Three-dimensional printing (3DP) and additive manufacturing (AM) have evolved rapidly, enabling engineers, researchers, clinicians and medical-device specialists to develop new innovations and approaches to biomedical engineering.

To keep pace with the extraordinary developments in the global phenomenon that is 3D printing, and to ensure that our biomedical-engineering students were being trained for the future, Prof Conor Buckley, assistant professor in biomedical engineering in Trinity College Dublin, conceptualised and established Med3DP in 2015. Med3DP is a student-led initiative creating on-demand medical devices using 3DP technology. Embedded as part of the Design and Innovation Module within the MSc in Bioengineering, which trains and educates engineers to enter the medical device and biomedical sciences industry, the program spans both engineering and medicine and is inventive in its multidisciplinarity. Med3DP is unique in its educational ethos. At its core is the belief that engineers can make a global impact on humanitarian healthcare.

Inspired by an article highlighting the work of Dr Tarek Loubani, who was 3D printing stethoscopes to alleviate medical supply shortages caused by blockade in the Gaza strip, Buckley believed that this aspect of engineering was something all engineers should experience and embrace. As an engineering academic accustomed to incorporating cutting-edge technology into his research, merging 3D printing with his teaching modules was a logical and exciting step. The first step in this initiative was to establish a 3D-printing facility for the students to work together and bring their ideas forward. Together with Prof Kevin Kelly, approximately €18,000 in support was raised by the generous contributions from the Head of Department and colleagues in mechanical and manufacturing engineering, which allowed the purchase of a number of desktop printers, basic tooling and supplies. This prototyping facility officially became known as BuildBase, which provided the platform that was needed to bring Med3DP to fruition.

The project brief

Padraig Irwin and Katelyn Genoud at Dublin Maker 2017[/caption] From the outset, the brief for Med3DP was quite open for the students to interpret and determine how they wished to proceed. Buckley provided an overview of different activities by various organisations and laboratories from around the globe. These included the work being pioneered by Dr Julielynn Wong, who uses cutting-edge technology to deliver healthcare solutions in diverse environments from outer space to remote communities with limited access to healthcare resources, as well as FieldReady, which addresses many humanitarian needs through technology, design and engaging people in new ways.

For Med3DP, students were tasked with developing engineering solutions to enable rapid 3D printing of single use, disposable medical devices to alleviate medical difficulties and logistical challenges associated with remote areas and disaster zones. In addition, students were tasked with developing a website with instructional videos and all designs were to made publicly available for download. In the first year, students successfully designed and fabricated a number of instruments including for example a finger-splint kit, umbilical-cord clips, tweezers, surgical kits and stethoscopes. In 2016, Michael Monaghan, Ussher assistant professor in biomedical engineering, joined the faculty of the Mechanical and Manufacturing Engineering Department at TCD and took the reins of co-ordinating the Design and Innovation Module in the 2016/2017 academic year.

As new faculty and being at a stage of his career that is critical in establishing his own research group – and balancing the role of educator, mentor and administrator – he looked to his fellow colleagues in engineering for advice in the new role. “I was already aware of Med3DP during my research career in Germany through Twitter and press releases and found it a very innovative approach to teaching and learning,” he said. “When asked to take Med3DP into the approaching academic year, I jumped at the chance, applying some tweaks to fit with my style of teaching and to accommodate the new cohort of students enrolled in the Design and Innovation Module.” For that new cohort of students, originality was again keenly pushed and, as Monaghan points out, even if the students were inspired by a pre-existing design, they had to modify it. Each student received an anonymous survey, seeking out those with design skills, leadership skills and medical students. Monaghan and his teaching assistants then created four teams composed of members from complimentary backgrounds. The final assessment mode was a presentation of each group’s project, with students explaining why it was designed in such a way, why it cost so much and how an average person who may not have the technical training would use it.

Focus on invention and modification

The focus on both invention and modification is clearly represented in the devices produced by Med3DP, with each one showing a remarkable attention to detail. A breast-pump design, for example, with multiple printed parts including an attachment for generic plastic bottles, was repeatedly rejected until the final iterated design worked. Another team produced an otoscope attachment to enable inner ear investigation using a conventional smartphone. Attention was always paid to practicality, as “there’s a difference between functionality and usability”, according to Monaghan. Some devices are entirely innovative, such as the fetoscope, designed to observe the foetal heartbeat – something that the Med3DP team seem confident does not yet exist in a 3D printing design sense. Even their website is original in open-sourcing their designs to the public and offering instructions on how to assemble and use them. Monaghan explained: “The website design and construction is completely spearheaded by the students.

