Saide Jorge Calil

Biomedical Engineering Department and Centre for Biomedical Engineering, University of Campinas – UNICAMP, 13083-881 Campinas, S?o Paulo, Brazil

2015 特別供稿專欄

What National Societies Should Do to Increase Capacity of Global CEs Professional Development

Saide Jorge Calil

Biomedical Engineering Department and Centre for Biomedical Engineering, University of Campinas – UNICAMP, 13083-881 Campinas, S?o Paulo, Brazil

編者按：2015年10月21日，《中國醫(yī)療設(shè)備》雜志社獨(dú)家承辦了“第一屆國際臨床工程與醫(yī)療技術(shù)管理大會”（ICEHTMC 2015），大會主席由美國FDA醫(yī)療設(shè)備顧問委員會主席、美國臨床醫(yī)學(xué)工程學(xué)會首任主席Yadin David先生和解放軍總醫(yī)院醫(yī)務(wù)部副主任、中國醫(yī)師協(xié)會臨床工程師分會會長周丹共同擔(dān)任。來自14個(gè)國家的臨床醫(yī)學(xué)工程學(xué)會的主席、23個(gè)國家的60多位醫(yī)學(xué)工程的領(lǐng)軍人物、世界衛(wèi)生組織醫(yī)療器械委員會的協(xié)調(diào)員及國內(nèi)580多位醫(yī)工專家與會交流，共同搭建世界臨床醫(yī)學(xué)工程的學(xué)術(shù)平臺。大會共征集了62篇臨床醫(yī)學(xué)工程領(lǐng)域的優(yōu)秀論文，主要包括醫(yī)療技術(shù)創(chuàng)新、醫(yī)療技術(shù)管理、醫(yī)療設(shè)備維修模式、標(biāo)桿管理、醫(yī)療設(shè)備監(jiān)管及風(fēng)險(xiǎn)管理方法、醫(yī)療設(shè)備評估和采購方法、醫(yī)療技術(shù)人員的職業(yè)化發(fā)展、醫(yī)療技術(shù)評估等8個(gè)主題。本刊自2016年第1期起開始刊登大會征集的優(yōu)秀稿件（每期1～2篇），分享醫(yī)學(xué)工程領(lǐng)域的最新動態(tài)，以供同行參考。

Despite the growing needs from hospitals for activities such as risk control, cost management, quality control and digital communication, most clinical engineers are not aware or do not risk to be responsible for these tasks. Unfortunately, the majority of CEs do not defy the comfortable state but keep claiming the lack of support from administration. Up to now, the Body of Practices as well as the Body of Knowledge for Clinical Engineering is not a world consensus. Hence, Clinical Engineering Societies must start to discuss how to change this situation; how to improve the interaction not only among clinical engineers but with the health staff and discuss how to help clinical engineers to present themselves as problem solvers regarding medical equipment technologies. Ultimately, the Clinical Engineering Societies must start a regional movement to define what is the Clinical Engineering model that best suits the need of the health system and communicate the academy about their findings. Here it is discussed some initiatives to be adopted by regional clinical engineering societies to promote the profession.

