ASSIST-U Digital Rectal Examination Simulator from Imperial College London

rectal exam simulator

Recently the Imperial College London put together some research regarding the education of DREs utilizing ASSIST-U haptics simulator system, built by the program. The video below shows the progress of the simulated environment which provides a safe environment to repeatedly perform DREs including: 3D meshes, CTA decision making (state machine), internal view, modeling of coccyx, prostate gland and rectum, as well as haptic effects are integrated. Colored spheres indicate next steps to perform. An internal view shows patient-specific anatomy (from left to right: coccyx, rectum, prostate and bladder). Controls (right-centre) integrate CTA actions. Other controls (top) are set to fine-tune haptic force effects.

Advanced Simulation System for Training Unsighted Examinations and Procedures (ASSIST-U):

The Research Project

Sponsored Advertisement:

Colorectal and prostate cancers are some of the most commonly diagnosed cancers accounting for 13% and 12%, respectively. The early detection of these diseases is essential and Digital Rectal Examination (DRE) plays a crucial role for diagnosis, screening and clinical outcome. During a DRE, a clinician inserts his/her index finger through the back passage in order to examine the rectum and the prostate, while the patient is usually lying on their side with both legs up to their chest. Such examinations are conducted almost entirely by feel as visual cues are minimal. As a result, DRE is uniquely challenging to learn and teach as there is no connection between trainer and trainee. On the one hand, the trainee is unable to see what the trainer is doing and, on the other hand, the trainer is unable to feel what the trainee is feeling resulting in an ineffective assessment of performance. Simulation offers obvious benefits by allowing learners to practice repeatedly and build up skills in safety. Notwithstanding, current models have major deficiencies as the wide range of normal and abnormal findings is not adequately reproduced, and the rehearsal on isolated bench top models lacks crucial elements of the clinical encounter.

Main Objectives

By changing the way the skills of internal examination are taught and acquired, this research project aims to augment the learning experience based on solid cognitive, analytical, technological and educational studies. This learning experience will be achieved 1) by allowing the learner to playback and graphically observe what an expert palpates (visual mode) in order to appreciate patient-specific organ differences and understand the steps involved during examination, 2) by asking the learner to playback and haptically follow what an expert palpates (expert-guided mode) in order to start building a mental representation of the internal structures and understand the exertion of forces when touching internal regions, and 3) by asking the learner to perform the examination independently (interactive mode) in order to be able to assess his/her performance. The implementation of real-time and realistic models for deformation, haptics, friction, classification and assessing will be fundamental for interactivity and realism.

Learn most about the ASSIST-U DRE Simulator
on the Imperial College London Website

Sponsored Advertisement:

Limbs & Things Releases New PROMPT Flex Obstetrical Task Trainer

birthing task trainer limbs and things prompt

Just heard about a newly launched PROMPT OB task trainer from Limbs & Things with the denomination of “Flex”. The new FLEX improves on the 12 years of PROMPT use by healthcare simulation champions around the world, which improves anatomical accuracy and ease of use. And because this product is modular, there is a lot of value available out of just one task trainer! Check out the video and official press release below for more details.

From the Official Press Release:

Developed in collaboration with leading clinicians, the Limbs & Things PROMPT Flex Birthing Simulator is based on over 12 years of evidence-based outcomes using the original PROMPT Birthing Simulator. This product provides the ideal training solution for all skills relating to routine and difficult childbirth.

Consultant Obstetrician and Academic Clinical Lecturer in Obstetric Global Health, Dr. Joanna Crofts, said “The PROMPT Flex is an exciting development in birthing task trainers. Its realism, flexibility and versatility ensure it is a vital component of effective childbirth training.”

