The time-honored practice of utilizing sick patients for teaching purposes has become more difficult as duty hours for house staff became restricted, teaching was displaced by regulations and considerations for patient privacy and indigent patients became private patients through insurance. When patients were available, students were not, and when students were present, patients were not. The need for simulation was evident. Other than live patients the only other means of teaching diagnostic techniques is by textbooks, videos, and actors.


There is also a growing realization of the need for patient safety as an ethical issue with preparedness as the fundamental prerequisite for patient safety -- thus training becomes foremost in importance.


The magnitude of the potential need for this product can be estimated by considering the number of medical, osteopathic and nursing schools in the United States which would need a training manikin. By our estimate of 160 medical and osteopathic schools and 1,937 certified nursing schools there is a potential of 2,097 institutions that would need a device. Estimating that each class or course in physical diagnosis could utilize two manikins, this would give an initial estimate of 4,194 units in the United States alone.


The present legislative direction of health care provision for an estimated additional 20 - 30 million presently uninsured Americans give some credence to a belief that there will be a significant expansion of the numbers of physicians and nurses required to care for them, thus necessitating a demand for preparedness training with manikins.

2. The scientific soundness underpinning the mechanical design

​​3. The existing burgeoning simulation industry

1. The established need for a simulator of abdominal illnesses

AN ABDOMINAL SIMULATOR

​​​The SmarTummy is a manikin designed to mimic some of the common ailments of the human abdomen such as appendicitis, gallbladder disease, peritonitis, and tumors or swellings. Its use is in the training or education of medical students, interns, residents, nurses and other health care personnel. The value of SmarTummy rests upon three fundamental factors:

The translation of the idea of a simulation manikin to an actual device was brought about through the collaboration of Dr. Walton Shim and two graduate engineers, Larry Martin and John Salle, in the creation of a prototypic inflation system through a pressure manifold that allowed specific areas of the abdomen to be inflated to representing lumps and distension in different parts of the abdomen (See Figure above). The manikin is controlled through a graphical user interface (GUI).


SmarTummy was the winner of the 2013 University of Hawaii Schidler Business College Competition for which it received $10,000 in cash and $7,500 in services and a semifinalist in the Chapman University 2013 California Dreamin' Business Plan Competition. Among a field of 59 applicants SmarTummy was selected by the American Society of Mechanical Engineers (ASME) as third place winner for a prize of $10,000 in April, 2014. These accomplishments attest to SmarTummy's strength and market suitability. The SmarTummy team has been working closely with local and mainland simulation centers, receiving letters of support endorsing their willingness to integrate SmarTummy into their curricula and provide feedback on the initial design and detailed data on its effectiveness.

There are existing manikins to train healthcare workers in CPR (Cardio-Pulmonary Resuscitation) and insertional techniques such as esophagoscopy, bronchoscopy, catheterization and colonoscopy but, strangely, no commercially available product for abdominal palpation. SmarTummy is the first of its kind, a first mover, in an established field, and would meld seamlessly into preexisting products. Simulation is widely used in industry for flight training and for situational medical emergency preparedness. The medical simulation market was an $850M market in 2012 and is forecast to be $1.9B in 2017, a 120% increase in five years. There are numerous publications that substantiate the efficacy of simulators in medicine. The ultimate target market for SmarTummy in the U.S. includes 2,097 medical, osteopathic, and certified nursing schools not counting hospitals and military medical training facilities. Using a projected price of $100,000 per manikin, 2,097 medical, osteopathic and certified nursing schools in the United States, and assuming two units per school, gives a market projection of 4,194 units, resulting in sales of $419,400,000. As we progress in our development of a clinical prototype in the climate of intense interest in the burgeoning field of medical simulation, manikin manufacturers will become increasingly interested in the product. Additional marketing strategies available to the SmarTummy marketer including leasing, software licensing and instructional workshops. There would be the additional value of maintenance contracts and curriculum guides designed to teach physical diagnosis using the manikin and detailed data on its effectiveness.


The SmarTummy team has progressed steadily and confidently. We have been granted four patents for intellectual property rights, #9,087,458 (7/21/15), #9,117,377 (8/25/15), #9,336,695 (5/10/16), and #9,542,862 (1/10/17) but our next goal is an important one -- to build a prototype, a working model of SmarTummy that can progress to production for widespread sales and distribution. For further information, please contact Walton K.T. Shim, MD, FACS, Managing Partner, at wshim@hawaii.edu, Larry K. Martin at larrykmartin@gmail.com, or John Salle at john.salle@gmail.com.