134
IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING, VOL.
BME-22,
NO.
2,
MARCH 1975
Function of a Hospital Biomedical Engineering Internship Program
Organization ROBERT A. PEURA,
and
MEMBER, IEEE, JOHN MEMBER, IEEE, WALTER G.
R. BOYD, MEMBER, IEEE, ALBERT SHAHNARIAN, DRISCOLL, AND H. BROWNELL WHEELER
Abstract-This paper describes the development of an internship program between St. Vincent Hospital (SVH), a large commnunity teaching hospital, and Worcester Polytechnic Institute (WPI), a school of engineering. The primary objective of the internship program is the education of the student through problem solving in the hospital environment under close faculty-physician supervision. WPI receives an expanded educational base, and SVH receives a diversified base of technical assistance. During the last three years of operation 70 students, 12 faculty, and 15 hospital project advisors have worked together on 29 different student projects. The organization and operation of the internship program are presented, and the essential features leading to its success are analyzed.
INTRODUCTION IN MANY PROFESSIONS a period is normally set aside in which a student undergoes practical training under the supervision of a senior member of the profession prior to assuming full job responsibility. This process has been long accepted in the training of law clerks, medical interns, etc. Biomedical engineers in growing numbers are needed to work in the clinical environment, whereas a few years ago they were trained almost exclusively as independent research investigators [1]. In a recent survey of the engineering schools in the U.S., it was found that approximately 20 percent of the programs have either a required or optional internship or residency program with a hospital [2]. This paper outlines the organization and function of a successful internship program and may be of particular interest to institutions involved in the education of biomedical engineers.
PARTICIPATING INSTITUTIONS Worcester Polytechnic Institute WPI is the third oldest independent technical college in the United States and has an enrollment of 2,100 underManuscript received July 17, 1974; revised October 13, 1974. This program was supported in part by National Science Foundation Grant GY-9353. R. A. Peura is with the Department of Electrical Engineering and Life Sciences, Biomedical Engineering Program, Worcester Polytechnic Institute, Worcester, Mass., and the WPI-SVH Internship Program, St. Vincent Hospital, Worcester, Mass. 01610. J. R. Boyd is with the WPI-SVH Internship Program, St. Vincent Hospital, Worcester, Mass. 01610. A. Shahnarian is with Worcester Polytechnic Institute, Worcester, Mass., and the WPI-SVH Internship Program, St. Vincent Hospital, Worcester, Mass. 01610. W. G. Driscoll is with Facilities Development and the Department of Biomedical Engineering, St. Vincent Hospital, Worcester, Mass., and the WPI-SVH Internship Program, St. Vincent Hospital, Worcester, Mass. 01610. H. B. Wheeler is with St. Vincent Hospital, Worcester, Mass. 01610, and the Department of Surgery, University of Massachusetts Medical School, Worcester, Mass.
STUDENT
graduates and 550 graduate students. In 1971 an innovative approach to undergraduate engineering education, the WPI Plan, was adopted by the faculty. The B.S. degree is awarded on the basis of demonstrated competence, rather than on the basis of the traditional accumulation of academic credits. Each student works with a faculty advisor to design a program appropriate to his own needs and goals. The degree is awarded to the student when he has successfully demonstrated competence by the completion of four degree requirements: a Major Qualifying Project in his major technical field of study, an Interactive Qualifying Project emphasizing interactions among technology and human need, a minor in the humanities, and a competency examination in his major field. A recent monograph gives a comprehensive view of the operations of the WPI Plan [3]. Project activity is integral to the total education of the student at WPI. Students typically spend a total of one academic year in project work. Each qualifying project requires the equivalent of one-quarter year full-time effort. Some students will spread their project work over two or more 7-week terms while others will spend full time for one term. Students are encouraged to gain project experience by undertaking independent study or non-qualifying projects before attempting their qualifying projects. The project involvement brings the student beyond the classroom environment with traditional academic problems to the challenges of real and unsolved problems, the type of work he will be expected to do when permanently employed [4]. The Biomedical Engineering Program at WPI is a graduate program under the joint sponsorship of Worcester Polytechnic Institute and Clark University, with the close cooperation of the University of M\fassachusetts Medical School and the Worcester Foundation for Experimental Biology. Students with a B.S. degree in engineering, physical science, mathematics, or life science may earn an M.S. or Ph.D. in biomedical engineering. An option is available for undergraduate students to earn a B.S. degree in engineering with a biomedical engineering emphasis. Students must demonstrate competency in biomedical engineering through their major project work and a competency examination in biomedical engineering.
