IUPESM - the development of Key ProgrammesYou are invited to comments these and to participate into the planning and subsequent implementation stages of these programs. As decided in the IUPESM General Assembly in Nice last September, the President Keith Boddy together with the administrative council is actively pursuing a more fruitful relationship with the International Council of Scientific Unions (ICSU). One of the lines of activity is to identify, develop and launch programs that serve the needs of the medical physics and biomedical engineering communities and could be implemented jointly with the ICSU. Five such key programs areas have now been identified. Below a summary of each is presented. Each will consider the following elements: public and governmental understanding of the present and potential contributions of physical and engineering sciences and technology to health care; development of Health Policies, issues associated with Developing Countries, issues associated with Emerging Countries, teaching and training, continuing professional development, research and development, dissemination of information and links between academia, public sector and industry. 1. International health policies for the millennium; governmental and public understanding of present and future applications of physical and engineering sciences in medicine and their implications for the care of patients and disabled people The general public has a poor understanding of science and technology, which extends to governments and civil servants. It is tacitly realised that highly qualified graduate scientists, including engineers and technologists, have an important role in patient and healthcare, despite not knowing what such roles are. Most significantly, there is a lack of recognition at governmental level internationally of the wide ranging and fundamental contributions by "back-room" professionals, such as medical physicists and biomedical engineers. It is essential to remedy or, at least, alleviate this situation for several important reasons. First, in general terms, the stature of scientists has diminished in the eyes of the public to the point where there is even distrust. Many applications of science and technology are viewed as abstruse and the "advancement of knowledge" of little everyday benefit to people's lives. Ramifications include a diminishing recognition of the professional status and qualifications of scientists, a growing lack of interest among younger generations to pursue degrees of higher education in science and ultimately a lack of trained scientists. Secondly, while postgraduate training and continued professional development are well-established for the medical profession and usually accepted as a norm by governments and funding bodies, this is not always the case for scientists. There is, therefore, a growing perception that science is of little immediate benefit to mankind, salaries and careers are becoming less and less attractive and educational and training opportunities are either fewer or not chosen. To redress this imbalance and trend, a window of opportunity is offered by medical physics and biomedical engineering where experience shows the surprise and appreciation expressed by those previously unfamiliar at the everyday usefulness, immediate application as well as the relevance of scientific research and development for the health and care of patients and those with disabilities. The aim of this program is to improve and expand such understanding within nations and internationally. An invitation is extended to ICSU to collaborate directly and play a major role in this initiative. Such collaboration would also greatly enhance its prospects for success. Contact persons: Keith Boddy, email : kboddy@rmpd-ngh.demon.co.uk Jean-Pierre Morucci, email : morucci@cict.fr 2. Evidence based health technology Medical physicists and biomedical engineers have traditionally been involved in both the development and application of various technologies in medicine. Internationally there has been a growth in 'evidence based medicine' which is particularly concerned with the implication of a medical procedure on the eventual outcome to the patient with concerns about its health benefit and cost effectiveness (see e.g. http://hiru.mcmaster.ca/cochrane/). This is a particularly important area for the IUPESM to develop as its members have a responsibility for a wide range of technologies associated with diagnosis and therapy in medicine and health. Health Technology Assessment This is a term that is now internationally used where the word 'technology' is used to describe any procedure in its widest sense. We are particularly concerned with its more traditional meaning as applied to medical devices or equipment. This whole area requires significant training, education, development and co-ordinated research and will grow from its initial, present, very low base to very rapidly over the next decade. It is of particular importance to countries who wish to maximise any expenditure that is made in medicine and health is terms of patient outcome. Health Technology Assessment (HTA) is therefore quite different from equipment evaluation in that the latter is concerned with whether a piece of technology or equipment is doing what its manufacturer or user thinks it should be doing. However HTA seeks to answer questions more directly related to healthcare. Does the procedure (diagnostic or therapeutic) have an impact on the management of the patient, and more specifically, on the eventual health outcome? What are the health economic consequences of the particular technology? Is its use cost effective in the provision of healthcare in a general sense? International organisations such as the Cochrane collaboration have, for a number of years, been setting up databases of key research publications and stimulating evidence based medicine in a number of medical specialities (eg obstetrics and gynaecology). There is a similar need to develop evidence based medicine associated with medical technology and IUPESM will play an important role in such developments. We have already said that there are specialist groups within physical and engineering sciences in medicine who organise