Efficacy of Clinical Simulation-Based Training in Biomedical Engineering Education

Insights from a Virtual Clinical Immersion Program

Clinical immersion programs provide opportunities for biomedical engineering (BME) students to observe the clinical environment and medical devices in use, often leading to the identification of unmet clinical needs. Due to hospital restrictions during the COVID-19 pandemic, in-person clinical immersion programs were generally not possible in summer 2020. Therefore, a six-week virtual clinical immersion program ran that summer. The program included meetings with guest clinicians and medical device sales representatives twice per week, and a group discussion held once per week. The meetings incorporated de-identified videos of medical procedures, clinician commentary of the videos, live video tours of hospital areas, clinician presentations, presentations and demonstrations by medical device sales representatives, and opportunities for discussions with these guests. The meetings were recorded and saved to create a Virtual Clinical Immersion Library. Pre and post program student self-assessment surveys showed significant increases in five ABET learning outcomes, two BME learning outcomes, and four program-specific learning outcomes. Post-graduation survey results of alumni from this program showed that all respondents had secured a job in the biomedical/engineering field or postgraduate education less than three months after graduation. These alumni are currently employed in the fields of biomedical products, healthcare, research and development, higher education, biotech, consulting, pharmaceutical, and other engineering. Overall, this virtual clinical immersion program filled a gap caused by COVID-19 pandemic closures and provided many benefits to the students that participated. The virtual program also provides an enduring library of video resources for current and future BME students.

The Efficacy of Body-Weight Supported Treadmill Training and Neurotrophin-Releasing Scaffold in Minimizing Bone Loss Following Spinal Cord Injury

Spinal cord injury (SCI) can lead to significant bone loss below the level of the lesion increasing the risk of fracture and increased morbidity. Body-weight-supported treadmill training (BWSTT) and transplantation strategies using neurotrophins have been shown to improve motor function after SCI. While rehabilitation training including BWSTT has also been effective in reducing bone loss post-SCI, the effects of transplantation therapies in bone restoration are not fully understood. Furthermore, the effects of a combinational treatment strategy on bone post-SCI also remain unknown. The aim of this study was to determine the effect of a combination therapy including transplantation of scaffold-releasing neurotrophins and BWSTT on the forelimb and hindlimb bones of a T9-T10 contused SCI animals. Humerus and tibia bones were harvested for Micro-CT scanning and a three-point bending test from four animal groups, namely injury, BWSTT (injury with BWSTT), scaffold (injury with scaffold-releasing neurotrophins), and combinational (injury treated with scaffold-releasing neurotrophins and BWSTT). BWSTT and combinational groups reported higher biomechanical properties in the tibial bone (below injury level) and lower biomechanical properties in the humerus bone (above injury level) when compared to the injury and scaffold groups. Studied structural parameters, including the cortical thickness and bone volume/tissue volume (BV/TV) were also higher in the tibia and lower in the humerus bones of BWSTT and combinational groups when compared to the injury and scaffold groups. While no significant differences were observed, this study is the first to report the effects of a combinational treatment strategy on bone loss in contused SCI animals and can help guide future interventions.

The BIORES-21 Survey: Insights Into Remote and Online Education in Biomechanics and Mechanobiology

The COVID-19 pandemic necessitated mainstream adoption of online and remote learning approaches, which were highly advantageous yet challenging in many ways. The online modality, while teaching biomedical engineering-related topics in the areas of biomechanics, mechanobiology, and biomedical sciences, further added to the complexity faced by the faculty and students. Both the benefits and the challenges have not been explored systematically by juxtaposing experiences and reflections of both the faculty and students. Motivated by this need, we designed and conducted a systematic survey named BIORES-21, targeted toward the broader bio-engineering community. Survey responses and our inferences from survey findings cumulatively offer insight into the role of employed teaching/learning technology and challenges associated with student engagement. Survey data also provided insights on what worked and what did not, potential avenues to address some underlying challenges, and key beneficial aspects such as integration of technology and their role in improving remote teaching/learning experiences. Overall, the data presented summarize the key benefits and challenges of online learning that emerged from the experiences during the pandemic, which is valuable for the continuation of online learning techniques as in-person education operations resumed broadly across institutions, and some form of online learning seems likely to sustain and grow in the near future.

