As the Society for Medical Simulation has now reached a landmark decision to change its name to match that of our Journal, soon to become the Society for Simulation in Healthcare, another set of name and word issues also arises for the Journal. That is, what to call the device used to replicate the patient's body? Those in the media seem fond of calling it a “dummy,” especially when they can make a sly turn of phrase as in, “Doctors Learn from Smart Dummies.” The inventors and designers of patient simulators prefer to think that “Dummies Learn from Smart Doctors.” Still, this leaves us to contemplate other words to represent the patient simulation device.
Let me make this a bit of a personal story. Back in 1986 we conducted our first simulation with only a head and neck airway training device to represent the patient. Shortly thereafter we switched to a device that included a thorax as well as the head and neck—a device called “Eddie Endo” (whose manufacturer I have now forgotten). In our first paper1 on simulation in Anesthesiology, we had to choose what to call the patient device. I honestly can't remember if Eddie Endo was described by its maker or seller as a “mannequin” (from French) or “manikin” (from Dutch) or in some other terms. I seem to recall that we knew of such a device in CPR training as (phonetically) a mănĭkĭn, but I don't remember ever seeing the name in writing in a medical context. In the U.S., the common term for a clothing display figure is “mannequin.” Perhaps drawn by my years of study of the French language in high school we naturally submitted the paper to Anesthesiology with the French-originated spelling “mannequin.” This was actually questioned by a reviewer, but I remember checking a handy dictionary that indicated the two spellings as equivalent. In those days, one couldn't easily check a dozen dictionaries from one's desktop, so we stayed with the French spelling.
Recently, as we formed the Journal, some members of the Editorial Board raised the question: Is it mannequin or manikin, and should the Journal require one or the other spelling to be standard. Nowadays, it is possible to check all sorts of things from one's desktop, so here are some facts related to this question.
* Both mannequin and manikin are listed as equivalent terms in many dictionaries, and some British dictionaries suggest that mannequin is a U.S. term or spelling for manikin. The most common meaning of mannequin is to describe a figure used to display clothing. In old-fashioned usage, this could be a human being (a model) or an inanimate object.
* Manikin originated from a Dutch term for “little man” (a dwarf). Besides being a different spelling for the clothing model, some dictionaries also listed definitions related to a wooden artist's model and to an anatomic model used for teaching in medicine. The Oxford English Dictionary gives the anatomic model definition as the third for manikin and traces this usage back to as early as 1831.2
* The original paper about the Sim One simulator produced at the University of Southern California in the late 1960s used the term manikin,3 as did papers describing the cardiology simulator now known as “Harvey.”4 Other devices produced for resuscitation training have also traditionally been described as manikins.
This information, had it been more easily available in 1986–1988, might conceivably have led us to use the term manikin, and perhaps on to today, that would be that. However, as William S. Burroughs opined5 and Laurie Anderson echoed,6 “Language is a virus,…” indicating that words, phrases, and ideas are constantly changing in meaning and usage. Thus, we need to look at the situation in 2006 for the usage of the terms mannequin and manikin. Just as the Internet now facilitates looking at multiple dictionaries and finding previous publications, it also facilitates counts of words and phrases in common use.
As of February 2006, the following facts were true:
* A Google search of “manikin” + “resuscitation” or + “CPR” gave 34,000 and 74,000 hits, respectively. When “mannequin” was substituted for “manikin,” there were 23,000 and 49,000 hits, respectively. Obviously, in the context of resuscitation, manikin is the more common term.
* A Google search of “manikin” + “simulation” gave 40,000 hits, but “mannequin” + “simulation” gave 88,000 hits. When these searches used “medical simulation” rather than just “simulation,” the results were 33,000 for “mannequin” and 21,000 for “manikin.” Thus, in the context of simulation, mannequin is more common.
* A search of Index Medicus (ie, PubMed) showed 251 hits for “mannequin” and “simulation” and 233 hits for “manikin” and “simulation.” Of these hits, 90% were in common, and the unique terms showed a slight advantage for mannequin over manikin.
Thus, when discussing simulation in healthcare, for whatever reason, mannequin has become the more common term, but considering the overall framework of simulation applications, the two terms can be considered more or less equivalent. Finally, a straw poll of attendees at the 2006 International Meeting on Medical Simulation revealed a small preference for mannequin, but most respondents considered the two terms essentially interchangeable.
Thus, based on this information, on opinions from the Editorial Board, and on the admitted bias of the Editor-in-Chief, Simulation in Healthcare is adopting the following policy:
* We recommend the term mannequin to be used to describe the physical device in a simulator that physically replicates the patient.
* We will accept the use of the term manikin if that is the authors' preference.
* The same term shall be used consistently throughout a paper, unless it is discussing historical or etymological issues requiring the use of the two different terms.
Another Etymological Issue
Some authors are using the term human patient simulator to refer to the generic field of patient simulation for human beings. However, Human Patient Simulator is the trade name of a specific simulator product sold by Medical Education Technologies Incorporated (METI). As the Journal is about simulation in healthcare—clearly implying the care of human beings—there is no need to append “human” to the term patient simulator when meaning the generic device or the field as a whole. Should we publish papers on veterinary simulation, perhaps we will ask the authors to use the term canine patient simulator or the like. The term Human Patient Simulator is still appropriate when referring to specific characteristics of the METI product. The Instructions for Authors will publicize this policy and the copyediting staff will include it in the processing of papers accepted for publication.
Finally, in a light-hearted note, I find it fascinating that the study of words and word origins is etymology, whereas changing only a single letter converts the word to the study of insects, entymology. Indeed, what's in a name?