Guest article from David Halliwell - Manikin Mentality: Please don't abuse your manikins...

David Halliwell gave me permission to re-post an article he wrote on LinkedIn. Check it out below - and follow him on LinkedIn to keep up with all his great articles.

Whilst showcasing our new manikin products at conferences around the world this year our team at Lifecast have become obsessed by trying to understand the mindset of the user - trying to get to grips with why they behave differently with x manikin vs manikin y.

Is it realism of the features? Is it weight or warmth or touch? What exactly is making the difference? What can we do to increase Realism?

Smell, colour and fine detail...

I understand the manikin is only one small part of the training event - and the skills of the educator, the environment, the props, the learning contract, the debrief are all key components.

I have always been a fan of the "magician and the wand" discussion - please see below... BECAUSE if your manikin is an expensive Wand - then your magician needs to look after it!

I understand that there are different simulation tools for different jobs... and that with the right tools and people we can get the student to 'suspend their disbelief '.

Emotional Attachment / Buy in - are all concepts we have explored as we continue our journey to build tools that will transform simulation. Working with great brains to re-think the traditional simulation concepts.

As Educators / Trainers we need to try and explore the way tools are used - how and why they work - and long term to explore - how do they benefit student outcomes?

Recently I've noticed that there are a great deal of manikin abusers out there! 

Medical Manikin's are usually expensive tools - increasingly engineered to look and feel real - with new features being designed by companies around the world each week - yet as I watch people use them I sometimes feel concerned by the lack of care or attention they are given by participants.

In my previous NHS roles I would often spend £100,000+ a year (Every year) to replace broken manikins.

There are some common observations....

Rough intubation - a "I will get this tube down if it kills me!” mentality. Not every person is easy to intubate - not every manikin should be easy - maybe the educators are actually looking at how you cope when you can’t quite see the perfect view with ease.

If you continue to DIG around in the Away - rather than fall back, regroup and use plan B techniques - you are maybe not the right person to be playing with Airways.. 

Maybe its a positioning issue? Maybe its the tool you are using? Standard blade vs difficult airway blade - size of blade etc... Maybe the manikin is designed to be somewhat awkward.

Shoving OP airways in (without care…) Sufficient Attention is not given to OP Airway insertion - If you insert an airway with the little attention to detail that we see in manikins you really could be causing significant damage - to teeth and to soft tissues.

You may not know but the OP Airway causes more damage to teeth in Anaesthetised patients than the Metal Blade of the Laryngoscope -

Shoving fingers in places where fingers shouldn’t go! - Recently I’ve seen many people "Shoving their fingers down the Lady manikins throat"... Why? I don’t get it.. Is it sexual? because ... it sure as hell isn’t clinical!

When I ask them what they are doing they say - "I was having a feel of the anatomy" - (Really? - Do you do that with your patients?) "

"I was seeing if I could digitally intubate" -  When did you last do that to a patient in your theatres? I understand that these skills exist - and maybe for 0.005% of patients and clinicians these may be skills you need, but maybe we could save hundreds of thousands of pounds to the NHS by just thinking differently...

Please try and 'Treat your manikins with the same care and respect with which you would like to be treated...'

Its a simple message - Please look after your manikin like you would expect to be looked after... Manual handling, Clinical skills, Skin care, the list goes on...

I feel we need a shift in mentality - TREAT YOUR MANIKIN LIKE YOU WOULD A PATIENT! newsletter - june 29, 2017

I received a nice email Michelle Castleberry, who is part of a small team responsible for ALEX: the first patient communication simulator.

ALEX is comparatively quite unique to other simulators. He's 100% cloud connected, he has an HD camera in his right eye, he uses bluetooth tech for crystal clear sounds (anterior & posterior lungs, heart, and bowel), and he's integrated with Google Cloud Speech API for speech recognition (and then some of our engineering magic for speech response!).

Lifecast's website is now live:

Introducing a step change in realism for the medical training industry.
Lifecast Body Simulation is developing a range of high accurate and life like “bodies” which will transform the way medical training is both delivered and absorbed. Designed and produced in Great Britain to the highest quality, the range currently includes a newborn baby, toddler/child and adult male with a geriatric to follow later in 2017, all available in a wide range of ethnicity options.
 Wow! Looks so real...

Wow! Looks so real...

Gaumard's Victoria Patient Simulator now comes with interactive eyes...

From their website:

Victoria’s new eye movement and automatic tracking features can illustrate signs of stress, stroke, head trauma, drug use, nerve impairment, and many other diseases and conditions.

