U.Va. develops Prostate Exam Simulator

Early detection through physical examination is one of the key factors in successfully treating prostate cancer.

Now, health care providers will be able to gain applied training early in their medical education and careers with new simulation technology developed at the University of Virginia that will allow them to experience numerous scenarios that simulate prostate cancer.

The Virginia Prostate Exam Simulator is an interdisciplinary project involving three U.Va. faculty members: Gregory Gerling, assistant professor of systems and information engineering; Dr. Marcus Martin, professor of emergency medicine; and Reba Moyer Childress, assistant professor of nursing.

The interactive tool is capable of simulating more than 100 malignancy scenarios. The simulator consists of an anatomical model with four different prostates that can be altered by the inflation and deflation of small water balloons inside. The simulator models a breadth of physiological conditions that might take years to encounter through traditional patient examinations, said Martin, who is also interim vice president and chief officer for diversity and equity.

The project's goal was to create multiple conditions - situations that were reconfigurable on demand by the clinician, simulating graded stages of cancerous tumors and benign prostatic hyperplasia in a life-like model.

Childress, an expert in simulation education, directs the School of Nursing's Clinical Simulation Learning Center. "Collaboration has helped us develop a realistic and robust simulator for teaching students and practitioners. The simulator is user-friendly, accurate and representative of how an actual patient will present," she said.

A distinguishing feature of the design is that it provides immediate feedback to participants - both the instructor and the health care professional in training. "It provides a situation where they can make mistakes and learn," Gerling said.

Training begins with supervision, followed by unsupervised scenarios. As it provides a gradation of experience, the simulation builds confidence, Martin said.

Prostate cancer detection is increased by coupling the rectal exam with prostate specific antigen testing, he said. "Early detection is the key, and VPES trains students on early detection."

Each year more than 200,000 cases of prostate cancer are diagnosed and about 30,000 men die from the disease. African-American men are twice as likely to get prostate cancer as white men. It's the second leading cause of cancer deaths in American men, he said.

According to the American Cancer Society, the five-year survival rate is 100 percent for patients whose prostate cancer is discovered early.

Gerling and engineering graduate students are working to produce a number of the simulators to be used in labs in the Nursing School and the new Claude Moore Medical Education Building.

The project is ongoing and will include refinements of the simulator and curricular initiatives are being developed in nursing and medicine to use the new technology.

The U.Va. Patent Foundation has licensed this technology to health care product supplier NASCO International Inc.

"We are delighted that we were able to help move this innovative simulator to the marketplace, where it will fulfill a critical need for enhanced training of medical professionals in detecting prostate cancer," said Miette H. Michie, executive director and CEO of the U.Va. Patent Foundation. "This project is an excellent example of the many U.Va. discoveries that are making a positive impact on patients' lives."

The simulator project began in 2006 with $50,000 from the Academy of Distinguished Educators in the School of Medicine. Additional funding includes a $390,000 grant from the Congressionally Directed Medical Research Program.

Gerling and engineering graduate students worked on all aspects of project, creating the electronics and software, developing the soft silicon of the torso model that replicates human tissue and refining the techniques for making the balloons work.

Former graduate student Sarah Rigsbee, now at the Johns Hopkins Applied Physics Lab, built the first version of the simulator, and Nighuan "Miki" Wang, now at Microsoft, applied her research to the quantification of finger palpation techniques. Isabelle Rivest built the second user interface, and Angela Lee produced the second-generation version, which includes computerized adaptive testing algorithms that allow the simulator to evaluate the user's responses.

Martin and Childress lent their expertise in clinical and medical aspects related to prostate exams, education experience for nursing and medical students, residents and attending urologists and what is desired in teaching medical and nurse practitioners.

The collaborators also called on the expertise of urologists Drs. Dan Theodoresco and Tracey Krupski, prostate cancer experts, to help with development of the synthetic prostate tissue.

Nursing and medical students joined the research study team, providing feedback on skill development aspects of the training device at every level of the project.

"There's truly an art to collaboration," Childress said. "We learn each other's roles to understand each discipline's perspectives. It takes many disciplines to create a simulator."