A Portable Palpation Training Platform with Virtual Human Patient *Tyler Niles +D. Scott Lind *Kyle Johnsen tniles11@uga.edu dlind@mcg.edu kjohnsen@uga.edu [*]University of Georgia (UGA) and [+]Medical College of Georgia (MCG) Abstract Palpation (the application of touch to the surface of the body) is an essential clinical skill. Correct palpation is part of a complete physical examination and it assists a clinician in making an accurate diagnosis, while poor palpatory skills can lead to diagnostic errors. As with any clinical skill, palpation is best learned through repetitive practice with constructive feedback. Unfortunately, changes in healthcare provide fewer opportunities for hands-on learning of this essential skill. Unlike other clinical skills, palpation has no immediate feedback to the learner regarding their performance. For example, when students are learning how to insert an intravenous catheter, failure to perform the technique correctly results in no blood return in the catheter. However, students do not know if they are palpating an abnormality if they have never felt it before. This inherent difficulty makes expert feedback even more vital to learning correct palpation. Existing research tools have addressed some of these challenges through simulation techniques that do not require experts, and can provide feedback on palpation pressures and palpation patterns. We describe a novel computer-based palpation training system, leveraging existing approaches, with an emphasis on sensing accuracy, directed- feedback, portability, and user experience. 1 – Introduction The acquisition of clinical skills, including palpation, is an ongoing challenge in medical education. Learning clinical skills using the traditional apprentice-based methods is increasingly difficult in the current healthcare environment. Simulation is an attractive addition to standard methods of teaching clinical skills. Computer- based simulation permits standardization, lowered costs, increased patient diversity, and improved feedback to provide a minimum level of student competence. We present a design for a portable, computer-based simulator that enables students to practice and receive feedback when performing a clinical breast examination (CBE). The simulator incorporates a virtual human for medical interview training and a force sensing platform for palpation training. The primary benefits of this innovative design are palpation sensing accuracy, portability, visual feedback, compatibility, and provider-patient conversation. In the new millennium, breast cancer is the most common type of cancer diagnosed in women and the second most common cause of death from cancer in women (CDC, 2009). Early detection of breast cancers is the most important method to improve survival rates. Early breast cancer screening research suggested that finding small masses by physical examination was largely serendipitous (Martin et al, 1979), motivating imaging techniques such as mammography. However, a more recent study involving nearly 300,000 women found that the combination of a mammography and CBE can improve early detection of breast cancer—provided correct execution of the CBE (Chiarelli et al, 2009). Furthermore, a CBE has a lower direct cost than mammography, and CBE provides opportunities for provider-patient communication that patients may not receive during mammography screening. Unfortunately, many providers feel that they are not properly trained in CBE techniques, limiting the use of proper CBE techniques (Iannotti et al, 2002; Wiecha and Gann, 1993). To assist with CBE training, a number of inert mannequin simulators are available, such as the silicone breast models from Mammacare®. These mannequin simulators offer the opportunity for students to practice breast examination technique on standardized models. In addition, the breast models can be embedded with materials or inflatable devices to simulate breast abnormalities (Gerling et al, 2002). To improve upon the feedback, some have incorporated force sensors into the mannequins, alongside visualizations of the force being used (Pugh et al, 2008). Finally, an immersive simulator has been created that combines a full-size mannequin and a virtual patient (a mixed reality human) to practice both CBE and medical history-taking simultaneously (Kotranza et al, 2009). The goals of the simulator described in this work are similar to the aforementioned tools: to improve and standardize the manner in which breast examinations are conducted. Our simulator builds upon and leverages these existing works, filling a gap between sensor-augmented mannequins and mixed reality humans, and providing unique opportunities for training.