Harvey was one of the earliest medical simulators available for training of health care professionals. Harvey was created in 1968 by Dr. Michael S. Gordon at the University of Miami. Harvey is currently sold by the Laerdal Corporation.

Background

Considered one of the groundbreaking products in medical simulation, the

cardiopulmonary The blood circulatory system is a system of organs that includes the heart, blood vessels, and blood which is circulated throughout the entire body of a human or other vertebrate. It includes the cardiovascular system, or vascular system, tha ...

patient simulator Harvey provides a method of standardized testing for real-time procedures, and skills of the trainee, usually a

medical student A medical school is a tertiary educational institution, or part of such an institution, that teaches medicine, and awards a professional degree for physicians. Such medical degrees include the Bachelor of Medicine, Bachelor of Surgery (MBBS, MB ...

resident Resident may refer to: People and functions * Resident minister, a representative of a government in a foreign country * Resident (medicine), a stage of postgraduate medical training * Resident (pharmacy), a stage of postgraduate pharmaceuti ...

. First demonstrated in 1968, the Harvey simulator is a

mannequin A mannequin (also called a dummy, lay figure, or dress form) is a doll, often articulated, used by artists, tailors, dressmakers, window dressers and others, especially to display or fit clothing and show off different fabrics and textiles. Pr ...

that performs more than 25 different cardiac functions of the human body, varying

blood pressure Blood pressure (BP) is the pressure of circulating blood against the walls of blood vessels. Most of this pressure results from the heart pumping blood through the circulatory system. When used without qualification, the term "blood pressure" r ...

breathing Breathing (or ventilation) is the process of moving air into and from the lungs to facilitate gas exchange with the internal environment, mostly to flush out carbon dioxide and bring in oxygen. All aerobic creatures need oxygen for cellular ...

pulse In medicine, a pulse represents the tactile arterial palpation of the cardiac cycle (heartbeat) by trained fingertips. The pulse may be palpated in any place that allows an artery to be compressed near the surface of the body, such as at the nec ...

heart sounds Heart sounds are the noises generated by the beating heart and the resultant flow of blood through it. Specifically, the sounds reflect the turbulence created when the heart valves snap shut. In cardiac auscultation, an examiner may use a stetho ...

and

heart murmurs Heart murmurs are unique heart sounds produced when blood flows across a heart valve or blood vessel. This occurs when turbulent blood flow creates a sound loud enough to hear with a stethoscope. Turbulent blood flow is not smooth. The sound dif ...

. As years have passed, Harvey has been upgraded with the addition of more advanced cardiac functions, with the intention of creating a general and also in-depth program in

cardiology Cardiology () is a branch of medicine that deals with disorders of the heart and the cardiovascular system. The field includes medical diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart d ...

. Harvey is used to teach all levels of medical education. For beginners, the simulator is used to teach

blood pressure measurement Arterial blood pressure is most commonly measured via a sphygmomanometer, which historically used the height of a column of mercury to reflect the circulating pressure. Blood pressure values are generally reported in millimetres of mercury (m ...

techniques and help students recognize a heart murmur. For more senior level medical students, Harvey can mimic heart sound variation with respiration, along with a variety of cardiac issues, such as

carotid In anatomy, the left and right common carotid arteries (carotids) (Entry "carotid"
in
jugular The jugular veins are veins that take deoxygenated blood from the head back to the heart via the superior vena cava. The internal jugular vein descends next to the internal carotid artery and continues posteriorly to the sternocleidomastoid mus ...

venous Veins are blood vessels in humans and most other animals that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are the pulmonary and umbilical veins, both of which carry oxygenated b ...

pulsations. Medical students and cardiologists are not the only people who use mannequins such as Harvey to learn bedside techniques. Other specialties, such as

anesthesiology Anesthesiology, anaesthesiology, or anaesthesia is the medical specialty concerned with the total perioperative care of patients before, during and after surgery. It encompasses anesthesia, intensive care medicine, critical emergency medicine, ...

, internal medicine, and

Emergency Medicine Emergency medicine is the medical speciality concerned with the care of illnesses or injuries requiring immediate medical attention. Emergency physicians (often called “ER doctors” in the United States) continuously learn to care for unsche ...

, have also seen benefit from the trainer.

