It is perhaps helpful to start the discussions with a definition of engineering in its broadest sense, which Blockley1 does in the preface to ‘Engineering, A Very Short Introduction’ as follows:
“Engineering is the discipline of using scientific and technical knowledge to imagine, design, create, make, operate, maintain and dismantle complex devices, machines, structures, systems and processes that support human endeavour.”
Clinical Engineering is the contextualisation of this practice applied to medical technologies used in healthcare and there is now an established career framework for engineers within the NHS. These roles span all activities above with engineers working across the spectrum from hands on medical equipment life cycle activities through to Clinical Scientist roles working with patients undertaking clinical measurement or rehabilitation engineering activities, as well as device risk management and governance.
Clinical Scientists have been trained internally within the NHS with the current STP curriculum, running since 2011, which was specifically designed to develop engineers as critical system thinkers, who understand technology, together with patient and organisational needs. The 3 year supernummary scheme, funded by Health Education England, enabled trainees to undertake a part time MSc and a programme of work based learning with co terminus registration with the Health and Care Professions council as a Clinical Scientist upon completion. The programme was structured to undertake 3 month rotations in the first year introducing all areas of clinical engineering followed by specialising in either:
- rehabilitation engineering
- clinical measurement
- device risk management and governance
The National School of Healthcare Science review of STP curricula has been an opportunity to reflect on the existing curriculum and whether it meets the needs of the NHS in developing the future workforce. This has led the curriculum review team to bear in mind a number of points when developing principles to underpin the design of the future curriculum:
- The Higher Specialist Scientist specialty in Clinical Biomedical Engineering launched in 2014 and there is the opportunity for alignment of the content.
- Whilst the STP scheme is aimed at developing Clinical Scientists the trainees are also aspirant Chartered Engineers and alignment of the scheme with Engineering Council requirements, articulated in UK-SPEC is desirable
- An observation from Trainees that they feel they are only eligible to apply for jobs in the specialty they have trained in needs addressing.
- Small Departments feel they cannot cover all aspects of the scheme so often feel cannot take trainees.
- The NHS, via the long term plan is articulating the need for changed service delivery models opening up new roles for clinical engineers. The response to the covid pandemic has highlighted the flexibility of the clinical engineering workforce to adapt to new roles and service delivery models
- Technological changes, (e.g. with software being identified as a medical device) and more distributed technologies require former medical device management approaches to be extended to healthcare technology solutions.
- The need for an agile workforce to respond to the digital future
- Increased training capacity.
Taking into account the points above it was concluded that a focus on equipping trainees with the fundamental aspects of clinical engineering principles and practice maximised the potential future workforce. The vision being that trainees at qualification could then apply for any clinical engineering Band 7 role and specialise post registration with employers safe in the knowledge that as Clinical Scientists newly qualified staff had the self-awareness and core skills to develop necessary specialist activities. In order to take this approach the core curriculum has been revamped with the following key principles in mind that trainees must develop:
- the ability to work with patients
- expertise in Healthcare Technology Management
- analytical skills to underpin critical thinking
- systems thinking approach
The curriculum has been developed with the above principles in mind. There are perhaps two areas of concern to clinical engineering departments when looking at the new proposal:
- Rotations have been lost
- Specialties are no longer present and ‘my department’ won’t be able to deliver the new modules
Whilst it is true the year one rotations are standardised across all programmes and are much more like acquaintanceships none of the former clinical engineering learning content has been lost. The rotation content has been embedded into the specialty training, as this makes for a more rounded trainee as irrespective of former specialties all trainees should be competent in healthcare technology management, clinical measurement, patient facing activities and innovation. Rather than forgetting rotations on entering the specialty there is now a more robust bringing to life practice contextualised to the work of the training centre. The lack of specialty specific training should not be a barrier to training delivery as the curriculum has been designed to enable the trainee to gain the experience necessary within the work of the training department.
Whilst change is always challenging the review team are to be commended for developing a curriculum that meets the challenges of a changing world and strengthens trainee’s ability to join the NHS in both existing and future roles
1 Engineering A Very Short Introduction, Blockley, D, Oxford University Press, 2012