Abstract
Emergency airway management is a space that sits at an intersection between precision and urgency. Seconds matter, visibility is limited, and the tools in a clinician’s hands can directly determine whether a patient survives. In my thesis, I set out to contribute to this space through both a technical and sociotechnical perspective. My technical capstone focused on improving the standard bougie, a flexible introducer used to guide an endotracheal tube (ETT) into the trachea. We aimed to improve its steerability and integrate oxygen delivery and suction into the device. While examining existing airway devices, I noticed a pattern: many medical devices that are technically sound never reach or benefit the patients who need them most. This led me to question how “success” in medical device innovation is defined and whether current approaches unintentionally reinforce disparities. This motivated my sociotechnical research, which investigated current evaluation criteria and used stakeholder interviews with clinicians to better understand the gap between technical performance and real-world adoption.
The technical portion of my thesis produced a scaled, non-functional prototype of a redesigned bougie that focused on improving maneuverability during difficult airway scenarios. Existing bougie designs lack adequate steerability, particularly in anterior airways, where the larynx is shifted forward and precise navigation is critical for successful intubation. Our design addressed this by incorporating enhanced steerability at both the distal tip and sub-distal shaft, allowing for more controlled and precise navigation using a mechanism inspired by a Bowden cable system. While we successfully demonstrated these improvements in our prototype, the device was not fully tested due to size and fabrication constraints. In parallel, we created a detailed plan to integrate oxygen delivery and suction by hollowing out the bougie and using a standard Y-connector system but were unable to implement these features in the scaled model. Despite these limitations, this work reinforced my interest in working in medical device design, particularly working on innovations that work directly with users to improve patient outcomes.
In my STS research, I examined how medical device success is currently defined and why this definition often provides an incomplete picture of real-world use. This topic was particularly meaningful to me because I wanted to understand where the unequal distribution of technologies originates and how we might address it. Existing scholarship introduces STS frameworks that analyze the roles of technologies and users, infrastructures, and governance systems in informing adoption. This literature foundation guided my interview approach, focusing on how clinicians experience institutional practices that shape technology integration. The interviews revealed that adoption depends not only on technical performance but also on factors such as cost, training requirements, workflow integration, and institutional capacity. They also highlighted how many of these innovations disproportionately benefit high-resource settings while leaving others behind. These findings aim to help future engineers design technologies that can be realistically implemented, accepted, and sustained across diverse clinical environments.
Together, these projects showcase the importance of integrating technical, social, and organizational perspectives in engineering. Early in the design process, and after conversations with our advisors, we realized that our initial bougie redesign concept was not very user-friendly or aligned with clinical workflows. This reinforced a key idea from sociotechnical work: users and technologies shape each other, and even a technically functional device can fail if real-world contexts are not taken into account. This understanding extends to the responsibility of a good engineer to design for accessibility, usability, and equity. As shown, even well-intentioned innovations will fail without this broader perspective. By applying STS insights to my technical design, I plan to shift my approach to focus not just on whether a device works, but on how it translates into real clinical practice.
