Over the years, the healthcare simulation community has recognized the need for greater initiatives to promote diversity, equity, and inclusion (DEI) across clinical simulation training. In doing so, companies who manufacture medical simulation products have worked to become more inclusive and design their products with diversity in mind to avoid a lack in racial, ethnic, sex, and age diversity. As more healthcare simulation resources before digital, the push for improved DEI must remain equally critical. One way this is being made possible is through the use of diverse facial overlays across simulation-based medical training. This HealthySimulation.com article highlights research published in July 2022 that emphasizes the need for this application.
Titled “Application of 3D Printing in Training Health Care Providers; the Development of Diverse Facial Overlays for Simulation-Based Medical Training” this research specifically describes the development of diverse and cost-effective facial overlays produced using 3D scanning, 3D printing, and silicone to be used on top of the current medical manikins at Lakeridge Health Hospital (Oshawa, Ontario, Canada). The aims of this development and quality improvement work were to a) develop two cost-effective facial overlays using AM techniques and b) use the Michigan Standard Simulation Experience Scale (MiSSES) (Seagull FJ, Rooney DM) to gain feedback from endpoint users during advanced cardiovascular life support (ACLS) training course.
Authors Julia Micallef, Anusha Broekhuyse, Sanjana Vuyyuru, Randy Wax, S K. Sridhar, Jane Heath, Suhair Clarke, and Adam Dubrowski began this process by determining that two facial overlays would be developed based on the two groups that represent the highest percentage of visible minorities in the Durham Region (Ontario, Canada). Facial overlays representing the South Asian (31.8%) and Black (29.6%) races were chosen.
According to the research, the facial overlays were developed from the 3D scans of two volunteers. They were then used to create the design of 3D printed molds, in which silicone was poured in. Next, pigments were added to the silicone to match the skin tones of the two volunteers, and these specific tones were used as the base color for each facial overlay. To add realism to the overlays, details, such as wrinkles, eyebrows, and lip color, were painted on top of the base using additional pigmented silicone.
Related Article: DEI Call to Action: The Importance of Racial Equity Across Simulation Leadership
Other design features included neck overlays were created to provide continuity of the skin tone of the facial overlay, the eyes of the facial overlays were cut out to retain the functionality of the medical manikins and the mouth was cut open to allow for intubation training. Altogether, the costs to manufacture both facial overlays came to $182.68. However, feedback obtained from medical students suggested a need to improve the functionality of the facial overlays by making the mouths bigger and less stiff for easier intubation.
“The AM technologies used to develop the facial overlays have three benefits. First, it allows healthcare learners to improve their clinical skills in diverse scenarios that are more representative of the patient population. Secondly, it provides a parsimonious solution that will allow program directors and stakeholders to meet diversity requirements within budgetary constraints,” the researchers wrote. “Finally, this approach allows the overlays to be specifically crafted so that they are catered to the patient population in any particular geographic region.”
Ultimately, this research helps determine that cost-effective and diverse facial overlays are able to be successfully created to be used on top of the medical manikins, especially when simultaneously employing additive manufacturing techniques (3D scanning, 3D design, 3D printing, and silicone work). Yet, some functional issues needed to be resolved before a formal and larger-scale evaluation of efficacy can be conducted. Regardless, today facial overlays are currently being employed by healthcare learners at Lakeridge Health Hospital.
The researchers noted that the following software was used to design the facial overlays: Artec Space Spider 3D scanner (Artec3D, Santa Clara, CA), Fusion360 (Autodesk Inc., San Rafael, CA), and Ultimaker Cura 3D printing software (Ultimaker B.V., Utrecht, Netherlands). Additionally, the following materials were used to construct the facial overlays: Ecotough polylactic acid (PLA) filament material (Mississauga, Ontario), Dragon Skin 10 NV silicone (Smooth-On, Macungie, PA), THI-VEX (Smooth-On, Macungie, PA), Ease Release 200 (Sculpture Supply Canada, Toronto, Ontario), Silc-Pig coloring (Smooth-On, Macungie, PA), and TKBD-01 Mini Baby Doll Silicone Paint Trial Kit (Sculpture Supply Canada, Toronto, Ontario).
Examples of Facial Overlay Products
EchoMask (Echo Healthcare): The EchoMask is designed to enhance the fidelity of simulators by providing a dramatic increase in the level of realism in learners’ experience. EchoMasks can be worn by standardized patients or fitted onto existing manikins. Other features include:
- Chest and back plate with integrated breasts on female models
- Advanced Manufacturing technology to prevent tearing
- Medical grade silicone
- Latex free
- Easy case and maintenance – no staining
- Ethnicity options available on request
- Fits over all manufacturers’ simulators
SimMan Facial Overlays (MedicFX): MEDICFX facial overlays, add realism to healthcare simulation training, making scenarios more believable and engaging. These facial overlays also assist with overcoming age, gender, racial bias, and problem-solving. MEDICFX facial overlays are created with a very soft and durable Silicone. Most of them are designed on the Laerdal SimMan 3-G but can fit other Manikins. The company also has faces created specifically for other manikins. The facial overlays can be worn by Standard Patients as well, depending a little on the face shape of the wearer. Each face has been handpainted by MedicFX’s artists.
