Studying BME in the United Kingdom By Nadya Anscombe
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n the United Kingdom, the field of engineering in biology and medicine is so new that universities cannot agree on what to call it or even where to teach it. Undergraduate students in the United Kingdom can register for degrees in bioengineering, biomedical engineering, medical engineering, clinical engineering, medical physics, or even rehabilitation engineering; and these could be taught in specialist institutions, mechanical and electronic engineering departments, medical schools and hospitals, or even by distance learning (see “Long-Distance Masters”). Before 2002, the term bioengineering did not even feature in the database of undergraduate courses held at the Higher Education Statistics Agency (HESA), but today, it is one of the fastest growing engineering disciplines with several universities offering undergraduate courses for the first time each year. While several universities have offered taught master’s courses in bioengineering and all its variants for some time, undergraduate courses in the subject are a relatively new concept in the United Kingdom and have resulted in every university designing its own course with its own curriculum and specialties. Undergraduate courses in bioengineering are often standard mechanical or electronic engineering courses, with additional biology- or medicine-related modules added in the final year. It is for this reason that statistics on the number of bioengineering graduates is difficult to find. According to HESA data, there has not been an increase in bioengineering graduates over the last six years. This is because they are often classified as mechanical engineering or physics graduates and not as bioengineering or medical physics graduates. This means that the discipline of bioengineering is not well known among prospective students or their parents, so persuading them to choose bioengineering as a degree is often the first challenge that needs to be overcome. Julia Shelton, director of taught courses in the School of Engineering and Materials Science (SEMS) at Queen Mary University in London (QMUL), says that attracting students is difficult because the subject is not taught in schools and students have often never considered combining engineering and medicine before. QMUL was one of the first universities in the United Kingdom to offer three- and four-year undergraduate degrees in medical engineering. Based at the SEMS, the medical engineering course has many aspects
Challenges, Choices, and Change
Digital Object Identifier 10.1109/MPUL.2011.942601 Date of publication: 11 October 2011
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in common with other courses offered by the university, such as medical and dental materials. But rather than graduating as materials scientists, the medical engineering course is accredited by the Institution of Mechanical Engineers, and students graduate as engineers with a qualification that enable them to progress, with appropriate work experience, to full chartered engineering status. “We have to do a lot of outreach work in schools in order to persuade parents that medical engineering is a proper subject,” says Shelton. “We have seen a resurgence in mechanical engineering applications, which has helped, and we find that the subject also attracts a large number of female students who ordinarily would not consider engineering.” The QMUL medical engineering courses are different than many other bioengineering or biomedical engineering courses run at other universities because, rather than sending students off to other schools to attend medical or biology lectures, the students are taught by SEMS staff who are active in medical engineering research, with a wide range of interests. This enables QMUL to deliver a wide range of specialist modules and also to support a diverse number of projects. “We have redesigned our course many times and we are now confident that we have found the best way of teaching this subject,” said Shelton. “Some of our teaching is centered on problem-based learning. For example, we don’t teach anatomy as a separate subject. The students learn anatomy and physiology as part of their other modules, through addressing clinical medical engineering problems and their final-year design project, which is often carried out in partnership with either industry or hospitals” (see “Problems and Projects”). This collaboration with hospitals and industry can be a huge challenge to organize, but is ultimately very rewarding for the students. Ensuring that the students have no gaps in their knowledge of clinical topics, such as anatomy, is also a challenge with this type of course, but Shelton and her colleagues at QMUL believe that the students learn and retain physiology and anatomy information better when they have learned it in this way. In most other bioengineering courses across the country, medical subjects, © STOCKBYTE AND ED SIMPSON
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Long-Distance Masters The most innovative and unique taught master’s program available in the United Kingdom is an M.Sc. degree in medical physics from Open University, a university that has pioneered distance learning (Figure S1). While the bulk of students come from the United Kingdom, this M.Sc. is available globally because it is taught entirely through distance learning. “We have students from many different countries, including the Bahamas, Nigeria, and the Ukraine,” said Elizabeth Parvin, module team chair at Open University. “Many of our students have full-time careers, perhaps working in a hospital already, and want to further their career.” The students are provided with a study guide that leads them through a comprehensive set of resources. At the heart of the student’s study is a personalized Web site where students can access all the study materials as well as the university’s extensive electronic FIGURE S1 The Open University five-treatment plan on screen. library. Students are also given access to an imageprocessing package and a radiotherapy treatmentdifferent backgrounds, and while many of them might already work planning teaching package. Contact with a personal tutor is in a clinical environment, many will never have been in a maintained via electronic forums and e-mail. Assignments are radiotherapy department.” So Parvin and her colleagues went to a submitted electronically at regular intervals and returned to the large hospital and filmed inside the radiotherapy department to student with extensive comments as well as marks. explain to all the students what all the different pieces of equipment Students are expected to work between 12 and 15 hours per are called and how they work. Second, to teach radiotherapy, for week by researching assignments, attending lectures online, or example, students need to learn the basics of how to plan working with tutors online. The course consists of three modules: radiotherapy treatment, and for this they are given remote access to imaging in medicine, radiotherapy and its physics, and a project. a teaching package on radiotherapy treatment planning produced Those students wanting accreditation by the Institute of Engineering by Sheffield Hospital. Using this they can work out treatment plans and Physics in Medicine must do an extra module that includes for different regions of the body. Students on the imaging module topics such as statistics, health and safety, and anatomy, and the use an image processing package to learn how to get extra project they undertake must be a practical project. Students information from images. typically take around three years to complete their master’s degree. For the imaging and radiotherapy physics modules, the final Alternatively, it is possible to accelerate the program by working assessment involves the presentation of a poster and short review more intensively for more than two years or to spread it out over a (imaging module) and a 15-minute conference-style presentation longer period. (radiotherapy module). In both cases, these require the student to “Doing a master’s degree through Open University is hugely use electronic journals to research a subject beyond the core challenging for the students because most of them work full time material of the module and present it to a general medical physics while they are studying,” said Parvin. “But this also means that some audience. For students who can travel to Milton Keynes, where of them have expertise in areas that can be useful to the other Open University has its headquarters, these assessments are carried students, and they will help each other out by answering questions out at conference days and are often the one and only time students in forums that we have set up.” get to meet their tutors and each other in person. For students from Lectures take place online using a video conferencing package distant places, the assessment can be carried out via video or called Elluminate. The lecturer gives a PowerPoint presentation and telephone. students are able to “raise their hands” or “applaud.” Each student has “While teaching through distance learning can be extremely a headset with a microphone, so they can ask questions and interact. challenging, it is also very rewarding,” said Parvin. “Our students are “Teaching medical physics at Open University is challenging for highly motivated, very hard-working, and a delight to teach.” many reasons,” said Parvin. “First, the students come from many
such as anatomy, are taught as a separate subject. For example, at Newcastle University, which will have its first bioengineering graduates in 2013, anatomy is taught to mechanical engineers using a combination of innovative software, human joint models, bespoke teaching materials, and peer-to-peer learning (see “Teaching Anatomy to Engineers”). Tom Joyce, module leader, explains, “For the majority of the bioengineering students, this would be the 14 IEEE PULSE
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“We have to do a lot of outreach work in schools in order to persuade parents that medical engineering is a proper subject,” says Shelton.