Key Features:

  • Realistic pelvic floor
  • Articulating thighs for McRobert’s manoeuvre
  • Stretchable perineum
  • Software with built-in modifiable, timed checklist of events
  • Recording of drills for annual competency or debriefing
  • Complete Cervical Dilatation, station, presentation, and effacement training
  • Stand-alone and hybrid use
  • Wireless force monitoring of baby
  • Full term infant weight and size
  • Fully articulated baby with correct anatomical landmarks

PROMPT Flex offers clinicians many options for use, including individual training, assessment of knowledge and team training for crisis Maternity emergency events. PROMPT Flex can be used as a stand-alone product, or integrated into hybrid simulation using SPs (Standardized Patients). Additionally, the modular nature of the product will extend its use for cervical assessment (including dilatation, effacement, station and presentation), cesarean section and post-partum bleeding scenarios.

Using the latest Bluetooth technology, the force monitoring component is now available as a wireless solution combined with software which is compatible with PC, Mac, iOS and Android, recording traction applied to the baby’s head, as well as interventions and time to deliver baby. Results recorded can be reviewed and used as a debriefing tool or annual competency record.

About Limbs & Things

With over 25 years of research and experience in healthcare simulation, Limbs & Things is a leader in the medical education field. Recognized globally for our superior and comprehensive product offering, our trainers provide a realistic hands-on learning experience for academic and clinical professionals. With distributors in over 70 countries, offices in the UK, USA & Australia, and UK manufacturing, Limbs & Things provides hand-crafted, quality task trainers that aid in the improvement of patient outcomes.

For more info visit the new Prompt-Flex Website today!

Pulse Research & Development Shares How They Helped One Inventor Train the World

A recent LinkedIn article by Donna Eldridge (shared with permission) from Pulse Research & Development shares a fascinating journey of invention!

pulse r & d

“It was my arm standing in as the C-arm, my cell phone as the fluoroscope, an iPad and a block of silicone… that was our first training model.”

Jerry Long, Director of International Marketing at Boston Scientific had a challenge; “How could we as a company and as an industry impact the number of endourology procedures globally and especially in emerging markets?”

With the Society of Endourology, Jerry and his team convened thought leaders in urology to find some possible solutions. They were well aware that the three barriers would be: Training, Capital Equipment, and Reimbursement – which is especially tricky in some regions. The group decided to focus their efforts on training. They saw training as the activity most likely to launch – and predicted it as the most direct strategy to get physicians to do more procedures.

Supported by BSCI leadership, The Stone Institute was established to develop an integrated training program that could be taken around the world.

Like most new endeavors they began with limited resources to see if their idea was workable and eventually scalable. Would they be able to attract physicians? Could it be replicated internationally? How would it affect surgeon perspectives for treatment? And would the program find support with partners in the field?

The objective was to create a consistent high-quality training program combining didactic and hands-on instruction to improve key surgical & procedural skills advancing the level of expertise for Stone Disease globally.

The expectation was to grow the volume of procedures performed worldwide with the overall intention of improving patient health.

At the completion of the initial training programs, evaluating the first participant feedback, and with Jerry’s arm quickly wearing out, the team began planning improvements for the next round of training. A second-generation training model involved hacksawing off the back of an old office chair to get the required ‘C-shape’ for the C-arm and creating a rough SLA or 3D printed kidney. Additional training programs garnered more and better feedback on both the classroom training and the hands-on surgical lab.

The next stop was the Boston Scientific model shop where the first of many portable, radiation free, C-arm designs was crafted and operable calyceal molds were cast.

More training, more feedback, and required improvements were made.

They now had enough information to have Pulse Research + Development create & produce in quantity, beautiful & branded 8th generation models: realistic mini C-arms and surgical practice kidney calyces that provided a very real-life surgical experience, designed to be totally congruent with The Stone Institute.

In the 18 months since The Stone Institute was established, 630 physicians have been trained globally in the surgical skills for flexible ureteroscopy and percutaneous nephrolithotomy (PNL).

