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  1. 1. Annals of Biomedical Engineering, Vol. 34, No. 2, February 2006 ( C 2006) pp. 276–281 DOI: 10.1007/s10439-005-9028-x Interdisciplinary BME Education: A Clinical Preceptorship Course for Undergraduate Bioengineering Students PETER F. DAVIES1, 2, 3 and MITCHELL LITT1, 3 1 Institute for Medicine and Engineering, University of Pennsylvania, Philadelphia, PA; 2 Departments of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA; and 3 Departments of Bioengineering, University of Pennsylvania, Philadelphia, PA; (Received 21 March 2005; accepted 9 September 2005; published online: 11 February 2006) INTRODUCTION COURSE OBJECTIVES At the University of Pennsylvania, as at most other The course has two major objectives implemented by institutions, the exposure of undergraduate Bioengineering several components (Table 2). The first is to expose (BE) students to real-life medical problems that are BE undergraduate students to a range of clinical areas amenable to biomedical engineering solutions is highly that either employ bioengineers or in which BE tech- variable. Experience is often limited to a visit to an niques and approaches are critical for the effective im- operating room or to a medically relevant industrial or plementation of clinical procedures or clinical research. biotech setting; significant exposure to a clinical setting is This is accomplished through 18 h of interactive lectures usually delayed to graduate level work or later. Although (in 12 clinical areas) given by selected clinical faculty. there are a number of graduate courses that introduce The second major objective is knowledge acquisition by biomedical engineers to clinical problems, undergraduate immersion in a single clinical speciality. This is accom- BME education is very different from graduate education plished through a Preceptorship in a clinical division of and has distinctly different objectives. We propose that the Medical School/University Hospital (or in the recently BE students who will graduate to become employed in the added opportunities in the Dental and Veterinary schools) private sector as well as those who choose to pursue medical for 10 weeks. The last four lectures and the first 2 weeks school or graduate engineering degrees will benefit by of preceptorship overlap. Pairs of students are assigned to exposure as undergraduates to both the breadth and depth a Preceptor (and/or designated surrogate) in a clinical divi- of clinical practice and clinical research in the hospital sion, department, or center for in-depth exposure to a single and its laboratories. Indeed such exposure will assist specialized clinical environment. The course is run in the some students in their subsequent career choice. A course Spring semester of Junior year. Table 3 outlines a current (Table 1) to address objectives appropriate to an under- schedule and Table 4 lists the clinical specialities available graduate curriculum was proposed, approved, and offered for in-depth preceptorship study in 2005. on an experimental basis to five students in academic year BE400 therefore introduces both broad and selective as- 1999–2000, with increasing numbers in subsequent years. pects of clinical medicine to upper Junior year students who By 2004–2005, 124 students have completed the course. have completed 2.5 years of a rigorous BE curriculum but Experimental introduction of the preceptorship was both have limited hands-on clinical knowledge or experience. A timely and appropriate at the University of Pennsylvania course in Human Physiology is taught earlier in the same where interdisciplinary education has been a prominent academic year and the preceptorship is concurrent with objective of the University’s strategic plan,1,3 and where the last term of a required four-course laboratory sequence a cross-school center, the Institute for Medicine and involving experiments and projects involving all aspects Engineering (IME), was established in 1996 to bridge of BE science, problem solving, and design.5 The labora- engineering to all aspects of biomedical research and tory courses emphasize experimental work incorporating training, and to develop novel interdisciplinary educational subject matter taken in the second and third years (biome- and research initiatives.4 chanics, biomaterials, biophysical chemistry, biotransport, biosignals) as well as physiological and cell growth exper- Address correspondence to Peter F. Davies, Institute for Medicine iments. and Engineering, University of Pennsylvania, 1010 Vagelos Labora- tories, 3340 Smith Walk, Philadelphia, PA 19104. Electronic mail: BE400 is intended to impress upon the students the im- portance of engineering knowledge, research, and design 276 0090-6964/06/0200-0276/0 C 2006 Biomedical Engineering Society