clinical engineering; health technology

1 INTRODUCTION

For the last 30 years, the health area has been experiencing a tremendous advance not only on new medical devices for diagnosis and therapy but on areas such as risk control, cost management, quality control and digital communication. Unfortunately, Clinical Engineering did not follow the same advance. One of the major problems faced by the Clinical Engineering profession today is the lack of definition about who can be called a Clinical Engineer, what is the necessary academic background, what is the body of knowledge and what are the activities ofa person to be called clinical engineer. Contrary to well established professions such as Electric Engineering, Civil Engineering, Chemical Engineering and so on, Clinical Engineering lacks an harmonized and worldwide concept about what does it mean and what are the activities developed in its field. This lack of knowledge comes not only from outsiders of but also from “self denominated clinical engineers” working in some of the activities belonging to the profession. In the majority of countries, medical equipment maintenance groups self-denominate themselves as Clinical Engineering Department or Division or Group, making the unders-tanding about thescope of the profession a bit more complicated. Hospital managers understand only what “clinical engineers” show they are capable to develop. Depending on the region, selfdenominated clinical engineers have no idea that Clinical Engineering is a speciality of Biomedical Engineering, a wellestablished profession, and that the scope of activities goes way beyond the maintenance management. Though at first this do not seem so important to the health area, the consequences to the Clinical Engineering profession are quite damaging. Activities such as quality control, risk management, cost control and even research on medical technologies, that should be developed by clinical engineers, are done by professionals with little knowledge regarding medical technology. Economists, administrators and even Information Technology people are working in the clinical engineering field despite the existence of a “clinical engineering team within the health unit. To worsen things a little more, even among clinical engineers worldwide there is no consensus about what are their activities. As a consequence, “Clinical Engineering” training courses are preparing the students as their coordinators understand about the profession. There is no preoccupation about feedback from the community or a wide discussion about what are the needs of the health area regarding medical technology. In several countries, the conveniently selfdenominated “Clinical Engineering” training courses prepare the students just for medical equipment maintenance. Contrary to other societies created for well established professions, Clinical Engineering societies are normally confined within their region/ countries and establish the professional activities and research (if any) to the kind of understanding of their members about what is Clinical Engineering. It is true that in some international events, students from different countries present the outcome of the research developed in their country but, unfortunately, most of the attendants are also students and almost no feedback is taken back and discussed with the societies. In general, presidents of Clinical Engineering societies do not belong to the academy and have little support for traveling expenses. In fact, these presidents fell more comfortable among the local society members and are reluctant to face the challenging of an academic world The lack of understanding from hospital managers as well as clinical engineers about the scope of the professional activities is not recent and not exclusive to smaller or developing countries. In 2006, Steven Grimes stated “We have never before had the wealth of technical tools and resources within our reach to provide higher quality healthcare to a larger segment of the US and world’s population ... and at the same time we don’t seem to be able to gain real ground fast enough in our efforts to provide that care[1]. Five years later, detecting the same lack of communication among US clinical engineers, Dave Harrington wrote several recommendations to improve the profession[2]. A survey conducted by the author (not published) in 2010 among industries, hospitals, government and academies, showed that most of the future expectations regarding the clinical engineers activities, were the same one they should be already doing since they were already trained by the current clinical engineering courses. Despite many other clinical engineers are detecting this need to improve the profession, there are few publications, researches and even initiatives to mitigate the problem. One of the few moves towards this improvement was done in Europa trough BIOMEDEA in 2005[3]. One of the objectives in 2005 was to harmonize the academic curriculum as well the professional activities in Europe. Unfortunately the initiative did not progress as it should and the harmonization did not happen. However, during this meeting it was organized 5 different workshops to discuss:①Criteria and guidelines for Accreditation of Biomedical Engineering in Europe;②European Protocol for Training Clinical Engineers in Europe;③European Protocol for Certification of Clinical Engineers in Europe;④European Protocol for Continuing Education of Clinical Engineers in Europe;⑤IFMBE International Register of Clinical Engineering;⑥Patient Safety Biomedical/Clinical/Hospital Engineering Providing a safe Healthcare Environment. The BIOMEDEA meetings