Studying the Effects of Shoulder Dystocia and Neonate-Focused Delivery Maneuvers on Brachial Plexus Strain: A Computational Study

The purpose of this computational study was to investigate the effects of neonate-focused clinical delivery maneuvers on brachial plexus (BP) during shoulder dystocia. During shoulder dystocia, the anterior shoulder of the neonate is obstructed behind the symphysis pubis of the maternal pelvis, postdelivery of the neonate's head. This is managed by a series of clinical delivery maneuvers. The goal of this study was to simulate these delivery maneuvers and study their effects on neonatal BP strain. Using madymo models of a maternal pelvis and a 90th-percentile neonate, various delivery maneuvers and positions were simulated including the lithotomy position alone of the maternal pelvis, delivery with the application of various suprapubic pressures (SPPs), neonate in an oblique position, and during posterior arm delivery maneuver. The resulting BP strain (%) along with the required maternal delivery force was reported in these independently simulated scenarios. The lithotomy position alone served as the baseline. Each of the successive maneuvers reported a decrease in the required delivery force and resulting neonatal BP strain. As the applied SPP force increased (three scenarios simulated), the required maternal delivery force and neonatal BP strain decreased. A further decrease in both delivery force and neonatal BP strain was observed in the oblique position, with the lowest delivery force and neonatal BP strain reported during the posterior arm delivery maneuver. Data obtained from the improved computational models in this study enhance our understanding of the effects of clinical maneuvers on neonatal BP strain during complicated birthing scenarios such as shoulder dystocia.

In vivo biomechanical responses of neonatal brachial plexus when subjected to stretch

Neonatal brachial plexus palsy (NBPP) results from over-stretching of the neonatal brachial plexus during complicated birthing scenarios. The lack of information on the biomechanical response of the neonatal brachial plexus complex when subjected to stretch limits our understanding of the NBPP injury mechanism. This study aims to fill that critical gap by using a neonatal piglet animal model and providing the in vivo biomechanical properties of the neonatal brachial plexus complex when subjected to stretch. Forty-seven brachial plexus levels (identified by the four brachial plexus terminal nerve branches namely musculocutaneous, median, ulnar, and radial), obtained from 16 neonatal Yorkshire piglets (3-5 days old), were subjected to stretch-induced failure. The average maximum load and corresponding strain were reported to be 16.6 ± 1.3 N and 36.1 ± 1.6%, respectively. Maximum loads reported at the musculocutaneous level were significantly lower than the median and radial levels. No differences in strains at failure were reported at all four tested levels. Proximal or distal failure locations were reported in 83% of the tests with 17% mid-length ruptures that were primarily reported at the bifurcation of the median and ulnar brachial plexus levels. Histological studies reported an overall loss of wavy pattern of the nerve fibers, an increase in nerve spacing, fiber disruptions, and blood vessel ruptures in the stretched tissue. This in vivo piglet animal study offers insight into the NBPP mechanism by reporting biomechanical, injury location, and structural damage responses in neonatal brachial plexus when subjected to stretch.

Using an Accelerated Undergraduate Needs Finding Course to Build Skills, Inspire Confidence, and Promote Interest in Health Technology Innovation

