By Jane Elliott
BBC News, health reporter
Dr Carla Pugh makes an unusual shopping trip at the start of every academic year as she prepares teaching materials for her medical students - to porn emporia and toy shops.
Sex shops can provide useful teaching tools....
Worried by the quality and anatomical accuracy of mannequins available for her students to practise on, Dr Pugh decided to take matters into her own hands and provide her own.
"One model that was available for teaching the students had the rectum in the wrong place, in another the prostate was in the wrong position.
"The penises that were available were made of styrofoam and they were all the same.
"So I decided to get my own," said the assistant professor of surgery at Northwestern University's Feinberg School of Medicine, Chicago.
"I had to go into porn shops and ask for lots of penises, all sizes, erect and not erect, circumcised and non-circumcised. I was met with gales of laughter in the shops."
She also frequents toy shops for materials, but admits she does not tell the shop assistants what she wants her weird collection of objects for.
"They would be really freaked if they knew I wanted the dolls to cut up," she laughed.
She also buys baby dolls for delivery models, squishy balls are used to represent ovarian masses and harder wooden balls for ovarian cancers.
Models are combined with computer technology
"I think my students are clueless about what I have gone through to get the materials to teach them - but what students do know the work their teacher has done to prepare?"
Dr Pugh has also patented technology to combine portions of fully formed anatomical mannequins with computers to teach medical students to do exams on the body's most private and sensitive areas - genitalia, breasts and rectums.
At the prostate station students can examine several models of the male posterior.
In each they have a fully formed anus and rectum. There are paper-thin sensors inside to measure a student's touch and send individual readings to an attached computer monitor.
These are the sort of exams, she said, that students are often most worried about performing and which medical school instructors can also find embarrassing.
Dr Pugh practised on her own dolls as a child
"We've got big issues in the US with sexuality," said Dr Pugh.
"These guys have to be able to do it and act professional, so that adds a lot of pressure."
Cadavers are still used for anatomy, but Dr Pugh said that, as in the UK, there has been a shortage of bodies being offered for donation.
But she added that even when these bodies were available, often they were not suitable for students to practice on.
"Many of the women who donate their bodies have had hysterectomies, so the students do not have a uterus to practise on," she said.
She also added that practising on a rigid rigor mortis body was very different from the softer form of the live body that her students would encounter.
Aids are devised to give a naturalistic feel
Dr Pugh said her simulators were not perfect, but that they were close enough to the reality for the students to know whether their touch is too rough, too soft - or if they have missed a key spot entirely.
They provided a much needed bridge, she said, between traditional medical training where students often go straight from textbook to exam room with live patients, where they observe skilled doctors in action.
"Guess what? They are sweating bullets because they haven't had a scenario where they can talk about it comfortably, safely and with someone who is more knowledgeable."
Dr Pugh began performing "surgery" on her dolls as a child, transplanting eyes and limbs with a sewing kit borrowed from her mother.
She said she had always maintained a hands-on approach to medicine.
But she felt very disappointed by how little 'real-life' practice she was able to do as a student herself.
"It frustrated me because I was unsure. I didn't have the level of access to the human body that I wanted."
Dr Pugh's prostate simulator
She came up with the idea for her technology while working on a doctorate in education at Stanford University and obtained a patent for the sensors and data accumulation technology in 2001.
Pugh formed a licensing agreement with Medical Education Technologies Inc, a company specialising in medical training products, in early 2003.
Her pelvic exam simulators are already on the market at prices ranging from $16,000 (£8,200) to $20,000 (£10,300) each, and are used by more than 60 medical and nursing schools around the US.
The prostate exam simulators used in the class, as well as those for breast exams, are still in prototype form.