agency for Erasmus+ Education & Training (Nuffic).
Developing innovative AI and extended reality technologies
To train students and surgeons, LAIXR developed two innovative extended reality (XR) and AI simulators which are already in use at LUMC. Firstly, the CPR Training Simulator which simulates a fully interactive cardiac surgical operating room. The XR-glasses guide participants through every step of the resuscitation protocol in real time. Secondly, the ECMO Training Simulator simulates a fully interactive intensive care unit, focusing on the machine which provides artificial life support. Achieving these results took a diverse, interdisciplinary consortium, with game-technology students, AI-specialists, and healthcare professionals, each contributing their unique expertise.
Practice anytime, anywhere
“Access to innovative tools should not be limited to the privileged”, says Dr. Mahtab, and this philosophy shapes one of the main goals of the new project proposal. Truly inclusive software means that anyone would have access to quality training, even without internet connection. This is why LAIXR incorporates the fair-share principle: ensuring equal opportunities for all. “The goal is to make our tools available to use for everyone worldwide, regardless of where users live and what their backgrounds may be”, Max explains. To adjust to local environments, the tools should be tailored to market prices according to a country’s wealth and translated into as many local languages as possible. Through these dimensions, the LAIXR group incorporates a form of social justice into their projects.
Clear performance tracking to improve learning outcomes
In addition to expanding the two XR-glasses, LAIXR is developing AI Hand-tracking System to track real-time surgical hand movements and assess performance more objectively. Hand-tracking will allow students to track their personal learning progress based on an objective ‘gold standard’. This method avoids risk of personal bias in the assessment and offers students true insight into their development. As Max put it, "objective assessment is a clinical need”, but the impact goes further than that, for example by preventing dropouts and burnouts. This innovation thereby extends well beyond its clinical and academic value, carrying real social and ethical significance as well.
Max expressed that the training environment should be as realistic as possible. This is a precondition to successfully put skills into practice. One of Max’s new colleagues decided to try out the CPR Training Simulator. The week after, the trainee had to treat a patient with cardiac arrest after cardiac surgery. She said, “I pictured the VR experience, felt myself calm down, and went back to the step-by-step response I learned in the simulator”.
Recognising simulations as an integral part of healthcare education curricula
By integrating the XR training tools into formal qualifications, the LAIXR group aims to make them mainstream. Such simulations could become an integral part of healthcare curricula, as they currently are in other sectors, such as the aviation industry. To ensure widespread adoption, formal recognition through the European Qualifications Framework (EQF) is essential. The LAIXR group is actively working towards this through ongoing talks with CINOP on the Netherlands Qualifications Framework (NLQF) and the European Association for Cardio-Thoracic Surgery (EACTS).
A geopolitical race for knowledge
“We as Europe desperately need to innovate with our own resources to stay competitive", Max states. Innovation in healthcare matters because it makes Europe able to stand on its own in the world, both for training skilled healthcare professionals and for delivering better care to patients. LAIXR is hopeful about securing Erasmus+ funding again and aims to make a lasting impact. Its next steps focus on embedding these tools as a standard part of curricula, making them widely available beyond LUMC, and bringing the innovations to market.
Edris Mahtab defended his PhD thesis at the Leiden University in 2008 and obtained his MD degree from the Leiden University in 2010. This was followed by a residency in cardiothoracic surgery at the Leiden University Medical Center (LUMC). From 2016-2023, Edris worked as a cardiothoracic surgeon at Erasmus Medical Center in Rotterdam and currently he continues his career as a cardiothoracic surgeon at the LUMC. Edris Mahtab is a cardiothoracic surgeon specialised in adult heart and lung surgery. He is the lead of several (post-)graduate educational programs. Edris is the PI of several scientific projects and supervises (PhD) students of diverse academic backgrounds. He is the co-inventor of a number of educational Virtual Reality based simulators and surgical planning tools. Edris Mahtab is the founding director of Leiden AI and XR (LAIXR) Group.
Dr. Samuel Max, BM BCh (Oxon), blends his expertise in engineering with his medical proficiency as a physician, Senior Researcher at DUTCH, and PhD candidate at the Department of Cardiothoracic Surgery at Leiden University Medical Center. Having graduated from the Universities of Surrey, Utrecht, and Oxford, he is now pursuing a PhD focused on medical extended reality (XR) technologies. As Senior Researcher within the DUTCH national programme, Sam focusses on interoperability, implementation, and clinical impact assessment of evaluation frameworks for large-scale national healthcare innovation and data infrastructure initiatives. Within the LAIXR group Sam serves as Scientific Lead, coordinating a multidisciplinary team of technical and medical experts in the design and implementation of XR and AI applications for cardiothoracic surgery.
Context
How do we prepare young Europeans to work alongside robots and algorithms? Why should we measure radio waves with European partners? And how can medical institutions adopt artificial intelligence in line with GDPR? These are the sorts of questions we explore in our special article series; "Knowledge Without Borders." Covering education, research, and innovation, Neth-ER tells stories from across the European knowledge sector showing the impact of European collaboration and EU funding.