was fully aimed to the European countries but produced very useful documents that still helps as reference to set training courses worldwide. One of the documents, “Protocol for Training Clinical Engineers in Europe”, distinguishes and establishes the training for five levels of Clinical Engineers: Trainee, Basic, Senior grade, Principal and Chief[4]. Unfortunately, this is one of the few worldwide known published reports suggesting the subjects to be used to train clinical engineers. Though not well known, another complete study about the training model in United Kingdom was produced by Alice Bovin for her Master of Science thesis[5]. The study presents and discusses the model used to train clinical engineers in UK, and compares this model to the one used in USA. In general, the policy adopted by clinical engineers to divulge their current activities is through oral presentations in regional meetings designed only to clinical engineers. This is good to communicate their progress but notefficient to divulge the professional potential to other health professionals. Clinical Engineering events are confined within the country borders or even smaller regions such as counties. Some of these events gather hundreds of professionals and raise the curiosity of students who are willing to learn and work in this profession. Most of them, sponsored by Clinical Engineering societies, invite keynote speakers coming from different areas such as Economy, Medicine and Biomedical Engineering. Despite these excellent initiatives, the knowledge stays confined within the borders of clinical engineering. One good example of integration among professionals working in the health area comes from the Association for Electrical, Electronic and Information Technologies – VDE from Germany. It congregates 5 societies; Information Technology, Power Engineering, Biomedical Engineering, Microelectronic and Microsystem and Measurement and Automatic Control. VDE promotes the interactions among the societies and transfer the scientific achievements to industry and health area[6]. According to Voigt and Magjarevic[7], German scientists in the field of biomedical engineering, bioengineering, clinical engineering, and medical ICT are organized in the DGBMT which is the German Society for Biomedical Engineering[8]. Such experience is very positive since this integration helps Clinical Engineering professionals to be better known and to work together with several other technical professionals. One interesting mention is that clinical engineers working within governmental health structure seem to be doing quite well and developing significant and important projects towards the health system. Some examples can be found in Brazil, Mexico and Albania, where clinical engineers were hired by the Ministry of Health to help on projects regarding medical technology and are playing quite important roles, mainly on projects involving medical equipment procure-ments and inclusion in the country’s health system. No doubt that there are countries and places where clinical engineering professionals are doing well and not struggling to survive and be recognized. However, whatever the reasons for these successful experiences, the huge majority claims for better recognition, mainly the ones working within hospitals. They ask for better integration with the health staff and to be heard by the hospital administrators on matters regarding medical equipment technology. However, despite the growing needs from hospitals administrators regarding activities that indeed belong to clinical engineers, most of them do not risk to step forward and become responsible for tasks such as risk control, cost management, quality control and digital communication. As a consequence, the hospital administration hires other professionals since they are not aware that those are also Clinical Engineering duties. This is a recurrent problem where Clinical Engineers do not defy the comfortable state but claim no support from administration. On the other side, support is not given by the administrators due to lack of knowledge about how wide are the Clinical Engineering professional activities besides maintenance management. Perhaps, the major point discussed among the Clinical Engineering Societies is not only the training subjects but what is the best model for Clinical Engineering to be adopted in the country/region. As mentioned already, there is no consensus regarding the activities and the most advertised model came from the USA. The wide spread of the English language and the very active Clinical Engineering Society (American College of Clinical Engineering-ACCE) whose members are also very active in publications makes the American model for Clinical Engineering worldwide known and adopted. Few Clinical Engineering societies developed an efficient and focused survey to understand what are the real needs of the health system and feedback the information to the academia. If they did, few of them divulge the results through publications. Hence, Clinical Engineering Societies must start to discuss how to change this situation. How they can improve the interaction not only among clinical engineers but with the other health groups such as nurses, medical doctors and hospital administrators. Discuss what role they shall play to make clinical engineers less afraid to present themselves as problem solvers regarding medical equipment technologies. Ultimately, the Clinical Engineering Societies must start a regional movement to define what is the Clinical Engineering model that best suits the need of the health system and communicate the academy about their findings.

