Science Friday
Hosted by Flora Lichtman and Ira Flatow
On-screen and in hospitals, fake body parts are getting more and more realistic. That helps medical students practice for real procedures.
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Hey, I'm Flora Lichtman, and this is Science Friday.
SciFrid just got back from Columbia, Missouri, where we were doing a live stage show with radio station KBI. So today in the pod, we are bringing you a conversation from Mizzou's Jesse Auditorium about a guy with a Mary Poppins bag full of fake body parts. I kid you not.
Some smells may arise, too. So we have what we refer to as liquid butt.
If you, like the entire staff of Science Friday, have been binging The Pit, you may have noticed that medical dramas are looking really real these days, like you're watching in your PJs on your couch. But those intubations and surgeries look so real, it's like you're in the emergency room. But it's not just TV doctors that are using hyper-realistic body parts to simulate medical procedures. Real doctors in training, physician assistants and nurses are using prosthetics to learn how to sew stitches and draw blood and practice other procedures, which means it is someone's
job to sculpt these hyper-realistic body parts, these silicone stand-ins for arms and eyes and other appendages. And that is what my next guest does for a living. Damon Coyle is a medical sculptor and innovation specialist at the University of Missouri, right here in Columbia. Welcome to Science Friday.
Thank you.
Damon, I see you have props.
Are you, is this for me?
It's yours.
Damon just gave me an ear. That feels a lot like an ear. Can I take it home?
That's yours, it's my business card.
This is amazing, this is the best gift I've ever gotten.
Truly.
What else did you bring?
Oh geez. In my Mary Poppins grab bag here. Quite a few appendages. Various bits of human anatomy.
I see a placenta up there.
Yes, that's exactly what this is. So, a lot of my job is research. Reducing the reality gap in simulation to make the medical education that much more robust for our learners and abroad. I took plenty of photos of my wife's placenta. Or was it my daughter's placenta? I'm not sure. Who does a placenta belong to, really? Chicken and egg? For the placenta. You got a magnet here to take out of the baby's belly button. If you want to go and feel that.
I would love to.
It looks wet, but it's just shiny. It's not actually wet.
It's very real. As someone who's also seen a placenta. This is, it's almost too real.
Thank you, thank you.
How, how long does it take to make one of these? Well, let's take the baby you have up here.
The baby, okay, so that, that with a sculpt, maybe about a week's worth of sculpting and then making the molds.
You're sculpting with what? What's the first step?
Right, so, for instance, let's use this neonatal IV access. So, getting a very small IV cannulas into a very small sick baby in the neonatal intensive care unit, right? Very difficult procedure to perform. This starts, at least this particular project started with a clay, a ball of clay.
So this is a clay tiny baby leg?
That's correct, yep. And I have, I had the NICU nurses take photos with the parents' permission, of course, of patients that were in the NICU in order for me to get the accurate size. And of course, all the small details, veins and wrinkles and such, need to be represented in order for the experience to be immersive.
So you start with clay, you sculpt the body part, and then what happens?
You make a series of molds. So it's one thing to make... A one-off prop, right? And that's normally what you see in the special effects or the movie industry in Hollywood. They'll have a series of props that they'll use for various shoots. What I like to do and what we spend a lot of time is trying to solve the engineering problems of making molds so that we could make as many of these in the future as we want. Or, better yet, you know, license this to industry such that we can share all the work that we've done here at the University of Missouri with the rest of the world. Because if our clinicians, our nurses, our medical students, our nursing students, our
dieticians, our OTs and PTs are getting use out of these products, it stands to reason that everybody else globally will get a really good use out of it as well.
How widespread is the use of prosthetic models like these for training medical professionals?
Oh, it's very, very common. Our role is to facilitate the replication of interactive clinical environments. Practice as though we're playing, no different than athletics, right? Or practicing an instrument. You practice repetitively until that becomes muscle memory such that when it is game day, when you have that scalpel in hand, you've done it 102,000 times.
Damon, how many people in the world have your job?
I don't know of any counterpart in the United States that has a role specific to mine, that's working at a state-funded land-grant university at a clinical simulation center that is doing what I'm doing, and that is refined prototypes of medical educational tools.
So this is a one-of-a-kind program here at Mizzou?
Yes, and I'm very, very grateful and very, very fortunate.
That's very cool. I think we should do a demonstration.
Okay, let's do a demonstration.
Should we go to our table?
