ABSTRACT

The three year old New York Center for Biomedical Engineering (CBE) is a consortium involving faculty and staff from more than a dozen New York area institutions. The unique and innovative program in biomedical engineering that has been developed under its aegis is described. This includes curriculum, coursework and teaching method.

INTRODUCTION

Active biomedical researchers at a consortium of five institutions collaborated in the establishment of the New York regional Center for Biomedical Engineering (CBE). The five founding institutions in the CBE consortium are the City College School of Engineering (SOE) and the Graduate School of the City University of New York (CUNY), the CUNY Medical School, the Hospital for Joint Diseases of the New York University School of Medicine (HJD), the Hospital for Special Surgery (HSS) of the Cornell University Medical College (CUMC) and the Graduate School of CUMC.

The center was established in February 1994 as the result of a Whitaker "Special Opportunity" Award in Biomedical Engineering to develop an undergraduate bioengineering program. The Center developed a graduate program with support from the National Science Foundation under its Combined Research-Curriculum Development program in the Engineering Education and Centers Division of the Directorate for Engineering. The grant was entitled "Cell and Tissue Engineering Curriculum Development."

In the next section the motivation behind the development of the center is described and, in the sections that follow, the undergraduate program, the graduate program and the teaching methods are described. The final section is a summary.

BACKGROUND MOTIVATION: NATIONAL RATIONALE: ECONOMIC AND MANPOWER REQUIREMENTS

The United States is pre-eminent in biotechnology and medical device development. The national administration has identified new technology as the engine of economic growth and has pledged to sharply increase federal financing of research into so-called critical technologies, biotechnology included. This thrust should increase the manpower needs in this field into the next century, making it essential that we attract and retain the intellectual talent available in our resident population. However, we should anticipate that the development and implementation of new technologies will not only improve quality of life and the economic condition of the health-care industry, but will also increase the cost of the delivery of health care. Indeed, there could be a net economic loss to the nation by fostering these technologies willy-nilly. It is therefore incumbent upon biomedical engineers to demonstrate their professional responsibility by taking the lead in assessing the true impact of the introduction of new biomaterials and devices. The companies that will thrive in the next century are those that will introduce technological innovations that not only improve our health care but also contain or decrease its cost. The biomedical engineering professionals educated through the CBE consortium are educated broadly across engineering and scientific disciplines which gives them the breadth to prepare economic and societal impact statements in conjunction with the development of new technologies.

During the period 1990-95 our national health care bill has increased by 150%. That increase has not been due to the cost of new technology alone, but in large part can be attributed to the attitudes of people developing and using those technologies. In deciding upon the introduction of new health care technologies, biomedical engineers have generally been directed by the answers to the three questions: Is it technologically feasible? Is it safe and efficacious? and Can a profit be made selling it? We have instituted coursework to educate CBE students with a different viewpoint. Just as in other societal engineering areas such as water resources, pollution control and transportation, a systems approach must be adopted for the analysis of the total impact of new technologies and devices on health care. No longer can manufacturers enjoy the luxury of considering only whether a new product works and whether it can be sold. They must also consider the product's social, economic, and ethical impact on the health care system, indeed on society at large. We must identify the optimal solutions to our health care needs in light of their real societal costs, for those costs can no longer be passed on to society without considerable penalty.

NATIONAL RATIONALE: MINORITIES IN BIOMEDICAL ENGINEERING

The Center seeks to construct an educational pipeline from high school to the doctorate for the training of students in biomedical engineering. The beginning and middle of the pipeline has been established with the Whitaker Foundation grant. The beginning of the pipeline is the active recruitment of high school students and the middle of the pipeline is the undergraduate program. Support for the upper portion of the pipeline, the graduate program, comes from the National Science Foundation under its Combined Research-Curriculum Development program in the Engineering Education and Centers Division.

