coração

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-
pfd@pobox.upenn.edu portance of engineering knowledge, research, and design
276
0090-6964/06/0200-0276/0 C 2006 Biomedical Engineering Society

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. 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. 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. 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. 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
http://www.upenn.edu/almanac/v42/n13/agenda.html
2
We are most grateful for the superb commitment of the BlackboardTM website: http://company.blackboard.com
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: http://www.med.upenn.edu/ime
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 http://www.seas.upenn.edu/be