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Advan. Physiol. Edu. 33: 91-97, 2009; doi:10.1152/advan.90120.2008
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ADV PHYSIOL EDUC 33:91-97, 2009
© 2009 American Physiological Society

HOW WE TEACH

Effects of unique biomedical education programs for engineers: REDEEM and ESTEEM projects

Noriaki Matsuki1,2, Motohiro Takeda1, Masahiro Yamano1, Yohsuke Imai1, Takuji Ishikawa1 and Takami Yamaguchi1

1 Department of Bioengineering and Robotics, Tohoku University, Sendai, Japan 2 New Industry Creation Hatchery Center, Tohoku University, Sendai, Japan

Address for reprint requests and other correspondence: N. Matsuki, Tohoku Univ., 6-6-01, Aoba, Aramaki, Aoba-ku, Sendai 980-8579, Japan (e-mail: matsuki{at}pfsl.mech.tohoku.ac.jp)


   Abstract
TOP
 Abstract
Introduction
 METHODS
 RESULTS AND DISCUSSION
 GRANTS
 REFERENCES
 
Current engineering applications in the medical arena are extremely progressive. However, it is rather difficult for medical doctors and engineers to discuss issues because they do not always understand one another's jargon or ways of thinking. Ideally, medical engineers should become acquainted with medicine, and engineers should be able to understand how medical doctors think. Tohoku University in Japan has managed a number of unique reeducation programs for working engineers. Recurrent Education for the Development of Engineering Enhanced Medicine has been offered as a basic learning course since 2004, and Education through Synergetic Training for Engineering Enhanced Medicine has been offered as an advanced learning course since 2006. These programs, which were developed especially for engineers, consist of interactive, modular, and disease-based lectures (case studies) and substantial laboratory work. As a result of taking these courses, all students obtained better objective outcomes, on tests, and subjective outcomes, through student satisfaction. In this article, we report on our unique biomedical education programs for engineers and their effects on working engineers.

Key words: problem-based learning; case study; Recurrent Education for the Development of Engineering Enhanced Medicine; Education through Synergetic Training for Engineering Enhanced Medicine


   Introduction
TOP
 Abstract
 Introduction
METHODS
 RESULTS AND DISCUSSION
 GRANTS
 REFERENCES
 
CURRENT ENGINEERING APPLICATIONS in the medical arena are extremely progressive. To develop new technology in the medical arena, it is important to train personnel in the knowledge of both medicine and engineering (7, 10). However, it is rather difficult for medical doctors (MDs) and engineers to discuss issues because they do not always understand one another's jargon or ways of thinking. Although medical science has been advancing rapidly, most of these advances have been based on the engineering technologies of other sciences. Applying current engineering technology to medicine could advance the field much more quickly. To encourage the development of current technologies, biomedical engineers should actively cultivate the medical arena. Ideally, medical engineers should become acquainted with medicine and current engineering (11). To this end, Tohoku University in Japan has managed a number of unique reeducation programs for working engineers. Recurrent Education for the Development of Engineering Enhanced Medicine (REDEEM) has been offered as a basic learning course since 2004, and Education through Synergetic Training for Engineering Enhanced Medicine (ESTEEM) has been offered as an advanced learning course since 2007 (Fig. 1).


Figure 1
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  		Fig. 1. Concepts of Recurrent Education for the Development of Engineering Enhanced Medicine (REDEEM) and Education through Synergetic Training for Engineering Enhanced Medicine (ESTEEM) courses.

 
The major communication issues between MDs and engineers derive from their formation, educational background, and forma mentis. The MDs' approach to a given problem is heavily influenced by their "field" experience and their knowledge. While experience is a vital ingredient in the bioscience field, especially when safety is concerned, it can also prove a limiting factor to the pace at which innovation develops, in that a very conservative approach is usually adopted. In addition, because of their education, MDs tend to privilege the more familiar biological perspective to a given problem, and this kind of inclination denies the multidisciplinary approach required nowadays in bioengineering. On the other hand, engineers tend to think purely in technical terms because of their lacunate medical knowledge. As a result, a knowledge gap originates a communication problem between the two branches of science, engineering and medicine, which needs to be bridged if true technological innovation is to be achieved in bioengineering applications.

