ACCREDITATION OF BIOMEDICAL ENGINEERING PROGRAMS IN EUROPE - CHALLENGE AND OPPORTUNITYINTRODUCTIONAccreditation of engineering, technology and applied science programs is a well established procedure in many countries, above all the United States, where the American Accreditation Board for Engineering and Technology, ABET, is the famous and often feared institution granting the much desired accreditation. Even in those parts of the world, where no accreditation agencies exist, ABET with its global range of activities provides the service of an accreditation-like evaluation, offering recognition as "substantially equivalent" to an accredited program in the US. In the United States, a university or college can hardly be nationally renowned or even be accepted as a high quality educational institution without having their programs, mainly the undergraduate programs, accredited. In addition to issues such as the comparability of degrees and qualifications, accreditation is also considered a service to students and their parents who pay the tuition fees, giving them the confidence that the chosen college offers a quality education that is worth spending all that money. In Europe, the situation is quite different. Here, education is free of cost, and the national governments guarantee the quality not only of primary and secondary education, but also of academic programs. Hardly anybody in Europe paid any attention to the accreditation of academic programs until the recent rapid development of the European Union raised the issue of mobility and the related problems of mutual recognition of degrees. It is the Bologna Declaration that has noticeably focused European attention on harmonising European education and introducing quality control. The process started with the Sorbonne declaration in 1998, followed by the Bologna declaration in 1999 and the Prague meeting in 2001. The main players in this development are the universities. Thus, the European University Association (EUA) met in preparation of the Prague summit in Salamanca in March of 2001, and identified six important themes in the creation of the European Higher Education Area:
Thinking about how to realise the requests for employability, mobility and compatibility, it becomes obvious that the most urgent issue in this context is to generate an agreement on accreditation, since accreditation based upon criteria that are being agreed to throughout Europe is a necessary prerequisite to achieve all the other goals. Today, more than 150 universities, universities of applied science, polytechnic schools and academies in Europe offer educational programs in biomedical engineering at all academic levels, but with only little international co-ordination of contents and required outcome qualifications. However, continuing globalisation of economies and science calls for harmonisation, not necessarily harmonisation of the educational programs, but harmonisation of qualifications that are connected to the graduation from an academic program. Thus, we need the initiation of European structures for accreditation, warranting the comparability, compatibility and mutual recognition of BME degrees. National quality assessment and accreditation schemes have to be established where they do not yet exist, and they have to be harmonised, i.e. they need to satisfy those criteria which the European BME community will have to establish on a transnational basis and mutually agree upon. It is obvious that accreditation not only plays an important role in ensuring transnational mobility for education, training and employment, but that it is also directly related to the issues of health care quality. It offers the additional advantages of providing confidence for the employer that the employee has the necessary education, training and responsible experience, and confidence for the user of the service, meaning the patients, that those providing the service are effective and competent. Accreditation of biomedical engineering programs also addresses the important European aim of "freedom with responsibility", meaning that the universities have to take care that the academic programs they offer are competitive and are recognised by employers in order to attract students. Similarly, the students will have to be well informed in order to select where they want to get their education and what that education shall comprise to be employable. Mobility is just one facet of this process, and the existing degree barriers preventing biomedical engineers from moving freely within Europe need to be lifted. As their contribution to support students to make an informed decision on their choice among academic programs, IFMBE and the newly forming European Alliance for Medical and Biological Engineering are currently establishing a homepage providing all available information to students on BME programs in Europe, comparable with the American BMENet. At first glance, the easiest way to achieve harmonised accreditation in Europe seems to be to just expand ABET's authority, or to establish ABET-like structures and procedures and apply the American requirements for accreditation. But could we then assure adequate European influence? The main path towards European accreditation must be through the European governmental bodies responsible for education, meaning the Bologna group of ministries, the universities, and last but not least the national accreditation councils. It will still not be that easy to define internationally accepted criteria, minimum requirements and competencies. Difficulties result from the enormous diversity of partially incompatible educational systems in Europe, as well as from the exceptionality of the young, highly dynamic discipline of biomedical engineering which offers a whole range of different qualifications and directions, related to various engineering speciality matters and which, as a part of the so-called life sciences, is reaching far into neighbouring sciences such as medicine, biology and biochemistry. Adding to the problem are the many established programs within the classical engineering disciplines offering specialisation in BME up to different levels of qualification or competency. The last but not the least of the problems that we are facing in contrast to the situation in the US is that European governments will not be willing to give up their authorities and rights to determine academic education. OUTCOME BASED ACCREDITATIONA crucial issue in setting up accreditation procedures has so far been the establishment of minimum requirements and curricula. These have to include educational prerequisites for entering a BME program, course duration, basic and advanced biomedical engineering topics including mandatory and