April 22, 2008 — Nursing students cluster around a lifelike model of a human torso, practicing their palpation technique for a prostate exam. They're putting the computerized medical simulator through its paces, testing it to see if it really does help clinicians learn to distinguish between nearly 100 different diagnostic combinations.
The simulator is one of three designed by University of Virginia engineering professor Gregory Gerling and his research group. Through collaborations with Reba Moyer Childress in the U.Va. School of Nursing and Dr. Marcus Martin in the Department of Emergency Medicine, students are also evaluating devices for teaching clinical breast examination and chest tube insertion. They're hoping to show that these new prototypes will improve the way health care trainees learn before they practice on human patients.
Iowa farm boy
Gerling, a software and industrial engineer, hasn't formally studied biology since high school, and denies he was ever a computer geek. Growing up on a family farm in a small town in Iowa, he didn't have a computer of his own until his last year of college. The only reason he stumbled into electronics is because of a teacher he had in high school.
"She encouraged me to study whatever I wanted," Gerling said of the woman who introduced him to computer science. "So I started taking individual courses with her. I never intended to be a professor," he added. "I would have enjoyed being a farmer, but those were not good times for farmers, and my mom would have probably killed me. I was just planning on getting a good job."
In many ways, however, the professor is still an Iowa farm boy. His approach to research questions is rooted in the everyday realities of life on the farm.
"One of the things about farming that's cool is you're a jack of all trades," he said. "That is, in part, why I do some of what I do. When you're a farmer, you're nearly always in a situation where you lack money and equipment. Something's always breaking, and you have to come up with innovative and effective solutions."
Like his extended family back home in Iowa that is always willing to lend a hand, Gerling finds that coming up with innovative solutions in the lab is much easier when he's surrounded by bright, enthusiastic research assistants and collaborators.
Graduate research assistant Daine Lesniak says Gerling's passion is infectious. "If you think I'm excited, you should listen to Greg," Lesniak said. "That's one of the things I really like about working with him. He really does care about the work, and that rubs off."
"I think this job is similar [to farming]," Gerling said. "You're sort of a private operator as a professor. I'm running my own show, to some extent, and that's how it was on the farm. The cool thing is, you can be at it for life, and you're always learning. You always have new students coming in with new ideas. It's a very refreshing experience."
“I’m very lucky to be working with my collaborators, including excellent graduate and undergraduate students,” said Gerling. “They’re the ones doing the real work. It is a privilege to get to work with them.”
Graduate research assistant Daine Kesniak (SEAS ’09) says that Gerling’s enthusiasm is infectious. “That’s one of the things I really like about working with him. He really does care about the work, and that rubs off.”
The mystery of human touch
Gerling started out as a computer software engineer at Motorola in Chicago. It was exciting work, he says, and he was good at it. Too good, because he was soon being promoted right out of the excitement and into management, and that's not where he wanted to be.
After doing research as an undergraduate at the University of Iowa and working on short-term projects at Rockwell-Collins and NASA's Ames Research Center, Gerling decided to return to his alma mater for a graduate degree in industrial engineering. He'd develop some projects, he thought, then start his own company. But the thrill of research hooked him.
As a graduate research assistant, Gerling was asked to develop a prototype for a medical simulator that would improve on the current models used to teach clinical breast examination techniques. That technology typically involved four or five fixed "lumps" positioned within a solid silicone model of a human breast. Breaking from that paradigm, Gerling designed and patented a device that used a balloon apparatus to vary the size, position and tactile hardness to mimic different lesions of the human breast. It also included an electronic feedback system to help trainees gauge the accuracy of their performance.
Answers stir more questions
Developing this more realistic simulation, however, provoked more questions. What is it about the sensation of touch, Gerling wondered, that makes it possible for some people to gain mastery of the procedure while others can't, even after extensive practice?
"It makes no sense to me," he said. "Your finger and my finger are not that much different. The density of receptors is the same. The skin properties are basically the same. So how come I can feel the tumor so well, and you can't feel it at all?"
The questions propelled Gerling into an exploration of the neural and mechanical mechanisms underlying touch. He completed his Ph.D. dissertation on that topic and has continued to focus on it since coming to U.Va. in 2005. Now, in addition to medical simulators, he's probing the sensation of touch. The researcher recently received a prestigious Defense Advanced Research Projects Agency grant to develop a computational model of touch sensation for the next generation of neural prosthetic hands.
"You get immersed in these problems, which cross the traditional boundaries of engineering," Gerling said. "There are all these interesting aspects to human sensation. Once you start looking at the physiology, it's amazing how well it works. With the simulators, we know how to build fairly complex electrical and mechanical systems. But look at human neurophysiology. We're not even close to building that. It's a fascinating set of systems."
Driven by the problems that emerge from his research, Gerling never dreamed he might one day be involved in areas so far removed as neurophysiology and educational theory.
"Greg has this interesting combination of backgrounds and experiences," said colleague Stephanie Guerlain, an associate professor in the systems and information engineering program. "He has a unique combination of mechanical engineering, software engineering and human factors engineering. He has a lot of enthusiasm and energy, and that guides everything that he does."
"We'll follow the problem wherever it goes," Gerling said. "If it goes into psychology, we'll follow it into psychology. Before graduate school, I had little mechanical engineering training, but we've followed it there. You're continually learning new things. I’m privileged to have the opportunity."