One of the most revealing examples of the necessity to fill the gap between engineers and MDs is represented by the development of new clinical devices. Engineers will try to improve the current technology often at the expense of ease of use because they have little appreciation of clinical medicine and have no field experience. On the other hand, MDs often complain about the difficulty of using new devices rather then providing useful (and vital!) feedback to the engineers because, due to their lack of a proper grasp of technology, they privilege ease of use at the expense of innovation. A knowledge gap translates into an innovation-impairing communication gap, which education programs such as REDEEM and ESTEEM can help to alleviate, if not entirely remove. So, it is our view that programs like REDEEM and ESTEEM are becoming a necessity in biomedical science. It is paramount that engineers and MDs communicate effectively, and that can only be achieved with a knowledge common ground.

The purpose of REDEEM is to train medical engineers to understand the ways in which MDs and scientists think. Students in this course are engineers who are involved with biomedical science or who want to study it.

The curriculum has two goals. The first is to cover a broad range of topics from basic biology to clinical medicine, social medicine, and biomedical engineering (Fig. 2, A and B). The second is to use three different learning systems to provide opportunities to systematically study biomedical engineering, from the basics to the higher levels. These three learning systems can be outlined as follows:

  1. Lectures: explaining ideas in such a way that it makes it easy to understand the basics of biology, clinical medicine, social medicine, and medical engineering.
  2. Laboratory work: deepening and refining knowledge through experiments using biological techniques.
  3. E-learning: self-confirming acquired knowledge and experience.


Figure 2
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  		Fig. 2. A: REDEEM curriculum. B: number of classes taught within REDEEM. One class is 1.5 h. a, Lectures; b, laboratory work.

 
Engineers can use this unique curriculum to learn new ways of thinking about medicine and biology.

In contrast to REDEEM, ESTEEM is an advanced course. The objectives of this curriculum are to explain the ways in which MDs think and to create synergy between the business community and academia by breaking the barriers between them (Fig. 3). The curriculum includes advanced clinical medicine, specifically surgery, for engineers (Fig. 4, A and B). Lectures are ground breaking in that MDs present and discuss their clinical cases in the format of a clinicopathological conference, with students joining in the discussion as engineers. Students can ask the MDs various questions and share ideas or comments. Through such discussion, students come to understand some of the the ways in which MDs think. The laboratory work is also unique in that it consists of clinical diagnostic and therapeutic work. Students understand the meaning of various surgeries, how to make a diagnosis, and the use of surgical techniques as therapies. After the course, they are certificated by a committee of the university and are supposed to act as mentors at their companies for university interns. Experienced engineers with greater knowledge and technological expertise can create and direct new medical engineering business.


Figure 3
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  		Fig. 3. Concept of ESTEEM: ESTEEM works as a synergy between the business community and academia, like Na+-K+-ATPase in a cell membrane.

 

Figure 4
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  		Fig. 4. A: ESTEEM curriculum. B: number of classes taught within ESTEEM. One class is 1.5 h. a, Lectures; b, laboratory work.

 
Collaboration between medicine and engineering is advancing in the world of business, but there are few forums available for producing mutual understanding and still fewer for working engineers to acquire a biomedical education. Thus, we developed REDEEM and ESTEEM, two unique biomedical education programs for engineers. The reason why these education programs are aimed at engineers and not at MDs is essentially due to the different speeds at which technology, on the one hand, and biology and medicine, on the other hand, are developing. It can be very hard to educate MDs, who have a poor technical knowledge, in engineering so that they can understand benefits from it and all the underlying technical issues. This is mainly because engineering is an extremely broad field, and advances in technology are very quick and diverse. Instead, it is our opinion that it is comparatively easier to educate engineers in biology and medicine in a profitable way. For the reasons above, we offer our programs to engineers and not to MDs. The unique, key strength of our programs is that they cover a broad range of topics, from basic biology to clinical medicine. In particular, discussion programs between MDs and engineers revolve around real case studies, and, to the best of our knowledge, this is a unique feature of the programs in the world. In this article, we report on these programs and discuss their effects on working engineers.