African-Americans and Hispanics comprise only 3% of the entire national graduate engineering enrollment at the Ph.D. level and, for historic reasons, mentioned below, significantly fewer pursue careers in biomedical engineering. In contrast, at the City College approximately 55% of the undergraduate and 30% of the graduate students are African-American or Hispanic. In 1996 the College was the largest source of minority engineering baccalaureates in New York State and enrolled nearly 25 percent of all such engineering undergraduates in the six state midAtlantic region. The current national output of minority biomedical engineering Ph.D.'s is less than three a year. It is thus realistic to expect that the CBE will produce a significant fraction of the African-American and Hispanic Ph.D.'s in this discipline.

INSTITUTIONAL AND REGIONAL RATIONALE

New York City enjoys the largest concentration of health care delivery services in the nation, and the health care industry is the largest, by far, and fastest growing employer in New York City (New York Times, May 25, 1993). However, prior to the creation of the CBE in 1994 there was no major diversified public training center for biomedical engineers in the New York metropolitan area. The institutions involved in the CBE do collectively what none can do individually. The Hospital for Joint Diseases has had no student base from which to draw engineering students since NYU closed the doors of its Engineering School two decades ago. The Cornell University Medical College has a potential source of engineering students at its main campus in Ithaca, but the large distances and difficult commuting arrangements have prevented a close collaboration. The SOE at the City College has major existing faculty strengths in biomedical engineering, but has not had the resources to develop a graduate training program in biomedical engineering that provides an adequate laboratory and clinical environment.

Three unique features of this consortium are (1) its unequaled potential for creating an educational pipeline for producing minority Ph.D.'s in biomedical engineering, (2) its special focus on the social and economic needs of urban communities, and (3) its institutional arrangement between public and private, educational and health care delivery components. This consortium between public and private educational institutions and health care delivery and educational components is a unique undertaking from a national perspective.

RATIONALE FOR INNOVATIVE CURRICULUM DEVELOPMENT

The CBE has constructed an innovative, interdisciplinary, interdepartmental multi-institutional core curriculum for graduate training in biomedical engineering. One chronic problem in the teaching of biomedical engineering nationally is the extraordinarily rapid development of the field and the rapid obsolescence of existing textbooks. In the CBE we have developed a methodology that employs a new combined lecture and seminar teaching approach in which the "classical" course material is covered in the lecture format and the "modem" material or current research is covered in the seminar format employing student reviews of specialized research areas based upon recent research papers. This methodology is intended to maximize student participation in the classroom, library research and independent study. The intent is to produce a resourceful bioengineer, one who is comfortable with interdisciplinary collaborative work relationships and is more proficient in writing about and expressing diverse technical ideas.

CBE UNDERGRADUATE PROGRAM: THE BIOMEDICAL ENGINEERING CONCENTRATION

The Biomedical Engineering Concentration consists of seven cross-disciplinary courses of which students will be asked to select five courses. Engineering undergraduate students in chemical, electrical and mechanical engineering may take these courses and, upon completion of the Concentration, they obtain a Certificate in Biomedical Engineering in addition to their engineering degree in chemical, electrical or mechanical engineering. The option is five courses or 15 credits, only 9 credits of which will need to be taken from existing engineering elective course requirements. Three of the credits could be a Math and Science requirement and three of the credits could be a Liberal Arts requirement. Each course carries 3 credits and meets for 3 hours per week. The undergraduate courses with engineering emphasis, of which the students must take three, are Cell and Tissue Mechanics, Cell and Tissue Transport, Cell and Tissue material Interaction, Biomedical Signal Processing and Instrumentation, and Biomedical Image Processing. In addition the students must take a biology course entitled Cell and Tissue Systems Physiology for Biomedical Engineers, and a liberal arts/social studies course entitled Social, Economic and Cultural Impact of Biomedical Technology. The course on the social, economic and cultural impact of biomedical technology is very innovative and has been well received. It is described in greater detail in the following paragraph.