first time they had been formally introduced to anatomy and the associated medical terminology. Research has shown that even medical students frequently encounter problems understanding certain dynamic aspects of functional anatomy, so for engineering students the subject can be particularly challenging.” To make learning anatomy interactive and fun for the student, Joyce applied for funding to buy dedicated anatomical software and also
Problems and Projects At QMUL, students learn about the challenges of medical engineering through problem-based learning and industry-led projects (Figure S2). For example, take the case of Michael’s Knee (a professional footballer) who has hurt his knee. The students are given a complete case history and are told about the symptoms in detail. The students are then asked to gain information from the symptoms and suggest tests that could be used to allow accurate diagnosis of the clinical problem. Results from diagnostic tests and possible treatment options are discussed as well as rehabilitation regimes and the likelihood of the patient being able to return to professional sports. In this scenario, the patient presents classic symptoms of an acute rupture of the anterior cruciate ligament (ACL). By working through this scenario, the FIGURE S2 QMUL students in a tissue lab. students develop an understanding of the anatomy of the knee and the ACL and menisci in particular and understand how this injury can alter functions. They set out. Where a group is struggling, the facilitator should become also gain knowledge of diagnostic, treatment, and rehabilitation more proactive but in a manner that guides rather than informs. We options for patients suffering from a ruptured ACL and torn find that this is a very effective way of learning and also gives the meniscus. students skills, such as group work and report writing, which they The students are required to keep notebooks in which they will need in their careers.” record the information they have acquired and details of In the fourth year of the medical engineering degree, students experimental protocols and results. They work in groups to write work on a group design project, many of which are associated with about their findings that are presented in the form of a clinical an industrial sponsor. This is a major exercise that occupies 50% of report prepared for the chief medical officer of the player’s students’ time in the fourth year. “In the professional world, football team. engineers do not work in isolation, and therefore need to be good at “We ask the students to keep notebooks because not only does managing complex group design work,” said Knight. “Our group it document the progress of their learning, it is also something that design project offers students a challenging and realistic professionals are required to do so that an organization can assignment, helping them prepare for the real world in professional document intellectual property claims,” explains Martin Knight, engineering.” director of the Medical Engineering Degree Program at QMUL. In The examples of current and previous group design projects group sessions, the students are assisted by an academic facilitator include investigation of shock wave lithotripsy for unblocking an whose role is to guide the discussion in a manner that should allow encrusted urethral stent (sponsored by P&N Medical), the students to understand the problem and find appropriate development of an arthroscopic suturing tool for the repair of answers. “Just as in professional situations, the students appoint a shoulder tendons (sponsored by Atlantech), development of a chair to chair the meeting and a secretary who takes notes and bioreactor for cartilage tissue engineering (sponsored by Bose), distributes them to members of the group,” said Knight. “The and design of an improved ankle replacement implant facilitator is not there to provide answers, so may take an extremely (sponsored by DePuy). passive role when a group is working well and achieving the goals
in which degree courses are developed in U.K. some models of human joints. He also arranged universities. For example, until recently, Oxford a two-hour visit to the dissecting rooms of The IPEM does accredit University offered only a one-year taught masNewcastle University’s Medical School where an M.Sc. degree in ter’s program in biomedical engineering. Four students were given access to human hip and medical engineering, years ago, the Department of Engineering Sciknee joints. “The software was expensive, but but it currently ence realized that it had appointed enough facfeedback from the students has been very posdoes not accredit ulty with an interest in biomedical engineering, itive,” said Joyce. “Mechanical engineers like undergraduate and it started to offer the subject to its underto see things three-dimensional (3-D), and graduates. And in 2008, the university set up the software and joint models certainly help degrees. the Institute for Biomedical Engineering, where them grasp the subject quickly.” the research in this area is now consolidated. The bioengineering degree at Newcastle In the United Kingdom, Oxford is unique in the way it was developed because the School of Mechanical and Systems teaches engineering. All its students are taught the same core Engineering believed it to be an important and growing area subjects for the first two years, and then they have a choice of modern engineering and found it to have enough staff inof six options: mechanical, electronic, chemical, information, terested in teaching the subject. This is often the organic way SEPTEMBER/OCTOBER 2011
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Teaching Anatomy to Engineers At Newcastle University, the subject of bioengineering is taught as a module for more than two semesters to a combined group of fourth-year undergraduate students as well as postgraduate taught master’s students in the School of Mechanical and Systems Engineering. One part of this module involves the students writing an engineering critique of a commercially available design of a total joint replacement prosthesis. As such a critique needs to be founded on a full appreciation of the anatomy and function of the human joint that is being replaced; the challenge was how to facilitate student learning on the complex subject of anatomy [S1]. The module starts with a series of lectures on FIGURE S3 Students at Newcastle University learn through innovative total hip replacement and biotribology. These give software and models. appropriate background knowledge through a case study of the most common and successful type of joint replacement. After this, students are allocated an individual Scientific (Weston-super-Mare, United Kingdom) and organized project where they were asked to critique a specific design of a two-hour visit to the dissecting room of Newcastle University’s replacement joint and describe the anatomy of the relevant Medical School. Students first worked through the software natural joint. using bespoke training notes written by Joyce. He also wrote Each of these projects was intended for one of the less notes in relation to the human joint models and students