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Note: While this instructable is published under J Scott Christianson's account, the credit for this project is shared equally between Scott and Chris Sanders.

Request: If you are an Instructables member, please consider voting for this project in the three contests in which it is entered (click on vote icon above). We'll use any contest prizes for community, undergraduate and/or graduate classes!

Background

In health care, a Simulated Participant, Standardized Patient, or Sample Patient (referred to as an SP) is an individual trained to act as a real patient in order to simulate a set of symptoms or problems. Simulated Patients have been used in the education and evaluation of an array of health care providers including nursing, medical, pharmacy and social work learners.

The standardized patients are taught to deliver specific patient case information to learners. The standardized patients communicate and deliver the patient's history in a way that meets the needs of the specific learning experience (usually orally or using simulated patient records). The history portion of the SP simulation experience can be reproduced with effective standardized patients and retains a high fidelity to typical patient encounters.

However during the encounter, the SP is not able to simulate certain physical findings that the learner may attempt to obtain by examination: for example, an abnormal eye exam, heart murmurs, abdominal noises, or crackling lung sounds. These findings must be delivered by means other than observation by the students, thereby interrupting the patient encounter. The lack of realism can introduce disruption and may present a less authentic experience.

In this project, we were specifically looking for methods to improve the delivery physical findings and represent physical elements of an SP in a way that continues to assist the learner in a realistic patient encounter. As such, our first step was to inventory the methods by which findings are, and could be, delivered to the learner.

Step 1: Options for Findings Delivery

Option 1

Find ‘real’ patients with abnormal findings that the students could examine and practice their skills. This would represent one of the best possible solutions but is unrealistic for several reasons: Lack of available patients who would be willing to serve as standard patients; Any such SPs would be limited in the encounter experiences they could provide (a one-trick pony so to speak).

Option 2

Find standardized patients with medical conditions to fulfill the role for learning experiences. An example, find standardized patients with fundoscopy eye exam abnormalities. Find standardized patients for death and dying scenarios by finding standardized patients that have experience with abdominal cancerous masses. As with Option 1, while this might represent one of the best scenarios for findings delivery, it is unrealistic to use for at scale.

Option 3

Utilize a normal healthy SP to represent medical history, some physical findings and hard to recreate physical findings through paper findings cards. Medical findings are delivered to a participant when appropriately triggered. The standardized patient delivers paper-based findings cards during the encounter. Using this method the SP can deliver findings card that states ”heart murmur found in M3” or “lungs sounds are crackling”. These paper cards can be held by the patient and deliver to the learner during an encounter. This is the currently used system at the simulation center. This has several problems/risks:

  • The SP can drop or mix up the cards.
  • The learner does have the opportunity to come in contact with the patient in the same way they would in a "real world" encounter.
  • The learner may be misled by seeing that the SP has many or few cards, perhaps indicating the complexity of the simulated case.

Option 4

Utilize a normal healthy SP to represent medical history, some physical findings and hard to recreate physical findings through electronically generated methods. The standardized patient delivers electronic based findings through a tablet device during the encounter. The method allows the standardized patient to select and present a mix of digital content including images, sounds or video into the experience of the learner. This can be accomplished by the standardized patient presenting the appropriate electronic content via a computer or tablet device when the learner asks to investigate a specific physical aspect of the human body.

Option 5

Utilize a normal healthy SP to represent medical history and some physical findings and represent hard to recreate physical findings through electronically generated methods. An additional standardized assistant can remotely view the live interaction between learner and standardized patient and then identifies triggers and delivers electronic based findings through a tablet or computer device during the encounter. The method allows the standardized patient to focus on representing the history part of the encounter and a remote assistant then triggers the appropriate digital content including images, sounds or video into the experience of the learner. This can be accomplished by the remote assistant presenting the appropriate electronic content via a computer or tablet device when the learner asks to investigate a specific physical aspect of the human body.