  • Accommodation test: automatic horizontal tracking and manual vertical tracking
  • Strabismus: exotropia and esotropia
  • Nystagmus: eyeball twitching
  • Blepharospasm: eyelid twitching
  • Ptosis: eyelid droop
  • Realistic idle eye movement
  • Independent pupillary light reflex
  • Mydriasis: blown pupil
  • Anisocoria: unequal pupil sizes
  • Programmable blinking rate
  • Consensual pupillary light reflex
  • Real-time eye movement control via software joystick

I've mentioned Figure1 before, but wanted to remind people its a great place to get images and case ideas...



I just came across this useful site:

Welcome to the HomeGrown Simulation Solution area of the Simulation Innovation Resource Center (SIRC) website. Created by education professionals to address tricky issues in simulation, HomeGrown Simulation Solutions comprises self-made items, creative adaptations to existing items, simulation recipes, and ideas that add to the suspension of disbelief in simulation. Each item includes objectives for use, ideas to integrate it into the curriculum, and step-by-step instructions that provide a roadmap for replication.

Saw this on the SUN forum - fill it out to win a chance at a prize!

Interested in influencing product development in the healthcare simulation industry? We are looking to gain insight into how the current market of simulation equipment is meeting your needs. If you can, please take this 20 min. or less International Simulation Survey to share your experience and influence the future of healthcare simulation product development. Participants will be entered into a drawing to win an Apple Watch, iPad Mini, or Echo Dot!
Make your voice heard and perhaps win a prize -- We sincerely appreciate your participation:

And last but not least, I will plug this article on sim and funding we just received to build a small high fidelity pod with control room, debrief room, sim room, skills/cadaver room. Exciting news for us.... with more to come.

 Fourth-year resident, Dr. Samantha Jang-Stewart (left), participates in a simulation training exercise at the Simulation Bay at the QEII Health Sciences Centre. (RPM Productions)

Fourth-year resident, Dr. Samantha Jang-Stewart (left), participates in a simulation training exercise at the Simulation Bay at the QEII Health Sciences Centre. (RPM Productions) newsletter - april 21, 2017

Watch this great TEDtalk from Peter Weinstock, the Director of the Pediatric Simulator Program at Boston Children's Hospital/Harvard Medical School. Amazing stuff.

SimGHOSTS 2017 USA Early-Bird Registration has opened.
This year it is being hosted at the WakeMed Center for Innovative Learning in Raleigh, North Carolina, from August 1-4.
I'm excited to say I'll be going to this - my first time... yay!

Cool - I didnt know about these 'Symeyes' from CAE for Lucina and Athena

Operative Experience were doing a demo at the IWK (a near by Hospital) so I grabbed a few pics. Check out their website or contact Jane O'Reilly , their VP of Global Sales at if you have any questions.

Miguel Correia sent me some info from Body Interact

This software launched it 3 years ago, and last year won the Best Product in Show at IMSH16.
The simulation scenarios are made in partnership with various associations like American Heart Association, American College of Cardiology, some of the biggest Hospitals in the US and some other European institutions/associations. It's also constantly being updated to meet various guidelines requirements.

Simbodies has launched their website - go check out the most realistic simulators i've ever seen.

Attention: Gaumard customers of Canada - just an FYI in case you didn't hear:

Minogue Medical has become the exclusive distributor for Gaumard’s high & mid fidelity simulators in Canada. Minogue offers personalized service and outstanding technical field and telephone support. Minogue's 30+ years of service excellence will provide you with the experience and well-established presence across Canada to best support your needs. Minogue built its reputation serving customers of many other leading medical product companies, including da Vinci, SCHILLER, ClearFlow and EDAP TMS.

Together, Gaumard and Minogue are here whenever you need us. See the newest high-fidelity, wireless and tetherless simulators anytime at, visit or call Minogue toll-free at 1-800-665-6466 for customer service and help in selecting the best new Gaumard simulators for your needs. newsletter - march 14, 2017

Dan Raemer, who I met a few months ago while he was in Halifax teaching a CMS course, has started a great side project with

Go buy some stickers like I did! (and no... I don't make any money from them)

From his site:
The spread of simulation throughout the healthcare world has been a wonderful technique to improve education, teamwork, and patient safety.  Thousands of programs around the world are actively innovating every day to deliver high quality simulation sessions in a variety of settings with a wide array of educational goals.  Promoting this evolution must not stop, as the aspirations and achievements are truly remarkable.