commonly replaced human joints, specifically the shoulder, elbow, worked in self-selected groups to answer preset questions wrist, ankle, and various finger and toe joints. By gaining a full based on the models. understanding of the anatomy of human joints, Tom Joyce, module “I find that Web-based learning empowers the learner, enables leader, intended that his bioengineering students would individualized instruction and collaborative peer-to-peer learning, appreciate the inherent challenges of joint replacement and and transfers greater control to learners to decide when, how much, problems faced by clinicians who have to implant such devices. He and to what extent study and instruction takes place,” said Joyce. “It also explained students how artificial joint replacement can allows learners to progress at their own pace and provides the improve people’s lives and felt that the students want to learn facility for student-centered learning, making students responsible more about the subject. for their own learning.” To aid with this anatomical understanding, Joyce applied for a grant to buy dedicated anatomical software as well as models Reference of human joints and incorporated these into his teaching [S1] T. Joyce, “Non-traditional subjects taught to engineers: A case (Figure S3). The anatomical software chosen was Primal Pictures study of teaching anatomy,” in Proc. Conf. Paper Engineering Systemic edition (http://www.primalpictures.com/). He also Education, The Higher Education Academy Engineering Subject bought static and dynamic models of human joints from 3B Centre, 2010 [Online].
This lack of consensus also means that students and their civil, or biomedical engineering. “Thirty years ago, we only potential employers are concerned whether they will gain sufhad three streams,” said Stephen Payne, course director for ficient knowledge of engineering to be effective the taught M.Sc. in bioengineering at Oxford engineers and can obtain enough knowledge of University’s Engineering Sciences Department. medical topics to feel that they are gaining the “Now we have six streams and medical engi“Ensuring that sufficient exposure to clinical expertise. In many neering is very popular.” students get a good ways, the first of these considerations will be anThe subjects taught under the banner of education in both swered if students complete a degree accredited biomedical engineering include physiology, engineering and by one of the various professional institutions signal processing, image processing, tissue medical aspects is a such as the Institution for Mechanical Engineers engineering, and drug delivery. This may and the Institution of Physics and Engineering be significantly different than what other major challenge,” says in Medicine (IPEM). An accredited degree will universities teach as part of a bioengineerSandra Shefelbine. require appropriate output standards in engiing degree because the subjects depend on neering knowledge and other numerate subjects. the specialties of the staff. “We play to our The IPEM does accredit an M.Sc. degree in medical engineerstrengths,” said Payne. “Biomedical engineering, or bioening, but it currently does not accredit undergraduate degrees. gineering, is such a new area that U.K. academia has not yet However, this seems to be changing, as a spokesperson for IPEM agreed on a core of subjects that should be taught. There is told PULSE magazine: “IPEM plans to play an increasingly imno standardization, but I would be interested to see if this portant part in the accreditation of undergraduate degrees in happens in the future.” 16 IEEE PULSE
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medical physics, bioengineering, medical engineering, and biomedical engineering in the future and is seeing an increased demand for this from universities in the United Kingdom and overseas.” “Ensuring that students get a good education in both engineering and medical aspects is a major challenge,” says Sandra Shefelbine, who teaches first-year mechanics and also orthopedic biomechanics to master’s students at the Imperial College in London (Figure 1). At Imperial, undergraduate students study a range of traditional engineering as well as bioengineering modules from the start of their degree. Subjects in the first and second years include not only electrical engineering, mechanics, and mathematics but also mediFIGURE 1 Study of bioengineering at the Imperial College in London. cal sciences, cell biology, and wet laboratory skills. In their final year, the students cover a her lecture. “I find students are much more willing to answer range of topics focused specifically on bioengineering such truthfully using clickers, rather than a ‘hands-up’ voting system as imaging, modeling, biomechanics, synthetic biology, and where they are often persuaded by the majority,” she said. “The informatics. real-time feedback of student understanding was useful to me “The challenge is making sure that our students are masto gauge where I should spend more time on certain concepts. ters of something and not a ‘jack of all trades,’” says Shefelbine. Guessing the outcome of the experiment with a clicker system “Imperial is one of the few universities in the United Kingdom will encourage students to think conceptually about the physics that has a department of bioengineering and offers undergraduproblems.” ate and postgraduate degrees in the subject.” All the classes our While using wireless clickers has brought many benefits, it students take are taught in the department of bioengineering, has required Shefelbine to rethink how she delivers her lecso while we do teach the fundamentals such as mechanics, we tures and the amount of material she uses. “It is a different are able to make sure that the content is relevant to bioengineerway of lecturing, and it requires reorganization of the delivery ing,” says Shefelbine. For example, when talking about conserof the lecture,” she said. However, she does not use the clickers vation of energy, Shefelbine might look at how insects jump, when teaching master’s students as they tend or when looking at mechanics, she might look at to be in smaller groups. “Like our undergraduhow children with cerebral palsy walk. ate degrees, our master’s program has become Shefelbine enjoys teaching and was a recent To capture the increasingly popular,” says Shefelbine, who winner of the ExxonMobil Excellence in Teachimagination of is a U.S. citizen. “The number of students has ing award, which is awarded annually to innoundergraduate tripled in the last three years, and I am pleased vative educators in engineering. To capture the students and that the United Kingdom is finally catching up imagination of first-year undergraduate students with the United States where the number of and help them grasp fundamental concepts, she help them grasp bioengineering students is much higher and still uses large-scale physical demonstrations in the fundamental increasing.” lecture hall. Each demonstration illustrates a concepts, There are many differences between the different mechanics concept and has the capabilShefelbine uses United States and the United Kingdom in terms ity of projecting real-time