Minimal invasive surgery (MIS, keyhole surgery) is one of the most important developments in surgery during the past decade. In the past and present, MIS training followed the apprenticeship model, where trainees watch a hundred or so procedures, before putting their own hands on a patient. With the emerge of virtual reality training simulators this is soon going to change. This new technology is promising as it provides safe and highly repeatable training opportunities, as well as assessment of a person’s capabilities.

Minimally invasive procedures are quite demanding:

-          there is no perception of depth
-          the procedure often require counter-intuitive movements
-          haptic feedback is limited

Research has shown that doctors differ in how fast they acquire the necessary  skills, and the proficiency they reach in the long term. Figure 1 shows three example learning curves.

Figure 1. Learning curves showing how efficiency of motions improve in laparoscopy.

These differences can partly be explained by individual differences between doctors, such as amount of training and cognitive capabilities, like visual-spatial processing ability.

The research field has long been on the quest for assessing such abilities reliably as to predict whether someone is likely to become a good MI surgeon.

MIS simulators also have great potential during the process of training. In every simulator session an abundance of performance variables are recorded (e.g., motion efficiency, see Fig 1). It is compelling to use such data to track the training progress of individual trainees. Furthermore, using learning curves, it may be possible to predict ahead of time, what performance level a trainee is going to reach (for example, participant 06 will reach a much better level than 03). In the future it may be possible to use learning curves from simulator data to select high potentials for a training program.

In this bachelor project you will set up a suite of simulator tasks and run a learning experiment on novice participants. Based on the results you will draw conclusions on designing simulator based trainings and simulator-based assessment. During your project you will work as in a team with other students and in close collaboration with Marleen Groenier from Technical Medicine.




Bronchoscopy is a central and important minimally invasive procedure used in a variety of medical specialties such as anaesthesiology, critical care medicine and pulmonology. Flexible bronchoscopy is frequently used by pulmonologists to diagnose patients with lung cancer. The procedure is technically challenging and the learning curve for new bronchoscopists is steep and highly individual. Acquisition of bronchoscopy skills should therefore start in a simulated setting, instead of training on patients right away, see figure 1 below.


Figure 1. Flexible bronchoscopy.

Research has shown that novice bronchoscopists performed better on patients following a simulation-based training compared to the traditional, supervised training method, see Ost et al. (2001). This is in accordance with a meta-analysis that found simulator training to be superior compared to no simulator training, across many simulators and medical specialties.

However, the design of the training depends on the experience level of the trainee as well as the goals of the curriculum. Therefore, a training should be adapted to the specific local context. This project is the first step of this design process.

Aim of the project

The goal of the project is to identify learning objectives for novices, intermediates and experienced pulmonologists in a simulation-based flexible bronchoscopy training program.


A cognitive task analysis, see Crandall et al. (2006), will be performed to identify steps of the procedure, processes, important concepts and decision points. Participants are recruited from the Technical Medicine program at the University of Twente and the Pulmonology department at the Medisch Spectrum Twente. The Simbionix GI mentor simulator at the Experimental Centre for Technical Medicine at the University of Twente is used for measurements.


Crandall, B., Klein, G., Klein, G. A., & Hoffman, R. R. (2006). Working minds: A practitioner's guide to cognitive task analysis. Mit Press.

Naur, T. M. H., Nilsson, P. M., Pietersen, P. I., Clementsen, P. F., & Konge, L. (2017). Simulation-based training in flexible bronchoscopy and Endobronchial ultrasound-guided Transbronchial needle aspiration (EBUS-TBNA): A systematic review. Respiration, 93(5), 355-362.

Nilsson, P. M., Naur, T., Clementsen, P. F., & Konge, L. (2017). Simulation in bronchoscopy: current and future perspectives. Advances in medical education and practice, 8, 755-760. doi:10.2147/AMEP.S139929

Ost, D., De Rosiers, A., Britt, E. J., Fein, A. M., Lesser, M. L., & Mehta, A. C. (2001). Assessment of a bronchoscopy simulator. American journal of respiratory and critical care medicine, 164(12), 2248-2255.

Tjiam, I. M., Schout, B. M., Hendrikx, A. J., Scherpbier, A. J., Witjes, J. A., & Van Merriënboer, J. J. (2012). Designing simulator-based training: an approach integrating cognitive task analysis and four-component instructional design. Medical teacher, 34(10), e698-e707.

Further reading

An example of a cognitive task analysis informed simulation-based training program:




Mind reading refers to getting a grasp on what someone is currently thinking of, without asking the person directly.

