Why weight?

The most surprising thing about the announcement of what claims to be the world’s first overweight female medical simulation figure is that it has taken so long to be developed.

By Christmas Medical and healthcare students at Aston University College of Health and Life Science, Birmingham, UK will be able to practise a range of clinical skills on R42 - so named to represent the percentage of people in the US who are obese - in a city where more than 60% of people are overweight or obese.

The open-mouthed, latex model - designed to represent a 145kg (320 lbs) female patient and developed by the university in collaboration with a commercial tech company Simulation Man - will enable students to practise a range of vital skills on a model that looks something like the patients they will have to deal with in real life. This includes including catheterisation, intubation and intramuscular injections

It surely can’t be long before the two models taking up residence at Aston acquire more homely names, from students getting to grips  with the challenges of catheterisation, intubation and intramuscular injections on  bariatric patients.

Let’s face it, bariatric patients are becoming the norm, as the world grapples with a global pandemic in obesity. Training has to reflect this.

Deputy Dean of the College of Health and Life Sciences, Professor Liz Moore, wants her students to be prepared for the world they will work in. She says: “It is estimated that around two thirds of adults in Birmingham are overweight, yet all of our manikins were slim. Whilst we have tried to represent diversity in terms of having adult and child manikins representative of different ethnic groups, this seemed a big oversight, particularly given the additional challenges of health care for obese patients.”

She explains that the new female models will allow students to practise where to put defibrillator pads on a larger model with breasts. Some information suggests that more than 2000 women in the UK per year die because of incorrect use of a defibrillator, yet practice on predominately male simulators. A bag valve mask system can be used on the manikin (which can also be more challenging on obese patients due to different facial features). Intravenous access can be more difficult in obese patients and can be practised on this model.

According to a review of medical training by Marissa Mastrocola at Massachusetts Medical School, very little information about obesity finds its way into doctors’ basic training, even though obesity is a global epidemic. She says: “There are several barriers thought to contribute to the under-recognition and under treatment of obesity. Physicians’ negative attitudes towards patients with obesity and their view of themselves as not prepared to treat obesity are two such barriers.”

These attitudes need to change. Says Jake Rahman, from SimulationMan who worked on R42 with Professor Moore: “We found that most simulation models are skinny and blond. Bariatric patients are represented by using bags and pillows, but they are not a small minority and are not being served well.”

Picture credit: Max Kirton/Simulation Collective.