A backlight illuminates fluorescent markers on a silicone face used to practice plastic surgery. Timothy Kenney
Medical simulation lab engineers next-generation training manikin
Surrounded by silicone livers, a 3D-printed rib cage, and a prosthetic arm covered in third-degree burns lies Frank, a simulation manikin dressed in camouflage army fatigues. Fresh off a nationwide tour to train combat medics how to respond to roadside bombs, his right leg is a mangled mess of blood, bone, and silicone, but he’s still serving an important purpose.
Affectionately named after Frankenstein, the roughly 6-foot manikin was developed by the UW Center for Research in Education and Simulation Technologies (CREST) as part of a Department of Defense (DOD) project to modernize training for combat medics. The finished manikin will have interchangeable limbs, an internal computer system, and a network of sensors that monitor how a simulation is progressing in real time.
Two former combat medics at CREST, Troy Reihsen and Jordan Gonzalez, used their experiences on the battlefield to create an immersive training exercise treating combat trauma. Inside a pitch black tent, Gonzalez hides his body under a hidden platform so the manikin fits seamlessly onto his head and arms, allowing him to scream and flail like a real trauma victim. Using only a headlamp and their medical pack, trainees attempt to calm the victim while tying a tourniquet around the manikin’s bleeding leg.
“A large-scale simulation like the combat medic project can feel a lot like a movie production set,” said Jason Speich, a traditional artist employed by CREST. “We traveled around the country with a team of over 40 people testing the simulator on military medics to see how well it worked.”
A prosthetic arm colored to appear covered in third-degree burns is used as part of combat medic simulation that recreates injuries suffered during a roadside bomb.
Timothy Kenney
Much of the DOD’s interest in medical simulation stems from its goal to improve training procedures for combat medics, but the CREST grant specifies that the manikin platform should have both military and civilian applications.
CREST’s latest project may be their most ambitious yet. The team won a competitive grant from the DOD last September as part of the Advanced Modular Manikin project project, securing $7.7 million over the next three years to develop an intelligent, customizable model patient that can fit the needs of any medical scenario. The finished manikin will have interchangeable limbs, an internal computer system, and a network of sensors that monitor how a simulation is progressing in real time.
“This is kind of the logical conclusion,” said CREST director David Hananel. “We’ve been trying to develop these high-tech medical simulators for 25 years, but we haven’t made a lot of progress. It’s really the last three to four years where it’s starting to take off.”
After almost a decade at the University of Minnesota, executive director Robert Sweet moved CREST to the UW last year, bringing with him a diverse team of simulation specialists. Recreating the complex anatomy of the human body requires a wide variety of professionals from all sorts of disciplines, including chemists, engineers, physiologists, computer scientists, and animators.
Simulation artist Jason Speich holds part of a silicone kidney used in surgical training. These organs are designed not only to appear realistic to the human eye, but also through imaging machines like x-ray.
Timothy Kenney
Speich, who started his career crafting sculptures and now uses those same talents to design immersive simulations. Speich never imagined he would be developing fluorescent silicone kidneys that shine under a blacklight or building a machine that replicates the subtle movement of organs during surgery, but he believes it’s the most fulfilling application of his skillset.
“For me, there’s a lot of similarities between art and a simulation lab like this,” Speich said. “Painting or sculpture can be seen as a way to represent something in a different medium and simulation does the same thing. We’re representing human anatomy in different materials, so it feels very familiar to me.”
They plan to equip the manikin with realistic features like warm skin, a wet tongue, a working system of fluid-filled veins, and a network of sensors that relay information back to the computer core in real time.
Resident artist Jason Speich sands down a model of the human body cavity so it can fit perfectly into the pelvis on the table. Timothy Kenney
The manikin’s sensory software will also react to any actions the user takes. For example, during a hypothermia simulation, the manikin could change the temperature of its skin based on how the student intervenes. The manikin could even be programmed to shout and groan like a live patient would to recreate the commotion combat medics and first-responders experience.
This technology could also allow the U.S. military to end its current practice of using live animals, such as pigs and goats, to train combat medics on invasive procedures. The U.S. military uses over 8,500 live animals every year for training purposes, according to a house bill filed in February. The DOD wants to move away from animal models but is hesitant to do so until researchers have demonstrated that medical simulations are equally effective training tools, according to Speich.
As part of the DOD’s grant, the final manikin platform will be open source, meaning the software and design information will be available for free. While it’s unusual for the DOD to be this transparent with its research, Hananel said that they see the benefits of many companies collaborating on a common platform.
“For too long simulation has been silos where everyone is pretty protective of their technology,” Speich said. “The way we’re approaching this from the start is letting everyone know that what we’re creating will be shared with everyone. It’s been a long time coming.”
In the same way that independent technology companies develop applications for the iPhone, CREST plans for the simulation industry to develop their own attachments and software for the manikin model.
One of the challenges of designing medical simulations, according to Hananel, is reinforcing dangerous habits when a simulated task doesn’t accurately reflect the procedure on a live patient. For example, when inserting a tracheal breathing tube into a manikin, if the simulated skin is too rigid, the student might cut with too much force on a live patient and damage delicate throat tissue.
Different batches of silicone mixtures are part of an experiment to design colored organs to help students differentiate between internal structures.
Timothy Kenney
CREST works with specialized clinical experts to make their simulations as accurate as possible and avoid reinforcing bad habits. These consultants return throughout the design process to test the latest simulations and give feedback on what areas need improvement.
“We walk through the procedures with clinicians in a tremendous amount of detail to understand their decision making process,” Hananel said. “They have to be realistic enough that the learner will recognize each cue, but it also needs to be subtle enough that if it’s a hard-to-recognize cue, they might just miss it and make the wrong decision [during training and learn from it].”
Medical students at the UW and worldwide will surely benefit from the scope of simulation research happening at CREST, but Hananel also wants to involve students in fields such as engineering and computer science to help further Frank’s capabilities.
A group of mechanical engineering students from a class about medical devices recently collaborated with CREST to design an arm attachment intended to train students how to insert an IV needle into a vein. The pronounced purple vein running down the center of the arm is surrounded by sensors that tell the user how well they did the procedure. If they push too hard, they could pierce through the vein, causing the manikin to bleed.
“A lot of what we do is interdisciplinary work, so there is a huge opportunity for student projects,” Hananel said. “It’s a perfect test case to make sure the standards we’re creating are easy enough to be building things for.”
Originally published in The UW Daily