Specialized biomedical engineering courses are available for advanced undergraduate and graduate students in the following areas: bionmechanics, biomedical instrumentation, biological systems, digital computation in biology and medicine, and biological signal analysis. A thesis is
PEURA et al.: HOSPITAL INTERNSHIP PROGRAM
required of all graduate students in which the student must solve an engineering problem in medicine or biology. Enrollment for the last few years has averaged about 20 graduate and 15 undergraduate students. St. Vincent Hospital SVH is a 600-bed community hospital committed to medical education. The post-graduate educational programs involve 81 residents taught by approximately 40 full-time hospital staff physicians. An active affiliation with the University of Massachusetts Medical School is maintained. A Department of Biomedical Engineering was established in the hospital four years ago and now employs two full-time engineers and two technicians. Six additional biomedical engineers are employed in other hospital departments and laboratories (Cardiac Catheter Laboratory, Non-invasive Cardiology, Clinical Pharmacology, Respiratory Diseases, and Vascular Research). Clinical and basic research is conducted in several hospital departments and in specialized laboratories, including an animal research facility.
135
neering Department, assisted by a Biomedical Engineer, direct and supervise the internship program on a parttime basis. They define the students' sphere of activity, maintain project and patient safety, provide technical back-up and resolve communications problems.
The Scope of Student Participation Fig. 1 illustrates the interaction of WPI and SVH resources and needs in the operation of project groups. WPI students, from freshman to graduate level, and faculty project advisors from nearly all engineering and science disciplines have been involved in the project activities. Students and faculty from the following degree programs have participated in the internship program: biomedical engineering, chemical engineering, chemistry, computer science, electrical engineering, life sciences, management engineering, mechanical engineering, and physics. The SVH laboratories and departments which have participated in the internship program include: cardiac catheterization, cardiology, clinical chemistry, clinical engineering, emergency medicine, hematology, hospital facilities, pathology, plastic surgery, radiology, respiratory diseases, ORGANIZATION OF THE INTERNSHIP surgery, and vascular research. As of this writing 13 difPROGRAM ferent projects are in operation in 8 areas of the hospital The internship program concept embodies off-campus with students from 9 technical backgrounds. sites where students get practical experience in problem solving. Students in the WPI-SVH Internship Program Operational Methods learn by doing, in contrast to didactic instruction. The One objective of the student's project experience is to formal arrangements, scope and operational methods of systematically plan and scientifically report his project the internship program follow. work. A step-wise progression from project inception to completion assists students in their planning and reporting The Internship Agreement activities. The development of projects is initiated by deThe internship program was formally approved in fining a set of specific hospital department objectives. A February of 1972 by the administrations of both institu- list of project descriptions is provided to the students, tions. The program operates without any exchange of with an indication of each project's objectives, the time funds between the two institutions. Undergraduate stu- involvement, and the technical background necessary. dents do not receive payment for their work, but pay Fig. 2 shows a flow chart of subsequent project developtuition for the experience as they would for any other part ment. Students interested in finding out about project of their education. Graduate students may act as research possibilities at SVH are invited to attend on-going student assistants and receive compensation. The non-payment project group meetings or exploratory meetings if there feature of undergraduate project work is required to in- is interest in developing a new project area. In addition sure that the school's educational objectives are main- to small group meetings of interested students, we have tained in preference to immediate manpower requirements had special tours of all the areas of the hospital where of the hospital. WPI provides a site director of faculty students are working. Through these repeated contacts rank who is assisted by a graduate student. They ad- between students, faculty and hospital staff, student inminister the student activities, explore potential project terest is generated, and a general assessment is made of areas, provide SVH project information to WPI students the student's technical ability to participate in a particular and faculty, and coordinate the project logistics between project. A student normally takes 3 activities (courses and projWPI and SVH. College facilities and scientific equipment are made available just as if the projects were conducted ect work in each 7-week term). Project objectives are on campus. The maximum number of students participat- defined for this period of time. This helps the student to ing in the internship program is regulated by the agree- limit the scope of his project activity to attainable goals ment to insure that each project can be properly super- and gives him a sense of accomplishment at the end of the 7-week term. Most of the projects extend for periods of vised. The hospital provides the working environment, mean- 21 or 28 weeks, with students spending the first 7-week ingful projects and direction by physicians interested in term preparing the project proposal and the final 2 or 3 the accomplishment of the project goals. Laboratory and terms in the execution and report writing phases. Once we have achieved a proper match, the student working space for the students, materials and supplies team prepares a project proposal detailing the objectives the Biomedical of Director Engiare provided. The SVH
136
IEEE TRANSACTIONS ON BIOMEDICAL
ENGINEERING, MARCH 1975
student group reports orally and in writing the past week's successes and frustrations and proposes specific objectives for the next week. At this time, the project focus and direction can be assessed and reoriented if necessary. Daily assistance to solve immediate logistical difficulties is generally provided by the SVH project advisor and by the more experienced students in the group. The constant interplay among novice, veteran, undergraduate and graduate students is encouraged, while the project advisors insure that each individual's participation is of educational benefit. The student project culminates in a written report and an oral presentation. High standards of report preparation are very importa;nt in preparing students for future work.