Yeah.
You've got like a Dexter table over here that we should...
Okay, so let's, um, let's set the stage here.
Okay, so we have like a full-size human arm.
Yes, this is a full-size human arm that is...
That looks and feels a lot like a human arm in a very creepy way.
Yeah, so the materials that we use are, um, it's a platinum-cured silicone. It's totally inert. It's not going to cause any skin sensitivities like latex would, um, historically. Um, and a little cool fact about this, um, normally, like I said, I'll start with a clay sculpt. Um, but for a composition this large, um, it would have taken me a long time to get all those small details and wrinkles and pitting and whatnot. So I actually used a life cast for this. So I had a model come in.
Who was the lucky model?
Oh, she was a beautiful, beautiful model. She was nine months pregnant, so she had about 20% extra blood volume.
And was really glad to be doing this, I'm sure.
And her vessels were just nice and plump and popping. And I said, "Honey," my wife.
"Please come in. It's gonna take 45 minutes tops." She was like this, with 20 pounds on her arm for four hours.
Sorry.
Can we give her a round of applause? Yes.
How many times can you stick this? And, like, how many times can you reuse one of your arms?
Sure. So that comes down to, uh, that's a design considerations. When I'm, as an industrial designer, those are the key learning objectives that I need to attack in order to make it a good product. Not necessarily a good training tool, but a good product. So, one, I'm trying to make these feel and look and behave realistically, but I also want them to be user-friendly, so they don't... Deteriorate and become useless, or they're prohibitively expensive. So, the skin of this is actually bolstered. If you look really closely, there's some fine, like almost fishnet fabric in there, and that's going to keep, punctures, it's going to keep that silicone from tearing if it's ever stretched. Think of like a chain link fence, right? Or ripstop fabric, when you have a fray in a sweater, it just keeps going and going.
This is going to stop that. So, thousands of sticks to answer your question. The limiting factor on this is actually the vessels, which are just quickly, you can just quickly pop them out. So, you can de-skinned this vessel? Yeah.
Whoa, right? So, we're looking inside, underneath the flap of this, there's like a skin flap, and you can peel it back, and then there are these tubes that are going through the arm.
Right, and a big challenge with this particular project, it took about 18 months all in to finish this, the finish line, was making sure that the vasculature was anatomically accurate. That's paramount. And then, secondly, making it a good product.
I mean, and the arm is jiggling like a real arm. It's really remarkable. Okay, so we've got arms to do a blood draw, and we've got like half a face here, there's two eyes, one is kind of bulging out. It's alarmingly lifelike, you just repositioned it, just quite scary. Okay, now what happens next?
All right, so this patient comes into the emergency room, say they were in a bar fight or a motor vehicle collision, and they've got some serious contusions around the eye, all right? They're coming in with complaints of vision loss, right? So, a good emergency med doc is going to take a good history and identify that there's probably what's referred to as a retrobulbar hematoma. That just means blood behind the eye, and it's pushing on the optic nerve, pushing on the blood supply. If not remedied, this patient's going to lose eyesight, right? So, it is an emergency. Okay, so what we're going to do is, we're going to do a procedure referred to as a lateral canthotomy. We need to get that eyeball, believe it or not, to be pushed out, right?
Because if it stays where it is, it's basically a gasket holding all that blood back there, and we need to let it forward, otherwise this patient's going to lose eyesight. So, let's go ahead and get going. First and foremost, I don't have any simulated anesthetic, but let's pretend this is, we're going to anesthetize this area because it's very sensitive.
That seems like a good idea.
You're welcome, patient. All right, so we would go ahead and say that this is an anesthetic, some lidocaine, we're going to go right. In here. But I'm gonna have some forceps. And what I'm gonna do is I'm gonna go in between the eye and the cantha, and I'm going to crush and hold that there for approximately one minute. And that's gonna provide what we call hemostasis, or stopping bleeding, right? If we don't do this, it's going to bleed when we cut it. Then we're gonna take our pair of scissors, and we're going to make a small incision. What I'm trying to do is I'm really feeling for a tissue density difference, right?
In a real-life scenario, and much like this scenario here, it's going to be very messy. There's gonna be a lot of swelling inherently. So, we really need to go by feel, which is, again, it's inherently a good model, because it's going to allow those emergency medical doctors to practice this procedure. And then we're gonna come in here and simply cut this bottom crease, right there. And what that's going to allow for is that eyeball to protrude forward. And, believe it or not, that is the end of the procedure. Very simple procedure. Notice I said "simple," not "easy." But there is no task-trainer product on the market that teaches this procedure.