   METHODS
TOP
 Abstract
 Introduction
 METHODS
RESULTS AND DISCUSSION
 GRANTS
 REFERENCES
 
The REDEEM and ESTEEM programs are intensive courses and run for 2 and 4 wk, respectively. The total number of hours and their composition are as follows: REDEEM, total of 40 h divided into 20 h for laboratory activities and 20 h for lectures and problem-based learning (PBL); and ESTEEM, total of 60 h divided into 20 h for laboratory activities and 40 h for lectures and PBL/case discussions.

To deepen the effects of the lectures, we undergo laboratory activities, including anatomic dissection of rabbits, Langendorf experiments for cardiac physiology and pharmacology, and DNA preparation. These two projects are financially supported by the Ministry of Education, Culture, Sports, Science and Technology and the Ministry of Economy, Trade and Industry of Japan. Students without a college-level exposure in the field of life science or medicine were selected. The attendance rates of both intensive courses were 100%, respectively.

REDEEM course. In all, 41 students took the intensive REDEEM course in 2005–2006. All were engineers. Of the 41 students, 55% worked for private companies and 24% for researchers at universities. A total of 82% of the students were male and 18% were female. With regard to age, 72% of the students were in their 20s or 30s and 19% were in their 40s. As for academic background, 45% of the students had master's degrees, 31% had bachelor's degrees, and 24% had doctorates.

ESTEEM course. In all, 20 students took the intensive ESTEEM course in 2007. Of the 20 students, 60% worked for private companies and 25% for researchers in academia. A total of the students 85% were male and 15% were female. With regard to age, 35% of the students were in their 20s and 30s and 45% were in their 40s. As for academic background, 30% of the students had master's degrees, 40% had bachelor's degrees, and 25% had doctorates.

Examinations. All students took a multiple-choice test before the first lecture to test their knowledge of biomedicine and clinical medicine; students answered the same questions after the final lecture to test the effect of the course. In REDEEM, the basic science part (cell biology, molecular biology, and anatomy/physiology) of the test was composed of 10 questions, each of equal value, for a maximum score of 10/10; in the clinical medicine section (internal medicine and surgery), the number of questions was 21, again with identical value, giving a maximum score of 21/21. In ESTEEM, the clinical medicine test (cardiology and gastroenterology) was composed of 10 questions of identical value, giving a maximum score 10/10.

In the practical experiments, students have to answer specific questions regarding the particular experiment at various stages during the work. This helps the students to understand how to treat cells, animals, and DNA through practical experience. In ESTEEM, engineers actually operate on pigs according to advice given by MDs, e.g., laparoscopic cholecystectomy and colon dissection. We don't have any exams in clinical laboratory works; the constant monitoring of the progress through the exercises mentioned above is the most important work to achieve our goals, i.e., to understand how MDs think and what MDs do.

Statistics. All data in this article are presented as means ± SE. To evaluate the effects of the education programs, we analyzed the scores of the pre- and posttests using Wilcoxon's signed rank test for REDEEM and ESTEEM, respectively. We defined a statistically significant difference as P < 0.05.


   RESULTS AND DISCUSSION
TOP
 Abstract
 Introduction
 METHODS
 RESULTS AND DISCUSSION
GRANTS
 REFERENCES
 
Many Japanese engineers working for private companies, and researchers at universities were interested in taking the REDEEM and ESTEEM courses as well as studying biomedicine. Our programs attracted young engineers, in particular, and those with master's and doctoral degrees. This might have been so because they have few other opportunities to learn about biology or medical science in Japan.

The most important points of our programs were focused on the issues of whether students could obtain better outcomes and feel satisfied with the courses. Therefore, it was important to cater to engineers when developing the programs (4). In the end, we developed two unique, interactive biomedical educational systems (REDEEM and ESTEEM) for engineers, with five specific components.

Component 1: modular lecture. Modular lectures are beneficial for working people because they tend to produce maximum benefit by making full use of the students' limited time. Most of our students attended all classes. In cases where a student was absent from a class, he or she could easily catch up because each class constituted a self-contained topic (8). Students could select classes according to their goals and purposes in ESTEEM, although it was difficult to develop optional classes because knowledge of basic biomedical sciences such as cell biology, molecular biology, and anatomy/physiology is indispensable to the understanding of medicine and the human body. Thus, those classes were designated as mandatory.