  • The innovative lab design has enabled a realistic and radiation-free environment for practicing surgical techniques
  • The novel clear silicon kidney model offers true-to-life needle puncture pressure and feeling
  • And the custom camera and software replicates fluoroscopy images on a screen
  • At each selected training site a core faculty member has been paired with a ‘local’ faculty member for training delivered at a hospital or conference center. The pairing integrates each program culturally, raising visibility and building trust.

The Results:

  • Post program surveys have found that surgeons doubled their confidence level in the key skills
  • Procedure volumes have increased overall, achieving the goal of improving patient health

Using direct and specific surgeon feedback The Stone Institute has been able to create the most captivating & compelling, practical & portable, striking & memorable experience possible. In addition to sites like South Africa, Brazil, Poland, Dubai, China, and Singapore – ongoing programs will continue to be offered around the globe.

“It’s scary to go out to the customer with something ugly or something that you don’t know is going to work. But it is wonderful to engage physicians in a way that gets them to jump on board and partner with you. The physicians every step of the way have been enthusiastic critics to improve the overall experience for the next group of trainees.” – Jerry Long, The Stone Institute

Visit for more!

Sponsored Advertisement:

Remedy Simulation Group Provides Innovators & Inventors with Product Development Support


Have an idea for a simulator or a working prototype that needs professional grade skins? The folks at Remedy Simulation provide awesome consulting services ranging from product prototyping to manufacturing, sales and marketing!

remedy sim

About Remedy Sim:

The Remedy Simulation Group is the new identity of Pulse Anatomical Model Company, Inc. We decided to rebrand our contract manufacturing business and retail business starting in 2015. While both sides of our business grow, we wanted to keep things simple for you with a new organization. Clinical simulation is a crazy busy job and keeping products you need front and center is our goal. All of our products are developed by combining industrial design with biomedical engineering to create winning solutions. Our models will always have a realistic physical component that can be touched, cut, poked, prodded, and felt in some manner. Medicine will always require interaction with a patient and being able to offer that same high level of interaction with our products is our goal. If you have an idea for a new product, we can walk you through the process of licensing your idea and selling it through our dedicated webstore and network of distributors. If your lab uses a special home made product, we can also build that just for you. This can free up valuable time to develop new products to meet the growing need all organizations have.

At Remedy Simulation Group we believe medical simulation plays an important role in the future of healthcare. Remedy provides you with two distinct ways to interface with our company: simulation training products and contract manufacturing. Our innovative products help students studying in the medical disciplines to develop important and necessary skills by providing tactile, realistic scenarios for learning. Contract manufacturing services are available to anyone looking for assistance with the production and sale of a product. At Remedy Simulation Group we look forward to working with you to Improve the Standard of Practice!

If you are a simulation provider or even another modeling company we offer contract manufacturing services. Our facility has grown from the famous closet in our first office to a new 3000 sqft facility that has room for expansion. The processes we use vary by project and we have the ability to integrate new materials and manufacturing methods as needed. We can work with an idea or duplicate and existing production line. Finally we can also help walk through the process of licensing your idea, manufacturing the product, and selling it through our dedicated web store. The website suggests that “Ivy”, Remedy’s first nurse designed IV Pad product is coming soon!

Learn more at the website!

OtoSim2 Otolaryngology Simulator Launched at IMSH 2015 | Video Interview


Continuing our IMSH 2015 Exhibit Hall Video Interviews, today we showcase the new OtoSim2 from Otosim! OtoSim 2 evolved out of the first Otosim product, which now has an instrumented otoscope so we can tell exactly where the student is looking, we can ask the student to find features, and provide verbal feedback through the computer. OtoSim 2 also doubles the number of images, adds case studies, allows you the potential to upload your own images, and allows for mass training for any number of students.

More from OtoSim’s Website:

OtoSim Inc. continues to innovate with a new simulation and training technology for otolaryngology. Interest and feedback gathered over the past 3 years from various healthcare practitioners has proven to be the catalyst for a novel breakthrough in otoscopy simulation: OtoSim 2.