Combat medic A combat medic, or healthcare specialist, is responsible for providing emergency medical treatment at a point of wounding in a combat or training environment, as well as primary care and health protection and evacuation from a point of injury ...

s and other military personnel also use this technology to improve their skills.

Educational rationale

The Harvey Simulator is a tool for

medical education Medical education is education related to the practice of being a medical practitioner, including the initial training to become a physician (i.e., medical school and internship (medical), internship) and additional training thereafter (e.g., Re ...

. Harvey was created mainly to improve

cardiovascular The blood circulatory system is a system of organs that includes the heart, blood vessels, and blood which is circulated throughout the entire body of a human or other vertebrate. It includes the cardiovascular system, or vascular system, tha ...

bedside skills in medical personnel. By mimicking the basic cardiac functions of the human body, Harvey provides a much more realistic training exercise than a traditional classroom lecture. By removing the risk of working on a real patient, simulators prepare medical students, or anyone else who uses the device, for real-world situations. As the medical world becomes more complex, more demand is placed on the need for training techniques that do not rely upon living patients, and Harvey is one of the answers to this demand. It and other similar simulators are very effective teaching tools, since medical students are more willing to attempt to learn on a mannequin than on a patient volunteer, and this saves both the teacher and the student valuable time. Studies with medical students have shown a significant difference between cardiology elective scores for students who used Harvey and students who did not.

History

The Harvey mannequin was named after W. Proctor Harvey, a physician at

Georgetown University Georgetown University is a private university, private research university in the Georgetown (Washington, D.C.), Georgetown neighborhood of Washington, D.C. Founded by Bishop John Carroll (archbishop of Baltimore), John Carroll in 1789 as Georg ...

and mentor of the Mannequin's creator, Dr. Michael Gordon. Before the Harvey simulator, there were other models such as

Resusci Anne Resusci Anne, also known as Rescue Anne, Resusci Annie, CPR Annie, Resuscitation Annie, Little Annie, or CPR Doll is a model of medical simulator used for teaching both emergency workers and members of the general public. Resusci Anne was deve ...

, designed to teach mouth-to-mouth ventilation, which did not actually simulate much of anything, and the lesser known Sim One, one of the first computer-driven simulators designed to simulate an entire human patient. Originally, three Harvey simulators were created, each representing a different disease. Since then, Harvey has been advanced to the point where it can simulate multiple diseases. Harvey's inner functions went through three main stages of development. The prototype used telephone

relay A relay Electromechanical relay schematic showing a control coil, four pairs of normally open and one pair of normally closed contacts An automotive-style miniature relay with the dust cover taken off A relay is an electrically operated switch ...

s and a four track tape to create heart movement and sounds, respectively. The first commercial model used a series of

cam Calmodulin (CaM) (an abbreviation for calcium-modulated protein) is a multifunctional intermediate calcium-binding messenger protein expressed in all eukaryotic cells. It is an intracellular target of the secondary messenger Ca2+, and the bind ...

s and

lever A lever is a simple machine consisting of a beam or rigid rod pivoted at a fixed hinge, or ''fulcrum''. A lever is a rigid body capable of rotating on a point on itself. On the basis of the locations of fulcrum, load and effort, the lever is div ...

s instead of telephone relays, but kept the 4-track tape recordings for sound. When the manufacturer of the tape recorder (Ampro Corp) went out of business, a

sound card A sound card (also known as an audio card) is an internal expansion card that provides input and output of audio signals to and from a computer under the control of computer programs. The term ''sound card'' is also applied to external audio i ...

was integrated to mimic heart sounds. The third and current version of this simulator uses a

servo motor A servomotor (or servo motor) is a rotary actuator or linear actuator that allows for precise control of angular or linear position, velocity and acceleration. It consists of a suitable motor coupled to a sensor for position feedback. It also r ...

and a sound card to mimic the cardiovascular functions of the human body. The first version of Harvey cost around $100,000, but the upgrades of a sound card and a servo motor cut the cost to around $50,000. Along with the second version of Harvey came a set of slides to show images of echoes and other medical imaging pieces helpful when diagnosing the disease. These slide programs were around 1998 replaced with software that allowed for video recordings. This software came in 1985, around the time of the first

aortic stenosis Aortic stenosis (AS or AoS) is the narrowing of the exit of the left ventricle of the heart (where the aorta begins), such that problems result. It may occur at the aortic valve as well as above and below this level. It typically gets worse ove ...