SOCIAL, ECONOMIC AND CULTURAL IMPACT OF BIOMEDICAL TECHNOLOGY

One of the most interesting and unique courses in the undergraduate Biomedical Engineering Option, according to the students taking the course, was the course on Social, Economic and Cultural Impact of Biomedical Technology taught by George Brandon of the CUNY Medical School. This course has two main themes, the interaction between biomedical technology and the societies in which it has evolved, and the anticipation and assessment of the impact of biomedical technology in the context of urban minority health needs.

The course was divided into three parts, two of them didactic and one practical. Part I was concerned with the history and growth of medical technology and the impact of biomedical technology on the structure and functioning of modern health care delivery systems. Part I also surveyed the economic, cultural and social factors affecting the spread and adoption of biomedical innovations; and the legal, ethical, sociocultural and psychological issues raised by specific biomedical technologies .

Part II covered issues related to the assessment and evaluation of biomedical technology, culminating in a summary of major social and ethical issues facing both the designers and the users of biomedical technology in the contemporary urban context.

While a good part of the course consisted of lectures from the instructors there were three departures from academic routines. Firstly, there were a number of guest lecturers, each of which brought a different expertise and perspective on the socioeconomic and cultural issues raised by biomedical technology. The speakers consisted of an anthropologist who had done field research on amniocentesis, genetics laboratories and genetic counseling; a philosopher concerned with the ethical obligations of the producers of defective heart valves and how they deal with them; a lawyer who was litigating a class action suit of silicon breast implants spoke on the legal issues of product liability; a radiologist speaking on the use and misuse of medical imaging technologies and the psychological and economic factors driving medical investment in them; two biomedical engineers, one speaking about the social and economic factors affecting the development of biomaterials and the second discussing the growth of assistive technology and the group process through which it is developed. Secondly, use was made of the distinctive pedagogical style of the Center which involved active participation of the students in a seminar like format during the recitation session scheduled once a week to complement the lectures. In these recitation sessions, students made presentations and discussed readings researched and selected by them concerning subjects covered in the lectures. The third departure was the term projects which composed the last part of the course and in which students worked in small groups. These were design teams which worked on their own. Lectures were suspended during this part of the course but the instructor was available to meet with students during the usual lecture time if needed.

Part III were group projects, proposed by students, which were to culminate in: 1) a prospective social/cultural/economic impact evaluation for a specific technology or device; 2) a similar kind of evaluation of a biomedical technology, device, system or procedure already in place; 3) a simulation of a system or variables affecting the usefulness or impact of a proposed devise, procedure or system.

Two projects came from last year's class. The first one was on the possible uses and impact of developing video conferencing for emergency rooms, surgery and long distance consultations. The second was concerned with evaluating and developing devices for artificial vision for the blind. In each case students looked not only at the technical challenges, costs of research development, and production but also at problems of access, the psychological and social issues affecting patients and health personnel.

This course was very well received by the students, all of whom put a lot of effort into their work including facing up to new and unfamiliar academic challenges such as the seminar format, and oral presentations. Students were especially gratified by the term projects and by having the opportunity to present the results of their work before their peers. For five of the six students enrolled in the course on Social, Economic and Cultural Impact of Biomedical Technology, it constituted their first exposure to the world of bioengineering. Five of the students were from mechanical engineering and one from chemical engineering.

Two concerns for the future: the seminar/recitation format and the students' responsibility it entails are not familiar experiences for these undergraduate students and there needs to be a way to facilitate this. Language comprehension is an important issue for some students in this course who otherwise might have less trouble in courses which are less word oriented as opposed to geometrical, mathematical or chemical symbolism.

UNDERGRADUATE HOSPITAL LABORATORY EXPERIENCES

The rationale underlying the laboratory experience is that the intense medical environment of a teaching hospital is an ideal place to supplement the basic education of bioengineers with practical experience and to expose them to "real-life" situations of the sort that will characterize their future careers. In the undergraduate program, each student is assigned a project from ongoing research activities, including projects involving cartilage repair, spinal fixation, fracture repair, physical chemistry of biomineralization, implant analysis, and function design and ergonomics in the workplace. Fellows work in concert with and under the tutelage of Department faculty members.