OtoSim 2 is the upgraded version of OtoSim with new software and hardware, and increased capabilities:

  • Verify student progress via the instrumented otoscope. Trainees can point with this device to complete the learning feedback loop.
  • Expand student knowledge through reviewing 380 high resolution images from the Hawke Library to instruct, practice, and test students
  • Save instructor time by connecting up to 14 OtoSim units to a single trainer laptop to effectively instruct groups at the same time
  • Supplement classroom instruction with 150 pre-annotated images for self-directed learning
  • Improve viewer retention through immersive full-screen experience with a simple, easy-to-use graphical user interface
  • Further increase student capability through advanced quizzes with randomized, realistic clinical scenarios that test both medical and patient interaction skills
  • Build student confidence through the use of the instrumented otoscope, allowing students to practice and improve their otoscopic

This is the only product I am aware of in this high-fidelity category of Otolaryngology simulation! OtoSim 2’s improvements make me think it will stay that way for some time to come.

Learn all about it on the OtoSim Website!

Supported Organization:

Simulab CentraLineMan Video Introduction

new centralineman

Recently HealthySim toured several US healthcare educational locations training with Simulab’s CentraLineMan, which is Simulab’s Central Vascular Catheterization training solution that allows medical professionals to train using real-time ultrasound guidance during catheter placement. Previously our video coverage on this topic included TraumaMan in-situ at LSU Health’s Surgical Suites, the use of Simulab products to train 200 learners at month at NorthShore University, as well as research that proves CentraLineMan prevents CVC infection and saves hospital costs at a ratio of 7:1, and finally a video introduction to Simulab.

In the latest video below, we cover the many unique features of CentraLineMan with a product breakdown:

The main body form of Simulab’s CentraLineMan is shown in the video, which not only includes the initial purchase base of the trainer, but also the interchangeable skin which fits securely into the system. Also available now is the additional rotating head module, which the original base trainer easily fits within. The head can rotate and pitch, to help provide learners the opportunity to more closely mimic correct technique depending on different procedures.

CentraLineMan Standard & Optional Systems Training Opportunities:

  • Central Vascular Catheterization Using Subclavian, Supraclavicular, and Internal Jugular approaches
  • Sterile technique
  • Locating vessels with ultrasound
  • Inserting Needle
  • Threading guidewire
  • Passing dilator and triple lumen catheter
  • Performing line maintenance
  • Learning to use ultrasound guidance during catheter placement
  • Locating vessels using palpable landmarks

Simulab’s CentraLineMan is anatomically correct and palpable so not only can you feel the clavicle and the sternocleidomastoid muscle heads but also the carotid pulse. This means  when you are training your physicians or residents on the procedure using the blind technique, you have all the necessary anatomy so they can complete the procedure correctly.

Of course, CentraLineMan is ultrasound compatible, with any machine out there. Therefore you can do the IJ, the subclavian, and the supraclavicular sites. CentraLineMan includes an arterial pulse bulb and venous syringe which allows you to increase or decrease the pressure in the vein for a larger or smaller target respectively.

cvc training simulator

By having the exit holes at the top of the body form, the CVC training system provides a realistic route to pass the guidewire which enables learners to see it with immediate visual feedback. You can pass the guidewire from all three locations: subclavian, superclavicular and the IJ sites.

Key Takeaways:

  • Responds to Ultrasound
  • Provides realistic soft tissue
  • Includes all necessary anatomical landmarks
  • Includes arterial pulse
  • Has two colors of simulated blood
  • Easy to refill simulated fluid reservoirs
  • Provides three access points
  • Is portable and affordable

A Simulation in Healthcare Journal research publication entitled “Cost Savings From Reduced Catheter-Related Bloodstream Infection After Simulation-Based Education for Residents in a Medical Intensive Care Unit” (Cohen, Elaine R. BA; Feinglass, Joe PhD; Barsuk, Jeffrey H. MD; Barnard, Cynthia MBA, MSJS; O’Donnell, Anna RN, BSN; McGaghie, William C. PhD; Wayne, Diane B. MD) which utilized CentraLineMan found that “A simulation-based educational intervention in CVC insertion was highly cost-effective… at a Return-Of-Investment ratio of 7:1 with a cost savings of over $700,000 dollars for the hospital”.