Fig. 1. The interaction between the resources and needs of WPI and SVH in the operation of student projects. HOSPITAL
STUDENT INTEREST
OBJECTIVES
PREVIOUS STUDENT WORK
WPI PROJECT INFORMATION
1
.EXLORATORY
MEETING
DEFINE SEVEN-WEEK OBJECTIVES
STUDENT PROJECT PROPOSAL WPI-SVH JOINT APPROVAL
STUDENT WORK-WEEKLY GROUP MEETINGS & REPORTS
FINAL PROJECT REPORT
Fig. 2. Project development at WPI-SVH Internship Program.
of their investigation, the methods, materials and equipa critical path analysis and a statement of the final anticipated result. This proposal is then jointly approved based upon its educational merits and value to the hospital department. The students begin their investigation making use of library material, special seminars, videotapes and other specially prepared instructional material, as well as through personal discussions with faculty consultants and physician project advisors. A student might find that he is deficient in a particular field of engineering or science needed for proper execution of his project and may decide to take a 7-week course in the next term to build up his technical base in that area and then resume the project. Weekly project meetings between the student group, the faculty project advisor, and the SVH project advisor are crucial for the successful operation of the project. The ment necessary,
REPRESENTATIVE STUDENT PROJECTS Students undertake projects, to satisfy their major qualifying project or thesis requirements, by applying their major field of study to solve problems in medicine. They may satisfy the interactive qualifying project degree requirement by investigating the interaction of medicine and technology with other disciplines, such as the social sciences. In addition, some students gain their initial project experience in nonqualifying projects. The following examples of student projects illustrate the various types of projects, the scope of the projects, and the continuity of the internship program operation. Major Field Projects Under the supervision of WPI faculty and the Department of Surgery, the internship students in the Vascular Research Team, Fig. 3, have applied their background to the solution of clinical problems in vascular disease. The overall -objective of the student investigation is to better understand the relationships between blood volume changes and electrical impedance changes in the leg. These measurements have now proved to be useful in the diagnosis and treatment of deep vein thrombosis, which has previously been notoriously difficult to diagnose at the bedside [5]. A biomedical engineering graduate student, who served as team leader, investigated the relationship between simultaneous measurements of electrical impedance and calf volume, as measured by air displacement plethysmography. He demonstrated that by expressing impedance and blood volume changes in terms of percentages, a consistent and predictable relationship can be demonstrated between these two variables. This student has presented the results of his work at regional and national biomedical engineering meetings [6], [7]. The preparation for these public presentations has been, from the perspective of his faculty advisor, an important educational experience for the student. In another aspect of the project, an electrical engineering senior examined electromagnetic field equations for a cylindrical approximation of the leg in order to compare theoretical solutions with actual impedance measurements due to blood volume changes. To obtain experimental
PEURA et al.: HOSPITAL INTERNSHIP PROGRAM
electrode tension on the measurements of leg impedance. Although no useful results were obtained from this work,
Fig. 3. Composition of a typical task force.
data on the relationship between fluid volume change and impedance variation, experiments were designed using liverwurst sausages which were a close approximation to the human leg in dimensions and electrical impedance. Holes were bored, simulating blood vessels, and results correlated quite well with theoretical analyses. Stimulated by his undergraduate studies, this student is now enrolled as a graduate student in biomedical engineering and is continuing his investigations concerning the spatial efficiency of sampling with tetrapolar impedance plethysmography. His predictions based on a computerized electric field model have agreed quite well with the experimental results found on the simulated leg model. This student also presented his results at a regional biomedical engineering conference [8]. A junior premedical student investigated the volume, surface area and circumference of the calf at a number of positions for a sample population of 100 college students. The results of this study have been useful in determining the relationship between the electrical impedance and volume changes. A biomedical engineering graduate student is examining impedance waveforms using signal analysis techniques to classify normal and abnormal recordings. The impedance signal, after release of a venous occlusive cuff, is being analyzed as a sum of exponential terms. It is anticipated that this technique for characterizing the impedance signal will standardize the interpretation of the clinical tests of venous outflow, undertaken to detect the presence of occult venous thrombosis. A freshman life science student in his first project experience at WPI examined the effect of circumferential
the project afforded an opportunity for him to learn from his mistakes and prepare him for more advanced project work. During the last year and one-half, a life science senior has extended the impedance plethysmograph technique to measurements of the arterial system. Reactive hyperemia tests were performed, and the rate of increase in arterial blood volume, or flow, for the vasodilated limb was found. The results of this feasibility study showed promise in predicting patients in need of arterial reconstructive surgery. A data base for computer evaluation of the venous thrombosis studies has been prepared by a computer science freshman and is currently being expanded to include all routine venous thrombosis tests. Laboratory technicians, previously unfamiliar with computer operations enter patient data and update and sort patient data as well as request statistical analyses on the test results. A computer model of the arterial system is presently being evaluated by a senior engineering student. The feasibility of using this model to analyze arterial pulse volume from impedance recordings is under investigation. The internship program served as a vehicle for a National Science Foundation study. The Student Originated Studies Program, supported 9 students for 12 weeks this summer in the Vascular Research Laboratory for the continued development of the electrical impedance arterial function test. The project was initiated and directed by the biomedical engineering graduate student who has been associated with the laboratory since his senior year. At the end of the summer each student prepared a written report and a formal oral presentation of their investigations. The students are further collaborating to write a monograph of their work. Fig. 4 shows students perform-
Fig. 4. Students developing an impedance plethysmographic arterial function test.
