JMIR Publications

Background:

For many decades, paradigms in health research consisted of male patients, animals, and cells. Only until relatively recently (1990s) has the NIH placed an emphasis on sex and gender considerations in grant proposals[1,2]. This bias has extended to healthcare simulation and training environments with very little sex-specific training applications available to the educator. Even cardiopulmonary resuscitation (CPR) manikins lack basic female anatomy, with one survey identifying one of twenty available commercial products having a breast overlay[3]. Of these applications no current advanced manikins have physiological alterations due to sex configuration of the patient. There is a critical need for expanded patient variability in the simulation space in order to teach healthcare providers the nuance involved in sex-specific physiology, anatomy, and communication skills[4–9].

Objective:

We focus this work on investigating the use of a simulation platform that can allow for patient-specific configurations, creating differences in the temporal response to airways trauma and resuscitation. We look at the differences between two patients, one male and one female, in response to airway trauma in three specific scenarios that provide the simulation training for the Medic One program out of the state of Washington. We create a unique scenario by considering the following: • Anatomically unique male and female robotic manikin • Unique initial patients for each scenario • Detailed scenario design focused on surgical airway interventions.

Methods:

We leverage the Modular Healthcare Simulation Education System (MoHSES) to facilitate and connect advanced physiological models of airway trauma to a robotic manikin. These models consider biological sex when constructing the patients' initial state by allometrically scaling volumes, masses, and pressures. Although the physiological models do not consider the vast hormonal differences in sex and their relationship to trauma, they do show marked differences between the physiological state of the patient during the simulation.

Results:

We show that for complex airway trauma patient cases, the physiological models that interface with an advance robotic manikin provide marked differences between biological sex configurations and the initial patient data. This initialization may be configured by the user to be leveraged in a variety of learning modalities by interfacing with the MoHSES platform.

Conclusions:

Physiology engines, such as BioGears, can play a fundamental role in creating accurate and realistic medical simulations, where changes in the patient’s condition – be it either improvement or deterioration – rely on appropriate and timely interventions by the students. But the ability of an engine to represent physiological changes over time, as the “patient” moves through consecutive echelons of care, becomes especially useful for a specific area of medical simulation: training our militaries’ combat medical personnel.

Clinicaltrial: