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Redesigning the Medical Examination Table for Improved Accessibility; An Analysis of a Systemic Approach on How Engineers Can Promote Diversity, Equity, and Inclusion in Designing Pulse Oximeters

Year: 2025
Type: dissertation
Abstract: In today’s healthcare landscape, many medical technologies are developed without fully addressing the diverse needs of all patients, resulting in systemic inequities in care. This issue stems from the exclusion of marginalized groups during the design, testing, and policy-making stages of medical device development. As a result, patients with disabilities and those from underrepresented racial and ethnic groups often face barriers to receiving equitable care. For instance, despite Section 504 of the Rehabilitation Act, traditional exam tables remain inaccessible to patients with mobility impairments. Similarly, studies show that pulse oximeters are less accurate for individuals with darker skin tones due to non-diverse engineering teams and unrepresentative clinical trials. My technical project addresses accessibility by designing a low cost, fully mechanical exam chair, while my STS research explores how engineers can integrate diversity, equity, and inclusion in pulse oximeter development. Together, these projects aim to confront the general problem of inequitable medical device design by advocating for inclusive, user-centered approaches that reflect the diverse realities of the patient populations they are intended to serve. Standard medical examination tables present significant challenges for patients with mobility impairments. These conventional box-style tables often fail to comply with Section 504 of the Rehabilitation Act, which mandates accessibility in healthcare settings. Despite this requirement, accessible tables are rarely adopted due to their reliance on expensive electronic or hydraulic systems. To address this issue, our capstone team aimed to develop a fully mechanical, affordable, and accessible medical exam chair that eliminates the need for complex electronics, promoting broader clinical adoption. Building on a previous capstone's work, we focused on designing key mechanical components and selecting cost-effective, durable materials. Our process included: (i) researching 1 accessible mechanisms and materials, (ii) finalizing design ideas, (iii) CAD modeling of key components like swivel, reclining, and high-low mechanisms, and (iv) surveying UVA healthcare professionals for input on usability and affordability. We developed a preliminary scissor-lift CAD model with the compliant range of motion (17–32 inches), a swivel base allowing 90° rotation, and a reclining backrest (90–180°) operated by a manual crank and ball screw linear actuator. Additional features included a headrest and adjustable armrests capable of rotating between 0 and 90 degrees. Survey feedback confirmed the urgent need for affordable, accessible equipment and validated our design direction. Our results emphasize the healthcare system’s lack of inclusive exam furniture and highlight the feasibility of low-cost, mechanical solutions. Future steps include force simulations, stirrup design, 3D printing of mechanisms, and prototyping to further develop and test the chair’s functionality. My STS research explored the question: How can engineers integrate diversity, equity, and inclusion (DEI) in the design and testing of pulse oximeters to reduce racial disparities in health outcomes? The paper argues that the historical lack of diversity in engineering teams and clinical testing populations contributed to racial biases in pulse oximeter (PO) performance, particularly for individuals with darker skin tones. By embedding DEI principles—such as diversifying engineering teams and conducting inclusive clinical trials—engineers can mitigate these disparities and design more equitable medical technologies. The research draws on both historical and clinical evidence. An analysis of the backgrounds of early PO developers (e.g., Takuo Aoyagi, Susumu Nakajima, Scott Wilber, Joe Kiani) revealed limited diversity, which likely influenced calibration practices that favored lighter skin tones. Early clinical trials in Japan and the U.S. similarly lacked adequate 2 representation of darker-skinned populations. Clinically, studies such as Sjoding et al. (2020) and Martin et al. (2024) found that POs consistently overestimated oxygen saturation in Black, Hispanic, and Asian patients. This inaccuracy contributed to higher rates of occult hypoxemia, especially among Black patients, who were three times more likely than White patients to experience undetected low oxygen levels. My STS paper concludes that systemic exclusion in PO development has perpetuated health inequities. To address this, engineering teams must be intentionally diverse, and clinical trials must include racially representative participants. A key future step is advocating for regulatory reform mandating inclusivity across all stages of development. Embedding DEI into both design and policy will help ensure life-saving technologies work effectively for all patients. This year, my work on both the technical and STS research projects has been incredibly rewarding and eye-opening. While I did not solve every challenge related to accessibility or health equity, I would like to believe that I have made meaningful progress in addressing these complex issues through design and critical analysis. Both projects deepened my understanding of the ethical responsibilities engineers have in creating inclusive solutions and highlighted how thoughtful design can directly impact patient outcomes. Both projects were fruitful in advancing the goals of combining empathy-driven design with engineering innovation to promote more equitable healthcare systems.
Source: Libra
DOI: 10.18130/atsv-j273
Author: Afsara Chowdhury
Language: English
Open Access status: green
OpenAlex ID: W6963014854
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