Abstract
Airway management sits at the intersection of precision engineering and high-stakes human decision-making. My thesis combines the design of a low-cost, steerable bougie with integrated oxygen delivery and suction capabilities to improve difficult airway intubation, with a sociotechnical analysis using Actor-Network Theory (ANT) to examine how clinician trust, usability, and workflow compatibility influence the adoption of airway management devices. My interest in this space is not purely academic; it is shaped by personal exposure to the realities of clinical practice through family members working in healthcare. Through conversations and firsthand observations, I have seen how even well-designed medical devices can fall short in real-world settings, often due to unintuitive interfaces, inconsistent performance, or added cognitive burden during already stressful situations. For example, devices like the Cheetah NICOM, while conceptually valuable as a non-invasive cardiac monitoring tool, can be difficult to use, prone to user error, and not always trusted by clinicians in practice. These experiences highlighted a gap between what medical devices are designed to do and how they are actually used, reinforcing that improving technical performance alone is not enough without understanding how devices are perceived and used in practice. Science, Technology, and Society (STS) provides the framework to address this gap, emphasizing that successful engineering solutions, particularly in healthcare, must account not only for technical performance, but also for the complex human and organizational contexts in which they operate.
The technical portion of my thesis produced a novel, low-cost, steerable bougie prototype designed to improve navigation during difficult intubations. Current bougies lack steerability and require removal for oxygen delivery or suction, creating delays that increase patient risk. To address this, my design incorporates a dual-segment steering mechanism, enabling both gross and fine control through distal and sub-distal flexure regions. A Bowden cable-inspired system allows bidirectional tip movement, while carved flexure zones guide predictable bending without sacrificing structural integrity. Additionally, a dual-lumen system integrated through a Y-connector enables simultaneous oxygen delivery and suction, eliminating the need for device switching during airway management. CAD modeling, finite element analysis, and 3D prototyping were used to validate mechanical performance and functionality. The resulting design maintains the familiar size and handling of existing bougies while significantly expanding its capabilities. This innovation has the potential to reduce intubation time, improve first-pass success rates, and ultimately enhance patient outcomes in emergency and clinical settings.
In my STS research, I investigated how clinician trust, usability, and workflow compatibility influence the adoption of airway management devices using ANT. This framework treats clinicians, devices, institutional systems, and clinical environments as interconnected actors that collectively shape outcomes. My analysis revealed that adoption is not determined solely by technical performance, but by “trust cues,” such as predictable behavior, tactile feedback, ergonomic design, and alignment with existing workflows. Clinicians rely heavily on these cues during high-pressure situations, forming trust through repeated interaction rather than abstract performance metrics. When devices behave inconsistently or introduce cognitive burden, clinicians may hesitate or revert to familiar tools, even if the new technology is objectively superior. My research contributes a trust-centered framework for medical device design, emphasizing that usability and human factors must be integrated early in development to ensure successful adoption and safe implementation.
Considering these projects together changed the way I approached both design and problem-solving. Initially, my focus was on improving the mechanical capabilities of the bougie, making it more steerable, more functional, and more efficient. However, through my STS research and the clinical perspectives I was exposed to through my family, I began to realize that even the most technically advanced device can fail if it does not align with how clinicians actually think and work in high-pressure situations. This led me to intentionally design with usability, predictability, and familiarity in mind, rather than simply adding new features. Framing the bougie within a broader sociotechnical system, using ANT, reinforced that its success depends on how well it fits into existing workflows and supports clinicians in real time. This shift in perspective pushed me to prioritize simplicity, intuitive control, and consistency under stress, recognizing that these factors directly impact both clinician confidence and patient outcomes. Moving forward, this experience will shape how I approach engineering problems more broadly. I now see ethical responsibility not just as designing devices that perform well, but as designing technologies that people can trust, rely on, and use effectively when it matters most. By grounding innovation in real human experience, I hope to contribute to medical technologies that not only improve performance but genuinely improve care.
