black lives matter healthcare simulation

I will never forget receiving a letter of complaint following a training course I had delivered. The complaint was not about the quality of the training, but the colour of the manikins. The ambulance service I worked for had hundreds of CPR manikins, black and white, or ‘light’ and ‘dark’ as they are described by manufacturers. I grabbed three bags of manikins that I knew were cleaned and ready for use, without considering what colour they might be. As it turned out they were all white, which did not seem a problem at the time, but it made one of my trainees feel the need to complain, for which I was devastated.

Following the complaint I had to give serious consideration to the solution to this problem:

  • Should I provide an equal number of black and white manikins? 
  • Should I research the demographic of the local population and provide an accurate representation? 
  • Is there data to suggest performing CPR on a manikin with a similar skin tone to the trainee makes them perform better or retain the information longer? 
  • Should I just make them all blue? (CPR Prompt from Simulaids)


Now, as a supplier of manikins, I understand the issue from a different perspective. White/light skin manikins are sold in far higher volumes. A recent thread on Twitter suggests this is evidence of racial bias in the training community. Or does it represent the fact that the largest market for training manikins, the US, is 72.4% white?[1] 


My view from inside the industry is that manufacturers make what they think will sell the highest volume so that they have the greatest impact on patient care. In the US and Europe, white is the predominant choice. Some manufacturers do offer black-skinned manikins, but due to manufacturing efficiencies, they tend to be simply dark-coloured versions of the white manikin, neglecting to take into account the difference in features.

An exception to this is Simulaids, who offer Paul, an African American manikin with facial features differing from the Brad manikin.



Virtual reality offers a practical solution to creating diverse patients whose individuality can be more than superficial. For example, PCS Spark is a collection of virtual standardised patients; male and female, young and old, black and white, with different histories and clinical presentations. 

Students can have real-time conversations with virtual patients, ask questions to find out what help they need and build empathy in a way that isn’t possible with traditional manikins. Try PCS Spark for FREE!


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