1. Introduction

This app is to operate "Physical Assessment Simulator Physiko Plus 2.0", featuring improved user-friendliness.

Four training modes have been prepared to meet a variation of educational needs.

This guide provides step-by-step explanations of each mode, screen layout, and operating procedures.

2. Table of Contents

3. Top Screen

This app is designed for skill training of healthcare professionals. It features two patient scenario-centered training modes and two skill training modes for individual task skills.

[Patient Mode]

• Select: Select a patient from the list of twelve patient examples for training.

• Edit: Create and edit original patients' data.

  These patient modes aim to provide comprehensive learning of physical assessment based on scenarios.

[Skills Training Mode]

• Clinical Tasks: A training mode to practice clinical skills such as assessment of vital signs.

• Heart Sound Test: A training mode to practice identifying and differentiating between various heart sounds.

  These modes are suitable for concentrated training designed to build specific competencies or improve existing techniques.

  

4. User Account Types

"Heart Sound Test" mode is configured with four different types of user accounts, each with specific permissions: administrator, instructor, student, and guest. The access rights for each type are as shown in the table below.

*1: A student account can be created on the login screen.

*2: Permission to view, edit and output only their own account info and test results

*3: Guest user without an account isn't permitted to create, edit, or save any data.

5. Common Section

5.1 Patient Screen

A common user interface is used for most patient screens in all modes except for "Clinical Task".

The screen includes basic menus such as "Top" and "Settings", as well as menu buttons for individual clinical skills.

📋Patient Screen

5.2 Clinical Tasks Screen

A common user interface is used for most of patient screens in all modes, except for "Clinical Task.”

The display design of heart rate, blood pressure, and explanation of findings are common for all training modes. When working on the clinical skills mode, select a finding on this screen.

Common Display Items:

• Select Findings

  Select clinical findings for training. The selected findings are instantly synchronized with the simulator.

  The findings are fixed except for "Clinical Tasks" mode.

• Heart Rate

  Current heart rate of the simulator

• Blood Pressure

  Systolic / Diastolic blood pressure value.

• Findings

  Display a window with in-depth information about the selected findings.

Below is an overview of the features of each procedure screen and the common elements:

📋Pupillary Reflex: Training in observing and assessing pupillary reflexes and pupil diameter changes.

📋Blood Pressure: Training to measure blood pressure by listening to Korotkoff sounds with a visual cuff pressure graph.

📋Heart Sounds: Training to recognize and differentiate heart sounds at the four main auscultation sites.

📋Lung Sounds: Training to recognize pulmonary sounds across upper to lower lung fields, anterior and posterior, and at the trachea.

📋Bowel Sounds: Training to recognize normal and abnormal sounds by auscultation.

📋ECG: Visual verification of electrode placement and training in 12-lead ECG waveform assessment.

5.3 Common Icons

Opens a pop-up with additional information on symptoms and findings.

Shows the text.

Hides the text.

Changes vital signs settings (heart rate, blood pressure).

Turns external speakers on or off.

6. How to Use Each Training Mode

6.1 Patient Mode: Select

6.1.1 Overview

Patient Mode: “Select” mode allows training with one of twelve preset patients.

Each patient has distinct background information and case history, enabling a realistic experience of the assessment process.

Subsequent training content and observation points vary depending on the selected patient.

6.1.2 Screens and Flow

6.1.3 Functions

🖥Patient Selection: Select a patient dataset from the twelve available presets.

6.1.4 Operation Flow

🧭[Starting the Simulation]

1. On the Patient Selection screen, select a patient and press “Start,” or press “Random” for automatic selection.

2. The “Patient Information” screen appears, and the simulator starts based on the selected dataset. Physical assessment training can now begin.

3. "Clinical Tasks" screens display real-time vital data including waveforms, pupillary reflexes, and ECG.