Collectively, the MSc students were responsible for website design and maintenance as well as uploading of current projects, while preserving an already increasing repertoire of medical-device designs that Med3DP has accumulated in the past years.” A particularly noteworthy past project is the stethoscope, comprised of two orange 3D-printed parts connected by generic tubing, surprisingly elegant and lightweight and just as functional as a standard model though only a fraction of the €200 price, coming in at around €1.50. Buckley pointed out that even the GPs they consulted with agreed that the comparison with commercial stethoscopes was extremely impressive, with Buckley noting, “Some of the consultants bargained with students for a few stethoscopes in lieu of their advice.” To enable successful collaborations, creative teaching methods were necessary as well as technological invention. “A lot of the traditional engineering that we do involves going to lectures, reading from textbooks, labs and exams,” Buckley said. “There’s no exam in this. The exam was being a team, being [continually] assessed and presenting.” It was a model welcomed by the students, who took the initiative to present their devices at the Dublin Maker Fair and InspireFest in the first year of Med3DP, which has now become an annual event. “The community outreach and public engagement has been a wonderful experience for the students,” added Monaghan. “The MSc students had to organise their exhibition booths, explain the concepts of 3D printing to non-experts and the overall goal of Med3DP. It reinforced their own understanding and deep learning of the project and honed their communication skills. It also led to greater exposure of the program through student interviews and media outputs and invitations to other fairs taking place in the country.”

Multidisciplinary work to benefit medical industry

As evident in the project’s name, benefiting the medical industry is already closely linked to the technology it centres on, but it is only one learning outcome that Buckley envisaged from the beginning of the project. Feeling that universities train engineers for industry rather than society, he saw a gap in the knowledge and skill sets of current students and understood that it had to be addressed.

“We had core biologist who had never been exposed to 3D printing,” said Buckley. “We had engineering students who’d never seen it before. So, I wanted to give them exposure to it and this was a good methodology for that. I wanted teamwork; I wanted multidisciplinary work; I wanted people with medical backgrounds working with engineers and designers, so they could understand and start communicating with one another. “For me, the nicest thing to see were the different dimensions that different students brought to the program. You had medical students suggesting they visit doctors for feedback, and then designers going out and meeting with them and working together. That’s how real life works.” Monaghan agrees, saying, “A certain level of [supervised] autonomy was given to the students throughout the Med3DP process. As mentioned, they ran and operated the Med3DP website but also had access to the @Med3DP Twitter handle and were strongly encouraged to engage with clinicians, radiologists, healthcare workers and humanitarians. This has led to a lot of worthwhile collaborations in Med3DP and also gave the students ownership of their work.” Monaghan also added that he kept a weekly diary of the students’ developments and the advice issued to them at each clinic. “At the end of the project, I could see that 95 per cent of my advice was incorporated,” he added. The project has certainly achieved its initial objectives: to train biomedical engineers in the use of 3D printing, to foster a culture of teamwork and multidisciplinarity, and to instil the belief that engineering innovative solutions can help make a global impact.

The project has far exceed expectations of both academics with students going beyond the classroom with their work, giving up their weekends to showcase at maker fairs, exhibitions and engage with the general public and potential students interested in pursuing engineering studies.

Developing the engineers' toolkit

Monaghan and Buckley will continue to drive forward this exciting teaching initiative, which will continually evolve while ensuring to teach the fundamentals of engineering science, and design iterations. Central to this project is an understanding of failure as a necessary and useful tool in the engineer’s toolkit. Over the course of the module, students worked with multiple iterations of their devices, and each week refined and reworked their designs based on the advice of the teaching assistants and academic. With this approach, Buckley and Monaghan are providing their students an opportunity rarely found in the engineering classroom: courage to succeed and the experience of failure. In addition, establishing integrated self-directed and problem oriented learning approaches in engineering curricula will no doubt inspire the next generation of engineers who will continue to advance this exciting technology.

Prof Conor Buckley, Department of Mechanical and Manufacturing Engineering, School of Engineering; Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute; and Advanced Materials and Bioengineering Research (AMBER) Centre, Royal College of Surgeons in Ireland & Trinity College Dublin

Michael Monaghan, Department of Mechanical and Manufacturing Engineering, School of Engineering; and Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute