Exploring the Intersection of Engineering and Medicine Through a Neuroscience Challenge Laboratory

Abstract

The medical curriculum is charged with training medical students who can possess both the technical and contextual abilities to adapt to the transformational world of medicine. This new objective would require incorporating engineering principles into the medical curriculum, which was formed by the University of Illinois as the Carle Illinois College of Medicine. As a fully integrated engineering based medical school, students partake in active learning modules that develop their quantitative, innovative, and entrepreneurship skills. An example of the active learning component of the curriculum is the “Neuroscience Engineering Challenge Lab.” The purpose of this study was to explore students’ perception of the lab and learn how the active-learning curriculum via the design thinking labs can be enhanced. Using a paired samples t test of pre- and post-survey results, we found that the students did not statistically gain a better understanding of the design thinking process (p = 0.052), which is expected due to the majority of students having an engineering background. Contrarily, the lab increased students’ understanding of ideation tools (p = 0.003), user-centered design concepts (p = 0.004), preparing a business plan pitch (p = 0.027), and students felt better prepared for their IDEA and Capstone project (p = 0.010). Based on the results, students are becoming more confident with understanding, experience, and applying these specific tools and skills. Therefore, the medical curriculum should provide opportunities for students to develop and apply their innovation skills through active-learning activities such as a Neuroscience Engineering Challenge Lab.

Introduction

It is widely known that the USA has the highest per capita expenditure in healthcare worldwide [1]. As we problem solve to help combat this issue, one of the root causes is the inefficiencies within the healthcare system. In fact, the efficiency of the US healthcare system is ranked lowest in comparison to many other developed nations [2]. Healthcare and the medical industry are transforming; increases in inequities, population, and technological advances present a lot of new changes for physicians. Physicians must possess the technical abilities to problem solve through healthcare challenges, while having the contextual and leadership abilities to create novel solutions tailored to patient needs [3, 4]. This reality was highlighted in 2007 when the Institute for Healthcare Improvement developed the triple aim of “better care, better health, and lower cost.” Therefore, the Institute for Healthcare Improvement has called for a reform in medical education. A solution that tackles all three points of the reform would require incorporating engineering principles into the medical curriculum. Thus, the Institute for Healthcare Improvement has encouraged the partnership between engineering and medicine [5]. The American Medical Association created the “Accelerating Change in Medical Education” initiative in 2013 to address the gaps in medical education and prepare new doctors to practice effectively by increasing technology and systems training, interprofessional education, and community health-related competencies [6]. The initiative awarded grants to 11 medical schools across the country, which have grown to a total of 37 schools, to be a part of a consortium aimed to transform medical education. Although the consortium is leading the way in changing medical education, only about one-fifth of the allopathic and osteopathic medical schools is a part of the reform [6]. The archaic medical curriculum lacks the training in technology utilization and efficiency improvement for medical students to have the tools needed to succeed at such an aim. Therefore, four-fifths of the national’s medical curriculum is charged to independently reform medical education by training medical students who can possess both the technical and contextual abilities to adapt to the transformational world of medicine.

Standard medical education consists of two preclinical years and two clinical years, in which the first 2 years build the academic groundwork of medicine by focusing on developing the students’ foundation in basic sciences relevant to understanding clinical medicine. Sidney Kimmel Medical College of Thomas Jefferson University was the first medical school to incorporate design thinking and medical making into the preclinical years of medical school to create an environment that fosters creativity and empower students to solve healthcare problems at the beginning of their medical education [7]. Their aim is to revolutionize patient care and improve health outcome by creating inviting spaces for medical students to design prototypes that help patients live their daily lives without being fully impacted by their ailments. Additionally, Texas A&M University created an EnMed program in 2017 to introduce engineering principles into medical education.

To further expand on the idea of intersecting design thinking and medicine, the University of Illinois formed a new medical curriculum as the Carle Illinois College of Medicine (CIMED) [8]. This is the world’s first engineering-based medical school aimed to meet the future demands of medicine by employing case-driven, problem-based, active learning curriculum with early clinical immersion. As a fully integrated engineering-based medical school, students partake in active learning modules that develop their quantitative, innovative, and entrepreneurship skills [9, 10]. About 70% of the students enrolled at CIMED have an engineering degree (experienced students), and the remaining 30% of students have a non-engineering background (naïve students). The innovation component of the curriculum was developed in a stepwise fashion so that students can acquire and develop skills and have opportunities to apply them in an environment that cultivates innovation and ingenuity. This framework allows students of all backgrounds to acquire and develop the tools and skills needed to become physician innovators. The phase 1 curriculum contains fourteen blocks, where students learn basic science and clinical and engineering topics. Each course is designed by a basic scientist, clinician, and engineer working together to design and coordinate curricular delivery [9].

With each subsequent phase of the curriculum, students can develop and apply their skills in an active learning environment. In phase one of the curriculum, students complete various innovation-themed projects as they relate to the clinical course. The innovation aspects of the curriculum, such as design thinking, are transferable to clinical medicine. Students learn how engineer intersects with medicine as they seek to improve healthcare outcome and standardize clinical process in engineering labs throughout phase one of the curriculum and apply the engineering principles during the next two phases where they end in final product [11]. In phase two (start of clinical rotations), the IDEA (Innovation, Design, Engineering and Analysis) projects are completed. With the IDEA projects, students generate new ideas to improve health care challenges during each clinical clerkship. During the IDEA course students are also exposed to topics such as, intellectual property and patents. In phase three, one of their IDEA projects is selected as their Capstone project with the goal of translating new approaches, technologies, and treatments in medicine. The Capstone project is formed by a group of medical students, bioengineer, and business students.

An example of the active learning component of phase one of the curriculum is the “Neuroscience Engineering Challenge Lab.” This activity is an initiative aimed at utilizing innovation to improve human conditions by simulating a business pitch for an emerging technology for a subfield in neuroscience. In this lab, we develop students’ understanding of the design thinking process, provide a workshop that develops these skills, and create a platform for students to apply the skills [12]. This study aims to explore students’ perception of the Neuroscience Engineering Challenge Lab and learn how the active-learning curriculum via the design thinking labs can be enhanced.

Methodology

Lab Design

Students who have a background in engineering are referred to as “experienced” students and those who have a background in other areas are referred to as “naïve” students. The purpose of the lab was to expose naïve students and re-introduce experienced students to design thinking tools by providing a 2-session lab experience. The lab experience challenged students in the design thinking process, user-centered design concepts, and business plan pitches. This approach places all students at a baseline level of understanding and utilizing application tools that they can use in the future.

The students had specific lab instructions for their innovation. They were instructed to select an application space from the following options: diagnostics, symptom treatment, neuro-enhancement, and disease treatment. Additionally, the innovation disease state options were as followed: autism, pain/headache, brain tumors, developmental disorders, peripheral nerve disease, autoimmune diseases, autonomic diseases, and ADHD. The challenge was for students to utilize the application skills developed to find a specific problem within an application space and disease state and propose a solution using a provided emerging technology example.

During the clinical neuroscience block, students were introduced to the Neuroscience Engineering Challenge Lab. The clinical neuroscience block of the curriculum is 8 weeks long, in which the challenge lab took place during weeks 7 and 8. The students were equally divided into teams based on their background and experiences. The teams explored the development of an innovative device or intervention using emerging technologies of relevance to neurology and/or neuroscience. In this lab, emerging technologies were innovations that would be on the market in the next 3–5 years. The students proposed ideas that could be the start of their senior Capstone Project. At the conclusion of the lab, the teams delivered an oral presentation in the format of a business plan pitch proposal.

The session objectives were as follows:

• Learn about design thinking, design process, decision-making tools, and user centered-designed.

• Design a solution that connects clinical science and real-world situations, including healthy lifestyle decisions.

• Effectively communicate a solution on a pitch format.

Each session was 110 min. Prior to the first session, the students were tasked with pre-readings and video assignments to prepare them for the session’s deliverables. The objectives for the first session were for students to (1) explore the development of an innovative device or intervention using emerging technologies of relevance to neurology and/or neuroscience and (2) introduce the concepts used in design thinking, including stages of the design process, brainstorming, decision matrices, and SWOT analysis. In the first session, each team was tasked with submitting PowerPoint slides that described their topic of choice, application space and disease state, the problem, current research, emerging technology solution, and anticipated impact of solution. Students were assessed on their participation and the content/organization of their preliminary PowerPoint proposals. In the second session, teams were required to deliver an oral presentation in the format of a business plan pitch proposal developed and finalized from the previous week. The teams had 5 min to present and additional time to answer follow-up questions. Students were assessed on their content, organization, visual aids, depth of investigation, depth of analysis, participation, delivery, and timing. Additional resources were provided to students on a video format around the topics: design process, user-centered design, designing with empathy, business model, patent, intellectual property regulation, R&D plan, and clinical strategy.

Research Design

Students answered pre- and post-surveys; rating their level of agreement on a five-point Likert scale. The designation of the numbers was very poor (1), poor (2), average (3), above average (4), and excellent (5). The questionnaire used in the study was developed by the instructors. Informed consent was obtained, and the study was approved by the University of Illinois Institutional Review Board. Students answered questions about their understanding and experience in design thinking, ideation tools, user-centered concepts, business plan pitches, and their comfort in applying these concepts to their future IDEA and/or Capstone Project. In the post-survey, students also had the option to qualitatively express areas of improvement for the lab, strengths of the lab sessions, and additional comments that they deemed helpful for future sessions. Descriptive assessments of the pre- and post-surveys were performed. The difference between the mean pre- and post- scores was assessed with a paired samples t test (α = 0.05).

Statistical Analysis

A one-tailed paired samples t test was performed to compare the mean responses of the pre- and post-survey. The level of significance was α = 0.05. Statistical tests were done using IBM SPSS Statistics for Windows (Released 2020. Version 27.0. Armonk, NY: IBM Corp).

Results

A total of 32 first-year medical students participated in the study: 11 females and 21 males. The following analysis is based on the 93.75% (n = 30) of the students who completed the surveys. Two surveys were excluded from analysis because they were incomplete. The average Likert score across all questions for the pre-survey was 3.21, in which students rated their understanding of the design thinking process to problem solving the highest (average 3.47) (Fig. 1). In the post survey, the average rating was 3.83 (Fig. 2). The students rated their understanding of ideation tools the highest with an average Likert score of 4.03. The lowest average Likert score in both the pre- and post-survey was the students’ experience in developing a business plan pitch (pre-survey average: 2.87; post survey average: 3.60).

Fig. 1.

Pre-survey results

Fig. 2.

Post-survey results

A summary of the survey analysis is illustrated in Table 1, where x̄ is the sample mean, “s” is the sample standard deviation, and the p value calculated for α = 0.05. The results show an increase in the average Likert score between the pre- and post-survey responses for all questions. The t test results determined question 1 post-survey responses were not significantly greater than the pre-survey results (p = 0.052). On the other hand, questions 2–9 post-survey responses were significantly greater than the pre-survey responses.

Table 1.

Descriptive statistics of the survey results

Question	Pre-Survey		Post-survey		p value	Effect size
#	x̄	s	x̄	s	α = 0.05	d
Q1	3.467	1.042	3.867	0.819	0.052	0.307
Q2	3.200	0.925	3.800	0.887	0.010	0.452
Q3	3.333	0.922	4.033	0.809	0.003	0.542
Q4	3.333	0.922	4.000	0.788	0.007	0.477
Q5	3.333	0.802	3.900	0.845	0.004	0.513
Q6	3.233	0.898	3.767	0.935	0.020	0.393
Q7	3.000	1.232	3.667	1.028	0.027	0.365
Q8	2.867	1.279	3.600	1.070	0.013	0.426
Q9	3.100	1.185	3.867	0.860	0.010	0.452

In the post-survey, students were able to qualitatively express areas of improvement for the lab, strengths of the lab sessions, and additional comments they deemed helpful for future sessions. To improve the lab, some students (37.5%) believed that the instructions and guidelines for the presentations needed more detail. During the challenge lab, the students had brainstorming sessions outside of the required in-class time. 15.6% of the students suggested adding a short in-class brainstorming session. 18.8% of the students suggesting more time to work on the project, and another 18.8% believed that the topic was constrained and did not encourage innovation. In terms of areas of strength, students reported that the lab was fun (12.5%) and encouraged innovation (15.6%) and teamwork (9.38%).

During the oral presentations, the students pitched a variety of business plans to solve health problems. For example, one group proposed an auto-injector as a solution for patients experiencing a myasthenic crisis. Another team created a glove with haptic feedback that would allow those with peripheral neuropathy to grasp and interact with day to day objects and apply the appropriate force. Students also proposed a beanie-baby cap as an early stroke detection system to aid neonatal neurologists and parents in rapid detection of neonatal strokes.

The presentations were graded as a group and individually. Individual student grades were based on technical contribution and presentation skills. The average group grade was 36.1 out of 40 points. Among the groups, the students scored lowest in depth of investigation and analysis.

