The skin color and gender of high-fidelity simulation manikins in US simulation centers and their use in cultural humility training

Abstract Objective Our objectives were to evaluate what proportion of simulation centers use high-fidelity simulation manikins to teach cultural humility, and to evaluate if manikin skin color and sex breakdown are representative of the USA population. Methods Surveys were sent to simulation centers from our simple random sample. Key outcomes included skin color and gender of manikins and if cultural humility was taught via simulation. Point and interval estimates were calculated for the proportion of light-, medium-, and dark-colored manikins, the proportion of female and male manikins, and the proportion of centers using simulation to teach cultural humility. Confidence intervals were employed to test the null hypothesis that light/medium/dark skin color was 60/20/20 and female/male was 50/50 which is extrapolated from the US Census data. Results Our response rate was 75% (41/55). All of the 41 responding simulation centers had manikins (1.0000, 95% CI: 0.9180, 1.0000). Twenty seven of the 41 simulation centers with manikins reported simulation scenarios with cultural humility (0.6585, 95% CI: 0.5127, 0.8044). Proportions of light-, medium-, and dark-colored manikins were 0.5150 (0.4669, 0.5625), 0.3086 (0.2651, 0.3547), and 0.1764 (0.1563, 0.1964), respectively. Proportions of male and female manikins were 0.6402 (0.6163, 0.6640) and 0.3598 (0.3360, 0.3837). The null hypotheses that skin color follows a 60/20/20 split and gender follows a 50/50 split were rejected. Conclusions Most simulation centers surveyed teach cultural humility via simulation, however their manikins do not reflect the sex and skin tone of the USA population.