TU/e innovation Space CBL Toolkit

How do you train engineering students for real life medical challenges? Jorge has been faced with this question and has found his answers in designing the course Digital Twin in Healthcare. Read the full interview here.

Key words: CBL, students, learn, teaching, problem, challenge, university, question, concept, labs, teacher, medical, engineering, sensors

Interviewer: Chiara Treglia

Chiara: Can you give a little introduction about yourself, your background, and how long you have been here, at TU/e? 

Jorge: Of course. My name is Jorge Alfredo Uquillas. I am originally from Ecuador […].Right after my high school graduation, I moved to the United States. I spent 15 years there. I studied chemical engineering, chemistry, and biomedical engineering. After that, I went back to Ecuador for about four or five years in 2015. I wanted to set up biomedical engineering departments in three or four universities. At that point, I had some time on my hands. Thus, I decided to go to medical school. I finished almost five years, but I did not want to become a doctor. I just wanted to study medicine to learn more about the medical body and other concepts, which helped me with my research. That period was very eye-opening because I realized that one does not need to go to class to learn medicine. There are many resources online. One, with some experience, can also learn much better in that way. I decided to spend many hours in the dissection anatomy lab. I wanted to learn a lot of things in a practical way […] I met Jan de Boer in my postdoc in Boston (MIT and Harvard Medical School) when Jan was spending his sabbatical year at MIT. I invited Jan to come to a conference in Ecuador, actually. After that, he asked me “Why don’t you come to Eindhoven?.” It was early 2020, before the pandemic […]. It was my first experience in a European University. […] My research is knee regeneration, ligaments, cartilage, tissue engineering, biomaterials, fabrication, and more. After my years of research, I was offered this position to develop the Digital Twin in Healthcare, the USE learning line […].  

 Chiara: It is fascinating to hear how organically you ended up in this position of creating this Digital Twin course, based on your background. I want to take a little step back in your story. I wanted to ask you, when did you first hear or learn about challenge-based learning? 

Jorge: When I arrived. In medical school, I heard about the term problem-based learning. That was just a term, it was not necessarily something that was applied. The idea was to have a statement of the problem. Then, everybody with strong theoretical knowledge about different elements of the problem gets together. They discuss how they can dissect the problem, how they would get to the root of the problem, and then they discuss the best solutions. In my experience in medical school, when we were doing more clinical cases, that was not the case. At the end of the day, we ended up with a solution that the teacher had in mind. That was the one and only solution that they would accept. This was the approach that, I realized, many future doctors learn about in medical schools. […] Challenge-based learning is a bunch of small problems that make a larger challenge. The students are tasked with solving these small problems every week. And they reach some milestones. Then, they can move forward to the next phase. Once they complete three or four phases, or more phases in the process, then they complete the challenge. 

Chiara: What was your reaction when you heard about the concept here, at TU/e, about CBL? 

Jorge: It was a positive reaction. People learn by doing. There is no way we can memorize all this information, and there is no way we can read all about it either. It is what I always say: medicine is not difficult. It is just too much. Right? At the end of the day, ask any doctor how much they learn from practice, and how much they memorized in medical school. They do not remember anything that was learnt by memorization […]. And we do the same, or remarkably similar, things in an engineering school, or in biology. I mean, when one studies cell biology, or biochemistry, students need to memorize a lot of things for the exams. However, lab is where you learn why these things are important to design a particular protein, and why these amino acids are the best that you can choose to create a specific peptide sequence. 

 Chiara: Would you say that you have grown into CBL yourself? 

 Jorge: it is something that I have matured over the years. I have found what works for me, and what I need to learn and read to know the basics. I need to start doing something hands-on right away. For example, when I came to TU/e, we had to do a project on ligament regeneration. So, I was the right person to dissect cadaveric legs. It sounds a little bit gross, I know, but that is what we did: we took the legs from a morgue. Obviously, we went through all the process, the protocols, as well as ethics. I led a couple of biomedical engineering students who knew nothing about anatomy through this project. In a month, I taught them by dissecting 25 legs. I taught them everything that needs to be learned about human lower limb anatomy, from the hip to above the ankle. I would say that they know more about the anatomy, compared to a second- or third-year medical student because there is no way a medical student can go through 20 sections. Cool, right?[…]

Chiara: My next question for you is when was the first time you decided to implement challenge-based learning?I understand that there was a collective decision on adopting CBL, in this case, USE learning line. Did you look at the course and think “oh, this actually fits the CBL way of working”? How did it go? 

