Analysis of the need for realistic circumcision manikin design as a learning resource for medical students in the clinical skills laboratory: Mixed methods study

Abstract

INTRODUCTION: Circumcision is a Level 4A clinical skill in the Indonesian Medical Doctor Competency Standards (Standar Kompetensi Dokter Indonesia [SKDI]) that every medical graduate must master. However, learning is currently hampered by the limited availability of manikins with adequate anatomical and functional realism, resulting in procedural training that is not fully safe, standardized, or meaningful. This study aims to analyse the need for a realistic circumcision manikin design as an effective learning resource by exploring the perspectives of students, lecturers, instructors, experts, and laboratory staff. METHODS: This study employed a convergent parallel mixedmethods approach. Quantitative data were collected using Likert-scale questionnaires from 214 third- and fourth-year medical students (total sampling) and analysed descriptively. Qualitative data were obtained through in-depth semi-structured interviews with four lecturers/experts and two laboratory staff members (purposive sampling), along with non-participatory observations and document reviews, and were analysed thematically. RESULTS: Quantitative findings showed that while students found the current manikins helpful, there was a high demand for improvements in anatomical realism (skin elasticity, prepuce variation, mucosal layers, and vascular representation), functional realism (tissue resistance, bleeding simulation, and complication management), and interactive features (objective feedback). Qualitative analysis further emphasized the need for accurate anatomy, functional simulation to support repetitive practice, integration with standardized patients, and considerations related to durability, portability, and cost efficiency. CONCLUSIONS: There is a strong need for the development of high-fidelity circumcision manikins that integrate anatomical, functional, and communication-scenario realism. The design blueprint generated from this study provides a foundation for next-generation prototypes aimed at improving the quality of clinical skills training in medical education.

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