Discussion

The novelty of an engineering medical school provides a positive outlook to healthcare challenges by developing medical professionals who have the skills and aptitude to create solutions that can tackle systemic challenges. The “Neuroscience Engineering Challenge Lab” is an example of how the medical curriculum at the Carle Illinois College of Medicine integrate innovation thinking into medicine. This lab utilizes an active-learning approach to give students hands-on experience early in the curriculum to prepare them for real-world problems in their medical career. The results of the survey revealed that the students did not gain a better understanding of design thinking process. This result is as expected. Majority of CIMED students have a background in engineering and technology and some prior experience with design thinking, thus they already exposed to design thinking. In fact, 78% of the students rated their experience in design thinking ≥ 3 on the Likert scale. This in congruent with the 70/30 split of engineering vs non-engineering backgrounds.

With the lab, the goal was to introduce tools to naïve students and re-introduce these concepts to experienced students to ensure, from a curriculum standpoint, that students are learning the skills and tools they need to be successful in subsequent projects. In the post survey results, the number of poor and very poor ratings in both the students’ understanding (Q1) and experience (Q2) reduced, and the number of average and above ratings increased. This increase is also shown across the post survey results for questions 2–9 as well. Furthermore, the survey results illustrated that the lab improved the students’ understanding and experience of ideation tools, user-centered design concepts, and developing a business plan pitch based on the statistical significance. However, the effect size was small for all, but ideation tools and user-centered design concepts. The results of the data illustrate that students felt more comfortable and confident in applying their skills for future curriculum intersection projects such as the IDEA and Capstone Projects after completing the lab.

The Neuroscience Engineering Challenge Lab is among many opportunities in phase one of the curriculum that students are provided the space to practice their skills as a future physician innovator. Based on the pre- and post-survey results of question 9, the experience of the lab increased students’ confidence in apply their skills and methods in future projects. Based on the pre- and post-survey results overall, students are becoming more confident with understanding, experience, and applying these specific tools and skills.

Limitations and Future Work

The study was conducted at Carle Illinois College of Medicine; thus, the findings are related only to the participants of this study and thus cannot be generalized. A larger sample size and various sample locations are needed to generalize results.

For future cohorts, the expectations of these categories will be thoroughly outlined with examples from past presentations. Additionally, students will receive an outline of expectations and deliverables for the entire engineering lab challenge in the first week. This will also address the area of improvement for students who believed that the instructions and guidelines for the presentations needed more detail. In terms of concerns with the topic being constrained and not encouraging innovation, future cohorts will not be limited to the application space, diseases, or emerging technologies that were provided. They will only serve as examples and possible starting points for the students. Due to required contact hour constraints in the curriculum, it is not feasible to extend project time and add in a brainstorming session. However, with the students knowing the expectations for the challenge lab at the beginning and encouragement of team interactions outside of dedicated class time, the hope is that the students will brainstorm together outside of required class sessions. Although students already understand design thinking, it is still in the curriculum’s best interest to ensure adequate knowledge of design thinking as provided by the school. To develop the understanding of design thinking in naïve students and enhance the understanding of experienced students, a new pre-reading assignment will be added and discussed in the first session. The goal is to provide students with new perspectives on how to utilize their skill of design thinking in various ways, especially in the medical field. Future assessments will take place to monitor student’s perception and understanding of design thinking. Additionally, future studies can assess the development of naïve students and the effect of interdisciplinary teams on the results of the lab.

Conclusion

The Engineering Challenge Lab created an opportunity for medical students to foster their creativity by enabling the students to become innovators and entrepreneurs; thus, developing skills and equipping the students with the tools needed to solve problems that would arise in clinical practice. As students with engineering backgrounds, students already had the knowledge to understand the concepts, which is shown in the pre-post survey results of question 1 and 2. The lab increased students’ understanding of idea tools, user-centered design concepts, preparing a business plan pitch, and felt better prepared for their IDEA and Capstone project. Through this experience, students will be equipped to apply the skills learned to their future IDEA and Capstone projects, which are geared toward solving current healthcare challenges. This would translate to medical students graduating with the technical and contextual abilities to confront the ever-changing demands of healthcare with confidence.

Declarations

Ethical Approval

Not applicable

Consent to Participate

Not applicable

Conflict of Interest

The authors declare no competing interests.