Introduction - Connection to EM

As in all industries, a new medical device solution requires economic viability to be successful. We quickly discard potential solutions to problems if monetary profit seems unlikely. Engineering students are often taught to do the same as they evaluate feasibility of solutions. EM asks us to look for contrarian views to accepted solutions and to create value. This module encourages students to both challenge conventional thinking in engineering solutions and explore ways to create added value for society.

The lecture presented before the activity (see attached file) asks students to engage with the following questions:

• How do we assess value in the ever-changing world of healthcare economics?
• Can a solution still be successful if the value it creates is non-monetary?
• What other types of value are there in medical solutions?

The goal of this module is to encourage freshman engineering students to develop a mindset in which they think beyond traditional economics and explore different dimensions of value in engineering solutions to medical problems. A backdrop of healthcare disparities was used to provide an abundance of opportunities to uncover new types of value, such as:

• The value of broadening access to healthcare solutions
• The value of achieving social equity in access to healthcare solutions
• The value of improving public health
• The value of preventing disease

In most cases, the types of value above appear to be in direct conflict with economic viability, as they would require low cost solutions aimed at patients of lower socioeconomic status. However, in a country in which there is a slow shift in medical reimbursements from pay-per-treatment to one based on quality initiatives and long-term benefits, these other forms of value can indirectly lead to economic value.

But these are complex topics, so how can freshman engineering students with limited, if any, exposure to different segments of society gain an appreciation of healthcare disparities?

While an immersive experience or the ability to learn from patients impacted by healthcare disparities would be best, such approaches were not feasible in our short learning module. Rather, a healthcare worker with extensive clinical experience helping such patients was recruited for an interview with the class in a live virtual meeting. This emergency medicine resident physician had previously spent seven years as an emergency nurse in an urban Level 1 Trauma Center. During these interviews, conducted in three separate sections of the course, the instructor prompted the guest with questions related to his experience with healthcare disparities. Students added their own questions as the interviews proceeded. Some issues that came up in the discussion included:

• Transportation challenges
• Language barriers inhibiting communication
• Lack of patient literacy preventing comprehension of treatment plans
• Cultural sensitivities and underlying bias
• Technical illiteracy and lack of internet access among elderly patients

Students were instructed to take notes during the interview, in particular identifying problems that they heard during the discussion.

Preparing the Students

As these were freshmen students, it was assumed they had no prior experience with identifying needs, nor of the economics of healthcare. Therefore, to prepare the students for the activity, a live virtual lecture period was used to provide an introduction to the following topics:

• Methods of identifying problems and conducting needs assessment in healthcare
• Healthcare economics and reimbursement
• Defining different types of value
• Exploring different types of medical solutions (pharmaceuticals, devices, wellness apps, etc.)

A brief low-stakes online quiz was administered following this lecture period to assess basic understanding of these topics.

Conducting the Activities

The student activities (see attached lecture and lab files) for this module were conducted in a two-hour virtual lab period using Microsoft Teams. It was broken up into the following sequence:

1. Interview with our healthcare provider (approx. 30 minutes)
2. Small group (3-4 students) breakout activity to narrow down to a single problem and brainstorm possible solutions (approx. 30 minutes)
3. Class discussion to share ideas from groups and introduce the assignment

Individual Assignment/Reflection

Following the small group activities, students were asked to compose a short document in which they identified a problem and solution discussed within their group (see attached reflection assignment file). They were also asked to identify barriers that they thought might have prevented the problem from being successfully addressed in the past. They were then instructed to reflect on the different types of value created by the proposed solution, specifically identifying both economic value and other types of value. An assessment rubric, used for grading the assignment, was shared with the students when the assignment was given.