The discussion raised here is just the first step to incentive clinical Engineering Societies to not only start such discussion but also interact to each other and exchange good and bad experiences regarding any initiative to improve the profession.

2 MATERIALS AND METHODS

This article was developed just to discuss what could be done by the Clinical Engineering Societies to improve the profession they represent. The suggestions presented was the result of many years of experience working as teacher and coordinator of a Clinical Engineering specialization course in Brazil, as member (since 2003) of the Clinical Engineering Division of the International Federation for Medical and Biological Engineering CED/IFMBE and as member of American College of Clinical Engineering – ACCE. It isalso the result of many and lengthy discussions with several colleagues working in the Clinical Engineering area all over the world and that fill the same lack of communication among clinical engineers, locally, regionally and worldwide. Here it is listed a set of suggestions about what the societies can and shall do to start discussing a way to implement them:

(1) Interaction with neighbour regional societies to learn and discuss the development and implementation of additional activities.

(2) Interact with the Clinical Engineering Division of the International Federations of Medical and Biomedical Engineering-CED/IFMBE to learn and discuss what CE communities worldwide are doing.

(3) Incentive CE articles from its members to be presented in scientific events not only for CEs but nurses, doctors and show them what Clinical Engineering can offer.

(4) Plan and develop Clinical Engineering Scientific events to present and discuss CE activities not yet regionally practiced.

(5) Understand what are the country needs related to the health system within all segments (government, hospitals, industry and academy) and discuss with the academy the best clinical engineering model to be adopted.

(6) Incentive CEs to write articles describing their experience on the day to day activities and suggestions to improve the quality of their work.

(7) Develop within the society website a newsletter to publish articles and comments activities not only from the society members but international invited specialists on specific subjects.

3 DISCUSSION

There is no recipe to achieve a better recognition for the CE profession but just suggestions on “how” to start this quest. Also, there is no method to help on how to develop the suggestions presented here. Each country or regional Society has to develop the strategy and measure the cost/benefit of each suggestion. To increase the capacity of the Clinical Engineering profession, CED already started several projects hoping not only for the CE Societies but also for individual participation. CED has created the“International Forum of Clinical Engineering Societies - IFCES”. The first meeting happened in the World Congress on Medical Physics and Biomedical Engineering – Toronto - June 2015. IFCES’s aim is to have a place where all Clinical/Biomedical Engineering Societies can exchange experience, discuss academic curricula, ask for help to solve regional problems and so on. To help and incentive the general communication among clinical engineers and Clinical/Biomedical Engineering Societies, CED developed a site “CED Global - http://cedglobal.org” where events, bibliography, different subjects and news regarding the profession can be found. Some of the site’s bibliography can be freely downloaded. CED also developed three different awards to incentive publications on Clinical Engineering as well as to homage people and Clinical Engineering groups. Those awards are: ① The Clinical Engineering Outstanding Teamwork award recognizes an individual or a group that foster and facilitated cooperation between healthcare technology managers; ② The IFMBE-CED award recognizes an individual or a group that provided outstanding regional or international contributions to the clinical engineering field; ③ The Best Clinical Engineering Article award recognizes an individual or a group that published the best clinical engineering article, in IFMBE conferences proceedings and journals.

However, none of these efforts will be successful without the collaboration of the Clinical Engineering community. Any initiative will fail if the communication among clinical engineers does not improve. Without this communication, the same problems and complaints that have been done for more than 10 years will remain exactly the same as today.

[1] Grimes S.President’s Column:Meet Stephen Grimes.ACCE News,2006,16(6):1-2.

[2] Harrington D.Why Clinical Engineering.ACCE News,2011, 21(3):4-6.

[3] BIOMEDEA.Biomedical and Clinical Engineering Education, Accreditation,Training and Certification,2004.Available from:http://www.biomedea.org/biomedea.htm.

[4] BIOMEDEA.Protocol for Training Clinical Engineers in Europe.BIOMEDEA Project,2005.

[5] Bovin A.A Review of Clinical Engineering Education in the United Kingdom.MSc thesis,Cranfield University–UK,2007.

[6] Homepage of the German Association for Electrical, Electronic and Information Technologies–VDE.Available from: http://www.vde.com/EN/Pages/Homepage.as.

[7] Voigt H,Magjarevic R.The German Society for Biomedical Engineering (DGBMT) within VDE.Launching IFMBEinto the 21st Century:50 Years and Counting.Berlin:Springer,2014: 156-157.

R197 [Document code] A

10.3969/j.issn.1674-1633.2016.08.001

1674-1633(2016)08-0001-04

Saide Jorge Calil, Biomedical Engineering Department and Centre for Biomedical Engineering, University of Campinas –UNICAMP, 13083-881 Campinas, S?o Paulo, Brazil.

E-mail: calil.saide@gmail.com