measurements onto a large-scale physical of bioengineering education. The field is more screen for student participation. “The main cost demonstrations. mature in the United States, and the main differinvolved was the salary for a full-time mechanence is that in the United Kingdom, courses tend ics technician to help put together the demonto have an emphasis on mechanical engineerstrations and equipment required,” said Shefeling or sometimes electrical engineering. In the United States, bine. “Now the demos are shared by various departments and degree programs tend to have a strong commitment to biology are a great resource that helps the students make the connecand its related disciplines. tion between two-dimensional problems on paper (or computer Another unique feature about the United Kingdom is screen) and 3-D motion.” types of job opportunities available to graduates. Although Shefelbine is a fan of wireless clickers and uses them in all the United Kingdom has led many of the developments in the her lectures. For example, before a demonstration, students field of bioengineering, from the design of the first clinically were asked to vote anonymously on what they think will hapsuccessful hip replacement in the 1960s to the development pen. They can also be used to give instant feedback. In this of computer tomography and magnetic resonance imaging, manner, Shefelbine can assess if the students have understood SEPTEMBER/OCTOBER 2011
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there are certainly not enough jobs for all the graduates from the students study. From September 2011, all training provibioengineering degrees currently being run in the United sions, including the highly regarded IPEM training schemes, Kingdom. For example, none of the large scanner manufacwill be replaced by new arrangements for health-care scienturers have their manufacturing base in the United Kingdom, tists (corresponding approximately to the previous job title of so any graduate wanting to work in this industry will go to clinical scientists), health-care science practitioners (correcontinental Europe or the United States. Howsponding approximately to the previous job title ever, according to a report by the Royal Acadof clinical technologists), and support workers emy of Engineering [1], the number of jobs in at the assistant/associate practitioner level. A large proportion bioengineering in the United Kingdom should Although IPEM has well-established training of bioengineering increase in the next few years as small and meschemes for the professions in its sector, this is by undergraduates in dium enterprises (SMEs) and start-ups look no means the case across the NHS workforce as a the United Kingdom for multidisciplinary people. The report states: whole. Also, while the IPEM scheme was highly are from overseas and “The large companies will continue to employ regarded by the DH and produces high-quality specialists, such as mechanical engineers or trainees, it was, according to the IPEM, “permany of them will go electronic engineers who have graduated with ceived as lengthy and not financially justifiable back to their native limited biomedical knowledge. . . . however, a in the long term.” countries to work in growing number of SMEs need their employees While many in academia and industry agree the bioengineering to have a broad range of background knowlthat a change was needed, many are not happy industry. edge for two different reasons. First, due to with how the changes have been carried out. their size, they are not able to employ a range of There are concerns about the speed at which specialists. Second, and more importantly, they MSC is being implemented and inadequate disare relying on turning novel ideas and concepts into devices tribution of universities offering B.Sc. and M.Sc. courses as and implants. Hence, they need multidisciplinary people such part of MSC, requiring some students to travel long distances as medical engineering graduates.” to participate. However, the report also points out that “Medical deAs this article went to print, an announcement was expectvice, medical implant, and equipment manufacture is genered from the DH about which universities have been awarded ally a small-scale, high-value-added industry; thus, the highly the contract to deliver the master’s courses that are part of the trained graduates completing such degrees will be working in Scientist Training Program. The first intake of students will be a type of manufacturing environment for which the United in September 2011, and there are expected to be about two or Kingdom is very suitable. However, it should be noted that, at three universities offering an M.Sc. degree as part of the MSC the moment, the U.K. manufacturing base in this area is low in program. spite of the appropriateness to the U.K. public limited company In a statement issued in April 2011, the IPEM stated: “MSC (plc) and the high U.K. research activity in the area of medical means radical change for IPEM, for our members and for the engineering.” areas of health-care science for which we speak. It has also This is perhaps one of the reasons that a significant numbeen clear from the start that changes were going to take place ber of graduates who have studied bioengineering in the United and that the status quo was not an option. IPEM Council and Kingdom end up working in finance and other industries unTrustees took the view that the institution should work with related to engineering. A large proportion of bioengineering the DH teams to make sure that the outcomes are in the best undergraduates in the United Kingdom are from overseas and interests of our professions, rather than simply opposing these many of them will go back to their native countries to work in proposals.” the bioengineering industry. It is hoped that with bodies, such as the IPEM, determined Many bioengineering graduates want to work in the National to promote the area of bioengineering (and all its variants) Health Service (NHS) of the United Kingdom, which is one of the and increasing job opportunities, more undergraduates will largest employers of scientists in the United Kingdom. However, be encouraged to study the subject in the future, irrespecthe NHS’s graduate training scheme is currently undergoing a tive of the degree’s official title or in which department it is complete restructuring called modernizing scientific careers (MSC). taught. The initiative is being led by the Department of Health (DH), not by any of the professional organizations, such as the IPEM. It has Nadya Anscombe (www.nadya-anscombe.com) is a freelance been under development for several years, with the overall aim science and technology journalist living in the United Kingdom. of harmonizing training arrangements for the numerous small scientific and technical groups in the NHS and improving workReference force flexibility. [1] E. Tanner, “First degrees in medical engineering: A positive step This initiative involves devolving the training of scientists for engineering?” in United Kingdom Focus for Biomedical Engineering. and engineers to universities and changing the curricula that Royal Academy of Engineering, 2007.