138
ing the arterial function test. As a result of this support, a practical, noninvasive clinical patient test for measurement of peripheral blood flow is under development. The students in the Vascular Research project group have been greatly motivated by the opportunity to work on a problem clearly related to patient needs. They have validated concepts behind the measurement of venous outflow obstruction in order to detect the presenc'e of clots, and this test has now been adopted by the hospital as a standard fee-for-service clinical laboratory procedure available to any patient in the hospital. These impedance measurements also promise to be beneficial in the evaluation and treatment of arterial insufficiency.
IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING, MARCH
1975
sure continuity of the project task group and facilitate the entry of other students into the program. Close supervision of new projects is mandatory. This faculty supervision is possible at WPI because of a complete revision of the curriculum and course formats. Less class contact time has been purposely designed into the program to provide faculty with more time to work with students on projects. Project supervision is a significant portion of each faculty member's academic load. A careful screening process takes place with each student before project work is begun. The interest of the student and an estimate of his ability to carry out what is proposed within the time constraints are the primary screening criteria. Involvement of the graduate students and upperclassmen in the project supervision has proved to be very valuable. This procedure aids in maintaining the continuity and stability of related projects. Not only is the student gaining technical experience but also management and administrative experience. Other ingredients for the successful operation of the internship program include: the educational emphasis of both institutions; the availability of both engineering faculty and interested physician advisors; the availability of specialized laboratories and appropriate medical and scientific instrumentation; access to patients; and a strong research base. Based on our experience we would advise others undertaking similar programs to recognize some of the potential problems that might develop. One of the most important aspects is the matching of a student's abilities, maturity and interest to a particular project. The obvious tendency of students to oversell the potential results from a project when the outcome may be unsatisfactory should be kept in mind. Without proper planning it is easy to overcommit the ability of the project coordinator to find students to work on a particular project and thus disappoint a potential sponsor. Finally, students tend to underestimate the time necessary for obtaining project materials.
Interactive Projects An innovative feature of the new undergraduate program at WPI is the "interactive project" [9]. The principle goal of the interactive project is to combine science and technology with other disciplines which relate to societal concerns and human need. The hospital, presenting a complex health-care environment, is an excellent area for these projects. The interactive project area is quite new to the engineering faculty and likewise to the internship program. A group of students is working with the Department of Emergency Medicine to investigate specific aspects of the emergency medicine outpatient system in order to build a data base to model the many complex system interactions. One group of students is analyzing the operations of the emergency room through the eyes of a consumer. A second group is preparing a procedure for collecting accident data with respect to location, ambulance response time, type of emergency, etc. The legal and ethical aspects of emergency care are being studied by a third group of students. A fourth group of students is looking at the socio-economic level of patients using the SVH emergency department. In most cases the information that the student groups are seeking is largely non-existent and is very important in order to begin to understand the complexities of the system. As these student groups com- Educational Benefits to the Student p]ete their project objectives, we expect that new students The value of the internship program in the education will continue to develop the emergency medical system of a biomedical engineer is perhaps best illustrated by model for Worcester County. outlining the actual experience of a student intern. This student was initially exposed to a project in the vascular DISCUSSION research task force when he was a senior in electrical engineering. His project objective concerned a basic investigaIngredients for Successful Operation tion into the source of the signal measured by the imFor the internship to be a successful educational ex- pedance plethysmograph. A literature search led him to perience, several conditions must be met. The faculty the conclusion that many clinical researchers had accepted project advisor must ensure that the project meets the early work in the field without critical review. He set forth educational needs of the student. There must be firm to establish an electric field model of the human calf. He guidance while still delegating maximum student responsi- improved his background and developed self-confidenice bility. The program must have well-established procedures in electric field theory by working with a professor in so that the student spends a minimum amount of time physics. The student developed sophisticated and effecin becoming familiar with site operations and is able to tive experimental techniques in order to validate his begin work on his project in a relatively short time. High model. Weekly group meetings impressed upon him the quality project reports must be required in order to as- need for well-written project proposals and progress re-
PEu.1
eCl al.: HOSPIT
IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING, VOL.
