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Medical mannequins: It talks, it bleeds, it's almost alive

Sunday, November 25, 2007 | 8:11 p.m. CST; updated 10:29 a.m. CDT, Monday, July 21, 2008
Jeffrey Spear, a fourth-year medical student at MU, performs an endotracheal intubation on "Russ," a human patient simulator, on Monday. Using the physiologically-correct mannequin helps the students learn how patients might respond to medications.

COLUMBIA —The scrubs-clad resident physician leans over the operating table to check on her patient, who is about to be anesthetized for surgery. Her assisting medical student checks the blinking monitor next to him.

“Are you doing all right, Russ?” asks Adriana McGarity, a fourth-year resident physician in anesthesiology as she prepares to give him a dose of anesthetics.

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“Uh, I’m a little nervous,” Russ says in a scratchy, slightly mechanical voice without moving his flesh-colored lips.

Five feet away, Joel Johnson, who is providing the voice of Russ, holds a microphone, smiling. Johnson is chairman of anesthesiology.

“Russ” is not a real patient but an advanced mannequin built to resemble a 33-year-old man. Under the care of Robin Wootten, director of the Russell D. and Mary B. Shelden Clinical Simulation Center, Russ and his friends — “Noelle,” the recently-acquired birthing mannequin, and “Baby Hal” — help train medical students.

These days, doctors-in-training can do anything from practice surgeries to team-training on the advanced mannequins at the simulation center.

Fourteen years ago, students would have been practicing on much different subjects. When Michael Hosokawa became the associate dean of curriculum for the School of Medicine, MU trained its students with a dog lab — a traditional practice in medical schools and science programs.

“Personally, I see the destruction of an animal distasteful,” Hosokawa said, “But if it had a benefit to it, then I could understand it.”

Hosokawa took it upon himself to find out whether using dogs was the most beneficial way to teach prospective doctors, or if the school should switch to the already promising computer simulations.

Aside from killing an animal, Hosokawa also found costs considerably outweighed benefits. It was expensive for the department to purchase and correctly handle the dogs before they were used in student training. Also, four students had to practice on one dog. With the computer simulation, each student works at his or her own pace and can repeat the exercise or take it home to study.

“Simulation, as you know, is not new,” Hosokawa said. “They were training pilots for decades with simulation. That’s what we’re talking about here. We want to use simulators so that our students have the skills they need to approach a patient, so we increase patient safety and comfort. The simulator has been a wonderful addition to education.”

Within a year of Hosokawa joining the MU Medical School, the use of animals in teaching had been phased out — a trend that mirrors what’s happening in schools across the country. According to the Chronicle of Higher Education, only a dozen of the nation’s 125 accredited medical schools still use live animals to teach skills in physiology, pharmacology and surgery.

“I don’t think in my wildest imagination could I have predicted we would have mannequins that can do all the things ours do,” Hosokawa said. “I saw an Air Force trauma team swing into action using a mannequin, and within a couple of seconds, they seemed completely unaware that they were working on a mannequin.”

Russ can perform many of the responses of a normal human patient. Russ can wiggle his fingers, blink, breathe, dilate his eyes and even talk through a microphone and speaker system. Russ also has a membrane in his chest that allows students to practice giving shots, and he can bleed, if the need arises.

“It feels pretty real,” said McGarity after giving her mechanized patient a dose of “medicine,” which is really a clear liquid the computer interprets as different drugs. “Especially when something goes wrong, it’s a great learning tool.”

Russ connects to a computer program that allows students to practice giving and monitoring the responses of certain drugs. The computer program is monitored by a second person, usually Wootten, who confirms the responses of the drugs and makes sure the simulated doses are correct.

“(Russ) can simulate disease states that you’re not going to learn on a real patient because we don’t want those things to happen on a real patient,” Johnson said.

The mannequins provide training for worst-case scenarios and complications that “hopefully we won’t ever see in our lifetime,” McGarity said.

The Medical School isn’t the only institution moving away from using live animals. Researchers at MU’s Comparative Orthopaedic Laboratory have developed a “joint in a test tube” that mimics the functions of an actual joint, decreasing joint testing on lab animals.

Using tissue or cells from dogs and other animals, the researchers grow tissues normally present in the joints of all mammals into a miniature “in vitro” joint. Instead of using a whole animal for one experiment, tiny amounts of tissue from a single dog make up to 50 in vitro joints.

The researchers can freeze the cells from one dog and use them for as long as 10 years, said James Cook, professor of veterinary medicine and surgery and the William C. Allen endowed scholar for orthopaedic research.

These models allow the scientists to perform research without using animals while still mimicking situations in real life, Cook said. Screening new drugs and procedures also is cheaper and saves more time than using live animals.

For example, drug companies routinely ask the laboratory to test drugs for joint problems. In the past, if a company wanted to test 20 drugs to determine on which it should concentrate , it required hundreds of dogs and years of research. Now, Cook can use 20 or so in vitro models to do the same study quicker.

“We save them millions, if not billions of dollars, and more importantly, thousands of animal lives,” Cook said.

Cook and his team spent three years developing the in vitro models so they could begin moving animals out of their research, following the Food and Drug Administration’s directive to “reducing, refining and replacing” animal models in medical research.

“For us, it was kind of a double motivation,” Cook said. “Obviously, our first goal, and our first job every day as veterinarians, is to relieve animals’ suffering and promote animal health. To accomplish this while simultaneously making research more effective and efficient in its progress toward treatment of joint disorders like arthritis in both animals and people is incredibly rewarding.”


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