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n the United Kingdom, the field of engineering in biology and medicine is so new that universities cannot agree on what to call it or even where to teach it. Undergraduate students in the United Kingdom can register for degrees in bioengineering, biomedical engineering, medical engineering, clinical engineering, medical physics, or even rehabilitation engineering; and these could be taught in specialist institutions, mechanical and electronic engineering departments, medical schools and hospitals, or even by distance learning (see “Long-Distance Masters”). Before 2002, the term bioengineering did not even feature in the database of undergraduate courses held at the Higher Education Statistics Agency (HESA), but today, it is one of the fastest growing engineering disciplines with several universities offering undergraduate courses for the first time each year. While several universities have offered taught master’s courses in bioengineering and all its variants for some time, undergraduate courses in the subject are a relatively new concept in the United Kingdom and have resulted in every university designing its own course with its own curriculum and specialties. Undergraduate courses in bioengineering are often standard mechanical or electronic engineering courses, with additional biology- or medicine-related modules added in the final year. It is for this reason that statistics on the number of bioengineering graduates is difficult to find. According to HESA data, there has not been an increase in bioengineering graduates over the last six years. This is because they are often classified as mechanical engineering or physics graduates and not as bioengineering or medical physics graduates. This means that the discipline of bioengineering is not well known among prospective students or their parents, so persuading them to choose bioengineering as a degree is often the first challenge that needs to be overcome. Julia Shelton, director of taught courses in the School of Engineering and Materials Science (SEMS) at Queen Mary University in London (QMUL), says that attracting students is difficult because the subject is not taught in schools and students have often never considered combining engineering and medicine before. QMUL was one of the first universities in the United Kingdom to offer three- and four-year undergraduate degrees in medical engineering. Based at the SEMS, the medical engineering course has many aspects
Challenges, Choices, and Change
Digital Object Identifier 10.1109/MPUL.2011.942601 Date of publication: 11 October 2011
12 IEEE PULSE
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in common with other courses offered by the university, such as medical and dental materials. But rather than graduating as materials scientists, the medical engineering course is accredited by the Institution of Mechanical Engineers, and students graduate as engineers with a qualification that enable them to progress, with appropriate work experience, to full chartered engineering status. “We have to do a lot of outreach work in schools in order to persuade parents that medical engineering is a proper subject,” says Shelton. “We have seen a resurgence in mechanical engineering applications, which has helped, and we find that the subject also attracts a large number of female students who ordinarily would not consider engineering.” The QMUL medical engineering courses are different than many other bioengineering or biomedical engineering courses run at other universities because, rather than sending students off to other schools to attend medical or biology lectures, the students are taught by SEMS staff who are active in medical engineering research, with a wide range of interests. This enables QMUL to deliver a wide range of specialist modules and also to support a diverse number of projects. “We have redesigned our course many times and we are now confident that we have found the best way of teaching this subject,” said Shelton. “Some of our teaching is centered on problem-based learning. For example, we don’t teach anatomy as a separate subject. The students learn anatomy and physiology as part of their other modules, through addressing clinical medical engineering problems and their final-year design project, which is often carried out in partnership with either industry or hospitals” (see “Problems and Projects”). This collaboration with hospitals and industry can be a huge challenge to organize, but is ultimately very rewarding for the students. Ensuring that the students have no gaps in their knowledge of clinical topics, such as anatomy, is also a challenge with this type of course, but Shelton and her colleagues at QMUL believe that the students learn and retain physiology and anatomy information better when they have learned it in this way. In most other bioengineering courses across the country, medical subjects, © STOCKBYTE AND ED SIMPSON
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Long-Distance Masters The most innovative and unique taught master’s program available in the United Kingdom is an M.Sc. degree in medical physics from Open University, a university that has pioneered distance learning (Figure S1). While the bulk of students come from the United Kingdom, this M.Sc. is available globally because it is taught entirely through distance learning. “We have students from many different countries, including the Bahamas, Nigeria, and the Ukraine,” said Elizabeth Parvin, module team chair at Open University. “Many of our students have full-time careers, perhaps working in a hospital already, and want to further their career.” The students are provided with a study guide that leads them through a comprehensive set of resources. At the heart of the student’s study is a personalized Web site where students can access all the study materials as well as the university’s extensive electronic FIGURE S1 The Open University five-treatment plan on screen. library. Students are also given access to an imageprocessing package and a radiotherapy treatmentdifferent backgrounds, and while many of them might already work planning teaching package. Contact with a personal tutor is in a clinical environment, many will never have been in a maintained via electronic forums and e-mail. Assignments are radiotherapy department.” So Parvin and her colleagues went to a submitted electronically at regular intervals and returned to the large hospital and filmed inside the radiotherapy department to student with extensive comments as well as marks. explain to all the students what all the different pieces of equipment Students are expected to work between 12 and 15 hours per are called and how they work. Second, to teach radiotherapy, for week by researching assignments, attending lectures online, or example, students need to learn the basics of how to plan working with tutors online. The course consists of three modules: radiotherapy treatment, and for this they are given remote access to imaging in medicine, radiotherapy and its physics, and a project. a teaching package on radiotherapy treatment planning produced Those students wanting accreditation by the Institute of Engineering by Sheffield Hospital. Using this they can work out treatment plans and Physics in Medicine must do an extra module that includes for different regions of the body. Students on the imaging module topics such as statistics, health and safety, and anatomy, and the use an image processing package to learn how to get extra project they undertake must be a practical project. Students information from images. typically take around three years to complete their master’s degree. For the imaging and radiotherapy physics modules, the final Alternatively, it is possible to accelerate the program by working assessment involves the presentation of a poster and short review more intensively for more than two years or to spread it out over a (imaging module) and a 15-minute conference-style presentation longer period. (radiotherapy module). In both cases, these require the student to “Doing a master’s degree through Open University is hugely use electronic journals to research a subject beyond the core challenging for the students because most of them work full time material of the module and present it to a general medical physics while they are studying,” said Parvin. “But this also means that some audience. For students who can travel to Milton Keynes, where of them have expertise in areas that can be useful to the other Open University has its headquarters, these assessments are carried students, and they will help each other out by answering questions out at conference days and are often the one and only time students in forums that we have set up.” get to meet their tutors and each other in person. For students from Lectures take place online using a video conferencing package distant places, the assessment can be carried out via video or called Elluminate. The lecturer gives a PowerPoint presentation and telephone. students are able to “raise their hands” or “applaud.” Each student has “While teaching through distance learning can be extremely a headset with a microphone, so they can ask questions and interact. challenging, it is also very rewarding,” said Parvin. “Our students are “Teaching medical physics at Open University is challenging for highly motivated, very hard-working, and a delight to teach.” many reasons,” said Parvin. “First, the students come from many
such as anatomy, are taught as a separate subject. For example, at Newcastle University, which will have its first bioengineering graduates in 2013, anatomy is taught to mechanical engineers using a combination of innovative software, human joint models, bespoke teaching materials, and peer-to-peer learning (see “Teaching Anatomy to Engineers”). Tom Joyce, module leader, explains, “For the majority of the bioengineering students, this would be the 14 IEEE PULSE
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“We have to do a lot of outreach work in schools in order to persuade parents that medical engineering is a proper subject,” says Shelton.
