1. Ped.IT : Pediatric Evaluation Device Intended for Training Revolutionizing the Pediatric Physical Examination through Simulation Zachary Henderson, Minsuk Kwak, Kshitij Manchanda, & Michelle Thorson Department of Bioengineering, Rice University, Houston TX, 77005 Email: 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 sizes 4  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. Acknowledgements We 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 SurveyParticipants 110 2 336