Biomedical Engineering in Croatia

1. INTRODUCTION

Research in the field of biomedical engineering started in Croatia in the late fifties of the last century. The background to biomedical engineering was represented by engineering and medical faculties and, later, the medical equipment industry. In the early seventies, lecturing in biomedical engineering was introduced into undergraduate programs (first at the University of Zagreb) and later to undergraduate and postgraduate studies at several universities in Croatia. The Croatian Medical and Biological Engineering Society (CROMBES) had the leading role in the continuing education of engineering staff working in health care facilities. Due to a (generally) small labour market and the unsatisfactory position of engineering staff within the health care system, and particularly the disturbance brought into the civil system by the aggression on Croatia in the last decade of the 20th century, no integrated biomedical engineering program was established jet (until the academic year 2001/02). Recognising the need for harmonising the education programs within Europe, CROMBES initiated the establishment of postgraduate studies in the field of biomedical engineering in 2001. At the same time, moves were made for recognition of the position of biomedical and clinical engineers working in health care facilities.

2. THE NATIONAL SOCIETY

The Croatian Medical and Biological Engineering Society (CROMBES) was founded in 1992, continuing the tradition of the Croatian Section of the former Yugoslav Biomedical Engineering Society (founded in 1984). CROMBES is an interdisciplinary scientific organisation, bringing together those who work in the field of biomedical engineering and medical physics. This is rather unusual for most European countries, but is not an exception (the Institute of Physics and Engineering in Medicine in the UK, for example). Since 1993, the Society has been a full member of the International Federation for Medical and Biological Engineering (IFMBE) and the European Federation for Medical Physics (EFOMP).

The Society is involved in the organisation of international and national scientific events in biomedical engineering, medical physics and medical informatics (in collaboration with the Croatian Society for Medical Informatics). The Society collaborates very closely with the State Office for Standardisation and Metrology, in particular with the Technical Committee TC-62, on the harmonisation of Croatian Standards with European and International Standards relevant for medical equipment.

The Society has published a professional journal since 1995 (Obavijesti HDMBT, in Croatian). Since 2000, the Slovenian and Croatian Biomedical Engineering Societies have published a common journal (Novice / Obavijesti) with contributions in Croatian, Slovenian and English.

In 2000, the Society had 110 members. The members are predominantly engineers, working in universities or in clinical facilities. Due to the interdisciplinary and scientific orientation of the Society, a number of physicians and stomatologists are Society members as well.

The Society has three divisions:

• Clinical Engineering Division
• Medical Physics Division
• Biomechanics Division.

The task of the divisions is to take care of the professional matters concerning clinical and biomedical engineers as well as medical physicists and to organise continuous education for those professions. One of the latest achievements (in spring 2001) was the establishment of a Working Group for Clinical Engineering and Medical Physics within the structure of the Ministry of Health. The aim of the Group is to give professional support and advice to the Ministry in matters of

• health care technology assessment and management
• continuous education of medical and engineering staff in clinical facilities
• (technical aspects of) implementation of EU Medical Device Directives.

Besides CROMBES, there are also other scientific and professional societies in Croatia that associate citizens interested in different aspects of technology application in medicine and the health care system:

• Croatian Society for Medical Informatics
• Health Association - Committee for Engineering and Technology in Health Care
• Croatian Medical Association - Society for Telemedicine.

3. EDUCATION, TRAINING AND ACCREDITATION

3.1 Education

University degree courses comprising lectures in biomedical engineering are provided at three Croatian universities. At the Faculty of Electrical Engineering and Computing, University of Zagreb, there are courses at undergraduate and postgraduate level, at the Faculty of Electrical Engineering, University of Osijek at undergraduate level only and at the Faculty of Electrical Engineering, Mechanical Engineering and Naval Architecture, University of Split, at undergraduate and postgraduate level. However, these do not result in a degree in biomedical engineering, but rather in a diploma (graduate - dipl. ing.; postgraduate - mr. sc. or dr. sc.) in electrical engineering. The undergraduate studies last for 9 semesters.

As an example, a list of subject courses at the Faculty of Electrical Engineering and Computing, University of Zagreb, is presented in Appendix 1. After four semesters, undergraduate students make a choice of program (out of six different programs). Lectures in biomedical engineering are given within the Industrial Electronics program.

3.1.1 The Proposed Postgraduate Program Structure

Working on plans and programs for recognition and education of clinical engineering in Croatia for a number of years, the Croatian Medical and Biological Engineering Society has worked out a model (program) which we consider to be the best, given the current state of Croatian society and its health care reforms, including the economical aspects of the reforms. One of the main considerations of this program was the small labour market. The proposed program is a postgraduate program, lasting at least four semesters, having some courses common to biomedical/clinical engineers and medical physicists, with a lot of practical work in the clinical environment and strongly leaning on international collaboration and mobility. For the time being, the diploma would specify the word "specialist" in biomedical/clinical engineering or in medical physics in order to comply with the present health care regulations.