Jorge: We knew that in our biomedical engineering curricula, we needed more hands-on courses. We have a lot of people, but we did not have a lot of labs. And, usually, the labs are strictly reserved for master thesis, PhDs, and postdocs doing research, which I completely understand. But at the same time, we need teaching labs. So, we decided that we were not going to overflow the labs, but we are still going to do something hands-on. Thus, the best second option was computational work. […] We thought that CBL aligned with our ideas. We also knew that the university was shifting towards CBL. Hence, we decided to structure it in that way. I want to change gears a bit and focus on a new tissue engineering book we just published a few weeks ago. In this book, at the end of each chapter, we generated a challenge-based learning module. The students can apply what they learnt throughout the chapter. The chapters themselves are written in a very student friendly way. This book is not a review paper, in which you put a lot of technical words. Instead, we rely on explaining definitions and concepts and basic things that you need to keep up in simpler terms. I think that having a CBL module at the end of each chapter is a genuinely wonderful way to apply what one knows. The students should produce solutions, we do not provide them with answers. Every solution is fine if it is logical, feasible, and you know how to justify everything that you have assumed. Then, we think that you are mature enough to handle the tools within that chapter. The Digital Twin in Healthcare course is remarkably similar to the tissue engineering book because students have a challenge that they are working on. 

Chiara: I want to go back in the timeline to the time when you started to experiment with challenge-based learning. I wanted to ask you about the reaction of the students, colleagues, and people around you in your ecosystem, in the faculty. 

Jorge: So, we like the idea to spice up a new course with CBL modules. The faculty liked the idea. […] In general, I think that if you have a good initial plan, it is easier to stick to it. Obviously, during the process, you should listen to people and to their feedback. However, it is still better than not having a plan at all. I know that this is only the second year of running the full course, and with 50 to 60 students on-site. We still have many things to change, and many more to learn and optimize. We always keep asking ourselves: “How are the students going to accept this teaching/assessing activity?” The beginning is usually a little chaotic. An issue that we see is that students must take ownership and responsibility for their project in a CBL course. However, often, students are not used to that, because they usually come from high schools. In high schools they learn, memorize, take an exam, and off they go to the next course. Historically, students’ values and intelligence is represented by numbers [grades], and that does not mean nor prove anything. And, here, we barely give them lectures, there is only one very manageable midterm, and so on. We just want to make sure that they have understood the concepts. They do not have to go through a three-to-four-hour engineering exam, like the ones that we see happening right now. […] We do not want that. However, we expect them to spend many hours designing their plan, understanding their strengths and weaknesses, and how they are going to find out what they do and do not know. How are they going to fill in the gaps in their knowledge? How are they going to teach their peers things they know? How are they going to connect with their clinical liaisons? How are they going to keep the challenge owner in the loop? There are many mature responsibilities, which they are not used to. That is why the beginnings are chaotic. 

Chiara: Would you say that then they grow into these responsibilities? 

Jorge: Yes, also, our clinical and industry liaisons see the value of this kind of education because they are in the real world. […] I realized that we help students develop a skill for finding papers, websites, and products for quality research and design. We must teach them that. In the very vast world of the Internet, we must teach them how to discriminate between good and bad data and information. So, we are there more to teach them soft skills, and how to deal with frustration, too. Students want fast results, and everything must work from the first try. Science does not work like that. It is usually super frustrating. I mean, you can spend months and months with failures of your experiments.  

Chiara: There is more value in failing than getting it right the first time. 

Jorge: Exactly. That is science. It requires iteration, frustration, difficulties. And this is what we are trying to show in this course. However, when they go to the real world, I would not say that it is going to be the same. But, at least, we try to teach them this in a friendly environment. […] It is important to mention that, in CBL, the progress of the teams is quite heterogeneous. Out of ten teams, for example, two or three can fly immediately. But then, the majority needs a lot more nurturing and helping. That is exactly why we need challenge owners and TAs who are willing to invest time into teaching. 