Option 6

Utilize a normal healthy SP to represent medical history and some physical findings and represent hard to recreate physical findings through electronically generated methods. Allow the learner to select the electronic based findings through a tablet device during the encounter. The method allows the learner to select and observe a mix of digital content including images, sounds or video into the experience. This can be accomplished by the learner selecting appropriate electronic content via a computer or tablet device when investigating a specific physical aspect of the human body.

Option 7

Utilize a normal healthy SP to represent medical history and some physical findings and represent hard to recreate physical findings through electronically generated methods. The standardized patient can deliver electronic based physical findings through defined voice commands to an in-room computer device during the encounter. The method allows the standardized patient to command the display of digital content including images, sounds or video into the experience of the learner. This can be accomplished by the standardized patient triggering voice commands for appropriate electronic content via a computer or tablet device when the learner asks to investigate a specific physical aspect of the human body.

Option 8

Utilize a normal healthy SP to represent medical history and some physical findings and represent hard to recreate physical findings through electronically generated methods. The standardized patient is outfitted with an array of sensors (QR codes, lights sensors, pressure sensors) to detect learner interaction. Based on the learners interaction sets of sensors and processors, sound output and displays can represent the appropriate electronic content. One example would be the use of a stethoscope that plays the appropriate content when placed in the correct location for lung or heart sounds.

After considering the options, we focused on developing a project to develop an open-source hardware and software project to deliver findings triggered via a sensor (Option 8).

<p>Fascinating concept, I hope you guys take this further. If you're after realism, you probably want to make the stethoscope as realistic and lightweight as possible. While it's hard to tell without actually hefting it, it looks a little heavy/clunky (yeah, prototype, I know). Some suggestions:</p><p> - The stethoscope tubing transmits sound remarkably well (it has to, right?) so you could just use a single ear bud speaker connected (and probably sealed so it's airtight) to the bottom of the tubing. Keep the standard stetho earpieces.</p><p> - The 3D printed casing for the whole kit is an interesting design and looks well thought out, however I'd be concerned that it would detract somewhat from the experience - because an authentic experience is what you're after primarily. Could you use a standard or slightly modified stethoscope end piece (diaphragm/cup I don't know what it's called, sorry) with a small reader on each side, then wire these readers (with the headphone wire) up the stethoscope and then down into a case that the user can keep in their pocket? Then you'll have more or less an actual stethoscope and the bulk of the hardware is out of the way in the pocket (I'd also add a clip for the women trainees who often don't have pockets)</p><p> - If you did have two readers, you could then differentiate between the use of one side or the other, and encourage situation-appropriate use.</p><p>Again, I think this is a great idea and I think education in areas like this is in for a lot of change in coming years - you guys are on the leading edge, keep it up.</p>
<p>Thanks for the great ideas and comments. I don't know if we'll develop it a lot more right now. Our short-term goal is to get feedback, new ideas and let others take it and make it better. </p><p>&quot;The stethoscope tubing transmits sound remarkably well (it has to, right?) so you could just use a single ear bud speaker connected (and probably sealed so it's airtight) to the bottom of the tubing. Keep the standard stetho earpieces.&quot;</p><p>Yes, we had thought about this and my colleague Chris wanted to go down this path, but I was worried about limiting the volume, and didn't want to risk blowing someone's ear drums out ! (the whole do no harm thing). But I think that it might work well, if you could make sure it is safe. Also there seems to be a wide range of quality in Stethoscopes. The one be got was $3-4 on ebay, but you can spend hundreds of dollars. So depending on the Stethoscope that the student is bringing to the simulation, they might have a different experience. That would be another concern of professors and students in a simulation environment. </p><p>I think that the use in vet schools would be very cool, as they rely on data collection more than asking a cow where it hurts!</p><p>Certainly, we agree that the enclosure could be much slicker. I was thinking a cone like shape for the final deisgn. The battery we used was overkill, and a small lipo (or seveal) could be used instead and would fit better in the enclosure. This was more for testing and proof of concept rather than production. </p><p>Thanks so much for your interest and comments. It means a lot. This is the first Instructable that we have published. Looking forward to sharing some more!</p>

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Bio: Most days, I am an Assistant Teaching Professor at the University of Missouri and a small business owner with decades of experience in project management ... More »
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