Opposed to some common belief[1], psychologists are well able to read people’s minds. The key to mind reading is to use so-called implicit techniques (Robinson & Neighbors, 2005), in contrast to the prevalent self-report methods. The variety of implicit methods falls into two classes. In free association tasks (e.g., Schmettow & Keil, 2013), the response is free form (such as telling a brief story after viewing a picture), which is then interpreted by the researcher using some detailed scoring rules. In experimental tasks, direction of thought is usually inferred from differences in response times.


A rather novel paradigm to mind reading is a variant of the well-known Stroop task. The semantic priming Stroop task implicitly assesses the strength of association between a picture and a word. Participants first view a picture, followed by a word that is written in colour. As usual in the Stroop task, the participant has to respond to the colour as quick as possible. When the participant has a strong association between picture and word, this leads to a distraction from the colour naming task and can be measured as a delay in response time. By using words out of several categories, one can determine the broad direction of thought, the participant experienced. 

To give an example: Supposed, you want to find out whether someone knows the fairytale of “Red Riding Hood”. You would prepare a set of pictures that cover the themes of the fairytale, for example showing an old lady, a wolf or a basket with food. Another set of pictures is not associated to the fairytale, serving as a control condition. In the same way two sets of target words are created. During the experiment picture-word pairs are presented in two conditions: either both are associated through the fairytale (e.g., picture of a wolf, followed by the word grandma), or they are completely unassociated (e.g., picture of car followed by grandma). When the response time for associated pairs are delayed, you would conclude that the person knows the fairytale.

The Stroop semantic priming task has been used before to assess attitudes towards computers (Schmettow, Noordzij, & Mundt, 2013; Sparrow, Liu, & Wegner, 2011). While the experiment itself is unlikely suitable as a measure of attitude, it can well be used for cross validation of questionnaires which are co commonly used in Human Factors research.

Research question

The classic Stroop task is a well-established experimental paradigm in cognitive psychology and the Stroop effect has been replicated dozens, if not hundreds, of time. In contrast, the semantic priming variant has only been used twice to our knowledge, making it susceptible. In this thesis project, the promises are assessed in one of two possible scenarios:

  1. Best case scenario: does the task produce the expected results under optimal
    conditions, i.e. when the expected associations are very strong, for example
    knowledge of fairy tales.
  2. Replication scenario: can the pioneering results of Sparrow et al., 2011 be replicated?


In your thesis project you will:

  1. Do a literature study covering experimental priming paradigms and the Stroop task
  2. Create a scenario with stimuli set (words and pictures, for example, fairytales and
  3. Run the experiment to test your hypothesis
  4. Conclude on whether the semantic priming Stroop task works and how it can be used in Human Factors research


Robinson, M. D., & Neighbors, C. (2005). Catching the mind in action: Implicit methods in personality research and assessment. In M. Eid & E. Diener (Eds.), Handbook of multimethod measurement in psychology (Vol. 7, pp. 115–125). Washington, DC, US: APA American Psychological Association.

Schmettow, M., & Keil, J. (2013). Development of an Implicit Picture Story Exercise Measuring Personal Motives for the Interaction with Technical Products. University of Twente.

Schmettow, M., Noordzij, M. L., & Mundt, M. (2013). An implicit test of UX: Individuals Differ in What They Associate with Computers. In CHI ’13 Extended Abstracts on Human Factors in Computing Systems on - CHI EA ’13 (pp. 2039–2048). New York, New York, USA: ACM Press.

Sparrow, B., Liu, J., & Wegner, D. M. (2011). Google effects on memory: cognitive consequences of having information at our fingertips. Science (New York, N.Y.), 333(6043), 776–8.




Every day people use multiple technologies to perform complex tasks, such as buying products online, informing their decision making, or supporting their work activities. Several independent evidences in literature converge on the idea that multiple elements affect people’s expectations toward the use of a technology, including individual attitudes, skills and capabilities and technology related aspects, such as: product’s aesthetics and usability perceived before the use, fluency, brand and price etc.

In many cases, (high risk) processes are dependent on the technology to deliver the appropriate service. It is perhaps reasonable to assume that the implicit agreement of this technology-driven world is that: people trust the technology they are using to perform task and decision making in terms of: performance, functionalities and reliability of outcomes. Trust towards technology does not happen immediately, but rather, it is built throughout the relationship between user and artefacts. This is a set of beliefs about a product’s characteristics – i.e., functioning, reliability, safety, etc. And it derives from the gained experience of people in the use of different technologies over time. User’s overall trust is, therefore, strongly related to the concept of user experience, i.e., experience with (and the exposition to) different products enable people to develop a set of general attitudes and beliefs toward those technology, including the overall trust.


