Ped.IT : Pediatric Evaluation Device Intended for Training

Revolutionizing the Pediatric Physical Examination through SimulationZachary Henderson, Minsuk Kwak, Kshitij Manchanda, & Michelle Thorson

Department of Bioengineering, Rice University, Houston TX, 77005Email: ricepedit@gmail.com

Background Physical examination skills are essential in order to assess the

health of pediatric patients. Almost 50% of medical students are do not receive sufficient

training for physical exam.1

Preparedness limited by: Patient variability Patient safety and comfort Rare disease occurrence Subjectivity in patient assessment

Medical simulation is an effective training tool.2,3

Current use of medical mannequins is limited by: Simulating adults in trauma situations only High cost ( > $150,000)

Our objective is to create a full-body pediatric mannequin that simulates conditions which are detectable by palpation during a physical exam in order to improve medical training.

Design Criteria Full body mannequin of average 6-10 year old

Correct body dimensions (100-115 cm) Correct organ sizes4

Low cost (<$2,500) Three integrated organ systems

Liver (normally 10-12 cm) Spleen (normally 7-9 cm) Lymph Nodes (normally 1-2 cm)

Simulates both normal and abnormal conditions related to each organ system

Realistic feeling skin Modular design for additional features and organ systems

Mannequin Design

References

Testing and Results Preliminarily surveyed Texas Medical Center physicians three times to

test the following on a scale of 1 (worst) to 5 (best): Accuracy of organ size Ability to feel abnormal organ conditions Realism of organ feel Realism of skin

Conclusions Innovation leads to:

More affordable mannequin (<$2000) Ability to simulate normal and a range abnormal organ

conditions shown by independent study More realistic mannequin skin/feel compared to

industry standards Ped.IT technology improves mannequin realism and

qualitative medical training to enhance clinical skills of medical professionals, in turn, ensuring better pediatric clinical care.

AcknowledgementsWe thank our mentors Dr. Jennifer Arnold, Dr. Amy Middleman, Dr. Renata Ramos, and Dr. Maria Oden for guidance throughout the project. We thank the OEDK for providing resources and space to conduct our design. We thank the Texas Children’s Hospital Simulation Center for providing additional support and space for testing. We also thank Laerdal for kindly donating a Nursing Kid pediatric mannequin for us to modify.

1. Bass, E.B. et al. Do clerkship directors think medical students are prepared for clerkship years? Acad Med. 79:56-61, 2004.

2. Devitt, J.H., Kurrek, M.M., Cohen, M.M., and Cleave-Hogg D. The validity of performance assessments using simulation. Anesthesiology. 95:36-42, 2001.

3. Tsai, T.C., Harasym, P.H., Nijssen-Jordan, C., and Jennett P. Learning gains derived from a high-fidelity mannequin-based simulation in the pediatric emergency department. J Formos Med Assoc. 105:95-98, 2006.

4. Netter, F.H. Atlas of Human Anatomy. Philadelphia: Saunders Elsevier, Inc, 3006, 548.

Electronic Control System- Voltage controlled actuators, located in chest

cavity, move liver and spleen to simulate abnormal conditions

- User controls organ movement through National Instruments LabVIEW VI

Actuator shown with liver with actuator connector LabVIEW VI Front Panel

Internal anterior cervical chains shown

Liver

Spleen

Neck Region- Enlarged lymph nodes- Exterior made from

Dermasol, bed foam- Lymph nodes- varying sized

balls attached by wire

Skin- Thin sheet of realistic feeling

Dermasol coated in powder

Shell- Modified Nursing Kid

mannequin shell from Laerdal

Heart and Lung Sounds- Simulate pediatric heart and

lung sounds at specific landmarks

- Emits VitalSim® sounds through external speakers

Abdominal Region- Simulate enlarged spleen and liver- Spleen created from taped Z-FLO bags- Liver created from tightly wrapped

Tempur-Pedic with firm edge- Internal structure made of Dermasol

and Tempur-Pedic

Battery Life Indicator

Organ Positioning Control

Autosave function

Record tracking

High scores noted for skin realism, organ condition, location, and feel on final, large-scale survey

Survey Participants

1 10

2 10

3 36