, and was designed around that case. Part of diagnosing aortic stenosis is listening to sounds in the neck, which in the first Harvey version was not possible because it had no neck sounds. The software also contains the images and videos from the original slide programs, along with the history of the patient.

Description

The current version of the Harvey simulator can mimic six different breath sounds, nine different cardiac auscultation areas, 30 different cardiac diseases, and 12 digitally driven impulses. The amplitude and intensity of the heartbeat is changeable. The trainees utilize a built-in

stethoscope The stethoscope is a medical device for auscultation, or listening to internal sounds of an animal or human body. It typically has a small disc-shaped resonator that is placed against the skin, and one or two tubes connected to two earpieces. ...

to listen to the sounds. Trainees may also manually

palpate Palpation is the process of using one's hands to check the body, especially while perceiving/diagnosing a disease or illness. Usually performed by a health care practitioner, it is the process of feeling an object in or on the body to determine ...

the pulses. When using Harvey, trainees also use the slide programs, which provide additional sources of instruction by giving patient history, examples of laboratory findings from real patients who had the disease, as well as therapeutic decisions, pathologic data, and

epidemiological Epidemiology is the study and analysis of the distribution (who, when, and where), patterns and determinants of health and disease conditions in a defined population. It is a cornerstone of public health, and shapes policy decisions and evidenc ...

data. Slide programs have since been replaced with computer programs that provide video instead of still pictures. Both the hardware and the software for this simulator were developed at the Medical Training and Simulation Laboratory at the University of Miami School of Medicine. Image:Harvey_old_external.jpg, Older version of Harvey Cardiovascular Patient Simulator Image:Harvey_old_internal.jpg, Removing panels on sides of older version of Harvey shows internal structure. Image:Harvey_old_cam.jpg, View of internal structure of older version of Harvey. Motor, shown near bottom of image, drives cam shaft shown. Image:Harvey_old_lever_guide.jpg, Lever guides along cam shaft have more elliptical shape to create movement needed. Image:Harvey_old_lever.jpg, Guides move levers. Plungers are attached to roller mechanism shown here to create movement of pulses and heart. Image:Harvey_new.jpg, Current version of Harvey along with its base. Black boxes at bottom allow for sound to be transmitted to multiple users. Image:Harvey_new_steh.jpg, Current version of Harvey showing stethoscope and control interface. Image:Harvey_new_internal.jpg, Internal control box is on left with

potentiometer A potentiometer is a three-terminal resistor with a sliding or rotating contact that forms an adjustable voltage divider. If only two terminals are used, one end and the wiper, it acts as a variable resistor or rheostat. The measuring instrume ...

s to control movement and sounds for current version of Harvey.

References

{{reflist, 2, refs= {{cite journal , vauthors=Cooper Jeffrey B, Taqueti VR , date=November 2008 , title= A brief history of the development of mannequin simulators for clinical education and training , journal= Postgrad Med J , volume= 84, issue= 997, pages= 563–570 , pmid=19103813 , url=http://pmj.bmj.com/content/84/997/563.long , access-date=2011-05-18 , doi=10.1136/qshc.2004.009886, doi-access=free {{cite journal , vauthors=Issenberg SB, Scalese RJ , year= 2008 , title=Simulation in Healthcare Education , journal=Perspect Biol Med , volume=51 , issue=1 , pages=31–46 , pmid= 18192764 , doi=10.1353/pbm.2008.0004 {{cite journal , vauthors=Wong SH, Ng KF, Chen PP , year= 2002 , title= The application of clinical simulation in crisis management training , journal=Hong Kong Med J, volume= 8, issue= 2, pages= 131–135 , pmid=11937668 , url= http://www.hkmj.org/abstracts/v8n2/131.htm, access-date=2011-05-18 {{cite journal , vauthors=Maran NJ, Glavin RJ , date=November 2003 , title=Low- to high-fidelity simulation - a continuum of medical education? , journal= Med Educ, volume= 37, issue= Suppl, pages= 22–28 , pmid=14641635 , doi=10.1046/j.1365-2923.2003.01408.x {{cite journal , author=Rosen, Katherine R , date=June 2008 , title= The history of Medical Simulation , journal= J Crit Care, volume= 23, issue= 2, pages= 157–166 , pmid= 18538206 , doi=10.1016/j.jcrc.2007.12.004 {{cite journal , vauthors=Oddone EZ, Waugh Robert A, Samsa G, Corey R, Feussner JR , date=October 1993 , title= Teaching cardiovascular examination skills: results from a randomized control trial. , journal= Am J Med , volume= 95, issue= 4, pages= 389–396, pmid=8213871 , doi=10.1016/0002-9343(93)90308-C {{cite journal , vauthors=Woolliscroft JO, Calhoun JG, Tenhaken JD, Judge RD , year= 1987 , title= Harvey: the impact of a cardiovascular teaching simulator on student skill acquisition , journal= Med Teach, volume= 9, issue= 1, pages= 53–57 , pmid=3669990 , doi=10.3109/01421598709028980 {{cite journal , vauthors=Jones JS, Hunt SJ, Carlson SA, Seamon JP , date=October 1997 , title=Assessing bedside cardiologic examination skills using "Harvey", a cardiology patient simulator. , journal= Acad Emerg Med, volume= 4, issue= 10, pages= 980–985 , pmid=9332631 , doi=10.1111/j.1553-2712.1997.tb03664.x, doi-access=free {{cite journal , vauthors=Issenberg SB, McGaghie WC, Hart IR, Mayer JW, Felner JM, Petrusa Emil R, Waugh Robert A, Brown DD, Safford RR, Gessner IH, Gordon DL, Ewy GA , date=October 1999 , title= Simulation technology for health care professional skills training assessment, journal=