Redesign a survey on the basis of previous experimental data, and perform a new expert and usability evaluation.


Borsci, S., Lawson, G., Salanitri, D., & Jha, B. (2016). When simulated environments make the difference: the effectiveness of different types of training of car service procedures. Virtual Reality, 20(2), 83-99. doi: 10.1007/s10055-016-0286-8

Corbitt, B. J., Thanasankit, T., & Yi, H. (2003). Trust and e-commerce: a study of consumer perceptions. Electronic Commerce Research and Applications, 2(3), 203-215. doi:

Fruhling, A. L., & Lee, S. M. (2006). The influence of user interface usability on rural consumers' trust of e-health services. International Journal of Electronic Healthcare, 2(4), 305-321. doi: 10.1504/ijeh.2006.010424

Gefen, D. (2000). E-commerce: the role of familiarity and trust. Omega, 28(6), 725-737. doi:

Karat, C. M., Brodie, C., Karat, J., Vergo, J., & Alpert, S. R. (2003). Personalizing the user experience on IBM Syst. J., 42(4), 686-701. doi: 10.1147/sj.424.0686

Lankton, N. K., & McKnight, D. H. (2011). What does it mean to trust facebook?: examining technology and interpersonal trust beliefs. SIGMIS Database, 42(2), 32-54. doi: 10.1145/1989098.1989101

Lawson, G., Salanitri, D., & Waterfield, B. (2016). Future directions for the development of virtual reality within an automotive manufacturer. Applied Ergonomics, 53(Part B), 323-330. doi:

Lippert, S. K., & Swiercz, P. M. (2005). Human resource information systems (HRIS) and technology trust. Journal of Information Science, 31(5), 340-353. doi: 10.1177/0165551505055399

Marie Christine, R., Olivier, D., & Benoit, A. A. (2001). The impact of interface usability on trust in Web retailers. Internet Research, 11(5), 388-398. doi: 10.1108/10662240110410165

Mcknight, D. H., Carter, M., Thatcher, J. B., & Clay, P. F. (2011). Trust in a specific technology: An investigation of its components and measures. ACM Trans. Manage. Inf. Syst., 2(2), 1-25. doi: 10.1145/1985347.1985353

Montague, E. N. H., Winchester, W. W., & Kleiner, B. M. (2010). Trust in medical technology by patients and healthcare providers in obstetric work systems. Behaviour & Information Technology, 29(5), 541-554. doi: 10.1080/01449291003752914

Pennington, R., Wilcox, H. D., & Grover, V. (2003). The Role of System Trust in Business-to-Consumer Transactions. Journal of Management Information Systems, 20(3), 197-226. doi: 10.1080/07421222.2003.11045777

Salanitri, D., Hare, C., Borsci, S., Lawson, G., Sharples, S., & Waterfield, B. (2015). Relationship Between Trust and Usability in Virtual Environments: An Ongoing Study. In M. Kurosu (Ed.), Human-Computer Interaction: Design and Evaluation: 17th International Conference, HCI International 2015, Los Angeles, CA, USA, August 2-7, 2015, Proceedings, Part I (pp. 49-59). Cham: Springer International Publishing.

Salanitri, D., Lawson, G., & Waterfield, B. (2016). The Relationship Between Presence and Trust in Virtual Reality. Paper presented at the Proceedings of the European Conference on Cognitive Ergonomics, Nottingham, United Kingdom.

Shin, D.-H. (2013). User experience in social commerce: in friends we trust. Behaviour & Information Technology, 32(1), 52-67. doi: 10.1080/0144929x.2012.692167

Ziefle, M., Rocker, C., & Holzinger, A. (2011, 18-22 July 2011). Medical Technology in Smart Homes: Exploring the User's Perspective on Privacy, Intimacy and Trust. Paper presented at the 2011 IEEE 35th Annual Computer Software and Applications Conference Workshops.


SUPERVISOR: DR. SIMONE BORSCI (3 students); DRS. LIDA DAVID (2 students)


Nowadays, European citizens frequently use digital systems to interact and exchange information with Public Services (eGovernments), ranging from small city councils to government agencies. Citizens rely more and more on online contents to inform their decision making, request services, perform transactions etc[1].