  2. 2. Interdisciplinary BME Education 277 TABLE 1. BE400: Clinical preceptorships in bioengineering A course that exposes undergraduate bioengineering students to clinical medicine and/or clinical research at a formative stage of training by: (i) Didactic instruction: in a lecture series that covers a broad spectrum of clinical material in which quantitative and engineering skills are important. Demonstrations and discussions are woven into this period. Provides breadth. (ii) Preceptorship: Immersion in a personalized 10 week period in a clinical speciality representative of biomedical engineering and the quantitative sciences. Preceptor is a practising physician and/or clinical researcher. Provides depth. in contributing to the success of clinical practice, research dents intending to follow careers in industry or postgraduate and device development. The students learn how design- BE studies and for whom opportunities for future clinical driven engineering skills are employed in biomedical re- experiences may be limited. The BAS degree is intended search that is complementary to hypothesis-driven research for students planning advanced work in medicine (premed) within a clinical setting. The students become familiar with or other professions. clinical medicine and the role of engineering in a hospital setting prior to entering their final year of undergraduate study. COURSE OUTLINE The preceptorship experience occasionally leads to the selection of a clinical problem for the senior year design Lectures-Demonstrations project, with a clinician as a major mentor or coadvisor Weeks 1–8 consist of twelve 90-min lectures by faculty to the project. This arises from the opportunity to engage of clinical departments/divisions representative of Bioengi- in ongoing clinically related research projects during the neering in medicine (see also Table 3). These are supple- preceptorship (Table 5). mented by discussion sessions and additional background provided by the course directors. The majority of lecturers hold an undergraduate and/or doctorate degree in Engineer- HISTORY AND STUDENT CRITERIA ing or Physical Sciences in addition to an MD, and most are pursuing clinically related research in addition to clinical The clinical preceptorship course (BE400) was launched responsibilities. in academic year 1999–2000 as a pilot with five students. In The slide content of each lecture is preposted electron- 2000–2001, 12 students were enrolled, and in 2001–2002 ically (BlackboardTM )2 for downloading, printing, and use enrollment was capped at 21 students. In 2002–2003, the by the students during the lecture. Teaching faculty often course was assessed and modified. Thirty eight students supplement this by the addition of website addresses, jour- enrolled in 2003–2004 and 48 students in 2004–2005; in nal articles, and further explanatory slides used during the the latter year, more than 30 clinical faculty participated. lecture. Two mid-term examinations that test knowledge of Class size is expected to approximately double over the next the lecture materials and that account for 40% of the grade 3 years. As an elective, first priority for acceptance is given are conducted in weeks 5 and 8. to BE students taking the ABET accredited Bachelor of Sci- To introduce the students to a clinical environment ence in Engineering (BSE) degree, followed by Bachelor well in advance of their Preceptorship, two lecture- of Applied Science in Biomedical Sciences (AS/BAS) ma- demonstration sessions are conducted in the division of jors, and then senior BE and other Engineering School stu- Cardiac Surgery during the second week where a surgi- dents if space remains. This order gives priority to BE stu- cal team performs cardiopulmonary bypass procedures and TABLE 2. Principal course components 1. Lectures/discussions and demonstrations in weeks 1–8. Lectures in the following areas: Anesthesia, Physical and Rehabilitation Medicine, Epilepsy Neurology, Neurotrauma and Repair, Cardiac Surgery (2), Pediatric Injuries, Cancer Pharmacology (Proteomics and Mass Spec), Pulmonary Imaging, Radiology and Medical Informatics, Interventional Cardiology, and Orthopaedic Surgery 2. Preceptorship in weeks 5–15. 3. Fulfillment of a research seminar requirement—3 seminar reports - throughout the semester. Coursework exams occur in weeks 5 and 8. Preceptorship presentations and the associated viva exams take place during Finals week.