BME-22,
NO.
2,
MARCH 1975
Function of a Hospital Biomedical Engineering Internship Program
Organization ROBERT A. PEURA,
and
MEMBER, IEEE, JOHN MEMBER, IEEE, WALTER G.
R. BOYD, MEMBER, IEEE, ALBERT SHAHNARIAN, DRISCOLL, AND H. BROWNELL WHEELER
Abstract-This paper describes the development of an internship program between St. Vincent Hospital (SVH), a large commnunity teaching hospital, and Worcester Polytechnic Institute (WPI), a school of engineering. The primary objective of the internship program is the education of the student through problem solving in the hospital environment under close faculty-physician supervision. WPI receives an expanded educational base, and SVH receives a diversified base of technical assistance. During the last three years of operation 70 students, 12 faculty, and 15 hospital project advisors have worked together on 29 different student projects. The organization and operation of the internship program are presented, and the essential features leading to its success are analyzed.
INTRODUCTION IN MANY PROFESSIONS a period is normally set aside in which a student undergoes practical training under the supervision of a senior member of the profession prior to assuming full job responsibility. This process has been long accepted in the training of law clerks, medical interns, etc. Biomedical engineers in growing numbers are needed to work in the clinical environment, whereas a few years ago they were trained almost exclusively as independent research investigators [1]. In a recent survey of the engineering schools in the U.S., it was found that approximately 20 percent of the programs have either a required or optional internship or residency program with a hospital [2]. This paper outlines the organization and function of a successful internship program and may be of particular interest to institutions involved in the education of biomedical engineers.
PARTICIPATING INSTITUTIONS Worcester Polytechnic Institute WPI is the third oldest independent technical college in the United States and has an enrollment of 2,100 underManuscript received July 17, 1974; revised October 13, 1974. This program was supported in part by National Science Foundation Grant GY-9353. R. A. Peura is with the Department of Electrical Engineering and Life Sciences, Biomedical Engineering Program, Worcester Polytechnic Institute, Worcester, Mass., and the WPI-SVH Internship Program, St. Vincent Hospital, Worcester, Mass. 01610. J. R. Boyd is with the WPI-SVH Internship Program, St. Vincent Hospital, Worcester, Mass. 01610. A. Shahnarian is with Worcester Polytechnic Institute, Worcester, Mass., and the WPI-SVH Internship Program, St. Vincent Hospital, Worcester, Mass. 01610. W. G. Driscoll is with Facilities Development and the Department of Biomedical Engineering, St. Vincent Hospital, Worcester, Mass., and the WPI-SVH Internship Program, St. Vincent Hospital, Worcester, Mass. 01610. H. B. Wheeler is with St. Vincent Hospital, Worcester, Mass. 01610, and the Department of Surgery, University of Massachusetts Medical School, Worcester, Mass.
STUDENT
graduates and 550 graduate students. In 1971 an innovative approach to undergraduate engineering education, the WPI Plan, was adopted by the faculty. The B.S. degree is awarded on the basis of demonstrated competence, rather than on the basis of the traditional accumulation of academic credits. Each student works with a faculty advisor to design a program appropriate to his own needs and goals. The degree is awarded to the student when he has successfully demonstrated competence by the completion of four degree requirements: a Major Qualifying Project in his major technical field of study, an Interactive Qualifying Project emphasizing interactions among technology and human need, a minor in the humanities, and a competency examination in his major field. A recent monograph gives a comprehensive view of the operations of the WPI Plan [3]. Project activity is integral to the total education of the student at WPI. Students typically spend a total of one academic year in project work. Each qualifying project requires the equivalent of one-quarter year full-time effort. Some students will spread their project work over two or more 7-week terms while others will spend full time for one term. Students are encouraged to gain project experience by undertaking independent study or non-qualifying projects before attempting their qualifying projects. The project involvement brings the student beyond the classroom environment with traditional academic problems to the challenges of real and unsolved problems, the type of work he will be expected to do when permanently employed [4]. The Biomedical Engineering Program at WPI is a graduate program under the joint sponsorship of Worcester Polytechnic Institute and Clark University, with the close cooperation of the University of M\fassachusetts Medical School and the Worcester Foundation for Experimental Biology. Students with a B.S. degree in engineering, physical science, mathematics, or life science may earn an M.S. or Ph.D. in biomedical engineering. An option is available for undergraduate students to earn a B.S. degree in engineering with a biomedical engineering emphasis. Students must demonstrate competency in biomedical engineering through their major project work and a competency examination in biomedical engineering.