Digital interfaces of eGovernments play an essential role in citizens lives, while policies and initiatives are being formed to enable accessibility to the contents and minimize social exclusion of disabled people[2],[3].

The overall vision indicated by the Tallinn Declaration of eGovernment seems far from being achieved by 2020, since “strive to be open, efficient and inclusive, providing borderless, interoperable, personalised, user-friendly, end-to-end digital public services to all citizens and businesses” is not equally achieved by all EU countries[4]. One of the key issues to achieve the vision of the Tallinn Declaration is to provide an equal right to quality of interaction with eGovernment systems. Unfortunately, quality of interaction, and in particular usability—defined by the ISO 9241-11 (2018) as “the extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency and satisfaction in a specified context of use”—is not a technical aspect which may be easily solved without a common framework of usability evaluation.

Current situation

eGovernment services reach 89% of satisfaction in terms of online support and help functionalities, and approximately 1 out of 2 (54%) eGovernment are Mobile friendly. Despite that, there is still a wide variation among EU countries in terms of implementing digital eGovernment in the population. Moreover, the goal of a borderless interaction with digital eGovernment services seems far to achieve because of linguistic and communication barriers, as well as differences in service design approaches.

The problem (s) addressed

The design of borderless eGovernment services cannot be achieved by just offering multiple language interfaces. In fact, “each communicative event is conditioned by the socio-cultural and experiential backgrounds of those involved[...] If such a background and the respective mindsets are not shared, misunderstandings can easily occur and negotiation of meaning is necessary to reach a common interpretation”[5]. Cross-border citizens, due to their lack of knowledge of contextual information, are likely to be affected by social, cultural and communication barriers that may prevent their comprehension of the necessary information and actions needed to comply with laws and regulations. This project will attempt to identify strategies and tools, and define guidelines to support the development of borderless eGovernment digital services. Through building customised strategies of design and communication, the aim is to enable cross-border interaction and to simplify freedom of movement at a digital level, for all European citizens.

Current solutions

Several countries and international organizations, partially recognising this issue, have created design guidelines to support designers to harmonise the image, identity, and communication style of eGovernment digital interfaces, and to provide a framework to ensure the quality of interaction for citizens. The common goal behind these guidelines can be summarised by the intent to unify (at an institutional level) the design elements of the digital systems of the eGovernment, and facilitate end-users to recognise functions and design elements. Furthermore, in some cases (such as the UK and Italian guidelines) these guidelines aim in providing a common framework for evaluation of users interaction. However, we are not aware of publications that have systematically analysed and compared the design guidelines for eGovernment.

Type of project

This is a Human factor exploratory work (i.e., not hypothesis-driven) to understand key aspects and major issues of Cross-Border Interaction in an attempt to facilitate and support free movement of citizens in European Countries. Qualitative and quantitative methods will be applied by students to carry out this work by performing usability and user experience tests.

The overall aim of this project

Your project will start with a systematic literature analysis around the main aspects that affect the usability of cross-border interaction and services (including language barriers), and in the development of cases and scenarios to test European Citizens (students, professionals). The aim of such cases would be the identification of difficulties in moving from one country to another, while complying with laws and regulations (documentation and tasks), and performing the essential tasks for becoming an active member of the landing nation e.g., pay taxes, set up utilities, rent/buy a house etc.

Alongside the literature analysis, you will:

  • Map and compare the current guidelines for service design of Government agencies and Multinational companies in and outside Europe. You will also perform an analysis of the similarities and differences of these guidelines (an initial list of guidelines will be provided by Dr Borsci)
  • Map the main tasks that every cross-border citizen has to perform to move from one country to another (suggested methods may include task analysis and journey mapping),
  • Then you will develop potential scenarios for testing Cross Border Usability and information retrieval to support moving from one country to another. These scenarios will be built from literature analysis and could be complemented by interviews with citizens (students/professionals) who have experience in moving from one country to another to for different reasons.
  • You will set up and perform simulated tests with participants to analyse the main issues to access appropriate information to organise the move to different nations (at least 2). Your analysis will include eGovenment digital service in which people may find relevant information to move from one country to another and may also include social networks and websites.  The analysis could be carried out within the framework of usability testing, however, expectations are that other aspects such as language and cultural barriers will be investigated throughout the simulated test.