  3. 3. 278 P. F. DAVIES AND M. LITT TABLE 3. Clinical preceptorship in bioengineering course schedule 2005 aortic valve surgery on a sheep. The session is preceded (two surgeons, a perfusionist, an anesthetist and surgical by an explanatory discussion led by cardiac surgeons who nurses), are able to ask questions and examine all aspects are also trained in biomedical engineering. The session is of the procedure in detail. We find this experience reveals repeated to accommodate up to 25 students at a time, con- in a practical manner the interplay between a specific clin- sistent with an unhurried discussion in the operating room. ical area and biomedical engineering both in the design It provides the students an introduction to surgery using a of replacement valves and the instrumentation associated non-human subject and allows free acccess to all aspects with the procedures. Furthermore, when they begin the pre- of both the instrumentation and the surgical procedures. ceptorship, the students have absorbed some sense of the In this setting the students, who interact with the team hospital environment. TABLE 5. Examples of clinical research encountered in pre- TABLE 4. Specialties participating in preceptorships (2005) ceptorships Anaesthesiology Pressure ulcer quantitation Cancer pharmacology EEG prediction of epileptic seizures (experimental surgery) Interventional cardiology Optimization of intervertebral disk design (replacement) Radiology Electrical therapy in healing Cardiac surgery Finite element analysis for cardiac valve design (replacement) Neurology Software development for remote patient self-reporting Medical informatics Micro-gas bubbles in anesthesiology circuits Neurosurgery Mass spectrometry: lipid hydroperoxides in cancer diagnosis Orthopaedic surgery Cerebrospinal fluid shunts in pediatric patients Pediatrics Intracranial electrodes in management of seizure prediction Pulmonary medicine 3-D point to point cardiac deformation (crystal sensors on heart) Rehabilitation and physical medicine Neurosurgical operating procedures Molecular cardiology Radiological image analyses of pulmonary dysfunction Nephrology Spinal cord injury Oral and maxillofacial Pediatric trauma and posttraumatic shock syndrome Veterinary hospital intensive care unit Acupuncture and nerve networks in wound healing Laboratory medicine-coagulation Anesthesiology: operating room procedures and instrumentation Vascular surgery Design of mechanical devices for joint rehabilitation Radiation oncology Intra-aortic balloon pump Pediatric cardiology Automated Twitch-Obtaining Intramuscular Stimulation (ATOIMS)
  4. 4. Interdisciplinary BME Education 279 Preceptorship STUDENT EXPERIENCES In week 5 each student is assigned to a participating We have found that an essential element at the beginning member of the clinical faculty who becomes preceptor and of the semester is a thorough introduction to the course clinical liaison; lectures also continue. Prior to assignment, content including a discussion of the rationale for the course students indicate their preference areas and usually receive design. The accessibility of the course directors, especially one of their top three choices. Pairs of students are assigned during the first weeks, is crucial. Students are naturally to each preceptor; occasionally a single student is assigned. apprehensive about a major change of learning environment The organization of the preceptorship is flexible and varies and the unfamiliar material, but are excited by the challenge. depending on the particular department/division to which An explanation of the relevance of what they already know, the student is assigned. The principal responsibility of the to what they are about to learn, is important. Introductory preceptor is to provide the student with meaningful expo- information includes (i) a brief outline of each lecture topic sure to the practise of medicine such that, combined with and background of the speaker, (ii) specific examples of reading and discussions, the student emerges with a signif- engineering-related clinical topics, and (iii) discussion of icant depth of knowledge in a specific area and recognizes experiences by two of the previous year students. The last the bioengineering-relevance. Usually there is exposure to item has proved to be especially useful. patients or to patient materials and often also an introduc- Approx 25% of the 2005 class plans to attend medical tion to a clinical research project. school. When the course expands to enroll the entire Junior Students are expected to spend a minimum of 6–9 h per year class, approximately 40% are expected to be pre-med week in these activities plus related background reading and students. We noted a slight difference when the premed study; most students significantly exceed this requirement. fraction was larger in the first 2 years; some pre-med stu- There are two progress report sessions with the course di- dents had had previous hospital experience and could act rectors midway through the preceptorship period to evaluate as informal mentors to their fellow students. By the end of student progress and to address any