However, there are dangers lurking.  As with anything new, unanticipated and subtle hazards exist and can be difficult to manage.  In healthcare simulation we are introducing programs with its array of real and simulated equipment, supplies, and medications.  We also bring a certain degree of deception, asking people to act as if things that are not real are true and things that are real are not.  All of these introductions are into a healthcare world that has its own difficulties maintaining a safe and error free environment.  The chance that this new world of simulation will lead to an accidental misuse of some simulated entity on a real patient or healthcare worker is real and worrisome.

On this website, we will try to present accidents and “near misses” from healthcare simulation that come to our attention.  We will try to use the collective wisdom of the field to present best practices and mitigation strategies to help the simulation community reduce the potential for harm.  Working together we hope to make the chance of a simulation related injury vanishing small.

I just heard about this company - Operative Experience.
Looks neat - anyone have any experiences with any of these?

Operative Experience Inc is on a mission to revolutionize surgical and medical team training. Using medical simulators with unprecedented anatomical and surgical fidelity within a rigorous experiential instructional paradigm, OEI will reduce training costs while increasing training effectiveness and retention. OEI is dedicated to applying this technology throughout the continuum of care, from tactical operations in the field to emergency procedures in the OR.

Intelligent Video Solutions has a video debriefing solution -

Here at IVS we’ve approached the simulation video observation, recording and debriefing challenge from a different perspective. We’re a video company that truly listens to our clinical education customers.  We’ve taken their feedback and developed a new tool to address an old challenge.

At it’s core the VALT solution is an incredibly simple but powerful tool.  The interface can be learned in minutes and the basic observation and recording tasks are often picked up intuitively without any extensive training or tech support.  We aim to minimize complexity and points of failure so that your recording system is always there when you need it for critical educational tasks.

That simplicity does not come at the cost of enterprise level features though. With VALT you can scale to any number of cameras and users all while incurring no per client, confusing ‘pay per feature’ license structures or budget crushing annual maintenance contracts.  We have built in critical data security measures and integrate into your existing user management and authentication systems to efficiently manage multiple departments, programs and ever changing groups of users. newsletter - february 02, 2017

News from Gaumard -
"Super Tory is the first and only newborn simulator specifically developed to meet the needs of neonatal intensive care professionals training in real environments. Super Tory introduces a host of technological breakthroughs in addition to its lifelike look. New advanced robotics and simulated physiology allow Super Tory to simulate true-to-life clinical presentations and respond to intervention with unparalleled realism."

A big thank you to Katie Gordon, Simulation Educator with the University of Maryland, for again sharing some of her scenarios with thesimtech community. She has sent a pediatric drowning case and a pediatric anaphylaxis reaction to a bee sting case. You can find them in the scenario section.

Also along the lines of free scenarios - Rob Cheeseman, Simulation practitioner with QuEST at the Frimley Health Foundation trust, shared with me this great resource of over 130 free scenarios:
The Health Education England - Thames Valley (HEE TV) ‘Clinical Simulation Scenarios’ library
I will add this great resource to the links page.

Samantha Gower shared this great article with me: Escobar Technologies’ Medical Simulator Is a Real Disrupter

When you are done reading the article go check out more on the Escobar brothers - exciting stuff -

Big news for simulation in Canada. The two major healthcare simulation organizations, SIM-one and the Canadian Network for Simulation in Healthcare (CNSH), have agreed to integrate by September, 2017.
The Boards of Directors of SIM-one and CNSH have signed a guiding principles document providing a time frame and process for integrating Canada’s largest healthcare simulation networks. This integration will create an interprofessional and interdisciplinary network to improve and expand programs and services for the simulation community across the country.

equipment we use - vol 1 - communication with confederates / patient simulator voice

Whenever I visit a new sim centre the first thing I do is look at the equipment they use. I love seeing what techs have purchased or solutions they have come up with to make their centres run more efficiently. In the spirit of sharing, I thought I would post what I have found has worked for some centres I've worked in.

I have no affiliation with any company and receive no financial gains from any of them.
By no means do I say these products are the best or that they are the right solution for you - they are just things that have worked for me, and might assist in your search to find solutions for yourself.

Today I'm going to share what we use as an audio solution for:
i. instructors (control room) privately talking to confederates (sim room)
ii. the voice of the patient simulator

I needed a transmitter (send the audio) and receivers (receive the audio).
I wanted:
- A wireless system. This makes it 'cleaner' and portable for in situ sessions.
- The ability for one transmitter to connect to various receivers (I have seen some cool smaller systems, but they were one transmitter to one receiver, and that won't work because we often have multiple confederates).