Specialized biomedical engineering courses are available for advanced undergraduate and graduate students in the following areas: bionmechanics, biomedical instrumentation, biological systems, digital computation in biology and medicine, and biological signal analysis. A thesis is
PEURA et al.: HOSPITAL INTERNSHIP PROGRAM
required of all graduate students in which the student must solve an engineering problem in medicine or biology. Enrollment for the last few years has averaged about 20 graduate and 15 undergraduate students. St. Vincent Hospital SVH is a 600-bed community hospital committed to medical education. The post-graduate educational programs involve 81 residents taught by approximately 40 full-time hospital staff physicians. An active affiliation with the University of Massachusetts Medical School is maintained. A Department of Biomedical Engineering was established in the hospital four years ago and now employs two full-time engineers and two technicians. Six additional biomedical engineers are employed in other hospital departments and laboratories (Cardiac Catheter Laboratory, Non-invasive Cardiology, Clinical Pharmacology, Respiratory Diseases, and Vascular Research). Clinical and basic research is conducted in several hospital departments and in specialized laboratories, including an animal research facility.
135
neering Department, assisted by a Biomedical Engineer, direct and supervise the internship program on a parttime basis. They define the students' sphere of activity, maintain project and patient safety, provide technical back-up and resolve communications problems.
The Scope of Student Participation Fig. 1 illustrates the interaction of WPI and SVH resources and needs in the operation of project groups. WPI students, from freshman to graduate level, and faculty project advisors from nearly all engineering and science disciplines have been involved in the project activities. Students and faculty from the following degree programs have participated in the internship program: biomedical engineering, chemical engineering, chemistry, computer science, electrical engineering, life sciences, management engineering, mechanical engineering, and physics. The SVH laboratories and departments which have participated in the internship program include: cardiac catheterization, cardiology, clinical chemistry, clinical engineering, emergency medicine, hematology, hospital facilities, pathology, plastic surgery, radiology, respiratory diseases, ORGANIZATION OF THE INTERNSHIP surgery, and vascular research. As of this writing 13 difPROGRAM ferent projects are in operation in 8 areas of the hospital The internship program concept embodies off-campus with students from 9 technical backgrounds. sites where students get practical experience in problem solving. Students in the WPI-SVH Internship Program Operational Methods learn by doing, in contrast to didactic instruction. The One objective of the student's project experience is to formal arrangements, scope and operational methods of systematically plan and scientifically report his project the internship program follow. work. A step-wise progression from project inception to completion assists students in their planning and reporting The Internship Agreement activities. The development of projects is initiated by deThe internship program was formally approved in fining a set of specific hospital department objectives. A February of 1972 by the administrations of both institu- list of project descriptions is provided to the students, tions. The program operates without any exchange of with an indication of each project's objectives, the time funds between the two institutions. Undergraduate stu- involvement, and the technical background necessary. dents do not receive payment for their work, but pay Fig. 2 shows a flow chart of subsequent project developtuition for the experience as they would for any other part ment. Students interested in finding out about project of their education. Graduate students may act as research possibilities at SVH are invited to attend on-going student assistants and receive compensation. The non-payment project group meetings or exploratory meetings if there feature of undergraduate project work is required to in- is interest in developing a new project area. In addition sure that the school's educational objectives are main- to small group meetings of interested students, we have tained in preference to immediate manpower requirements had special tours of all the areas of the hospital where of the hospital. WPI provides a site director of faculty students are working. Through these repeated contacts rank who is assisted by a graduate student. They ad- between students, faculty and hospital staff, student inminister the student activities, explore potential project terest is generated, and a general assessment is made of areas, provide SVH project information to WPI students the student's technical ability to participate in a particular and faculty, and coordinate the project logistics between project. A student normally takes 3 activities (courses and projWPI and SVH. College facilities and scientific equipment are made available just as if the projects were conducted ect work in each 7-week term). Project objectives are on campus. The maximum number of students participat- defined for this period of time. This helps the student to ing in the internship program is regulated by the agree- limit the scope of his project activity to attainable goals ment to insure that each project can be properly super- and gives him a sense of accomplishment at the end of the 7-week term. Most of the projects extend for periods of vised. The hospital provides the working environment, mean- 21 or 28 weeks, with students spending the first 7-week ingful projects and direction by physicians interested in term preparing the project proposal and the final 2 or 3 the accomplishment of the project goals. Laboratory and terms in the execution and report writing phases. Once we have achieved a proper match, the student working space for the students, materials and supplies team prepares a project proposal detailing the objectives the Biomedical of Director Engiare provided. The SVH
136
IEEE TRANSACTIONS ON BIOMEDICAL
ENGINEERING, MARCH 1975
student group reports orally and in writing the past week's successes and frustrations and proposes specific objectives for the next week. At this time, the project focus and direction can be assessed and reoriented if necessary. Daily assistance to solve immediate logistical difficulties is generally provided by the SVH project advisor and by the more experienced students in the group. The constant interplay among novice, veteran, undergraduate and graduate students is encouraged, while the project advisors insure that each individual's participation is of educational benefit. The student project culminates in a written report and an oral presentation. High standards of report preparation are very importa;nt in preparing students for future work.