problems. There is also the semester, however, student attitude and familiarity in frequent electronic contact between the clinical faculty and clinical matters appeared to be uniform. the course directors. The preceptorship ends with reports, As judged by the objective criteria of examination presentations, and a viva exam in the fourteenth week. grades, specific individual preceptor and instructor The viva takes place during Finals week. Each student evaluations, and graded reports on lectures and seminars, pair presents the preceptorship (PowerPointTM ;10–12 min) the great majority of students obtained a satisfactory outlining the biomedical engineering relevance, and giving breadth and depth of understanding of the lecture material an account of their activities. The presentation is followed and considerable depth in the preceptorship speciality. by questions from the course directorship (three or four Quantitative information on the career choices of the faculty). 50% of the final grade is determined by the viva students and whether the course influenced their eventual (final presentation, preceptor report, progress reports, and career path is limited. This is because it has been offered responses to questions). The clinical Preceptors and mem- only five times, and since student numbers were increased bers of the BE faculty are invited to the viva. gradually, the majority of those who took the course were An additional course requirement is that during the enrolled during the past 2 years and are still completing semester each student must independently select and at- Junior and Senior years. Consequently it is too soon to tend three research seminars on a BE-relevant topic that is collect meaningful data from them. However, we have associated with a biomedical problem. A one-page critique contacted 38 students who took the course in the early of each seminar is submitted. This activity constitutes the years and received responses from 29. Nine went to remaining 10% of the grade. medical school (two to MD-PhD programs), 10 to graduate school and 10 to various capacities in the private sector. PRECEPTORSHIP FACULTY FACULTY EXPERIENCE The core of clinical faculty has grown from 5 in 2000 to more than 30 in 2005; most faculty are also preceptors. The faculty experience complemented that of the stu- The currently available preceptorship areas are included in dents. It is novel and unusual for Medical School faculty to Table 4. Of 25 primary preceptors in 2005: 40% hold first mentor bright undergraduate students skilled in engineer- degrees in Engineering or Physics; 23 (88%) hold the MD; ing and quantitative sciences. All clinical faculty involved three (12%) are PhDs; six (24%) are MD-PhD; 7 (28%) are in the course reported a positive experience both in lectures women; three (12%) are minorities (two Hispanic; one East and in hosting a preceptorship; in most cases they were Asian). Of 48 students enrolled in 2005, 20 are women and very enthusiastic. The faculty gained by having students 14 are minorities. who brought a different point of view to clinical or research
  5. 5. 280 P. F. DAVIES AND M. LITT problems. The students are potential candidates for further distributed to the School of Medicine departments. In the medicine-related training in their Senior year and beyond. absence of external support, decisions related to the use of tuition income must be made. Our early pro-bono experi- INSTITUTIONAL AND OPERATIONAL ence with a small elective class was facilitated by a small CONSIDERATIONS number of highly motivated clinicians. However, for the larger numbers now enrolled, we think that the program From our experience to date, there are a number of con- will best succeed with some type of financial incentive in siderations that are important in designing and operating place. an interdisciplinary and interschool educational project. Of Personal considerations are very important. The cooper- these, we consider the most important to be structural, ation of two educational and research cultures as disparate financial, and personal. as medicine and engineering requires mutual respect. Per- Structural considerations relate to how an institution is sonal contact between the course leadership and the clinical set up to foster and operate interdisciplinary educational faculty needs to be built during the initial period and sus- projects. At Penn this was facilitated by the existence tained. The BME students quickly adapt to the medical of a formalized bridging institute, the IME, between the school environment and to date have been treated well. The Schools. Codirector leadership representing both the Medi- last 3 years of the course resulted in highly positive overall cal and Engineering Schools is essential; the Codirectors are student evaluations with scores of 3.6, 3.5 and 3.6 out of a also IME members which by definition reflects interdisci- maximum of 4.0. Informal interviews of the students pro- plinary interests. Since the bulk of the teaching is conducted vides valuable suggestions for incremental improvements by Medical School faculty, the course leadership must com- each year. mand the respect of the