One of the specific points of this program is to provide common basic courses for engineers and physicists, which is not usual in existing programs.

The other question arising from the present situation in Croatia is whether to name the program a clinical engineering or a biomedical engineering program. At the present time, the name "clinical engineer" is more often used in health care facilities.

In building up this postgraduate program, the preliminary assumptions were:

• qualification of students entering the studies - Dipl. Eng. or BSc diploma in engineering (electrical, electronic, mechanical or technology) or physics
• prerequisite knowledge considered as "a minimum requirement" for entering the program (mandatory topics), measurable according to the ECTS
• subjects of the postgraduate studies would consist of subjects mandatory for both profiles (CE and MP), subjects mandatory for one profile only and optional subjects
• such a structure should enable students to build up specific competencies/specialisation
• subjects intended for both profiles would mostly consist of interdisciplinary topics necessary for both profiles, i.e. selected topics of in anatomy, electrophysiology, biotechnology, etc.
• some of the students may be directed to attend and pass the exam (one or more courses) from the undergraduate engineering or physics programs in order to win the missing credits
• in order to enable the building up of a professional profile for each student, not to restrict him or her to a program offered locally, mobility within European universities should be stressed as one of the most important points of the program
• in addition, students should be encouraged to pursue their education to a higher level, to gain expertise in their profession (these two steps already exists within the European Federation of Organisations for Medical Physics).

We think that such a model could be accepted not only in Croatia, but also in transitional countries that do not have established undergraduate biomedical engineering, clinical engineering and medical physics programs and would be accepted by the international/national bodies for quality control and accreditation of academic programs. That program should be flexible, easily adaptable to the needs of the health care system and the society in general.

3.2 Training

At present, the Ministry of Health is preparing a new law regarding the organisation and systematisation of the health care system. The Croatian Biomedical Engineering Society has proposed that all those engineers (biomedical or clinical) as well as medical physicists who are in close contact with patients and/or life supporting medical equipment and therefore can significantly influence their health status should seek the professional status of "medical worker". Continuous training (after graduation) in accordance with the (existing) requirements for continuous education for medical professions and clinical practice should be introduced for those engineering professions. During the training, the trainees should be employed within the health care system to ensure their clinical practice. After finishing the training the trainees should pass the state exam (for their profession) to get a licence.

Since this schedule is still in development, an acceptable solution should be found for those engineers who already work in health care facilities and have undergone several additional training courses.

In the opinion of the Croatian Biomedical Engineering Society, the responsibility for organising the training should be in hands of the Society and under the control of the Ministry of Health and the university.

3.3 Accreditation of Education and Training

The degrees or related qualifications offered by universities are authorised by the Ministry of Science and Technology. Faculties seeking permission to run a graduate or postgraduate program have to demonstrate the quality of the program and an adequate system for its implementation to the National Board for Higher Education, a body of the Ministry of Science and Technology that is responsible for higher education quality assurance.

In addition, degrees and programs for professions practising in health care have to be accredited by the Ministry of Health.

Universities are self-governing institutions with full responsibility for the quality of their programs. They also decide on the content, duration and title of degree programs, which leads to notable variations.

Croatia has signed the Bologna Declaration and Croatian universities have started the process of harmonising their programs with the requirements and recommendations of the Declaration. Major changes in the structure of programs are expected in the coming years.

4. ADDITIONAL INFORMATION

At present, a scientific postgraduate program in Medical Physics is running at the Faculty of Nature Sciences, University of Zagreb. Most medical physicists practising in health care facilities have graduated from this program and have been awarded a Master's degree (mr. sc.).

Postgraduate education in medical informatics, oriented towards health information systems, was introduced in 1984 at the Medical School, University of Zagreb. This program has been attended by physicians and others working in health or educational institutions. Graduates obtain a Master's degree.

Appendix 1.

Faculty of Electrical Engineering and Computing
University of Zagreb

Studies in Electrical Engineering

Program: Industrial Electronics

* see Table 3.
** two humanistic elective courses are compulsory

*** courses common for undergraduate and postgraduate program

For more information, visit www.fer.hr

Ratko Magjarevic, Vedran Bilas
Faculty of Electrical Engineering and Computing, University of Zagreb
Croatian Medical and Biological Engineering Society
Ratko.Magjarevic@fer.hr