first time they had been formally introduced to anatomy and the associated medical terminology. Research has shown that even medical students frequently encounter problems understanding certain dynamic aspects of functional anatomy, so for engineering students the subject can be particularly challenging.” To make learning anatomy interactive and fun for the student, Joyce applied for funding to buy dedicated anatomical software and also
Problems and Projects At QMUL, students learn about the challenges of medical engineering through problem-based learning and industry-led projects (Figure S2). For example, take the case of Michael’s Knee (a professional footballer) who has hurt his knee. The students are given a complete case history and are told about the symptoms in detail. The students are then asked to gain information from the symptoms and suggest tests that could be used to allow accurate diagnosis of the clinical problem. Results from diagnostic tests and possible treatment options are discussed as well as rehabilitation regimes and the likelihood of the patient being able to return to professional sports. In this scenario, the patient presents classic symptoms of an acute rupture of the anterior cruciate ligament (ACL). By working through this scenario, the FIGURE S2 QMUL students in a tissue lab. students develop an understanding of the anatomy of the knee and the ACL and menisci in particular and understand how this injury can alter functions. They set out. Where a group is struggling, the facilitator should become also gain knowledge of diagnostic, treatment, and rehabilitation more proactive but in a manner that guides rather than informs. We options for patients suffering from a ruptured ACL and torn find that this is a very effective way of learning and also gives the meniscus. students skills, such as group work and report writing, which they The students are required to keep notebooks in which they will need in their careers.” record the information they have acquired and details of In the fourth year of the medical engineering degree, students experimental protocols and results. They work in groups to write work on a group design project, many of which are associated with about their findings that are presented in the form of a clinical an industrial sponsor. This is a major exercise that occupies 50% of report prepared for the chief medical officer of the player’s students’ time in the fourth year. “In the professional world, football team. engineers do not work in isolation, and therefore need to be good at “We ask the students to keep notebooks because not only does managing complex group design work,” said Knight. “Our group it document the progress of their learning, it is also something that design project offers students a challenging and realistic professionals are required to do so that an organization can assignment, helping them prepare for the real world in professional document intellectual property claims,” explains Martin Knight, engineering.” director of the Medical Engineering Degree Program at QMUL. In The examples of current and previous group design projects group sessions, the students are assisted by an academic facilitator include investigation of shock wave lithotripsy for unblocking an whose role is to guide the discussion in a manner that should allow encrusted urethral stent (sponsored by P&N Medical), the students to understand the problem and find appropriate development of an arthroscopic suturing tool for the repair of answers. “Just as in professional situations, the students appoint a shoulder tendons (sponsored by Atlantech), development of a chair to chair the meeting and a secretary who takes notes and bioreactor for cartilage tissue engineering (sponsored by Bose), distributes them to members of the group,” said Knight. “The and design of an improved ankle replacement implant facilitator is not there to provide answers, so may take an extremely (sponsored by DePuy). passive role when a group is working well and achieving the goals
in which degree courses are developed in U.K. some models of human joints. He also arranged universities. For example, until recently, Oxford a two-hour visit to the dissecting rooms of The IPEM does accredit University offered only a one-year taught masNewcastle University’s Medical School where an M.Sc. degree in ter’s program in biomedical engineering. Four students were given access to human hip and medical engineering, years ago, the Department of Engineering Sciknee joints. “The software was expensive, but but it currently ence realized that it had appointed enough facfeedback from the students has been very posdoes not accredit ulty with an interest in biomedical engineering, itive,” said Joyce. “Mechanical engineers like undergraduate and it started to offer the subject to its underto see things three-dimensional (3-D), and graduates. And in 2008, the university set up the software and joint models certainly help degrees. the Institute for Biomedical Engineering, where them grasp the subject quickly.” the research in this area is now consolidated. The bioengineering degree at Newcastle In the United Kingdom, Oxford is unique in the way it was developed because the School of Mechanical and Systems teaches engineering. All its students are taught the same core Engineering believed it to be an important and growing area subjects for the first two years, and then they have a choice of modern engineering and found it to have enough staff inof six options: mechanical, electronic, chemical, information, terested in teaching the subject. This is often the organic way SEPTEMBER/OCTOBER 2011
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Teaching Anatomy to Engineers At Newcastle University, the subject of bioengineering is taught as a module for more than two semesters to a combined group of fourth-year undergraduate students as well as postgraduate taught master’s students in the School of Mechanical and Systems Engineering. One part of this module involves the students writing an engineering critique of a commercially available design of a total joint replacement prosthesis. As such a critique needs to be founded on a full appreciation of the anatomy and function of the human joint that is being replaced; the challenge was how to facilitate student learning on the complex subject of anatomy [S1]. The module starts with a series of lectures on FIGURE S3 Students at Newcastle University learn through innovative total hip replacement and biotribology. These give software and models. appropriate background knowledge through a case study of the most common and successful type of joint replacement. After this, students are allocated an individual Scientific (Weston-super-Mare, United Kingdom) and organized project where they were asked to critique a specific design of a two-hour visit to the dissecting room of Newcastle University’s replacement joint and describe the anatomy of the relevant Medical School. Students first worked through the software natural joint. using bespoke training notes written by Joyce. He also wrote Each of these projects was intended for one of the less notes in relation to the human joint models and students commonly replaced