6.1.5 Others

6.2 Patient Mode: Edit

6.2.1 Overview

"Patient Mode: Edit" allows editing of patient data and simulation with the created patients.

The created patients can be saved and opened anytime for reuse.

The "playlist" feature enables setting up to three patients and switching between them at any time during simulation.

6.2.2 Screens and Flow

6.2.3 Functions

🖥Patient Editing: Create and edit patient datasets

6.2.4 Operation Flow

🧭[Selecting Patient Images]

Enter the following fields to select a patient image. Four image options are suggested based on the entered information.

• age

• sex

🧭[Saving a Patient Dataset]

1. To save the entered patient dataset, press the "Save" button.

2. When the save screen appears, enter a file name and press "Save" at the bottom right.

   

3. When the data saved successfully, "File name: XX" will appear in the patient information section.

🧭[Opening and deleting saved patient datasets]

1. To open or delete a saved patient dataset, press the "Select Patient" button.

2. When the Patient Selection screen appears, click the desired file name.

   

3. To open the patient dataset, press "Open" at the bottom right.

4. To delete the patient, press the "x" icon at the far right end of the line.

5. When "X" is selected to delete, an alert window appears. Read the message and select "OK" to proceed.

   

🧭[Exporting and Importing Patient Data Sets]

To export patient datasets to an external device or to import them from an external device, click the “Select Patient” button in the menu.

[Export]

1. Connect a USB flash drive to your PC.

2. On the Patient Selection screen, check the patient data set to export.

   

3. Click the “Export” button to start the export process.

4. Once the export completes successfully, a folder like the one shown below including the file of the patient datasets appear.

   

[Import]

1. Prepare a USB flash drive that contains patient data sets, and connect it to your PC.

2. Click the “Import” button to start the import process.

3. After the import completes, remove the storage device.

🧭[Playlist Settings]

1. To automatically switch patient datasets at specified intervals, press the "Playlist" button.

2. When the Playlist screen appears, select up to three patient datasets from Files at the top of the screen.

   

3. To change the order of the selected datasets, use the arrow buttons in Playlist at the bottom of the screen.

4. The running time for each dataset can be set to 1, 5, 10, 20, or 30 minutes.

5. Once the setup is complete, press Start to begin physical assessment training.

6.2.5 Others

6.3 Skill Training Mode: Clinical Tasks

6.3.1 Overview

Clinical Tasks mode provides separate training for six clinical skills:

Pupillary reflex, Blood pressure measurement, Heart sound auscultation, Lung sound auscultation, Bowel sound auscultation, Electrocardiogram (ECG)

Each skill is conducted on a dedicated training screen, where pulse waveforms, pupil reactions, dynamic blood pressure graphs, changes in vital signs, and case explanations with clinical findings can be observed.

In this mode, findings can also be selected or switched.

6.3.2 Screens and Flow

6.3.3 Functions

🖥Procedure selection screen: Select the clinical procedure you want to train and the corresponding procedure screen will be displayed.

6.3.4 Operation Flow

🧭[Basic flow to start training]

1. On the Procedure selection screen, select a clinical task.

2. The training screen for the selected task opens.

3. Choose the desired finding (normal or abnormal).

4. Adjust vital signs such as heart rate and blood pressure if necessary.

5. Begin training on the simulator by observing, listening, and assessing its condition.

🧭[Change the heart rate]

1. Click the Vitals Settings icon next to the heart rate field

   

2. Heart rate setting screen opens.

   

3. Change the heart rate using one of the following methods:
   1. Click the number to open the input field, enter the desired value, and press OK.
   2. Adjust the value with the slider.
   3. Press the "+" or "-" button to increase or decrease the heart rate.

      

4. Press the “Save” button will apply the settings to the simulator.

🧭[Change the blood pressure]

1. Click the Vitals Settings icon next to the blood pressure field.

   

2. The settings screen opens.

   

3. Adjust the blood pressure by one of the following methods:
   1. Click the number to open the input field, enter the desired value, and select "OK".
   2. Press the "+" or "–" button to adjust the blood pressure value.

