Interdisciplinary Clinical Immersion: from Needs Identification to Concept Generation

The development of medical devices is a tremendous challenge necessitating both a deep understanding of the user as well as interdisciplinary collaboration. The first step in the user-centered design process is needs identification, in which designers observe and empathize with stakeholders (e.g. patients, physicians, nurses) to identify unmet user needs both implicit and tacit. Historically, for engineering students, there has been a gap between understanding technical requirements and unmet user need. Commonly this gap arises from a lack of primary research, including observation and interviewing of relevant users prior to concept generation. To address this gap, the Richard and Loan Hill department of Bioengineering at the University of Illinois at Chicago (UIC) developed a novel clinical immersion internship to introduce students to needs identification and user-centered design. In the first year of the Clinical Immersion Program (CIP), small teams consisting of undergraduate bioengineering students rotated through two, three-week long periods in varying clinical departments, where they worked together to methodically observe environments, interview users, and identify opportunities. In the third year of the CIP, we enhanced the needs identification process by transitioning to interdisciplinary teams of both bioengineering and second-year medical students. In this current study, we report on the fourth, and most recent, year of the CIP. Here, the program was expanded so that interdisciplinary student teams were immersed full-time in a single clinical environment for the duration of the program, which culminated in initial concept exploration based on the identified clinical needs. Efficacy of the CIP was assessed by mixed-method analysis surveys administered preand post-program. On a five-point Likert scale from “strongly disagree” to “strongly agree” (0 and 4, respectively), students scored 3.6 ± 0.5 in response to “I feel confident working with an interdisciplinary team” and 3.9 ± 0.3 to “needs identification is necessary for the development of medical products” according to the program surveys. Additionally, students indicated 3.5 ± 0.7 when prompted “early concept generation enhanced my experience in this program”. These scores indicate that students were towards strong agreement and responded well to the program changes this year. Introduction: The healthcare industry is riddled with outdated, ineffective devices and delivery systems that do not adequately meet the needs of users. To design better devices and delivery systems, engineers utilize the engineering design cycle, and, while there are many variations of this cycle, design always begins with identifying user needs. However, while engineers are familiar with the technical aspects of the engineering design cycle, they historically lack experience in needs identification. This disconnect often results in designs which do not address the true needs of users [1]-[9]. Thus, it is imperative for engineers to be educated in both the technical aspects of design and in needs identification. One method of identifying these needs is user-centered design. User-centered design (also referred to as human factors engineering or human-centered design) is a methodical approach to design and has been used extensively in the healthcare industry [1]-[11]. The goal of this methodology is to design solutions around end-users’ needs, both implicit and tacit [12], [13]. This is accomplished using an empathetic approach to users at each stage of the design process, resulting in long-lasting and impactful solutions [14]. Indeed, failure to identify and meet user needs has been well studied, specifically in infusion pumps [15], [16], where unidentified needs and poor design resulted in numerous injuries, death, and eventual device recalls [17]. Therefore, the goal of the Clinical Immersion Program (CIP) at University of Illinois at Chicago (UIC) is to enable engineering students to create more impactful devices by introducing them to needs identification through user-centered design. The purpose of this paper is to report on the fourth year of the CIP. The program has continually evolved over the past several years according to feedback from program faculty, clinical mentors, and participating students. In 2014, teams consisting solely of undergraduate bioengineering (BioE) students were immersed sequentially through two, three-week long rotations in one of six UIC hospital clinical environments [10]. In 2015, the team and rotation structure remained unchanged, but three more clinical environments were added [10]. In 2016, the program expanded to accommodate interdisciplinary teams of BioE and second-year medical students from the University’s Innovation in Medicine (IMED) program. The IMED program is a four-year longitudinal, co-curricular experience which emphasizes the intersection of technology, medical device development, and health care delivery. In addition, rotation structure remained the same, but an additional three clinical environments were added to maintain small team size [11]. In the current reporting year of 2017, we maintained interdisciplinary teams of BioE and IMED students, but modified the rotation structure for a single, six week long immersion. This modification allowed teams to become more immersed in their clinical departments and begin concept exploration to address their identified clinical needs. This change was implemented due to overwhelming feedback from students and program faculty in previous program years. Ultimately, we believe this implementation allows students to more holistically understand the design process by not only identifying needs, but also reflecting on them in the context of exploring appropriate solutions. Methods: Program Structure: The CIP is a six week long immersion experience designed to familiarize students with needs identification as part of the engineering design process. Since 2016, students are placed into interdisciplinary teams comprised of two BioE (rising seniors) and two IMED (rising second year) students. Each week, student teams participate in a Monday workshop (six hours) and spend Tuesday-Friday in clinical immersion (35 hours). This program year, teams spent all six program weeks in a single clinical environment and supplemented their experience with needs identification by including initial concept exploration. The CIP is currently a paid summer experience for BioE students, whereas IMED students earn a partial tuition waiver. Due to ongoing program evolution, participant reimbursement, and availability of space in clinical environments, the program is currently offered to a limited number of students. Up to 12 BioE students are offered a position in the program annually (~17% of rising seniors), whereas all IMED students (~4% of all medical students) are required to participate. However, the limited availability of the program also presents an opportunity for comparative analysis between engineering students with and without the CIP a comparison we aim to assess at the conclusion of the program’s fifth year. Student Teams and Departmental Affiliation: This year, 11 rising senior BioE and 12 rising M2 IMED students participated in the CIP. Bioengineering students were selected based on an application process, academic qualifications, and an in-person interview with the bioengineering faculty. IMED students were selected after admission to medical school based on an application process, academic qualifications, and an in-person interview with IMED faculty. Students were assigned to a team based on medical specialty preference, and were subsequently placed in one of six clinical departments. Table 1 indicates student distribution per clinical department. Each team coordinated their weekly activity in their respective clinical environment with a faculty mentor from the affiliated department. Table 1. Student Distribution in Clinical Environments Department Number of BioE Students Number of IMED Students