national and international conferences, but there is often a reticence for such specialist groups to become involved in HTA as it may identify some of the newer, more expensive technologies as not being particularly cost effective. Hence organisations such as the IUPESM are essential to develop a broadly based initiative in the area of HTA. Evolving technologies One of the major questions internationally about evidence based technology is the fact that as general technology develops, the performance of a particular piece of equipment will continually 'improve'. It is essential to develop an international co-ordinated approach on how to deal with the assessment of such evolving technology to tackle the problem of spiralling costs in healthcare. The emphasis on increasingly improved performance, with correspondingly higher costs, has to be tackled. Appropriate technology The term 'appropriate technology' has been criticised by developing and emerging countries and there is a tendency to assume that it implies such countries can, and should, use equipment with a lower performance specification. The concept for appropriate technology is as valid to the industrialised countries as it is to the emerging or developing countries as it essentially relates to the use of equipment in a specific, healthcare and economic environment and seeks to find an optimum approach. Indeed in many circumstances, more expensive, 'sophisticated' technology may not only be less cost effective but have a poor impact on health outcome from a societal perspective than slightly lower performance technology. Thus the whole concept of appropriate technology can be addressed objectively under the auspices of evidence based technology. Contact persons: Michael Smith, email: mas@mphd1.novell.leeds.ac.uk Jan Persson, email: jan.persson@cmt.liu.se Peter Heimann, email: pheimann@eagle.mrc.ac.za 3. Medical equipment evaluation Much of the work of medical physicists and clinical engineers is associated with the use of equipment and technology associated with the delivery of healthcare, whether for diagnostic or therapeutic purposes. Central to this activity is the need for equipment evaluation i.e. the measurements and analysis to ensure that the equipment is doing what it should be doing from a physical or engineering perspective. Equipment evaluation is important, and would benefit from international collaboration, particularly in the following areas: Performance testing There are issues that are common to both physical and engineering sciences which are generic in the performance testing of equipment. Examples could include how to measure the resolution of medical imaging devices, or the strength and bio-compatibility of biomaterials used in patients. It is essential that standardised, robust procedures are used to determine the performance of equipment to the optimum delivery of healthcare. Quality assurance Having assessed the performance of equipment used in healthcare there is a need to instigate a regular programme of quality assurance/quality control measures to maintain the quality of performance of any such equipment. Safety Included in equipment evaluation is, of course, the issue of safety to the patient. Issues of safety are (a) inherent to the specific equipment and (b) associated with its usage. Thus medical physicists and clinical engineers must ensure safety from the perspective of the patient which would include performing measurements, adjustment if necessary, and education of the users of the equipment. Issues such as electrical safety or excessive radiation exposure are but two examples of this area. Environmental Environmental issues associated with equipment are also the remit of physical and engineering scientists. These can include (a) the influence of such equipment, and the consumables it may use, on the environment and (b) the effect of the environment on the equipment itself. Contact persons: Michael Smith, email: mas@mphd1.novell.leeds.ac.uk Peter Heimann, email: pheimann@eagle.mrc.ac.za 4. Education, training and continued professional development for the 21st century In 1997 at the Triennial meeting the IUPESM committed to develop a new program using electronic communication resources to address the continuing problems of inhomogeneous distribution of medical physics and biomedical engineering expertise with respect to the world-wide distribution of the human population. This problem was identified as having three separate sources: primary university education, continuing education and training following graduation, and development of professional standards of conduct. The program to improve the level and appropriateness of primary university education will use the WC2000 website to provide regional lists of graduate programs with detailed listing of curricula for programs worldwide. These lists are to provide easy student access to information on appropriate study programs but also to encourage program development by creating standards of self-comparison. Inclusion of lists of course contents, examination procedures, laboratory experiences, and dissertation requirements are suggested for prerequisites to inclusion of graduate education programs on WC2000. Listing will be separated into accredited and non-accredited programs to promote improvement in the level of training worldwide. In addition a program has been established to encourage linkages between graduate education programs in developed nations with sister programs in developing nations. In addition the Developing Nations Committee is working on programs to promote visiting faculty exchange and sharing of graduate level courses over electronic distance learning networks. Shared courses over distance learning networks is proposed as a cost effective method to improve curricula worldwide as well as promote regular interchanges for developing nations. Regional co-operation with creation of new graduate programs is encouraged. The need for Training and Continuing Professional Education in Medical Physics and Biomedical Engineering will be encouraged through regional listings of courses on WC2000. Participation of faculty from developed nations in regional education courses is promoted by collaborative efforts to provide