With a purchase price for a complete system still under $3000, acquisition into this Simulab training platform to teach these skills is easy. And since replacement skins allow for at least 50 full catheter insertions and cost less than $500 – Simulab has designed an affordable training product that clearly delivers realistic, high quality and cost efficient training.

To learn more about CentraLineMan, the only system that fits into the ASA guidelines, visit today or watch our previous video on how the platform can save on hospital costs.

Simulab Products Train 200 Healthcare Professionals A Month at NorthShore University Health System


Continuing our multi-part series on Simulab, this week we take a closer look at the successful utilization of their products by the Healthcare training staff at NorthShore University Health System’s Center for Simulation and Innovation. Lead by Dr. Ernest Wang Clinical Associate Professor and Medical Simulation Program Director, the program annually supports about 6,000 healthcare professionals, including residents and new students, 1400 of whom will use a Simulab product for training! I sat down with Dr. Wang to learn more about their program, and their overwhelming support for Simulab products and services. Watch the video interview or read the transcript from Dr. Wang’s testimonial below:

Need to catch up with other Simulab videos from this series? Take a look at our video introduction in Part 1, and a close up of TraumaMan in-situ at the LSU Interim Hospital during a surgical abdomen scenario in Part 2.

“NorthShore Center for Simulation is a 13,000 sq.ft. simulation center and we are a bit unique in that we are not housed on the campus of a academic medical campus or medical school. We are in a community based hospital system that services a 4 hospital health system and that plays into our mission of training adult level learners, who are in clinical practice, who use the center to maintain and update their skills. We have achieved accreditation with the Society for Simulation in Healthcare as a Center for Training Excellence. We have achieved accreditation with the American College of Surgeons, and more recently we have obtained the ability to run maintenance and certification courses for anesthesiologists.

We are target to have approximately 6,000 learners come through our space this year, of which probably about 200 a month will be using Simulab’s TraumaMan, TraumaChild, or CentraLineMan, during their experience.

The way we used to do procedure training was on cadavers with our residents. We would have two cadavers and have a whole group of residents come down, which we could only do about once a year because of cost. So as you can imagine, not everyone would get a first cut experience and the cadavers would not allow for the tactile feedback. So having TraumaMan and CentraLineMan has been a fantastic way to increase the training opportunities for our residents. We like the Simulab products because we feel like they provide: #1 a great tactile feel, its true-to-life – which is really important to be present so that learners get the sensory and visual cues, and #2 is the first cut experience, which is often times the most important thing that people can get out of these simulations.

simulab testimonials

It was really nice in our Trauma simulations, not only the residents managing the case well, but also being able to do the chest tube insertion in real time. We get to watch them did it, making the first cut, getting the pop through the pleura, which sounds and feels very realistic. And then you can see the expressions on their face that the residents are really into it, and that a sense that when there is blood coming out that they are doing this procedure on as real a person that is currently possible. That translates into the next time when they are doing this procedure on a real patient – they get the same tactile feedback, they get the same mental image and experience, so they gain confidence and they gain technical proficiency. The beauty is that, if there is something the learner is not quite sure of, they can talk it over with the instructor and then do it again to gain more experience. You can do these procedures as many times as you want on Simulab skins before you do it on a real patient. Mid-level providers can also practice wound-care and suturing techniques on the tissue.

We have been using Simulab products for the last seven years, and I feel comfortable saying that we highly recommend that if you are starting a program either in central line training, tube thoracostomy training, advanced trauma training, that you look at the products because they will definitely help your training initiatives and make your practitioners better.”

To learn more about, visit today -and be sure to tell them you saw our video!