Fig. 1. The interaction between the resources and needs of WPI and SVH in the operation of student projects. HOSPITAL
STUDENT INTEREST
OBJECTIVES
PREVIOUS STUDENT WORK
WPI PROJECT INFORMATION
1
.EXLORATORY
MEETING
DEFINE SEVEN-WEEK OBJECTIVES
STUDENT PROJECT PROPOSAL WPI-SVH JOINT APPROVAL
STUDENT WORK-WEEKLY GROUP MEETINGS & REPORTS
FINAL PROJECT REPORT
Fig. 2. Project development at WPI-SVH Internship Program.
of their investigation, the methods, materials and equipa critical path analysis and a statement of the final anticipated result. This proposal is then jointly approved based upon its educational merits and value to the hospital department. The students begin their investigation making use of library material, special seminars, videotapes and other specially prepared instructional material, as well as through personal discussions with faculty consultants and physician project advisors. A student might find that he is deficient in a particular field of engineering or science needed for proper execution of his project and may decide to take a 7-week course in the next term to build up his technical base in that area and then resume the project. Weekly project meetings between the student group, the faculty project advisor, and the SVH project advisor are crucial for the successful operation of the project. The ment necessary,
REPRESENTATIVE STUDENT PROJECTS Students undertake projects, to satisfy their major qualifying project or thesis requirements, by applying their major field of study to solve problems in medicine. They may satisfy the interactive qualifying project degree requirement by investigating the interaction of medicine and technology with other disciplines, such as the social sciences. In addition, some students gain their initial project experience in nonqualifying projects. The following examples of student projects illustrate the various types of projects, the scope of the projects, and the continuity of the internship program operation. Major Field Projects Under the supervision of WPI faculty and the Department of Surgery, the internship students in the Vascular Research Team, Fig. 3, have applied their background to the solution of clinical problems in vascular disease. The overall -objective of the student investigation is to better understand the relationships between blood volume changes and electrical impedance changes in the leg. These measurements have now proved to be useful in the diagnosis and treatment of deep vein thrombosis, which has previously been notoriously difficult to diagnose at the bedside [5]. A biomedical engineering graduate student, who served as team leader, investigated the relationship between simultaneous measurements of electrical impedance and calf volume, as measured by air displacement plethysmography. He demonstrated that by expressing impedance and blood volume changes in terms of percentages, a consistent and predictable relationship can be demonstrated between these two variables. This student has presented the results of his work at regional and national biomedical engineering meetings [6], [7]. The preparation for these public presentations has been, from the perspective of his faculty advisor, an important educational experience for the student. In another aspect of the project, an electrical engineering senior examined electromagnetic field equations for a cylindrical approximation of the leg in order to compare theoretical solutions with actual impedance measurements due to blood volume changes. To obtain experimental
PEURA et al.: HOSPITAL INTERNSHIP PROGRAM
electrode tension on the measurements of leg impedance. Although no useful results were obtained from this work,
Fig. 3. Composition of a typical task force.
data on the relationship between fluid volume change and impedance variation, experiments were designed using liverwurst sausages which were a close approximation to the human leg in dimensions and electrical impedance. Holes were bored, simulating blood vessels, and results correlated quite well with theoretical analyses. Stimulated by his undergraduate studies, this student is now enrolled as a graduate student in biomedical engineering and is continuing his investigations concerning the spatial efficiency of sampling with tetrapolar impedance plethysmography. His predictions based on a computerized electric field model have agreed quite well with the experimental results found on the simulated leg model. This student also presented his results at a regional biomedical engineering conference [8]. A junior premedical student investigated the volume, surface area and circumference of the calf at a number of positions for a sample population of 100 college students. The results of this study have been useful in determining the relationship between the electrical impedance and volume changes. A biomedical engineering graduate student is examining impedance waveforms using signal analysis techniques to classify normal and abnormal recordings. The impedance signal, after release of a venous occlusive cuff, is being analyzed as a sum of exponential terms. It is anticipated that this technique for characterizing the impedance signal will standardize the interpretation of the clinical tests of venous outflow, undertaken to detect the presence of occult venous thrombosis. A freshman life science student in his first project experience at WPI examined the effect of circumferential
the project afforded an opportunity for him to learn from his mistakes and prepare him for more advanced project work. During the last year and one-half, a life science senior has extended the impedance plethysmograph technique to measurements of the arterial system. Reactive hyperemia tests were performed, and the rate of increase in arterial blood volume, or flow, for the vasodilated limb was found. The results of this feasibility study showed promise in predicting patients in need of arterial reconstructive surgery. A data base for computer evaluation of the venous thrombosis studies has been prepared by a computer science freshman and is currently being expanded to include all routine venous thrombosis tests. Laboratory technicians, previously unfamiliar with computer operations enter patient data and update and sort patient data as well as request statistical analyses on the test results. A computer model of the arterial system is presently being evaluated by a senior engineering student. The feasibility of using this model to analyze arterial pulse volume from impedance recordings is under investigation. The internship program served as a vehicle for a National Science Foundation study. The Student Originated Studies Program, supported 9 students for 12 weeks this summer in the Vascular Research Laboratory for the continued development of the electrical impedance arterial function test. The project was initiated and directed by the biomedical engineering graduate student who has been associated with the laboratory since his senior year. At the end of the summer each student prepared a written report and a formal oral presentation of their investigations. The students are further collaborating to write a monograph of their work. Fig. 4 shows students perform-
Fig. 4. Students developing an impedance plethysmographic arterial function test.