In addition, students attend Bioengineering Research Meetings and Seminars. At weekly Research Meetings, Department staff and faculty typically report on recent work and gain valuable feedback from colleagues; during the summer, each student is required to prepare one such full presentation. In addition, a special series of weekly Seminars feature talks by Hospital faculty and distinguished outside guests. These lectures address such issues as health care economics, medical device regulation, and liability and ethics issues, as well as include instructional presentations on laboratory practices, oral presentation technique, report and paper writing, and slide making. The program concludes with summary presentations by each Fellow and the submission of a final report.

CBE GRADUATE PROGRAM: RESEARCH BASIS FOR THE GRADUATE COURSES

The curriculum development activities accomplished have been built upon the significant research strengths of the five institutions involved. A unique feature of this effort has been the commitment of distinguished researchers to the transfer of knowledge and skills to the students in the bioengineering core courses and in their laboratory contacts. The research expertise of the biomedical researchers in the consortium lies in biomaterials, biomechanics, biotransport and imaging and in the practical expertise of instrumentation and signal processing.

In technical areas associated with several of the proposed courses the researchers involved in this grant have provided some of the most important new developments in their respective fields. These developments are not yet part of existing texts.

DEVELOPMENT OF THE FIVE GRADUATE COURSES

Five courses of an interdisciplinary and interinstitutional (based at the City College) core program on cell and tissue engineering were developed. These five courses are at the first year graduate level and enabled students to obtain the Ph.D. degree in a traditional engineering discipline with biomedical engineering emphasis. The five course set includes cell and Tissue material interaction, cell and tissue mechanics, cell and tissue transport, cell and tissue imaging and cell and tissue signal processing and instrumentation. In addition to these five courses, the students take the physiology course with the medical students at CUMC.

THE TEACHING METHOD

The direction of biomedical engineering for the 21 st century requires a new approach to course development. In the past, biomedical engineering programs have used the classical fields of engineering as a basis, most notably mechanical, electrical and chemical engineering. The programs developed courses in biomedical engineering in which theoretical and experimental engineering tools were applied to study problems in medicine. These courses were almost exclusively taught by engineering faculty, were in the classical areas of biomedical engineering best suited to engineering faculty (e.g., rehabilitation, electrophysiology, tissue imaging, biosensors, cardiovascular mechanics, implant design, clinical evaluation) and rarely involved faculty from outside the engineering departments. Thus faculty from key areas such as biochemistry, anatomy, molecular biology and immunology were not included. As evident from the newer fields of molecular biology and bioprocessing, the 21st century will bring forth new concepts and methodologies for treating disease processes never before realized. This approach will use the new areas of cellular and tissue engineering to control biological function at the cell level and to restructure and repair damaged or injured organs at the tissue level. The biomedical engineer in the 21 st century will have to work with a multidisciplinary team comprised of biomedical, electrical and chemical engineers, basic medical science people (particularly physiologists and molecular cell biologists) and physicians. More importantly, the biomedical engineer of the 21st century will have to work on problems at the cellular and tissue level to understand such phenomena as the intrinsic and intricate interactions between mechanical stimuli and biological response.

Traditionally engineering has been taught in a lecture format in which the faculty member is the dispenser of knowledge and determines the questions; the student assumes a relatively passive role in the classroom. This format has limitations as an educational experience. Students do not have the opportunity to develop adequately the research tools and critical thinking and communication skills that are crucial in interdisciplinary technological areas which are rapidly changing, where text books are quickly outdated and "classical" material may be only 20-30 years old. In these areas, students need to become adept at locating source materials, reading in different fields, asking the right questions, seeing knowledge from different perspectives and discussing it with peers in a setting where it may be less important to be right initially than to articulate the ideas that lead to group solutions. To facilitate both mastery of this information and these critical skills, an innovative approach has been introduced in the teaching of the biomedical engineering courses.