Simulab TraumaMan Surgical Abdomen In-Situ Video @ LSU Health

surgical abdomen simulab

traumaman surgical abdomen

Continuing our video series on Simulab, this week we take a closer look at the TraumaMan in action with the newly released Surgical Abdomen system. We recently spent an afternoon with Dr. John Paige’s on-call surgical team while they did a mock trauma multiple stab-wound scenario in-situ in Operating Room 8 at LSU’s Interim Hospital in New Orleans. Watch this amazing video that takes you right into the TraumaMan abdomen of a high-stakes surgical training event:

John Paige, MD Associate Professor Clinical Surgery at LSU Health School of Medicine Department of Surgery, and Director of the American College of Surgeons Credit Institute Learning Center directs inter-professional education and team training utilizing high-fidelity manikins and Simulab products. Dr. Paige was apart of an AHRQ training grant from 2006-2008 where his team provided in-situ team training around Louisiana which helped develop the educational model we witnessed them still using now.

surgical training abdomen

“What we are doing here today is an in-situ simulation which brings the staff together from circulating nurses to scrub techs, nurse anesthesiologists, and surgeons to work together on team-work – which I think is a universal thing we can always continue to improve on. As well this training makes us more highly reliable and also helps to break down barriers and flatten hierarchy, which is what we like to preach.” John briefs the team about the scenario background: “The goal of this to talk about team-work skills and to work together. This is an older guy who was stabbed twice in the belly right at the Umbilicus. He was brought to room four where got 2 liters of fluid because he was hypotensive. He was initially resuscitated but now he has starting to go back down, and Dr. Mar has asked Fabien here to Xlap the patient”.

While the team preps, John talks to us about why Simulab is so helpful for this type of high-stakes team training: “What’s really great about the Simulab product is that you can do the tasks of the procedures, ie you can cut and you can put in a chest-tube much more easily. TraumaMan is useful for team-training because you are bringing the whole team in and you’re doing the actual procedure. For example we’re bringing in the post-graduate 2nd year residents and 3rd residents over at the center, alongside anesthesiologist residents as a way to get them some experience leading an x-lap, because while they get some real experience, they are not always the ones who get to be in charge. This is kind of their sign out, their final thing, this is the situational thing. And because you are training so many individuals, you are distributing the cost, and so its very reasonable because of that.

The team, lead by a 3rd year resident Fabien Grey, opens the patient’s abdomen to discover “a belly quite full of blood”. After suctioning for some time, she discovers there is an aortic injury right at the bifurcation. Communicating with her anesthesiologist, her assistant clamps the aorta, and then goes to work suturing the lacerated area. The level of realism of the Simulab TraumaMan product brings the tension way up as the surgeons must actually complete the procedure while working and communicating with the whole team. After the scenario concludes and before debriefing, the team remarks that the new TraumaMan Surgical Abdomen “felt real” and “mimics real trauma, almost to a T”.

Shortly afterwords, John’ simulation staff reset the scene with a second patient, still utilizing the same TraumaMan trainer. This time, however, the tasks necessary were a chest needle decompression and chest tube insertion. The level of realism is uncanny with the Simulab product, as when the needle is pulled a rush of air can be heard and the chest incision actually bled. Following this shorter scenario team participants shared that “this training was very worthwhile and also helped us build a lot more teamwork and cohesiveness as sometimes we only see the residents every few months, so it builds that teamwork and friendship because you have to be friends with the people you work with – especially when you are in close proximity when you are always are when working with a Trauma”.

LSU Health PGY3 Fabien Grey, who performed the surgery during the day’s training which utilized Simulab’s TraumaMan Surgical Abdomen said this about the training: “You know I’m a surgeon and I use my hands. When I start using my hands on the procedure my brain goes in a different way, which puts me in that frame of mind where it makes everything a lot more real”.

To learn more, visit the TraumaMan page on Simulab’s website and stay tuned for our next video covering all the features of this high-fidelity learning product!