      

4. Press the Save button to apply the settings to the simulator.

🧭[Audio Output via External Speaker]

To output audio to an external speaker, click the External Speaker Output icon near the audio waveform.

• output OFF

• output ON

6.3.5 Others

6.4 Skills Training Mode: Heart Sound Test

The Heart Sound Test is a quiz-style training that develops skill in identifying heart sounds by listening and selecting the correct sound name.

This mode consists of nine modules, each containing two patients with different cardiac conditions. Trainees select a module and practice auscultation with two patient cases.

Its operation is the same as in Patient Mode or Clinical Tasks Mode, and trainees can switch between the two patients while practicing within a selected module.

This mode also includes the following two unique features.

• Test Mode: This is a test in which trainees listen to the heart sounds and select the corresponding name of the sound. Trainees with a student account can save their own answers.

• Clinical Questions: Q&A quiz related to heart sounds, allowing trainees to deepen your clinical knowledge in addition to auscultation.

This mode has three types of account with different roles and permissions: Administrators, instructors, students, guests. For details, refer to the "User Account Types" section.

6.4.2 Screens and Flow

Administrator / Instructor

Student

Guest

6.4.3 Functions

🖥Login screen: Log in with a registered account, create a new account, or continue as a guest.

🖥Module Selection Screen: This screen allows selection of training modules as well as viewing past test results and account information.

🖥Heart Sound Auscultation Training Screen: This screen allows checking and managing heart sound test results for each account.

🖥Test mode screen: Performs a heart sound listening test and allows selecting the corresponding finding.

Student / Guest

🖥Clinical Question Screen: Conducts Q&A tests with clinical questions related to cardiac findings.

🖥Test Result Screen: Displays the details of saved test results and allows searching, printing, or deleting them.

🖥User Account Management Screen: This screen provides functions to search, edit, and delete registered account information.

6.4.4 Operation Flow

🧭[Create a New Account]

[Create a student account (anyone can create)]

1. On the login screen, click “New User” to open the account creation screen.

   

2. Enter the required information, then click “Register” to display the confirmation screen.

   

3. If the information is correct, click “Confirm” to complete the process.

[Create an instructor account (administrator only)]

1. Log in with an Administrator account.

2. From the menu, select “Create Account” to open the account creation screen.

   

3. From the Mode menu, select “Instructor.”

4. Enter the required information, then click “Register” and then “Confirm” to complete the process.

🧭[View and Edit Account Information]

1. Open the "Heart Sound Test" menu screen.

2. Select "Account Information" from the menu.

3. Information for the currently logged‑in account appears.

   

4. Click "Edit" to open the editing screen.

5. Make any changes, then click “Register”, followed by “Confirm”, to complete the process.

🧭[User Account Management]

Select User Account Management from the menu to manage registered account information.

• Log in as an Administrator or Instructor.

• Log in as an Administrator or Instructor. Search for accounts by ID, name, group name, or free text.

• To change the order of the list, click the Sort icon next to a column header. Each click switches the order between ascending and descending.

  

• Click the “Edit” icon to modify account information, following the same steps as View and Edit Account Information.

• Click the “Delete” icon to remove the account.

  

🧭[Use the Test Mode]

[Administrator / Instructor]

Administrator and Instructor account can check the heart sounds used in the test.

• Press "Heart Sound 〇" on the right side of the screen to play its sound on the simulator.

• Switch the visibility of the case name using "Show / Hide" button.

  

[Student / Guest]

For Student accounts or Guests, 10 heart sounds are randomly presented for auscultation training in a test format.

• On the test screen, press a Number button to play the corresponding heart sound on the simulator.

• After listening, select the heart sound name from the drop-down menu.

• Press “Check Answers” to display the correct answers for verification.

• Student accounts can save the test results.

