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Dr. Carla Pugh's simulator technology provides innovative physical testing to help doctors and medical students measure their ability to diagnose breast, pelvic and prostate cancers. Her research just won her the highest honor the United States government awards to science professionals. Pugh is a researcher and surgeon as well as an inventor at Northwestern University's Feinberg School of Medicine.



Dr. Carla Pugh works with her simulation technology to help medical students better diagnose breast cancer.

Simulator research to test for accurate breast cancer diagnoses wins Northwestern University’s Dr. Carla Pugh national honors

by Lauren Gold
Oct 04, 2011

Pugh, a researcher and surgeon at Northwestern University Feinberg School of Medicine, just earned the Presidential Early Career Award for Scientists and Engineers for her research in defining how to use her patented technology to set standards for clinical performance. Patented in 2001, her sensors help analyze hands-on performance through the use of pelvic, prostate and breast simulators.

The award is the highest honor bestowed by the United States government for science and engineering professionals.

Pugh successfully developed the breast simulator and simulation technology to physically measure the ability of medical students and physicians to detect breast cancer during clinical exams. The clinical exams back up mammograms and are the only screening many women receive.

Pugh and her team are building 100 sensor-enabled breast examination simulators, complete with simulated abnormalities, with a grant from the National Institutes of Health. Students and doctors can train with these and get immediate feedback on the accuracy of a diagnosis.

With the sensor-enabled simulations, Pugh said she believes it’s possible to identify proper and improper techniques that result in cancer diagnoses. Pugh previously invented a simulator and applied her patented sensor technology to teach students about properly completing prostate and pelvic exams.

She has worked with thoracic surgeons to develop tracheal and esophogeal simulators to help them learn how to properly insert stints in the esophagus for cancer treatment. Pugh talks about her passion for medicine and education that could lead to major changes in how we practice medicine.

Tell us about the simulators. What drew you to this kind of technology, as opposed to other kinds of research?

A big problem in the whole medical field is that we don’t have widely used objective measures of hands-on performance. So, when doctors get credentialed to practice medicine or get their license or board certification, it has always been a board certified test. It’s a written test. We have hoards and hoards of pencil and paper tests. But the reality is, medicine is a hands-on field. And we just don’t have the tests yet to assess whether you can do a surgical procedure to a certain standard or even a physical exam. The quirkiness about it is that it’s subjective. We use our hands a lot. I can use my hands and touch someone to try and feel a tumor, and my interpretation of that can be completely different from someone else’s.

Do you think these simulators could eventually be used for public health initiatives, such as classes for women to help teach them about self-breast examinations?

Definitely. I think there’s potential for it to provide information similar to what we have now access to on Google. I can build 100 breast models. I can get a mammogram of your breast and say, ‘Okay, your normal breasts are similar to patient 7A, and this is what you need to look for. This would be what the tumor might look like.’ You never know, I think that once people get it, and there’s money put into it, it could expand. I think the technology is there. We could do it tomorrow if someone would invest in it. I’ve made 30 breast models so far this year. The goal for the project is 100. The pelvic simulators are being manufactured and are in more than 100 medical and nurse facilities.

Do you hope to expand your research with sensor technologies? If so, in which fields, and how?

Right now, Northwestern already has a curriculum on the teaching side for medical students for these sensitive examinations. For teaching at Northwestern and at Stanford and many other programs, they use both my simulator as well as [volunteer] patients. I’ve done other things with sensor technologies with surgical procedures. I partner with specialists, like thoracic surgeons, who need help. There are new doctors that need to be trained on a new procedure, and an older doctor needs to learn how to do it. With the technology, we can go into so many fields. I helped test a new treatment procedure for deploying a stint in a cancer in the esophagus. We made a simulator for that. All it takes is a little creativity. Now that I have the sensor technology, I can build a lot of things. I put on my education hat and figure it out.

What does this mean for breast cancer research? Are people recognizing its importance?
It’s slow. Breast cancer research is a huge industry and an old dinosaur of sorts. There are protocols and common areas of research that are currently popular, and mine is not a popular area yet. It’s not mainstream. It would take several other researchers to gain more attention. It’s just the natural wave of how science progresses. It has the potential to become mainstream if other scientists find the same findings. A few people are working on it in different venues. There’s really a small group of us.

Do you think your research could help decrease the occurrence of medical malpractice?

I think that it definitely will help doctors. I think it will also help patients understand what I now understand about the human body. We don’t know everything. Medicine is a partnership. Yes, you might be the unique person who has a case that no one else has; that’s fair and okay. Somehow, we have to trust each other and try to do the best thing. Doctors are human. Doctors get sued because patients believe the doctors didn’t do their best. Hopefully, these simulators will ensure that doctors can detect that one centimeter tumor. I think it will help doctors. I think it will help patients. It goes both ways. It will help science. There’s a whole world out there with unanswered questions.

What was your motivation for this research?

My motivation was the surgical field. I started this when I was a graduate student getting a Ph.D. in education at Stanford University. This has been a 12-year project. I’m a very visual and hands-on person. After I finished my surgical residency at Howard University Hospital, I was very frustrated that there were these elements in the medical field. You learn science differently as a first and second-year medical student and as an undergraduate. It’s by the book, and there’s one right answer. Then, you get into the medical field, and patients have these things that are not by the book. There are so many different interpretations. This research was very meaningful to me, because, as a surgeon, I would say, ‘Wow, I feel good about my answer, but there’s no way to be 100 percent correct.’ In the whole profession of medicine, you’re going to give a drug, you’re going to subject them to tests; there’s this loosey goosey area. We’ve done pretty well with this area in medicine, but I believe we can do better.

What is your ultimate career goal?

I would really like this technology to go to the next level of really helping patient understanding. I want just a better understanding of medicine and to affect patient care outcomes on both sides. I really think it can affect the amount of money we spend on healthcare. I want this technology to have a positive effect on the patient and to ensure competency and efficiency on the part of the physician to practice medicine.