JAMA ''The Journal of the American Medical Association'' (''JAMA'') is a peer-reviewed medical journal published 48 times a year by the American Medical Association. It publishes original research, reviews, and editorials covering all aspects of biom ...

, volume= 282, issue= 9, pages= 861–866, pmid=10478693 , doi=10.1001/jama.282.9.861 {{cite book , title=Cardiology Patient Simulator Harvey Instruction Manual , year=1995 , publisher=University of Miami , location=Miami, Florida , pages=I1–III1 {{cite web , author=Gordon, Michael , year=1997 , title=All New Harvey, Major Changes , publisher=University of Miami , url=http://www.gcrme.miami.edu/#/harvey-major-changes , access-date=2011-05-18 {{cite web , author=Staff , title=Harvey the Cardiopulmonary Patient Simulator , publisher= University of Miami , url=http://www.laerdal.com/doc/172/Harvey-The-Cardiopulmonary-Patient-Simulator , access-date=2011-05-18 {{cite book , author1=Agabegi, Elizabeth D , author2=Agabegi, Steven S. , title=Step-Up to Medicine (Step-Up Series) , chapter=Diseases of the Cardiovascular system Section: Valvular Heart Disease , publisher=Lippincott Williams & Wilkins , location=Hagerstwon, MD , year=2008 , isbn=978-0-7817-7153-5 , url-access=registration , url=https://archive.org/details/stepuptomedicine0000agab {{cite journal , title=Personal discussion with Robert Waugh, MD and User:Gene Hobbs, May 20th, 2011 , journal=Personal Communication , publisher=Duke Human Simulation and Patient Safety Center , date=2011-05-20 {{cite web , date=2011-05-22 , title=Local soldiers get realistic combat medical training , publisher=WTAM 1100 Radio Cleveland , url=http://www.wtam.com/cc-common/news/sections/newsarticle.html?feed=122520&article=8605886 , access-date=2011-05-23 {{cite journal , agency=Associated Press , date=1981-10-31 , title=Harvey Teaches Students, Doctors About Health Care, journal=

The Ledger ''The Ledger'' is a daily newspaper serving Lakeland, Florida, and the Polk County area. The paper was founded on August 22, 1924, as the ''Lakeland Evening Ledger''. In 1927, it bought its main competitor, the morning ''Lakeland Star-Telegram' ...

{{cite journal , author=Kinney, David , title=Is It a Standard Man, or Stan D. Ardman? , journal=

LA Times The ''Los Angeles Times'' (abbreviated as ''LA Times'') is a daily newspaper that started publishing in Los Angeles in 1881. Based in the LA-adjacent suburb of El Segundo since 2018, it is the sixth-largest newspaper by circulation in the Un ...

, date=1999-08-01 , url=http://articles.latimes.com/1999/aug/01/news/mn-61471 , access-date= 2011-05-24 Dummies and mannequins Medical simulation