Each course is divided into a lecture format portion and a seminar format portion. These two course portions have fundamentally different objectives. The lecture format portion is intended to provide a concise conceptual overview of the classical material in each theme and basic background for the seminar part of the course, which will be presented by the students. A set of classroom notes covering the well established material was prepared for circulation to the students and supplemented by BOARDs. BOARD is an acronym for Background/Overview Article on Research Developments. BOARDs will have as their objective the description of the state of research in a specific area of biomedical engineering. The expositions are accomplished in a prose that is rigorous, concise, with an emphasis on mechanism and description of the background upon which the current research is founded. The models for these documents are the Bioengineering Science News articles that appear in the Biomedical Engineering Society newsletter. In the seminar format portion each student is responsible for presenting one, and perhaps, two topics. When the first BOARD is presented in class the faculty member shows, using as an example a paper cited in the BOARD, how to read and critically evaluate a scientific paper. The concept of scholarship, the method of researching a topic and the preparation of a scholarly article are described. The concept of plagiarism is discussed and methods of citation are described. The objective of this presentation is to aid the students in the preparation of their Review Of A Specific Topic (ROAST). ROASTs will have as their objective the description of the state of research in a highly focused and narrow area of biomedical engineering and are prepared by one to three students. The students are expected to perform a literature search to locate relevant papers on each topic and then to select what they believe to be the critical papers in the area after some initial reading. These student seminars are often enhanced by a research lecture series by consortium participants whose scheduling will be coordinated with topics covered in the course.

An important feature of the seminar format portion of the classroom learning process is the interaction of the presenting student with other students in the class and the role of the faculty member in guiding discussion. Two basic features of the seminar format are used: (i) the student or students make the basic presentation based on background reading and (ii) the student or students are assigned the task of formulating provocative questions to lead the class discussion on the essential ideas that highlight the report. The end-of-the-semester presentation may be an individual or a group effort with several students collaborating on a given theme which is then viewed from different perspectives. The instructor emphasizes critical evaluation and integration of the literature.

This type of seminar format is seldom followed in engineering courses since the material is more structured, basic texts exist and the student is assumed not to have the background or experience to "properly" present the topic. We have found that biomedical engineering naturally lends itself to a modified version of the seminar format because of its interdisciplinary nature, which allows examination of a problem from different perspectives, the important emphasis on experimental research in the life sciences and the descriptive nature of many research papers whose content can at least be understood by students with limited knowledge of the field.

Each group of topics in a course has a central theme covered by a BOARD. Students in a given theme are encouraged to work collectively as a research team in consultation with the faculty member and to discuss their topics with one another. In addition to an oral presentation, each student is a member of a team of one to three people responsible for preparing a ROAST. Every student is also responsible for formulating critical questions for class discussion. Grades are based on the student's ROAST contribution and an exam in which questions are randomly drawn from the entire pool of student questions that have been prepared as part of the student oral presentations. The research materials upon which the proposed courses are based is rapidly changing and not amenable for codification in a textbook format because of their rapidly dated nature. The BOARDs and selected ROASTs for each course are available at our web site. (http://www-me.engr.ccny.cuny.edu/CBE/).

We have sought to establish national educational models that are distinct in several ways. First, for education in a central urban setting the program demonstrates that far more could be achieved by using the resources available through multi-institutional cooperation as opposed to relying on a single institution. Second, our courses are a national model for the integration of recent research results into classroom presentations. Third, our biomedical engineering courses show how response at the cellular and the tissue levels may be integrated into a single course. Fourth, we will have increased the number of engineering Ph.D.'s with special expertise in biomedical engineering and, given the make-up of our student pool, increased the participation of underrepresented minorities in biomedical engineering.

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