Component 2: disease-based lecture (learning). Theoretical education tends to be boring, especially for engineers, who tend to try to understand the theory of a phenomenon through application. Because engineers are familiar with applying knowledge to solve real-world problems through experimentation or product development, it may be easier for them to learn, especially about theory, through concrete cases. With this in mind, we developed disease-based lectures. The concept of the lecture was to learn a biomedical science through the disease as an application. The lectures were conducted as follows: 1) introduction of the disease; 2) explanation of the relevant basic biomedical background; 3) explanation of the etiology; and 4) presentation of other relevant matters, such as clinical problems. Students learned about the mechanisms of the disease and the basic biomedical science underlying the disease; they reported that the context not only provided interest and motivation but helped them connect the basic science back to their own areas of study (8, 9).

Component 3: case study. ESTEEM is for advanced-level students, and its main purpose was to explain the ways in which MDs think. It is unique in the world because we have a special clinical education program based on real case studies, which are discussed between MDs and engineers. Lectures were conducted in a unique way: a surgical specialist presented a clinical case, and two other MDs discussed it as if it were a clinicopathological conference; students joined in the discussion as engineers. During the discussion, the doctors tried to explain the mechanisms of the disease, through relevant basic biomedical science, and clinical issues, from the diagnosis to the therapy and prognosis.

Case studies (case-based learning), which constitute a method of PBL, are one of the most effective education strategies for medical staff (2, 3). Various education programs have adopted PBL as a form of educational best practice (1, 5, 12, 14, 17); in our programs, this method provided engineers with the opportunity to develop the critical-thinking and problem-solving skills of doctors in a controlled environment. The presenting doctor, as the case author or a designee, led the discussion, but they were directed not to lecture. Until these programs were implemented, it had been nearly impossible for ordinary engineers who were not medical staff to hear, in a MD's own words, how he or she had thought about and treated a patient. During the discussion, students freely asked the doctors various questions and shared ideas or comments as engineers. Students came to understand the ways in which MDs think and treat the human body. A format in which MDs and engineers discuss the same issues constitutes a ground-breaking move and could lead to better mutual understanding.

Component 4: laboratory work. Laboratory work is a useful practical educational method that presents a practical example in relation to a specific theory or body of knowledge. As engineers tend to try to understand the theoretical mechanisms of a phenomenon through concrete examples, laboratory work is crucial for their learning. In REDEEM, laboratory work consisted of 1) cell biology (cell culture and plasmid transfection); 2) molecular biology [in vivo sample extraction (rat), DNA manipulation, and PCR]; 3) anatomy [histological staining, observation by microscopy, and animal anatomy (rabbit)]; and 4) physiology (Langendorff experiments). Through this laboratory work, students understood how to treat animals and perform biomedical experiments; they also learned the theories and facts of basic biomedical science. However, the program may need to add microbiology and pharmacology courses before it can be considered complete. In contrast, ESTEEM focused on clinical medicine. It consisted of 1) diagnosis [measurement (blood pressure, electrocardiograph, and respiratory function by spirometer) and auscultation] and 2) therapy [intravenous injection, minor surgery (enucleation of subcutaneous lipoma), and major surgery with a pig (laparoscopic cholecystectomy and ileoileostomy)]. Although students performed therapeutic work using models and animals, this format was ground breaking in that engineers who were not medical staff experienced medical practice. This trial was a great success because all ESTEEM students stated that they were satisfied or extremely satisfied after completing the laboratory work. The program that received the top rating was laparoscopic cholecystectomy and ileoileostomy on a pig under general anesthesia.

Component 5: pre- and posttests. The effects of our lectures were significantly reflected in students' test results. However, these effects might have been due not only to the lectures but also to the fact that the pretest may have indicated to students the essential points to study in advance, thus making it easier for them to understand the content of the lectures. The pre-/posttest method can be useful not only for determining the content of lectures but also for judging the effects of learning. The valid, reliable, and common method of testing knowledge is through a test, which in our case was multiple choice (Table 1) (16). However, the level of difficulty depends on the tutor. Hence, it is necessary to develop standardized questions for each subject. We had difficulty evaluating the effects of our programs with the tests. There have been many reports of the evaluation of the effects of biomedical education programs in various areas (6, 15, 18). We should evaluate not only the knowledge but also the thinking process involved, among other things. PBL tutorial assessment is helpful, but working people do not have the time to devote to the complete PBL method. We expect to deepen mutual understanding between engineers and MDs through our program and collaborative work.


