Toward the Development of A Realistic, Low-Cost “Gender Retrofit Kit” For Use In Combat Medicine Training
Authors: Alban Angela , Coiro Cheryl , Patel Trisha , Beaubien Jeffrey , Mazzeo Mark 
Published: June 2022

BackgroundBystanders often hesitate when rendering first aid to females, particularly it requires disrobing the individual (Leary et al, 2018). In addition to the delayed application of first aid, the lifesaver’s actual task performance may also be less effective than when treating injured males. This can occur, for example, when the lifesaver does not fully expose the wound (Bell et al., 2020). The Army has invested heavily in the acquisition of realistic patient manikins for training combat medicine skills. However, given logistical constraints, it will be difficult to acquire an equal number of female patient manikins. Therefore, the purpose of this study was to develop and test a low-cost manikin “Gender Retrofit Kit” (GRK). The GRK included a breast “vest” that is affixed to the torso, a realistic vagina that is affixed to the groin, a wig, facial makeup, and instructions for “feminizing” the manikin’s appearance. MethodWe recruited a convenience sample of 36 Combat Lifesavers and Combat Medics who were completing their recurrent annual training. At the end of their scheduled training, the participants were invited to practice three medical procedures (treatment of penetrating trauma to the leg via tourniquet, treatment of gunshot wound via application of a chest seal, and treatment of tension pneumothorax via needle chest decompression). Of the three medical procedures, only the last two required disrobing the patient. Therefore, we hypothesized that if performance issues were to occur, they would be localized here. The participants practiced the three procedures using two different manikin types: a standard male manikin and the GRK-outfitted manikin. The order of manikin presentation was counterbalanced. Measures of task quality, task completion times, and usability questionnaires were collected. Results and ConclusionsThe sample was primarily male (78%), and included nearly equal numbers of Combat Lifesavers (42%) and Combat Medics (44%). A post-simulation questionnaire suggested no significant mean differences between the standard vs. GRK manikins with regard to the simulators’ perceived realism, anatomical correctness, or ability to provide meaningful skills practice. However, statistically higher mean scores were reported for questionnaire items that focused on the female manikin’s realistic breast tissue, realistic skin texture, and feminine facial appearance. Linear mixed models were used to separately test the effects of participant gender (or job title), manikin gender, and their interaction on both task performance speed and quality. There were no statistically significant differences in task completion order or speed of task completion. All participants performed the three tasks in accordance with the Army’s MARCH-E algorithm, and all had similar completion times. With regard to the quality of task performance, the analyses revealed only one statistically significant main effect of manikin gender: the GRK manikin had a lower mean task performance score for the treatment of gunshot wounds, which required disrobing the patient to apply the chest seal. Based on the results of this exploratory study, we are prioritizing potential improvements to the GRK, and are planning a more rigorously-controlled validation study with the revised prototype. Additional implications and lessons learned will be discussed.