Go to a movie these days, and more often than not, you'll be viewing characters and action created by the bits and bytes of digital technology. And today, computerization is serving to put another group of thespians – medical actors – on the somewhat endangered list.

A case in point: the American Board of Disaster Medicine (ABODM; Atlanta) just unveiled a plan to use robotic patients rather than human actors to administer the performance assessment component of its exam for certification.

The rather non-intuitive reason for this: Computerized manikins are “more natural” then human actors in such tests, says David McCann, MD, chair-elect of the newly developed board and an assistant professor of family practice and emergency medicine at Mercer University (Macon, Georgia).

Such examinations come in two parts, a written test of knowledge and an oral test for demonstrating how well the physician can put that knowledge into practice, by treating a patient in a simulated disaster situation and seeing the patient's responses.

Typically, McCann told Medical Device Daily, human actors are used to be the “patients” in certification tests, to reenact diseases, or in this case, injuries from a disaster, providing physiological and verbal feedback.

But, McCann says, “Human actors have to be given a script, and they have to be trained in how to respond. And they can't change their physiological parameters. [For instance], they can't make their pupils behave in a certain way with certain chemical exposures.”

Hence, the responses to correct – or incorrect – treatment by the medical provider in a disaster situation are difficult to assess.

Enter the computerized patients, in this case, the human patient simulator (HPS) developed by Medical Education Technologies (METI; Sarasota, Florida), a manikin mathematically programmed with a complex scenario to provide “real-life” responses to treatment.

The ABODM last week reported completion of the components of its certifying exam and said that the HPS manikins will be the first-ever use of these high-tech simulators in a medical board certification program.

In practice, the METI simulators are indeed quite lifelike, according to Ron Carovano, director of development for METI.

The HPS “bleeds, tears, breathes, salivates, talks, pees,” Carovano told MDD, describing some of the physical “signage” that it is capable of – even “dies,” he says, if the treatment provided by the physician is very wrong and goes very badly.

In effect, the HSP is programmed to “thrive or deteriorate,” he says, in response to the treatments given.

If the “patient” in a particular disaster scenario is able to talk and respond, that effect too is provided, by an operator at a nearby console, giving responses to caregiver questions – in a variety of languages, if necessary – and enabling other changes in the simulator's responses in real time.

The simulator also provides further verisimilitude by allowing intubation and other invasive procedures that couldn't be performed on a human actor.

The ABODM itself is a recent spin-off from the board of specialties. Founded in February of this year, it went “live,” McCann says, in May. And the certifications are the very first to be provided for disaster medicine.

McCann acknowledges that this effort has been driven by the events of 9/11 and the increasing emphasis on the need for readiness to a range of possible disasters and potential terror attacks. And he also acknowledges that such certification is probably much overdue.

“Disaster medicine has been around for many, many years,” he says, of necessity practiced by a cross-sectional range of physicians. “What we believe is that it has matured to the point that it needs to be its own specialty. Disaster medicine has its own core competencies that must be learned.”

He says too that there has been some criticism from colleagues that the ABODM is launching certification before the establishment of any residence programs in this particular field, but he notes that emergency medicine also “started that way.”

“There's precedent for the way we're developing this. It's a timely thing, and a number of the people on the board are members of the federal government disaster medical assistance teams.”

Arthur Cooper, MD, a board member of ABODM, told MDD that the first certification exams will be administered in the fall and the use of the HPS “will be setting a precedent for all emergency healthcare professionals” both to provide expert treatment in disasters and to collaborate “with other acute care specialists during mass casualty events.”

McCann says that when the certification program is fully up and running, the ABODM expects to be giving up to 200 tests each year.

Carovano says that METI's focus since its founding has been the development of advanced technologies for providing medical education, at first “principally in schoolhouses” for people becoming registered nurses and paramedics. Its products include a range of models, such as babies and children, and for a variety of applications.

He says the movement from the schoolhouse to more complex specialty testing is a natural evolution, citing the parallel model of simulators for flight instruction. These too, he said, started in schoolhouse-type venues, with increasing sophistication allowing pilots to move from simulators to flying planes “full of passengers.”

The increasing sophistication of METI's products are represented by the evolving customization of software “that drives the specific scenario to do the actual testing or training” and an “enhanced learning experience,” Carovano says – and in pricing.

The company's basic models cost about $40,000, and then range up to $200,000 for its more sophisticated systems.

McCann credits METI for “bending over backwards” to develop a simulator to meet the needs of the disaster certification effort.

Carovano says, “We're fortunate to work with organizations to do this – this is being driven not by industry but by the needs of the organization. “The fact is that disasters are infrequent and the kinds of injuries that disasters produce are different enough from what is run-of-the-mill, that having a manikin that's capable of reproducing and responding physiologically to treatment is really crucial.”

He acknowledges the presence of competitor manikin products, but characterizes them as Chevrolets compared to the Jaguar-like sophistication of the HPS. “We believe that the HPS model is without any question the most sophisticated electronic manikin available at the present time.”