travel assistance for expert faculty. In addition, inclusion of expert faculty over distance learning networks is encouraged to provide interchange benefits at minimum cost. The last component of this three pronged attack is a program to promote professional recognition and job opportunities for medical physicists and biomedical engineers in their homelands. It is recognised as a common problem that well trained professionals returning home after foreign university training face the problem of not finding a position in their speciality. Their new profession is not recognised within the organisational structure of their native country. To address this problem WC2000 will provide regional and national information concerning the professional responsibilities and expectations for professional medical physicists and biomedical engineers. Listing web sites of professional accrediting bodies, standards of practice, calibration laboratories, sample examinations, licensing requirements and others will be provided. Downloadable versions of professional documents will be provided to offer well tested organisational paradigms for possible adaptation to needs in developing nations. It is emphasised that many of the initiatives planned here are already under development by national and regional organisations. It is not intended to replace or compete with such efforts. The IUPESM initiative is meant to provide global integration of regional information sources. Contact persons: Gary Fullerton, email: fullerton@uthscsa.edu 5. Global biomedical information networking and implementation for developing and emerging countries The intent is to make up-to-date medical physics and biomedical engineering information equally available to the 40,000 members of the Union in more than 70 nations on a continuing basis. This project enlists the co-operation of the Organizing Committee for the next triennial IUPESM World Congress on Medical Physics and Biomedical Engineering in the year 2000 to focus on electronic communication and the group made the following commitment to networking: "On March 1, 1997, the 7th meeting of the Organizing Committee for the World Congress on Medical Physics and Biomedical Engineering - Chicago 2000 (Chicago '2000) was held in Washington DC. The meeting was chaired by the Chicago '2000 Co-Presidents, Dr. William Hendee and Dr. Alfred Potvin. The Committee's efforts are shaped by the vision for Chicago '2000 developed by the Co-presidents: to plan a meeting that reflects the rapid evolution of electronic analytical and communications technologies in science and healthcare, and recognises the immediacy of a new millennium for scientific research, technology development and improved healthcare." The organisers of Chicago 2000 plan to improve communication by creating the WC2000 website as an inherent component of the Congress structure. The website provides a contact map that presently links to more than 200 information sites concerning the major categories:
The number of links will be expanded over the next three years to exceed more than 2000 by the year 2000. The last six of these categories have begun the slow process of knitting together a speciality specific network of websites to promote rapid effective distribution of cutting-edge information. The WC2000 website presently has an Editorial Board of seven led by the Editor-in-Chief, Dr. Gary D. Fullerton. It is planned to expand the Editorial Board with regional subgroups of four each from Asia, Europe and Latin America in 1998. The purpose of the Editorial Board is to assure the quality of information on sites accepted for linking into the network and promote the improvement and organisation of information available on those sites. The intent of the information linked under the Category "Technology market place" is to make information concerning instrumentation and supplies necessary for the practice of medical physics and biomedical engineering easily available to all. This information will make it possible to quickly improve the efficiency of members by putting the most appropriate and cost-effective tools in the hands of specialists world-wide. This section will also address technology assessment and safety issues in relation to industrialised and developing nations. The information linked under the category "Education resources" is intended to promote the evolutionary development of medical physics and biomedical engineering education by providing direct access to detailed information on the organisation and quality of educational preparation offered world wide. It is to make selection of the "best" program for the specific educational goals of a student possible from anywhere in the world independent of where that educational opportunity may be located. The goal of the category "Research resources" is to match the best investigators in medical physics and biomedical engineering with the resources and funding necessary for them to achieve their ends. The category 'Professional resources' addresses the need to improve the professional practice of medical physics and biomedical engineering by allowing international comparison of standards of practice, public health policies, licensing and others. Downloadable documents make the most recent developments in the profession available to all and improves the quality of practice by allowing, comparison of national performance with international levels of achievement. The "Job search" category is intended to assist the international community to match the best job candidates with jobs independent of the location of the position or the candidate. "Gateway to knowledge" provides links to the range of databases available to promote more effective performance of medical physicists and biomedical engineers in meeting the needs of mankind for improved healthcare. The rationale for the biomedical information networking project is the belief that mankind needs the optimal use of human intellect to resolve the problems facing a growing population. Improved computer networking will make it possible to improve health care while remaining within the increasingly stringent financial demands of the 21st century. Contact person: Gary Fullerton, email: fullerton@uthscsa.edu | ||