• Click “Shuffle” to randomly rearrange the 10 heart sounds.

  

🧭[Use Clinical Questions]

Select “Clinical Questions” from the menu to start training in QA format.

• Use the “Show/Hide” button to display or hide the answers.

• Some modules contain multiple questions. Press the “Next” button at the bottom right to move to the next question.

  

🧭[View Test Results]

Select “Test Results” from the menu to view saved test results.

• Search for accounts by ID, name, group name, or free text.

  💡

  Student accounts can only view their own results.

• To change the order of the list, click the Sort icon next to a column header. Each click switches the order between ascending and descending.

  

• Click the "Select" column to select an account.
  • Click the “Details” button to display a list of test results for the selected account.

    

  • Then click the "Details" icon on the list to open the result for 10 questions.

    

  • Click “Export” to save the test results as a file.

• Click the “Delete” column to remove all test results for the account.

6.4.5 注意点・補足

7. System Configuration

7.1 Overview

Adjust speaker volume, blood pressure calibration, language, units, ECG color standard, and Wi‑Fi settings.

To open this screen, click the gear icon on the top screen or select “Settings” from a menu.

7.2 Screens and Flow

7.3 Functions

🖥Volume Setting: Adjust the speaker volume for each auscultation site.

🖥Blood Pressure Adjustment: Adjust the displayed cuff pressure to match the actual reading.

🖥Language Setting: Change the language and unit settings.

🖥ECG Color Coding: Select the color coding standard for ECG electrodes.

🖥Communication Settings: Connect to or switch between Wi‑Fi networks.

7.4 Operation Flow

🧭[Wi-Fi Connection and Switching]

1. Select "Communication" from the settings screen.

2. Press the “Connect” button.

   

3. Available networks (SSIDs) will appear on the right side of the screen.

   

4. Enter the password if required, then click Connect.

5. When the connection is established, the message Connected appears, and the selected network name is shown under SSID. The connection is now complete.

7.5 Others

8. How to Exit the app

1. Display the Top screen. When on another screen, select Top from the Menu to return to the top screen.

   

2. Press the power icon in the upper‑right corner.

   

3. A confirmation message appears. Press OK.

   

4. The application closes and the power turns off automatically.

9. FAQ

Q1: I can't log in. What should I do?

A. Verify that the ID and password are correct.

The system is case-sensitive and distinguishes between full‑width and half‑width (double‑byte / single‑byte) characters.

If the problem persists, consult the owner of an Administrator or Instructor account.

Q2: I’m having trouble hearing heart or lung sounds. What should I do?

A. Check the volume settings.

On the Configuration screen, open Volume Settings and confirm that the volume for each auscultation site is high enough. Adjust the volume if necessary.

Q3: I cannot save patient datasets.

A. Verify that age information is entered.

After entering age (and gender), the Save button becomes active.

Q4: I want to create a Instructor account.

A. Instructor accounts can only be created by an Administrator.

Log in as an Administrator, select Create Account from the menu, set Mode to Instructor, and enter the required information.

Q5: I want to delete the account I created.

A. Only Administrator or Instructor accounts can delete accounts.
Student accounts and Guests cannot delete accounts. Ask the owner of an Administrator or Instructor account for deletion.

Q6: I cannot save the results of the Heart Sound Test.

A. Test results are saved only for Student accounts.

Guests cannot save test results.

Q7: I cannot connect to Wi-Fi

A. On the Communication Settings screen, press Connect to display available SSIDs.
Connection may fail due to an incorrect password or weak signal.
Try another SSID or check the network environment.

Q8: I want to learn more about variations in heart and lung sounds.

A. Use the Case Explanation or Finding Explanation buttons available in each mode.

Finding Explanation describes what conditions abnormal heart or lung sounds indicate.

Case Explanation provides the patient’s background and key points for physical assessment.

Use these functions whenever questions arise during training.