As more and more medical devices become computer based, there is an increasing need for hospital staff and clinicians to be properly trained on the use of this equipment. No longer can a physician or nurse pick up an unfamiliar device and quickly learn how to use it. Considering the volume of staff in any given hospital or health care enterprise, it is increasingly difficult for a vendor to provide comprehensive training on a new medical device to every end user who works on every shift across multiple campuses. Some hospitals and vendors have tried to provide computer-based training as a means to provide large-scale training. In some cases this type of training works, but it is very dependent on end users actually completing the computer-based training. And some users may not be comfortable with using a computer, so this type of training is not always a reasonable option for them in place of hands-on training.

The good news is that clinical engineering does have the knowledge to effectively supplement the limited training a vendor may provide, assuming that clinical engineering has the staff available to provide such training and a mechanism in place to provide the training when it is needed.

As devices become more computerized, they may be more difficult for end users to learn to use, particularly for users who have only limited experience with computerized medical equipment. Increasingly, vendors rely on a "train the trainer" approach to train all end users in a facility. This is an opportunity for biomeds to provide additional value to the hospital by stepping in and being the "super users" who can then provide additional end user training. Clinical engineers (CEs) and BMETs have the necessary technical expertise to understand how to use the devices as part of their need to service the devices. However, there are some unique challenges to be faced by a clinical engineering department if they are going to provide medical device training.

Staffing Challenges

First, staffing is an issue. Given the significant demands already placed on a clinical engineering department's time and the potentially increasing demands if the department begins to assume more responsibility for some networking aspects of medical devices, it may be difficult for the department to free up staff to provide training. While biomeds may be able to provide training for a device with limited users, such as emergency-department (ED) physicians who may use a portable ultrasound scanner for trauma cases, it may be much harder to provide training for devices, such as computerized infusion pumps, that are used by a large number of people. Clinical engineering will need to budget its time to ensure that if it takes on additional training responsibilities that it can do so and also decide under what circumstances. Will clinical engineering set up limitations on when and how users can be trained, or will this be an on-demand service? Will clinical engineering set up group training sessions and expect that departments pick up training for individuals who cannot attend the larger training sessions? Ultimately, if clinical engineering commits to providing training but is not available to do it, this is a larger disservice to the organization than not having clinical engineering assume this responsibility.

Technical Training Only

A second and perhaps larger issue is that clinical departments have seen such good success in having clinical engineering or information technology (IT) train its staff on the use of medical devices and systems that they assume that these departments will also take responsibility for providing clinical education. Clinical departments also may believe that anything to do with a computer-based device now falls into the clinical engineering or IT area. For instance, biomeds may be able to show ED physicians how to use a portable ultrasound scanner and all the functionality that scanner can perform, but they cannot train those physicians on what the physician should scan or on what comprises good clinical ultrasound images. Clinical engineering does not have the clinical knowledge to provide this training, nor does it know how best to use a particular device in a clinical setting. If biomeds provide training on a new device to a clinical department, they should make it very clear that any clinical training—such as determining best practices for using the device, managing clinical/workflow issues associated with the device, etc—will be handled by the individual clinical department.

Communicating Knowledge

A final area of concern is whether or not clinical engineering has staff who can be effective trainers. While a CE may have extensive knowledge of a particular device and all its functionality, that individual may not be able to communicate that knowledge to a much less technical end user. Or that CE may not feel comfortable training a large group of end users at one time. An ineffective trainer provides little benefit to the user who ultimately needs that training to effectively use a medical device to provide proper patient care. Therefore, it is essential for clinical engineering management to successfully screen its staff to determine who has the necessary skills and desire to provide effective end user training.

Ken Olbrish, MSBE, is an enterprise imaging system administrator in the Information Services Department for the Main Line Health System in suburban Philadelphia. For more information, contact .