I also wanted to get a wireless speaker system to use as the patients voice. I don't really like the quality of the system most high fidelity patient simulators come with, I want it to be portable so we can set up anywhere, and I like the idea of having a wireless mic that can be easily handed around for different people to be the voice.

After doing some research I decided that the products below, made by Anchor Audio and Williams Sound, were the best solution for me - covering all my needs and best cost/quality ratio.

Below are the transmitters. The transmitters can send audio to the wireless patient voice receiver speaker or wireless confederates in-ear receiver - depending on channel they are set to (16 to choose from). We purchased one of each. Most of our users opt for the collar mic to talk to confederates and the handheld mic to be the patients voice - but the choice is up to them.

Anchor Audio WB-8000 transmitter with Anchor Audio CM60 collar mic

Anchor Audio WH-8000 transmitter handheld mic

Below are the receivers. We use the bodypack with earbud for the confederates (we bought four units) and the wireless speaker for the patients voice (by just placing it under the bed).

Anchor Audio ALB-8000 receiver with Williams Sound EAR 013 single mono earbud

Anchor AN-Mini speaker with wireless option. We also purchased the rechargeable battery pack for this, for times when plugging it in was not an option.

This simple setup works well for us, and the quality is great.

If you have any questions/comments or want to share what has worked well for you, please feel free to add a comment below or send me an email. newsletter - october 25, 2016

A big thank you to Kelly McMann for sharing the following scenario now found in the scenario section

Topic: Labor and delivery, postpartum hemorrhage
Title: Normal Delivery with PPH
Target: Maternal - Child Course - Nursing Education

Great new website with a focus on the very important debrief -

Effective feedback and debriefing play a critical role in healthcare education in both simulated and workplace-based environments. Debrief2Learn supports clinical educators by sharing resources to guide faculty development and exploring the latest innovations. We aim to create an online community of practice for health professions educators while advancing knowledge through cutting-edge collaborative research.

This looks pretty neat. I'm excited to see how VR and AR progress in simulation in the future.

Virtual Medical Coaching offers you the world’s first true Virtual Reality application for learning radiographic positions and principles. In the radiation free simulator, the user can perform radiographic examinations as in the real world, critique the resulting images and get instant metric feedback in a way that is impossible in conventional education. The simulator allows for unlimited training in the immersive, safe environment.

My good friend Chris Tuffnell has started the TEL ME More Telegraph. It aims to bring you 'hot off the press' information and current opinion on all things related to digital, education, innovation and medical simulation, throughout the Middle East and Internationally.

This is so neat... a new realistic human body model created to train medics for trauma surgery. Read about it here, or at least watch the video below (had an issue with sizing...) newsletter - august 09, 2016

I've finished uploading some donated scenarios - we are now up to 60!
I've put them in alphabetical order to help with finding what you're looking for.
Thank you for all your contributions (especially Katie Gordon from the University of Maryland School of Medicine, and Babar Haroon from Dalhousie University Medical Program).

Had a great visit/chat with the team from KeyIn last week while they were in Halifax. Check out there visit write up here:


Gaumard has intriduced the Omni2 (looks like their version of a SimPad).

The new OMNI 2 is an easy-to-use, wireless device interface designed to operate Gaumard patient simulators and skills trainers. It offers instructors the essential tools to drive simulation-based training sessions without the complexity of programming. Simply tap and go.

For more information check out their website here:

A cool moulage video I found on TraumaFX website:

I just found out about this company - SimUCare

One of their products is the SimUTrach. Check out the video below: quick update - july 19, 2016

Sent to me from Wayne McGeary:

Hi Andy

Just to let you know I am attaching a template for you to release on thesimtech site.
This has been entirely constructed by myself and consists of templates for :
Blood biochemistry results
ABG/VBG Standard ED type machine
ABG/VBG ITU type format
It is an excel chart with tabs for each.
The Blood biochemistry results change font colour (blue normal input - red and bold text) when abnormal results are detected, which is the format our Hospital lab results are viewed.
The ABG/VBG templates display Up arrow with high results and down arrow with low results again mirroring clinically what our hospital machines output is like.
Hope people find them useful and would appreciate some feedback.

Download it here and give it a try. Thanks Wayne!

PS - Ive uploaded a few new scenarios, with more to come this week...