This photograph is… striking. It’s easy to make a quick joke about like, “Hey! Check out the latest Wii U accessory!” but we took it a few steps further. We’ve tracked down Benjamin Lok, a doctor who worked on the project to ask him exactly what’s going on in the photo, and his answers were fascinating.

We came across the photo when comedian Rob Delaney tweeted it earlier this month:

Like we said: It’s easy to make a joke about, but we wanted to know what was going on. We know that the medical profession uses simulators for various procedures to let students practice techniques without putting anyone (or their butts) in harm’s way, but this is unlike anything we’ve ever seen. We had to know more.

We went down the single weirdest Google search rabbit hole we’ve ever been a part of, but at the end of it we found Dr. Benjamin Lok. He worked on the prostate exam simulator in the photo. Obviously — because someone has his hand in a robot butt — we had some questions.

Glen Tickle: So what exactly are we looking at this photograph?

Dr. Lok: The image shows a medical student practicing a prostate exam on a virtual patient. The virtual patient prostate exam simulation is designed to help students practice and reduce anxiety with intimate exams. In the experience, the student talks to a virtual person and is able to practice their communication skills. The students can conduct a realistic prostate exam on the plastic mannequin. The mannequin is instrumented with force sensors that can measure where the student is examining and with how much pressure. This enables the system to provide a realistic encounter with a virtual patient that includes communication and physical exam components.

Intimate exams (including the clinical breast exam and prostate exam) are extremely high stakes and high impact scenarios for medical students. However, currently there are few tools to enable the practice and acclimation to what are very anxiety generating interactions. Currently, students receive minimal practice and interaction in intimate exams due to the high cost for training and high anxiety nature of the exams.

So our research group has spent the past 4 years exploring whether we can improve medical students preparation and performance in intimate exams using simulations, such as the one seen in the photograph.

Did you create this simulator?

Working with Dr. Carla Pugh, University of Wisconsin, who invented a mannequin with sensors on the prostate to track student performance, we combined the prostate simulator with my research group’s (www.virtualpatientsgroup.com) work into virtual patients simulation. The resulting experience is a life-sized, realistic virtual person that medical students can speak and gesture with to interact. Furthermore, the medical students can perform a realistic prostate exam using the physical simulator. This combination of real and virtual elements is called mixed reality.

How was it developed?

This work was supported by the National Science Foundation. The work explored if virtual humans could provide anxiety-reducing, and skill-enhancing training experiences for medical students.

Is it currently being used?

This work has been piloted at both Drexel University Dr. D. Scott Lind and the University of Florida. The promising results will hopefully lead to this simulation being mandatory.

While researching this image to find you we came across a number of analog prostate exam simulators. How is this device different?

This simulation has two distinct differences than analog prostate exam simulators. First the simulator is connected to an interactive virtual human patient. This virtual human patient (named Patrick), can talk to the learner, expresses fears and concerns about the prostate exam, and presents a realistic patient encounter.This enables the student to work on their interpersonal skills.

Second, the simulator has force sensors embedded into the prostate that tracks student performance. This enables two things: 1. The student gets real-time feedback on how they are doing, including coverage of the prostate being examined and the amount of pressure being applied. Consider this, how would a medical student know if they are doing a good prostate exam? Currently it is impossible for the educator to gauge performance. This simulation provides performance, feedback, and an opportunity to learn and lower anxiety.

The most frequent joke we saw about the image is that the simulator is some sort of peripheral for a video game console, but that doesn’t seem like a bad idea to us. Do you think consoles like the PS4 or Xbox One could be used in medical training?

The PS4 and XBox One are powerful computers, no different than a PC. So from a functional perspective (that is computational power), consoles can easily provide the computational power to do training. With the console’s cheap price and fantastic computational power, they can be used for training.

How interactive is the software? Does the on-screen patient react based on the procedure?

Absolutely. That’s the whole idea. Patrick expresses fears when the learner brings up the need for a prostate exam. Thus the student needs to learn and practice empathy. How many of us have gone to the doctor and wished they had worked on their bedside manner skills? My group aims to use simulation to address this critical need!

How do you feel about the attention you and the simulator have gotten now that the image has gone viral?

I understand that the image will likely generate a response by the viewer, spanning the gamut from humor, to disgust, to curiosity. However, this is important, novel work to help medical students improve their patient communication skills, especially in intimate exams.

This work has very serious scientific underpinnings to improve healthcare in the United States. This work was published in the largest, international virtual reality conference (IEEE Virtual Reality 2013) and the work can be viewed here:

I ask the reader to recall if they have had encounters with medical professionals where they wished more empathy or sympathy should have been expressed. We are working to train the next generation of health care providers on their interpersonal skills.

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We’d like to thank Dr. Lok for taking the time to answer our questions, even though those questions were mostly about a robotic butt. It’s important work that could lead to much more pleasant doctor/patient interaction, and for that too, we thank Dr. Lok and the team that built Patrick.

(Image via Dr. Benjamin Lok)

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