optional subjects, the ratio of lectures/practice/laboratory work and the minimum requirements for the independent work of the student. Due to the diversity and incompatibility of the various national educational systems, such an approach would, however, be obsolete from the beginning, if European harmonisation and mutual recognition of degrees are to be achieved. As a solution to this problem, accreditation must be outcome or competency based. Instead of imposing curricula, courses, duration and prerequisites to enter the programs, the outcome, i.e. the aptitude of students graduating from these programs will be the factor deciding on accreditation. Nevertheless, recommendations still need to be established for topics, courses and other contents of educational programs in order to achieve the required outcome. It is this approach to accreditation of academic programs that ABET has recently adopted, too. CRITERIA FOR ACCREDITATIONThe IFMBE Ad-Hoc Committee on BME representation in Europe, now being replaced by the Protem Committee of the planned European Alliance for Medical and Biological Engineering and Sciences, is currently, in cooperation with the European member societies of IFMBE, evaluating the diversity of existing BME programs and their situation with regard to accreditation throughout Europe. The Committee is preparing a white paper on the accreditation of BME programs in Europe. The Committee has also accepted the challenge to establish recommendations for accreditation criteria to be applied to pure and interdisciplinary BME programs within the new European framework of harmonised one and two cycle educational programs. To be internationally acknowledged, European accreditation has to rely on ambitious, but broadly accepted criteria. Broadly accepted means that all European countries must agree. This definitely is not an easy task. IFMBE and EAMBES, once reality, will aim at being accepted by the governmental bodies and the universities as the providers of BME expertise on the European level and support their member societies to provide the same services at the national level. With their recommendations, IFMBE and EAMBES will provide their European member societies, the European universities and other institutions of higher education that offer BME programs a uniform guide to comply with the necessary international harmonisation of higher education, to secure and to further improve the high quality of European BME education, to allow comparability of European BME qualifications and degrees, and thus to contribute to mobility for education, training and employment. The recommendations are intended to directing the attention of institutions of higher education and of governmental educational authorities to the essential contents of biomedical engineering education and thus to promoting European competitiveness in this dynamic discipline. The recommendations need to specify the criteria for accreditation including qualifying programs and degrees, the educational objectives and minimum requirements in terms of outcome competencies, organisational requirements, quality of teaching and teaching material, necessary minimum resources and facilities including the required qualification of the instructors, and the consequences of these criteria for the accreditation process, particularly the involved evaluation procedures. Accreditation criteria need to be provided for pure BME and mixed, undergraduate as well as graduate or one and two-cycle programs, training and continuing education corresponding to the European "lifelong learning" initiative. Lists of competencies have to be agreed upon that specify the necessary combinations of basic knowledge, basic BME topics, and advanced BME topics. Due to the enormous range of the different working areas in medical and biological engineering and the large variety of professions, each with different requirements regarding competencies, there cannot be a single list of topics with minimum aptitudes in the individual areas of BME, but there must be a whole range of different competency profiles, each of course requiring a specific curriculum, and each being tailored to the particular academic and professional level as well as to the speciality area. It is well understood that the recommendations for the criteria have to leave sufficient flexibility to permit the individual educational institutions to maintain or to develop their specific, local identities. International harmonisation or at least mutual recognition of degrees between individual countries or within larger areas such as the European Union requires that all parties involved agree upon the competency profiles. Getting to a broad international agreement on competency profiles might be relatively easy for traditional professions, it will, however, require major efforts and compromises for a discipline like BME which is well established in some countries, but only emerging in others, and that is expanding at an amazing speed. CONCLUSIONEuropean BME accreditation is expected to have major beneficial effects on the profession of medical and biological engineering with regard to professional qualification, employability in a global world, collaboration between healthcare providers, industry and universities, and the establishment of international research networks. However, in order to arrive at these desirable effects, co-ordinated and focused actions on national, European and global levels are required. Traditional European structures of education, research, and research funding, which are strictly national issues, are becoming more and more obsolete in a unified and harmonised Europe where mobility is mandatory, and need to be replaced or at least supplemented by structures providing the compatibility of systems. Future developments are determined right now and that does apply to biomedical engineering, its future development and its significance, too. It is imperative that the European community of biomedical engineers is participating actively in any and all decisions touching their profession, and it has to be ensured that others do not make these decisions without regard to our interests. It must also be ensured that the evolving system includes or at least remains open to those countries, which are not or not yet members of the EU. Therefore, all European societies representing biomedical engineering, medical physics, clinical engineering, medical informatics, artificial organs, biomaterials etc. must address the issues of the European Higher Education Area, and must work together to realise the required changes in a way that is beneficial to our profession and thus to society.
Joachim H. Nagel
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