human joints, specifically the shoulder, elbow, worked in self-selected groups to answer preset questions wrist, ankle, and various finger and toe joints. By gaining a full based on the models. understanding of the anatomy of human joints, Tom Joyce, module “I find that Web-based learning empowers the learner, enables leader, intended that his bioengineering students would individualized instruction and collaborative peer-to-peer learning, appreciate the inherent challenges of joint replacement and and transfers greater control to learners to decide when, how much, problems faced by clinicians who have to implant such devices. He and to what extent study and instruction takes place,” said Joyce. “It also explained students how artificial joint replacement can allows learners to progress at their own pace and provides the improve people’s lives and felt that the students want to learn facility for student-centered learning, making students responsible more about the subject. for their own learning.” To aid with this anatomical understanding, Joyce applied for a grant to buy dedicated anatomical software as well as models Reference of human joints and incorporated these into his teaching [S1] T. Joyce, “Non-traditional subjects taught to engineers: A case (Figure S3). The anatomical software chosen was Primal Pictures study of teaching anatomy,” in Proc. Conf. Paper Engineering Systemic edition (http://www.primalpictures.com/). He also Education, The Higher Education Academy Engineering Subject bought static and dynamic models of human joints from 3B Centre, 2010 [Online].
This lack of consensus also means that students and their civil, or biomedical engineering. “Thirty years ago, we only potential employers are concerned whether they will gain sufhad three streams,” said Stephen Payne, course director for ficient knowledge of engineering to be effective the taught M.Sc. in bioengineering at Oxford engineers and can obtain enough knowledge of University’s Engineering Sciences Department. medical topics to feel that they are gaining the “Now we have six streams and medical engi“Ensuring that sufficient exposure to clinical expertise. In many neering is very popular.” students get a good ways, the first of these considerations will be anThe subjects taught under the banner of education in both swered if students complete a degree accredited biomedical engineering include physiology, engineering and by one of the various professional institutions signal processing, image processing, tissue medical aspects is a such as the Institution for Mechanical Engineers engineering, and drug delivery. This may and the Institution of Physics and Engineering be significantly different than what other major challenge,” says in Medicine (IPEM). An accredited degree will universities teach as part of a bioengineerSandra Shefelbine. require appropriate output standards in engiing degree because the subjects depend on neering knowledge and other numerate subjects. the specialties of the staff. “We play to our The IPEM does accredit an M.Sc. degree in medical engineerstrengths,” said Payne. “Biomedical engineering, or bioening, but it currently does not accredit undergraduate degrees. gineering, is such a new area that U.K. academia has not yet However, this seems to be changing, as a spokesperson for IPEM agreed on a core of subjects that should be taught. There is told PULSE magazine: “IPEM plans to play an increasingly imno standardization, but I would be interested to see if this portant part in the accreditation of undergraduate degrees in happens in the future.” 16 IEEE PULSE
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medical physics, bioengineering, medical engineering, and biomedical engineering in the future and is seeing an increased demand for this from universities in the United Kingdom and overseas.” “Ensuring that students get a good education in both engineering and medical aspects is a major challenge,” says Sandra Shefelbine, who teaches first-year mechanics and also orthopedic biomechanics to master’s students at the Imperial College in London (Figure 1). At Imperial, undergraduate students study a range of traditional engineering as well as bioengineering modules from the start of their degree. Subjects in the first and second years include not only electrical engineering, mechanics, and mathematics but also mediFIGURE 1 Study of bioengineering at the Imperial College in London. cal sciences, cell biology, and wet laboratory skills. In their final year, the students cover a her lecture. “I find students are much more willing to answer range of topics focused specifically on bioengineering such truthfully using clickers, rather than a ‘hands-up’ voting system as imaging, modeling, biomechanics, synthetic biology, and where they are often persuaded by the majority,” she said. “The informatics. real-time feedback of student understanding was useful to me “The challenge is making sure that our students are masto gauge where I should spend more time on certain concepts. ters of something and not a ‘jack of all trades,’” says Shefelbine. Guessing the outcome of the experiment with a clicker system “Imperial is one of the few universities in the United Kingdom will encourage students to think conceptually about the physics that has a department of bioengineering and offers undergraduproblems.” ate and postgraduate degrees in the subject.” All the classes our While using wireless clickers has brought many benefits, it students take are taught in the department of bioengineering, has required Shefelbine to rethink how she delivers her lecso while we do teach the fundamentals such as mechanics, we tures and the amount of material she uses. “It is a different are able to make sure that the content is relevant to bioengineerway of lecturing, and it requires reorganization of the delivery ing,” says Shefelbine. For example, when talking about conserof the lecture,” she said. However, she does not use the clickers vation of energy, Shefelbine might look at how insects jump, when teaching master’s students as they tend or when looking at mechanics, she might look at to be in smaller groups. “Like our undergraduhow children with cerebral palsy walk. ate degrees, our master’s program has become Shefelbine enjoys teaching and was a recent To capture the increasingly popular,” says Shefelbine, who winner of the ExxonMobil Excellence in Teachimagination of is a U.S. citizen. “The number of students has ing award, which is awarded annually to innoundergraduate tripled in the last three years, and I am pleased vative educators in engineering. To capture the students and that the United Kingdom is finally catching up imagination of first-year undergraduate students with the United States where the number of and help them grasp fundamental concepts, she help them grasp bioengineering students is much higher and still uses large-scale physical demonstrations in the fundamental increasing.” lecture hall. Each demonstration illustrates a concepts, There are many differences between the different mechanics concept and has the capabilShefelbine uses United States and the United Kingdom in terms ity of projecting real-time measurements onto a large-scale physical