Many undergraduate educational experiences in biomedical design lack clinical immersion-based needs finding training for students. Convinced of the merits of this type of training for undergraduates, but unable to offer a quarter-long course due to faculty and administrative constraints, we developed an accelerated block-plan course, during which students were dedicated solely to our class for 3 weeks. The course focused on the earliest stages of the health technology innovation process-conducting effective clinical observations and performing comprehensive need research and screening. We grounded the course in experiential learning theory (with hands-on, collaborative, and immersive experiences) and constructivist learning theory (where students integrated prior knowledge with new material on need-driven innovation). This paper describes the design of this intensive block-plan course and the teaching methods intended to support the achievement of five learning objectives. We used pre- and post-course surveys to gather self-reported data about the effect of the course on student learning. Despite the accelerated format, we saw statistically significant gains for all but one sub-measure across the learning objectives. Our experience supports key benefits of the block-plan model, and the results indicate that specific course design choices were effective in achieving positive learning outcomes. These design decisions include (1) opportunities for students to practice observations before entering the clinical setting; (2) a framework for the curriculum that reinforced important concepts iteratively throughout the program; (3) balanced coverage of preparation, clinical immersion, and need research; (4) extensive faculty and peer coaching; and (5) providing hands-on prototyping opportunities while staying focused on need characterization rather than solution development. Based on our experience, we expect that this model is replicable across institutions with limited bandwidth to support clinical immersion opportunities.

Effects of Prestretch on Neonatal Peripheral Nerve: An In Vitro Study

Background  Characterizing the biomechanical failure responses of neonatal peripheral nerves is critical in understanding stretch-related peripheral nerve injury mechanisms in neonates. Objective  This in vitro study investigated the effects of prestretch magnitude and duration on the biomechanical failure behavior of neonatal piglet brachial plexus (BP) and tibial nerves. Methods  BP and tibial nerves from 32 neonatal piglets were harvested and prestretched to 0, 10, or 20% strain for 90 or 300 seconds. These prestretched samples were then subjected to tensile loading until failure. Failure stress and strain were calculated from the obtained load-displacement data. Results  Prestretch magnitude significantly affected failure stress but not the failure strain. BP nerves prestretched to 10 or 20% strain, exhibiting significantly lower failure stress than those prestretched to 0% strain for both prestretch durations (90 and 300 seconds). Likewise, tibial nerves prestretched to 10 or 20% strain for 300 seconds, exhibiting significantly lower failure stress than the 0% prestretch group. An effect of prestretch duration on failure stress was also observed in the BP nerves when subjected to 20% prestretch strain such that the failure stress was significantly lower for 300 seconds group than 90 seconds group. No significant differences in the failure strains were observed. When comparing BP and tibial nerve failure responses, significantly higher failure stress was reported in tibial nerve prestretched to 20% strain for 300 seconds than BP nerve. Conclusion  These data suggest that neonatal peripheral nerves exhibit lower injury thresholds with increasing prestretch magnitude and duration while exhibiting regional differences.

Using Virtual Reality in Biomedical Engineering Education

This study explored virtual reality (VR) as an educational tool to offer immersive and experiential learning environments to biomedical engineering (BME) students. VR and traditional two-dimensional (2D) videos were created and used to teach required communication skills to BME students' while working with clinical partners in healthcare settings. The videos of interdisciplinary teams (engineering and nursing students) tackling medical device-related problems, similar to those commonly observed in healthcare settings, were shown to BME students. Student surveys indicated that, through VR videos, they felt more immersed in real-world clinical scenarios while learning about the clinical problems, each team-member's areas of expertise, their roles and responsibilities, and how an interdisciplinary team operated collectively to solve a problem in the presented settings. Students with a prior in-person immersion experience, in the presented settings, reported VR videos to serve as a possible alternative to in-person immersion and a useful tool for their preparedness for real-world clinical immersion. We concluded that VR holds promise as an educational tool to offer simulated clinical scenarios that are effective in training BME students for interprofessional collaborations.

Perspectives on Bioengineering Clinical Immersion: History, Innovation, and Impact

Opportunities to provide clinical immersion experiences to bioengineering undergraduate students have expanded over the last several years. These programs allow students to observe the clinical environment in order to better understand workflow processes, the context in which medical equipment is used, and identify unmet needs firsthand. While each program focuses on identifying unmet needs, these experiences vary in content and implementation. Here we discuss features of clinical immersion programs, share details of our program after six years, and present data regarding post-graduation employment of our participants. Students who participated in the University of Illinois at Chicago Clinical Immersion Program are not more likely to pursue careers in industry as compared to non-participants, nor do they demonstrate an ability to find a job more quickly than non-participants. However, participants who did enter into industry self-reported that the program was impactful to both their career interests and ability to find their first employment position.