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ing the arterial function test. As a result of this support, a practical, noninvasive clinical patient test for measurement of peripheral blood flow is under development. The students in the Vascular Research project group have been greatly motivated by the opportunity to work on a problem clearly related to patient needs. They have validated concepts behind the measurement of venous outflow obstruction in order to detect the presenc'e of clots, and this test has now been adopted by the hospital as a standard fee-for-service clinical laboratory procedure available to any patient in the hospital. These impedance measurements also promise to be beneficial in the evaluation and treatment of arterial insufficiency.
IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING, MARCH
1975
sure continuity of the project task group and facilitate the entry of other students into the program. Close supervision of new projects is mandatory. This faculty supervision is possible at WPI because of a complete revision of the curriculum and course formats. Less class contact time has been purposely designed into the program to provide faculty with more time to work with students on projects. Project supervision is a significant portion of each faculty member's academic load. A careful screening process takes place with each student before project work is begun. The interest of the student and an estimate of his ability to carry out what is proposed within the time constraints are the primary screening criteria. Involvement of the graduate students and upperclassmen in the project supervision has proved to be very valuable. This procedure aids in maintaining the continuity and stability of related projects. Not only is the student gaining technical experience but also management and administrative experience. Other ingredients for the successful operation of the internship program include: the educational emphasis of both institutions; the availability of both engineering faculty and interested physician advisors; the availability of specialized laboratories and appropriate medical and scientific instrumentation; access to patients; and a strong research base. Based on our experience we would advise others undertaking similar programs to recognize some of the potential problems that might develop. One of the most important aspects is the matching of a student's abilities, maturity and interest to a particular project. The obvious tendency of students to oversell the potential results from a project when the outcome may be unsatisfactory should be kept in mind. Without proper planning it is easy to overcommit the ability of the project coordinator to find students to work on a particular project and thus disappoint a potential sponsor. Finally, students tend to underestimate the time necessary for obtaining project materials.
Interactive Projects An innovative feature of the new undergraduate program at WPI is the "interactive project" [9]. The principle goal of the interactive project is to combine science and technology with other disciplines which relate to societal concerns and human need. The hospital, presenting a complex health-care environment, is an excellent area for these projects. The interactive project area is quite new to the engineering faculty and likewise to the internship program. A group of students is working with the Department of Emergency Medicine to investigate specific aspects of the emergency medicine outpatient system in order to build a data base to model the many complex system interactions. One group of students is analyzing the operations of the emergency room through the eyes of a consumer. A second group is preparing a procedure for collecting accident data with respect to location, ambulance response time, type of emergency, etc. The legal and ethical aspects of emergency care are being studied by a third group of students. A fourth group of students is looking at the socio-economic level of patients using the SVH emergency department. In most cases the information that the student groups are seeking is largely non-existent and is very important in order to begin to understand the complexities of the system. As these student groups com- Educational Benefits to the Student p]ete their project objectives, we expect that new students The value of the internship program in the education will continue to develop the emergency medical system of a biomedical engineer is perhaps best illustrated by model for Worcester County. outlining the actual experience of a student intern. This student was initially exposed to a project in the vascular DISCUSSION research task force when he was a senior in electrical engineering. His project objective concerned a basic investigaIngredients for Successful Operation tion into the source of the signal measured by the imFor the internship to be a successful educational ex- pedance plethysmograph. A literature search led him to perience, several conditions must be met. The faculty the conclusion that many clinical researchers had accepted project advisor must ensure that the project meets the early work in the field without critical review. He set forth educational needs of the student. There must be firm to establish an electric field model of the human calf. He guidance while still delegating maximum student responsi- improved his background and developed self-confidenice bility. The program must have well-established procedures in electric field theory by working with a professor in so that the student spends a minimum amount of time physics. The student developed sophisticated and effecin becoming familiar with site operations and is able to tive experimental techniques in order to validate his begin work on his project in a relatively short time. High model. Weekly group meetings impressed upon him the quality project reports must be required in order to as- need for well-written project proposals and progress re-
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