of bioengineering education. The field is more screen for student participation. “The main cost demonstrations. mature in the United States, and the main differinvolved was the salary for a full-time mechanence is that in the United Kingdom, courses tend ics technician to help put together the demonto have an emphasis on mechanical engineerstrations and equipment required,” said Shefeling or sometimes electrical engineering. In the United States, bine. “Now the demos are shared by various departments and degree programs tend to have a strong commitment to biology are a great resource that helps the students make the connecand its related disciplines. tion between two-dimensional problems on paper (or computer Another unique feature about the United Kingdom is screen) and 3-D motion.” types of job opportunities available to graduates. Although Shefelbine is a fan of wireless clickers and uses them in all the United Kingdom has led many of the developments in the her lectures. For example, before a demonstration, students field of bioengineering, from the design of the first clinically were asked to vote anonymously on what they think will hapsuccessful hip replacement in the 1960s to the development pen. They can also be used to give instant feedback. In this of computer tomography and magnetic resonance imaging, manner, Shefelbine can assess if the students have understood SEPTEMBER/OCTOBER 2011
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there are certainly not enough jobs for all the graduates from the students study. From September 2011, all training provibioengineering degrees currently being run in the United sions, including the highly regarded IPEM training schemes, Kingdom. For example, none of the large scanner manufacwill be replaced by new arrangements for health-care scienturers have their manufacturing base in the United Kingdom, tists (corresponding approximately to the previous job title of so any graduate wanting to work in this industry will go to clinical scientists), health-care science practitioners (correcontinental Europe or the United States. Howsponding approximately to the previous job title ever, according to a report by the Royal Acadof clinical technologists), and support workers emy of Engineering [1], the number of jobs in at the assistant/associate practitioner level. A large proportion bioengineering in the United Kingdom should Although IPEM has well-established training of bioengineering increase in the next few years as small and meschemes for the professions in its sector, this is by undergraduates in dium enterprises (SMEs) and start-ups look no means the case across the NHS workforce as a the United Kingdom for multidisciplinary people. The report states: whole. Also, while the IPEM scheme was highly are from overseas and “The large companies will continue to employ regarded by the DH and produces high-quality specialists, such as mechanical engineers or trainees, it was, according to the IPEM, “permany of them will go electronic engineers who have graduated with ceived as lengthy and not financially justifiable back to their native limited biomedical knowledge. . . . however, a in the long term.” countries to work in growing number of SMEs need their employees While many in academia and industry agree the bioengineering to have a broad range of background knowlthat a change was needed, many are not happy industry. edge for two different reasons. First, due to with how the changes have been carried out. their size, they are not able to employ a range of There are concerns about the speed at which specialists. Second, and more importantly, they MSC is being implemented and inadequate disare relying on turning novel ideas and concepts into devices tribution of universities offering B.Sc. and M.Sc. courses as and implants. Hence, they need multidisciplinary people such part of MSC, requiring some students to travel long distances as medical engineering graduates.” to participate. However, the report also points out that “Medical deAs this article went to print, an announcement was expectvice, medical implant, and equipment manufacture is genered from the DH about which universities have been awarded ally a small-scale, high-value-added industry; thus, the highly the contract to deliver the master’s courses that are part of the trained graduates completing such degrees will be working in Scientist Training Program. The first intake of students will be a type of manufacturing environment for which the United in September 2011, and there are expected to be about two or Kingdom is very suitable. However, it should be noted that, at three universities offering an M.Sc. degree as part of the MSC the moment, the U.K. manufacturing base in this area is low in program. spite of the appropriateness to the U.K. public limited company In a statement issued in April 2011, the IPEM stated: “MSC (plc) and the high U.K. research activity in the area of medical means radical change for IPEM, for our members and for the engineering.” areas of health-care science for which we speak. It has also This is perhaps one of the reasons that a significant numbeen clear from the start that changes were going to take place ber of graduates who have studied bioengineering in the United and that the status quo was not an option. IPEM Council and Kingdom end up working in finance and other industries unTrustees took the view that the institution should work with related to engineering. A large proportion of bioengineering the DH teams to make sure that the outcomes are in the best undergraduates in the United Kingdom are from overseas and interests of our professions, rather than simply opposing these many of them will go back to their native countries to work in proposals.” the bioengineering industry. It is hoped that with bodies, such as the IPEM, determined Many bioengineering graduates want to work in the National to promote the area of bioengineering (and all its variants) Health Service (NHS) of the United Kingdom, which is one of the and increasing job opportunities, more undergraduates will largest employers of scientists in the United Kingdom. However, be encouraged to study the subject in the future, irrespecthe NHS’s graduate training scheme is currently undergoing a tive of the degree’s official title or in which department it is complete restructuring called modernizing scientific careers (MSC). taught. The initiative is being led by the Department of Health (DH), not by any of the professional organizations, such as the IPEM. It has Nadya Anscombe (www.nadya-anscombe.com) is a freelance been under development for several years, with the overall aim science and technology journalist living in the United Kingdom. of harmonizing training arrangements for the numerous small scientific and technical groups in the NHS and improving workReference force flexibility. [1] E. Tanner, “First degrees in medical engineering: A positive step This initiative involves devolving the training of scientists for engineering?” in United Kingdom Focus for Biomedical Engineering. and engineers to universities and changing the curricula that Royal Academy of Engineering, 2007.
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