Ultrasound technology is rapidly becoming a popular tool in medical and basic science education allowing students to see working organs in real time, giving education which is rich in context and relevance. There is a problem, however, in the choice of subjects. To mitigate safeguarding concerns, particularly in classes which would involve exposure of chest and breast tissue, the conventional approach is to recruit “slim young males with good acoustic windows” as subjects for classes (Johnson et. al, 2025). Essentially thoracic ultrasound classes default to the “standard 70Kg (Physiologic) male”. This practice has profound implications (Cheng & Yang, 2015). The subjects thus chosen are not representative of the diverse population that students will face in practice with profound downstream consequences. According to the British heart foundation, (British Heart Foundation, 2019) women are 50% more likely to receive an incorrect diagnosis during a heart attack, more likely to receive substandard treatment and more likely to receive inadequate aftercare leading to preventable cardiac deaths.  Previous work by this group (Hegarty et al., 2025) surveyed female medical students who said that while 83% wanted to volunteer as subjects for thoracic ultrasound classes, only 14% were likely to do so. A popular solution proposed by those surveyed involved working with Simulated Participants (SP) as subjects in thoracic ultrasound classes. Including female SPs is not without its challenges as students may inadvertently cross professional/sexuality boundaries (Kearney et al., 2018).

This study explores female SP views about participating in an ultrasound chest exam involving breast exposure. After local ethics committee approval, female SPs completed a survey, which was used to purposively select participants for a focus group (n=4). Another focus group was conducted with SPs (n=3) who had been videoed undergoing a chest examination.

The survey was completed by 37% (40/108) of female SPs. Most were willing to participate in a thoracic ultrasound scan, either videoed or live. Their motivations for participating were to rectify the invisibility of women in the curriculum; enhance the clinical competency and confidence of medical students; de-sexualise women’s breasts, especially among male students; and improve healthcare for women. Concerns they might have about participating related to the potential for male students, especially, to be unprofessional. Recommendations for preserving SPs’ dignity included providing the students with a pre-brief about the scan and expectations about their behaviour and ensuring the appropriateness of the environment in which the scan occurs. Providing a separate pre-brief for SPs to outline the procedure and to assuage any concerns they might have was essential.

Including female SPs in chest examinations is a matter of patient safety in tackling avoidable cardiac deaths among women (British Heart Foundation, 2019) and for improving the confidence and competency of students. This study offers guidance for promoting the dignity of female SPs in co-developing practical classes involving breast exposure.