School of Engineering
Please direct all questions about the flag proposal process to the Center for the Skills & Experience Flags.
BME 320 International Perspectives on Biomedical Engineering Design
Department of Biomedical Engineering
To satisfy the Global Cultures flag, at least one-third of course grade must be based on content dealing with non-U.S communities, countries, or coherent regional groupings of countries, past or present. Please describe which non-U.S. communities will be studied in this course, and how one-third of the course grade is based on study of the group(s).
In this course, students explore the impact of culture on healthcare delivery and design of healthcare technologies through comparison of Portugal and the United States (US). Comparison of Portugal and the US enables students to see the impact of culture on healthcare because people in these two countries have similar medical resources, as opposed, for example, to comparing a low-resource country such as Malawi to a high-resource country such as the US. Any decision scenario, including medical decisions, can be described in terms of three components:
- the available alternatives (i.e., what are the person’s options)
- outcome probability information (i.e., what are the chances of different outcomes occurring under each of the alternatives)
- the person’s preferences (i.e., how much value the person places on each of the possible outcomes) [1].
Two people can make different medical decisions when faced with the same alternatives (e.g., surgery for prostate cancer, watchful waiting of prostate cancer) and possible outcomes (e.g., survival with urinary incontinence, death) because they value those possible outcomes differently. Moreover, one group of people can systematically make different decisions from another group of people even when faced with comparable alternatives and possible outcomes if the two groups have different sets of shared values, i.e., they have different cultures. Since Portugal and the US have similar resources, and thus similar medical alternatives and possible outcomes, systematic differences in healthcare decisions between these countries are a result of their different sets of shared values, i.e., their different cultures. As an example of impact of culture on healthcare, consider some of the substantial differences between Portugal and the US in breast cancer care. Healthcare accreditation programs in the US recommend that at least 50% of patients with early stage breast cancer receive breast conservation surgery (rather than mastectomy), whereas the target established by European groups is that at least 70% should have breast conservation surgery [2]. Many more healthcare providers in the US recommend screening mammography starting at age 40 years (40% of providers) as compared to no routine screening (13% of providers), yet in Europe about the same number of providers recommend screening mammography starting at age 40 years (28%) as recommend no routine screening (27%) [3]. These statistics are representative of persistent differences in cancer care across several decades [4, 5]. Moreover, these differences in breast cancer care reflect different attitudes about intervention and managing risks that are also apparent in other aspects of daily living that students in BME 320 experience during their time in Portugal. For example, we take the students to a grocery store and discuss why eggs are refrigerated in the US but not in Portugal. (To keep eggs safe from bacteria, Portugal relies upon the natural protective coating of chicken eggs whereas the US washes away the coating and relies upon refrigeration instead. [6]) 50% of the course grade is for course participation: (a) the planning, conduct, and interpretation of interviews of healthcare professionals, (b) professional field trips, and © cultural activities. The participation grade is assessed via reflective writing assignments that follow each interview, field trip, and cultural activity and specifically prompt students to reflect upon cultural study. The templates for the reflective writing assignments are provided in a supporting document. The syllabus, also provided as a supporting document, includes a list of the healthcare professionals who were interviewed, the professional field trip locations, and the cultural activities in the preliminary offering of the course under a special topics number in 2017. 25% of the course grade is for summative, course-level reflection on cultural study. Students perform self-assessments of Global Learning and Intercultural Knowledge and Competence, pre-departure and at the end of the course. (Students are graded on completion of the self-assessments, not their self-assessed performance level.) Students also write an essay on the impact of culture on healthcare delivery and design of healthcare technologies. More information on this component of the course grade is provided in a supporting document. The remaining 25% of the course grade does not explicitly require the students to write about culture, though the project topics are defined based on the interviews described above. In small teams, the students write an abstract of an NIH-style proposal for a project to improve health-information technology; individually write NIH-style critiques of the other abstracts; participate in a mock NIH study section (proposal review panel) of the abstract; and then each team revises their abstract to address the feedback received.
The Global Cultures flag requires that an in-depth examination of the broader cultural context and perspectives of these non-U.S. communities. Please describe readings, assignments, and activities that allow students to engage in depth with these non-U.S. communities.
Students engage with Portuguese culture through each of the three primary course activities. First, students plan, conduct, and interpret interviews with healthcare professionals from both Portugal and the United States (via videoconferencing). They plan semi-structured interviews using techniques from human-centered design and readings on topics such the development of medical expertise, types of cognitive bias, and clinical decision-support systems. Through individual reflection and class discussion of the interviews with healthcare professionals, the students identify actionable problem statements pertinent to health information technologies. Second, students engage in half-day professional field trips to healthcare-related research facilities in Portugal. Through these field trips they interact with Portuguese students, healthcare professionals, and scientific and engineering researchers in their regular work environments. Third, the students participate in half-day cultural activities intended to provide a broader perspective beyond the healthcare context. These activities include introductions to the language, food, history, and art of Portugal. The syllabus in the supporting documents includes lists of healthcare professionals interviewed, professional field trip locations, cultural activities, and course readings.
The Global Cultures flag indicates that, ideally, a course will challenge students to explore the beliefs and practices of non-U.S. cultural communities in relation to their own cultural experiences so that they engage in an active process of self-reflection. Please describe some assignments or activities that give students an opportunity for this kind of reflection.
Students are challenged to reflect upon the impact of culture on healthcare delivery and design of healthcare technologies through writing assignments that follow each course activity (e.g., after each interview) and through a summative writing assignment at the end of the course. More information on these assignments is provided in supporting documents.