clinical faculty while retaining the principles and objectives of engineering education. Like- CONCLUSION wise, the educational priorities of the BE department must be represented through a senior educational specialist. Most An innovative undergraduate Clinical Preceptorship universities have appropriate faculty to accomplish this. course for Bioengineering students in their Junior year Financial considerations must be addressed, particularly has been introduced and developed at the University of when personnel of two such diverse schools are involved. Pennsylvania. At the end of the course, the students gener- During the first two “pilot years” of this course, the clin- ally fulfill the following criteria: icians gave of their time and efforts pro bono. As student 1. Understand how biology and bioengineering are numbers increased, a transfer of funds was negotiated from integral in selected areas of medical practice. the Engineering School to the IME for distribution to the 2. Apply bioengineering solutions to specific chal- Medical School to compensate for loss of clinical prac- lenges in clinical care and interventional medicine tice time. A modest stipend is transferred to the Chair of (improvements in instrument design; better quanti- the department where faculty are engaged in preceptorship tation; application of engineering design to clinical activities; the amount is proportional to the number of fac- research). ulty participating. We request that the Chair uses it as a 3. Achieve a level of familiarity (and comfort) with discretionary fund allocated for the use of each clinical the hospital/clinical environment. Preceptor. This mechanism attracts the cooperation of the 4. Appreciate the importance of interdisciplinary Chair and provides an important incentive to the preceptor training and skills. for continued participation in the course which competes 5. Show competence in the analysis of biomedical and with many other demands on the time of the clinical fac- clinical seminar presentations in which biomedical ulty. These are sensitive issues that require pre-negotiation engineering principles and/or practice plays an in- and are likely to exist in any institution contemplating a trinsic role. similar project. We recommend that an additional, external 6. Competence in the presentation of the preceptor- source of funding (e.g., from a Foundation or Federal Grant ship experience in an organized and professional Agency) be sought for the early years of course develop- manner and demonstrate in-depth understanding of ment. This will add cachet to the program. In our case, the clinical speciality. we were fortunate that the course became operational at about the same time that an application was submitted to Clinical faculty and students at Penn have enthusiasti- the Whitaker Foundation for a Leadership-Development cally embraced it as a useful example of interdisciplinary Award to the Department of Bioengineering. The course Engineering education. For most students it provides sig- concept, which was part of the application, was endorsed nificant assistance in career planning. by the Foundation and included in the final award. The As the student enrollment is increased each year (approx department of Bioengineering transfers an agreed amount 80 students are expected to enroll in the 2006 class), we will to the IME near the end of the course; stipends are then add more clinical areas into the program with preference
  6. 6. Interdisciplinary BME Education 281 given to those with high BME content. There is no shortage the Dean of the School of Engineering and Applied Sci- of such links; examples for future inclusion are robotics ence, Eduardo Glandt, PhD, and the Dean of the School of in laboratory medicine, bioinformatics, genomics and Medicine, Arthur Rubenstein, MBBS, for their support of proteomics as applied to systems-based clinical diagnosis interdisciplinary education. We acknowledge the generous and prognosis, experimental device medicine, advanced support of the Whitaker Foundation which has provided radiological and optical tomography techniques, robotic support through the department of Bioengineering to enable surgery, environmental medical procedures such as hyper- the course to develop. baric chamber therapies, and, when they assume clinical efficacy, experimental areas such as stem cell technology REFERENCES in tissue engineering, gene therapy, and nanomedicine. 1 Agenda for Excellence: Strategic Plan for the University ACKNOWLEDGMENTS of Pennsylvania. Almanac 14(13), 1995. Also available at 2 We are most grateful for the superb commitment of the BlackboardTM website: 3 more than 30 faculty of the University of Pennsylvania The Penn Compact: From Excellence to Eminence. Philadelphia Business J. Nov 12, 2004, p. 1. Health System who participate in the Clinical Preceptorship 4 University of Pennsylvania. Institute for Medicine & Engineering course. We are thankful for the support of the Chair of the (IME) website: BE Department and the Chairs of the clinical departments 5 University of Pennsylvania Bioengineering Department website: in which the preceptorships are hosted. We are indebted to