Wow, amazing.
You know, watching this, watching you work with these, it occurs to me that, like, the point is that it's so realistic, you know? That is what makes it an effective tool. The more, kind of, I'm like, "Ah!" As a layperson, the sort of more useful I'm sure it is to doctors and, you know, medical professionals who are training on it.
Yeah. In some instances, realism isn't paramount. Sometimes it's just rapid repetition for various procedures. But for most procedures, reducing the reality yap, such that you make the tissues feel real, you make them bleed, can do nothing but help the transfer of knowledge. And that's our goal at the Sheldon Simulation Center, is to transfer knowledge from the simulated environment, right? This replicated environment to the real world in order to reduce negative patient outcomes.
Stick around, we'll be right back after this short break.
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Do you have to think about other senses in preparing physicians for those realities, too?
Absolutely. Yeah, so we have feel, right? We got that down with the density of the tissues, trying to use various silicones in order to emulate the tissues that we're trying to simulate. We have quality paint jobs, building up translucent layers with an airbrush to try to make those skin complexions be very convincing. But there's smell, too, right? So we have a task trainer here. It's an IND trainer. It's incision and drainage is what that stands for. So you'd be able to lice this with a... I don't have a scalpel. I would do it right now.
And out would come some nice loculations and pus and some smells. Some smells may arise too, so we have what we refer to as liquid butt. That's not what it says.
Liquid butt. You heard it here on Science Friday. It exists.
And it's an oil-based, I don't know where it's derived from or how it's synthesized, but you can mix that in with petroleum jelly, which I have a recipe for making, you know, pussy loculations of a cyst. And I'll add that to it just to give our learners a little bit of a surprise because it's all about reducing the reality gap and transferring the knowledge.
Have you taken on the CPR dummy?
Have I done what?
Taken on the CPR dummy. I feel like everyone has trained on a CPR dummy. You know, they're like big and plastic. Do you have a version?
Oh, no, no, no, no, no. I haven't made an ultra-realistic one. Again, that's a really good example of where realism, making you look realistic, isn't paramount. They just need to learn good technique and when to do their rescue breaths and when to do compressions. Realism there is something that we can forego in order to get, you know, more personnel through a training or something like that. But no, I never have. That'd be cool, though.
Let's go to the audience. Go ahead.
Hi, Damon. Could you talk a bit about your background?
Oh, sure. Absolutely. I got my start in medicine through art. In an attempt to get better at the superficial muscle anatomy illustration, I took an anatomy course in high school. Quickly fell in love with sort of the taxonomy and of learning the medical terminology and all the Latin prefixes and suffixes. And it was just, it was conducive to my sensibilities. So I was like, okay, well, let's go down the path of medicine. I think that's where I would fit in. Went to medical school here at the University of Missouri. Dropped out of medical school here at the University of Missouri. And a big reason for that was I just, I simply wasn't fulfilled. I...
So much of what brings me fulfillment is creating and making tangible items that people can appreciate and that I can come back to and refine. And it just so happens that our executive director, Dina Higby, who's been with the Sheldon Simulation Center for 15 to 20 years, she forecasted that there is just quite the drought of optimal medical educational tools. And she happened to figure out my skill set while I was out of medical school. And just when I thought I was out, I'm back on campus.
As they say.
And yeah, and the rest is really history. And our catalog continues to grow as various departments at the university continue to find out about this resource.
Lots of questions from the audience. Let's go over here.
Is this work being used in veterinary medicine?
Oh, great question. Thank you. I had limited space up here, but I do have a canine rectal trainer right over there. I mentioned there's a drought of good, optimal training products for human medicine. It's even more Wild West in the vet med arena. There's only two or three, you know, heavy hitting manufacturers. So I have so much work when it comes to vet medicine, and one of them being the dog butt.
I can't think of a better place to leave it.
Damon Coyle, medical sculptor and innovation specialist at the University of Missouri, right here in Columbia. Thank you for coming on the show.
Thank you, Flora.
And that is about all we have time for. Lots of folks helped make this show happen, including...
Dee Peterschmidt. Praise a Gucci.
Kathleen Davis.
Santiago Flores.
I'm Flora Lichtman. Thanks for listening.
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