Chiara: Are the terms hands-on and CBL interchangeable for you? Do they have the same meaning for you? 

Jorge: Well, yes. It is proper problem solving. Being trained as an engineer and medical specialist, I learn every day. I am discovering different problem-solving skills daily. I find CBL remarkably similar. One needs to find the best solution possible. If there are no problems, then the course becomes super dull. 

Chiara: Do you have any concerns about CBL as an educational concept? Is there any skepticism? 

Jorge: […] The quality of the CBL product, and the quality of the CBL students, is directly proportional to the quality of the teaching and teachers. Do you want projects that are super technical? Do you rely then on PhD students and postdocs as TAs knowing that they may not have time? No. How can you then teach masters students or third year bachelor students to guide the teams? That is really a challenge because the evaluating teacher has around 60 people and they have 12 different projects. There is no way they can know exactly everything that happens in every single challenge. Nowadays, you cannot be a teacher or instructor who knows everything about the course that you are teaching. Based on all the breadth and wealth of information that you have about a certain topic, you cannot say that you know everything about something, say finite element analysis (FEA) for life. We, as instructors need to keep learning about the latest developments in our field, and learn what to “forget” and leave behind. If we do this, it is logical to revamp and re-engineer our courses every once in a while to renovate its content and the things we think are important our students need to learn. If we want to revamp and renovate the content, then we should also renovate the way we teach. Hence, CBL is a teaching approach that has helped us to keep our course learn and fast-paced.Only in our course, we use around six of these packages, and I have only used one. I sit and try to help the team that are using another package but most of the time I need to call my co-instructors and TAs who are the experts on that software. It does not really matter if I have done these things for many years, the platforms change. Then, you are a newcomer, super naive. That is CBL. Hence, one needs an efficient army of teachers to teach a variety of topics, each who is a specialists in their challenges and topics. Certainly, it is difficult to find such a varied and expert pool of teachers for one course and we have used the same teaching style and methodology for centuries.

Chiara: Going to my last question: where do you see CBL going within TU/e? 

Jorge: That is a tricky question. I do not know how people are going to adopt the challenge. You can always do the simple thing, you can always create a “CBL”, but you can just give all groups the same problem. You can have your unique answer, and whoever finds your answer gets the best grade. That is still CBL right? The students are still working on challenges, they are still finding the right solutions to real life problems. So, it depends on how you create the boundaries and what sources you are going to use to help the teaching. But, since you have so many challenges, what is right, what is wrong, and what is an average? You can only rate based on comparing the teams with each other. Since we have a lot of open-ended questions and problems in this course, it is difficult to evaluate and find the solution to this problem. 

Chiara: Is there anything that we did not touch upon that you want to maybe highlight or emphasize? 

Jorge: […] I like this movie called “Good Will Hunting”; I will use it to explain what I mean. I do not know if you have seen it, but Will goes to this Harvard bar, and he realizes that one can get the same education with a library card that costs $1.50. One can have everything at their disposal, rather than having to go to a fancy expensive university. Over time, I realized the same. I took this same approach back in medical school. However, I was more mature, and I wanted to study medicine because I wanted to know more, not to become a doctor. It was not something that was going to give me fame or fortune either. Coming from a family with many medical doctors, I know how they think. It was also expected from me to become a doctor as I am the oldest child. My second brother is a doctor now. But I really love discussing how they do things, which results in remarkably interesting conversations. It takes them time to admit and recognize things that they, as doctors, are doing wrong. It is difficult for them. Going back to my previous point; we have a university setting, and we do the same thing in the same way for centuries. We then produce these innovative ideas on how to teach better, which results in a lot of crashes and burns and fights. That is normal, people resist change. However, it requires people to be willing to change if they want better results. Everyone cares about our students, regardless of the teaching methodology. All the teachers I have meet in our course and other courses at TUe care about their students, regardless of the teaching methodology. At the end of the day, it is all about how much they are going to learn with your method. Students have so many things to learn, and you are the one providing them with this knowledge. You must learn to let go and lose control of how much students are going to learn; you need to know how to filter out what is important and what is not. That is the big problem that we are facing right now in every single university, going from the best universities in the world, to universities that do not have many resources like those I taught in South America.

Chiara: Thank you so much. This was great.