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  		Table 1. Pre- and posttest sample questions

 
As for the effects of these courses, posttest score means were significantly higher than pretest score means in every subject (P < 0.003 by Wilcoxon's signed rank test; Figs. 5, A–E, and 6, A and B). These results correspond to past reports (6, 15) that have indicated that interactive lectures are an educational best practice. Interactive lectures boost students' motivation, interest, attention, and active participation and lead to increased satisfaction and better learning outcomes. As most of the students in our courses also worked, they were originally very active in the study of biomedical sciences.


Figure 5
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  		Fig. 5. REDEEM pre- and posttest scores. A: cell biology (n = 36); B: molecular biology (n = 36); C: anatomy/physiology (n = 35); D: internal medicine (n = 38); E: surgery (n = 38). All data are means ± SE. *P < 0.01 vs. pretest scores.

 

Figure 6
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  		Fig. 6. ESTEEM pre- and posttest scores.A: cardiology (n = 18); B: gastroenterology (n = 18). All data are means ± SE. *P < 0.01 vs. pretest scores.

 
In basic sciences, the mean test score for anatomy/physiology (7.7 ± 0.2) was significantly higher than that for cell biology (4.0 ± 0.3) and molecular biology (3.7 ± 0.4, P < 0.0001, by one-way factorial ANOVA and Scheffé test). This suggests either that the levels of difficulty were different for each test or that cell biology and molecular biology were more difficult for students to understand from the micro model compared with anatomy/physiology, which may have been easier to understand from the macro model. In any case, students achieved almost identical improvements on every posttest in basic science, which were not statistically different. This suggests that students understood the difficult subject matter better after the lecture. In clinical medicine, the mean test score for internal medicine (10.9 ± 0.5) was significantly higher than that for surgery (6.7 ± 0.4) in REDEEM (P < 0.005 by Mann-Whitney U-test). Compared with internal medicine, which was easy to understand as a logical diagnosis, surgery may have been relatively difficult for students to understand as an applied therapy. In ESTEEM, there were no significant differences in mean pretest scores between cardiology (3.1 ± 0.4) and gastroenterology (3.5 ± 0.5). Students obtained better outcomes in both subjects after the lectures.

All students answered "satisfied" on a comprehensive evaluation of our programs and showed better outcomes on tests. This objectively and subjectively shows that REDEEM and ESTEEM are effective biomedical education programs for working engineers. After taking these two courses, students could understand how MDs think about and treat humans; they also learned how they, as engineers, could use this knowledge and technology to develop medical instruments. In fact, some alumni who belong to medical device companies commented that they became more familiar in their understanding of what MDs thought and requested about the device improvements. They could also create and direct new medical engineering businesses. For this, continuing biomedical education is crucial (13).

Conclusions. When developing a biomedical education program for engineers, it is very important to keep in mind engineers' tendency to try to understand theoretical mechanisms through concrete examples. Tohoku University has developed two unique biomedical education programs for engineers, REDEEM and ESTEEM. As a result of taking these courses, all students obtained better outcomes objectively, on tests, and subjectively, through a measure of their satisfaction. Interactive, modular, and disease-based lectures or case studies are effective educational strategies, and laboratory work is crucial. Pre- and posttests can be helpful not only in evaluating students' achievements but also in enhancing the effects of lectures or learning.


   GRANTS
TOP
 Abstract
 Introduction
 METHODS
 RESULTS AND DISCUSSION
 GRANTS
REFERENCES
 
The REDEEM project is supported by Special Coordination Funds for Promoting Science and Technology of the Ministry of Education, Culture, Sports, Science and Technology of Japan. The ESTEEM project is supported by a fund of Industry-University-Government Program to Foster and Strengthen Core Workforce for Manufacturing of the Ministry of Economy, Trade and Industry of Japan.

Received for publication March 17, 2008. Accepted for publication February 12, 2009.


   REFERENCES
TOP
 Abstract
 Introduction
 METHODS
 RESULTS AND DISCUSSION
 GRANTS
 REFERENCES
 

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