Novel undergraduate physiology laboratory using a human patient simulator

Undergraduate pre-medical education is generally taught using traditional didactic laboratories that include stepwise methodologies and expected outcomes. A human patient simulator (HPS) can be used as an open-ended laboratory tool outside the clinical spectrum to immerse undergraduates in scientific inquiry through student-generated experiments that apply the scientific method and parallel the scientific literature. These objectives are achieved during a 15-week semester. Our undergraduates have fundamental backgrounds in anatomy, physiology and research theory, but few have applied this knowledge through scientific investigation. This experience culminates 3 years of science education in a single project that encourages independence, creativity, accountability and critical analysis. This strategy also circumvents time-dependent concerns associated with the use of actual human subjects and required formalities (e.g. institutional review). The METI HPS is used in the course ‘Physiological Adaptation’ to understand human adaptation, rather than pathology, associated with environmental extremes or diseased states. Students must design physiologically realistic experiments using data from the primary scientific literature to modify the pre-programmed patient settings of the HPS to reflect physiological parameters in particular conditions (e.g. by lowering arterial saturation to simulate the effects of high altitude). The strengths of the HPS reside in its replication of the cardiovascular and pulmonary systems; hence, student projects generally centre on these systems and are chosen according to personal experience or interest; they have included conditions related to high altitude, breath-hold diving, temperature extremes, aerobic exercise, hypohydration and blood doping. In some instances, students opt to recreate published methodology to validate earlier work and test the fidelity of the HPS. Students are divided into groups of three or four for an introductory session on the HPS and to discuss potential ideas. Projects are approved by the instructor and may take several weeks to finalise. Groups are allowed to make changes, assumptions and decisions (including pilot trials) that will facilitate project development. Simulated trials are performed over several weeks and may require additional non-scheduled laboratory sessions to complete. Supplementary instruction on data analysis, the construction of ‘publishable’ tables and figures and final paper preparation is conducted. In their write-ups, students must compare the HPS and human physiology as reported in the literature. This laboratory parallels the collaborative research experience and is punctuated with a group oral presentation and a final written report prepared to the standards required for publication in a scientific journal. Course evaluations reveal positive reviews of this laboratory experience because it allows the opportunity to investigate topics in greater depth than in earlier coursework and incorporates student interests. Students have expressed some frustration that the HPS data were not always in line with their predicted outcomes, which further accentuates the nature of scientific research. This sentiment also reflects, in part, the inherent limitations of the HPS, which are evident when employing this tool outside clinical training; essentially, the HPS cannot replicate human physiology perfectly. However, this provides an opportunity for students to consider their methodological strategies during the semester and to make comparisons with findings in the literature in their final paper. Expectedly, some projects are more creative, physiologically meaningful or applicable than others; regardless, students have expressed positive opinions that the projects also strengthen their science writing and speaking abilities.