Potential outcomes

Potential outcomes will include:

  • Literature analysis of key aspects which may affect cross-border interaction;
  • Review and key factors of design guidelines;
  • Definition of common user journey, key tasks and barriers for people moving from a European country to another;
  • Strategies of information retrieval, and services to facilitate moving and to overcome
    barriers of cross-border interaction;
  • Analysis of experience of usage and usability of digital service, and likelihood of
    correct information retrieval for Cross-Border interaction.


[2]In Europe

[3]In USA, Section 508 of rehabilitation Act:

[4]Declaration of Tallinn:




Previous studies have shown the potential human factor problems of automated cars (Cunningham & Regan, 2015; Martens & Van Den Beukel, 2013; Saffarian, de Winter, & Happee, 2012). These mainly tie into the fact that the driver will obtain a new role and will be handling more monitoring and supervising tasks rather than continuous physical driving tasks such as steering.

It is necessary to assist the driver of partially automated cars on two elements: maintaining a base level of understanding about the current driving situation and rebuilding the drivers situational awareness during take-over. However, it is uncertain how this feedback should be communicated in an easily understandable and acceptable way. Furthermore, it is uncertain how this information should adapt to the current driving situation.

In order to gain information on how to provide effective and acceptable feedback in different situations, we look into a situation in which this feedback loop is already present: driver-passenger communication. More specifically, the interaction between driving instructors and their students. Driving instructors were chosen as they are the practical experts on giving feedback to teach and maintain the situational awareness of driving students.

Your role: During this project, you will conduct multiple observation/filming days with driving instructors within the region of Enschede. Then, you will analyse the obtained video data (including video data that was already gathered) in both qualitative and quantitative ways.  

Aim. This study investigates whether and which communication adaptations occur when the complexity of the driving scenario changes. These adaptations may then be applied in a naturalistic feedback system in partially automated cars. For example, if driving instructors tend to speak more slowly in highly complex situations, a feedback system of an automated car may provide slower speech feedback during a take-over in a highly complex situation.




In the past, whenever people collaborated it was in the same physical environment. Then, conference calling was introduced, allowing for some remote participation. This was later enriched with video, and now, immersive technologies are becoming more common.

Each of these technologies has consequences for the way collaboration can take place. For instance, a phone call is great for making an appointment, but not for creative processes.

The present study focusses on the consequences that immersive technologies, such as virtual reality (VR) and augmented reality (AR), have on collaboration. Can you have a meeting where the participants are virtually present? What types of tasks can be done in VR? How do you give someone instructions remotely? And, what are the advantages and disadvantages of collaborating remotely through the use of immersive technologies?

You will work with researchers at TNO in Soesterberg in answering these questions by exploring the current state of the art regarding meeting and collaborating in virtual/augmented reality, and by identifying knowledge gaps in the field of remote collaboration.

Most of the work can be done from the university but some visits to Soesterberg may be required. You will get an inside look in the work being done at TNO and a chance to gain insight on a variety of topics in a multidisciplinary team.


Klein, G., Ross, K. G., Moon, B. M., Klein, D. E., Hoffman, R. R., & Hollnagel, E. (2003). Macrocognition. IEEE Intelligent Systems, 18(3), 81–85.




At TNO, ongoing research is conducted on how the design of a workspace can enhance collaboration and task performance. The focus is on high-stake tasks and environments where optimal human-human, and human-machine collaboration is essential.

Prior to implementing new designs, they are evaluated for their effectiveness and safety. The present study focusses on implementing immersive technologies such as virtual reality and augmented reality in the evaluation process of these designs.

For example, immersive technologies enable designers to make quick adjustments to the design and experience the impact by virtually entering the workspace. Moreover, it allows the future users of the workspace to be included in the evaluation more easily as well.

One of the key challenges in evaluating designs in virtual reality is to determine what a user needs to see, do, or experience in order to get an accurate feel for the design. In other words, how can we ensure that an evaluation in virtual reality is representative for real-life implementation.

You will work with researchers at TNO in Soesterberg in exploring this challenge by determining what the current state of the art is regarding virtual evaluation methods, and by identifying knowledge gaps in the field of immersive technologies.

Most of the work can be done from the university but some visits to Soesterberg may be required. You will get an inside look in the work being done at TNO and a chance to gain insight on a variety of topics in a multidisciplinary team.


Dunston, P. S., Arns, L. L., Mcglothlin, J. D., Lasker, G. C., & Kushner, A. G. (2011). An Immersive Virtual Reality Mock-Up for Design Review of Hospital Patient Rooms. In Collaborative Design in Virtual Environments (pp. 167–176). Dordrecht: Springer Netherlands.