(E-167) Strategies for integrating bioethical frameworks within technical biomedical engineering curricula

Introduction:: As the field of biomedical engineering develops, emergent technologies will continue to challenge clinicians and engineers with novel ethical dilemmas. While no singular approach to ethics training will prepare students to handle these challenges, incorporating ethical inquiry into technical BME curricula is essential in preparing students for future success in resolving conflicts in values, virtues, and design. The recent revisions to the BMES Code of Ethics in 2021 have also emphasized the growing need to teach students the importance of duty and character with regards to protecting vulnerable populations, privacy, fidelity, and garnering public trust for new technologies. Compared to a singular engineering ethics class or reserving ethics training for capstone design, we have scaffolded principles in bioethics and engineering ethics within sophomore, junior, and senior level BME courses that cover biomaterials, mathematical modeling of biological systems, medical instrumentation, and bioimaging. We will present our strategies for incorporating ethics broadly in the undergraduate BME curriculum, including modern case studies that connect engineering content with training in bioethical principlism (autonomy, justice, non-maleficence, beneficence), stakeholder analyses, assessing unintended consequences, and risk/benefit calculations. We will measure the roles of integrated ethics training, self-efficacy and identity as a biomedical engineer, and ability to identify and resolve dilemma through longitudinal assessment across years in the undergraduate program.

Materials and Methods:: To initially integrate ethical principles in technical BME courses, we identified courses that met the following criteria: 1) required by all BME undergraduate students in sophomore and junior year; 2) not listed as a design course; 3) measured for assessing ABET Student Outcomes. Through this process, we identified BME2XX: Biomaterials and BME3XX: Introduction to Medical Instrumentation as best candidates. Additional courses were selected after initial implementation, including BME2XX: Modeling Cellular and Molecular Systems and BME3XX: Modern Diagnostic Imaging Systems. We identified topics that present modern examples of ethical dilemma that are directly associated with technical content. In-class assessments include minute papers on initial understanding of ethical principles[1], laboratory report discussions on ethical dilemma present within the material selection for a particular device[2], and analysis of risk-benefit models for implantable cardioverter-defibrillator[3].

To longitudinally study student self-efficacy with ethical training and ability to recognize and resolve dilemma, we will conduct surveys and focus groups of undergraduates. We have adapted a survey from Robert McGinn’s seminal study[4] of student perfection in value of ethical learning to correlate BME student career goals with their desired levels of ethics training. Multiple focus groups will be conducted in groups of five students. Three questions, from a pool of eight, focusing on current cases in the biomedical field, will be proposed to participants. Students will discuss as a group and each be given a chance to answer the prompt. Answers will be collected and scored on a Likert scale based on a rubric developed in Shuman’s study[5].


Results, Conclusions, and Discussions:: Course evaluation results from these courses emphasizes the growth of student self-efficacy in learning ethics within technical BME content areas. An analysis of student feedback emphasized how learning biomaterials as a multidisciplinary field of “biology, chemistry, physics, and ethics” was “incredibly stimulating” and demonstrated the “practical applications” of this field. Students also remarked that our broad integration strategy was “…the first time I had discipline-specific ethics content in an engineering class.” We will continue to qualitatively code student evaluations to assess the increase in ethics and ethics-coded phrases as an element of engineering technical content.



After collecting our data from the survey and focus groups, we will categorize each response based on the participants’ academic year and perform an ANOVA test to evaluate our results. The analysis of these responses will be done using the qualitative coding data analysis software NVivo 12 to identify common themes and ensure constancy between different groups and graders.



From our surveys, we expect that students’ perception of ethics education increases positively as their academic year increases. We also expect that students will possess a general impression that teaching ethics is valued at our institution, and critical for success in all future careers. From our focus groups, we hope to demonstrate that the ethical knowledge of our students increases proportionally with their academic year. We expect student’s response to include more perspectives as well as more comprehensive explanations as they age, resulting in higher scores on Shuman’s scale.



Furthermore, we want to clearly define how many students and in what classes we are successfully integrating fundamental ethics principles into technical courses. Our department currently utilizes the “ethics everywhere” approach. Comparing our results to McGinn [4] and Shuman’s [5] previous studies will allow us to draw concurrent conclusions about the effectiveness of this strategy and the development of ethical reasoning over time among our students. Future studies should seek to compare the results of our “ethics everywhere” approach to the ethical knowledge of students that experience single course or capstone class ethics training.


Acknowledgements (Optional): : This work is supported by the Lane Family Ethics in Technology grant. We thank the faculty who teach these courses for their assistance in integrating ethics in their curriculum.

References (Optional): : [1] T. L. Beauchamp, “The principles of biomedical ethics as universal principles,” Intercultural Dialogue in Bioethics, pp. 91–119, 2016.

[2] A. Binagwaho, K. Mathewos, and S. Davis, "Time for the ethical management of COVID-19 vaccines," The Lancet Global Health, vol. 9, no. 8, pp. e1169-e1171, 2021, doi: 10.1016/s2214-109x(21)00180-7.

[3] S. L. Kristensen et al., "Risk Models for Prediction of Implantable Cardioverter-Defibrillator Benefit," JACC: Heart Failure, vol. 7, no. 8, pp. 717-724, 2019, doi: 10.1016/j.jchf.2019.03.019.

[4] R. E. McGinn, “‘Mind the gaps’: An empirical approach to engineering ethics, 1997–2001,” Science and Engineering Ethics, vol. 9, no. 4, pp. 517–542, 2003.

[5] L. Shuman, C. Mitcham, B. Olds, R. Miller, H. Wolfe, M. Besterfield-Sacre, R. Pinkus, and M. Sindelar, “Can our students recognize and resolve ethical dilemmas?,” 2004 Annual Conference Proceedings.