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Received April 2, 2023, accepted July 3, 2023, date of publication July 11, 2023

Analysis of 2022 Chinese Clinical Engineering Body of 
Knowledge and Body of Practice Survey

By Jing Tong1, Kun Zheng2, Bin Li3

1 Shanghai Ocean University, China
2 Children's hospital Zhejiang University School of Medicine, China
3 Shanghai Sixth People's Hospital affiliated to Shanghai Jiaotong University School of Medicine, China

ABSTRACT

Background and purpose: Clinical engineers (CEs) face greater demands for their professional knowledge as healthcare 
technology, especially life support equipment, including ventilators and artificial heart-lung machines, becomes increasingly 
important and complex. However, there are significant differences in clinical engineering majors around the world, and inde-
pendent research on the body of knowledge and practice in clinical engineering is lacking in China.
Materials and methods: This study is an initial investigation into the body of knowledge and body of practice in the field of 
clinical engineering in China, conducted through a questionnaire-based survey. The aim of the survey is to collect important 
data from Chinese CEs.
Results: The investigators' background highlights that Chinese CEs are predominantly young, highly educated, and have limited 
work experience. Ongoing education and training will be needed to keep up with technological advancements. However, the 
future of clinical engineering in China looks positive. The survey of knowledge and work activities in the clinical engineering 
industry in China indicates that the main focus is maintaining the normal operation of hospitals. After  that, according to the 
future development trend of the hospital, new knowledge and practical activities are continuously expanded.
Conclusions: Although the survey provides insight into the knowledge and activities that are most relevant to clinical engineer-
ing in China, further research is necessary to establish a reliable body of knowledge and practice.

Keywords – Chinese Clinical Engineering, Body of Knowledge, Body of Practice, Clinical Engineering Survey.

Copyright © 2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY): Creative Commons - Attribu-
tion 4.0 International - CC BY 4.0. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) 
are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is 
permitted which does not comply with these terms.

INTRODUCTION

Clinical engineering is a multidisciplinary field that 
combines knowledge from several disciplines such as 
engineering, medicine, and computer science. The work 
of CEs involves the application of technology to improve 
patient care, safety, and outcomes in a healthcare setting. 
Their work is highly practical and requires continuous 

learning and experience to keep up with the rapidly 
evolving technology and medical practices. As a result, 
the body of knowledge and practice in clinical engineer-
ing has quickly grown over the years.

 However, this growth in knowledge has led to chal-
lenges in education and personnel training. On the one 

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21 J Global Clinical Engineering Vol.5 Issue 3: 2023

Tong, Zheng, Li: Analysis of 2022 Chinese Clinical Engineering Body of Knowledge and Body of Practice Survey

hand, the content taught in schools may not meet the 
knowledge needs of actual work, and different colleges 
and universities have different majors and curriculum 
settings, resulting in differences in knowledge structure 
and stock.1 Conversely, due to differences in working envi-
ronments, medical treatment focus, and existing hospital 
technology, CEs' knowledge and experience may gradually 
differ. These differences and deficiencies in knowledge 
and practical experience are common in the industry and 
pose a bottleneck for industry development and personnel 
training. Therefore, it is necessary to establish a correct 
knowledge framework in clinical engineering. 

Recently, the Global Clinical Engineering Alliance (GCEA) 
and IFMBE-CED jointly conducted a clinical engineer-
ing survey. This time, it is important to understand the 
type of knowledge that CEs need to develop their work 
(Body of Knowledge) and identify the activities that CEs 
carry out globally (Body of Practice). The ultimate goal 
is to define a set of disciplines to help any teaching unit 
revise and develop its academic program to train CEs. 
In the past, similar studies have been conducted from a 
global perspective.2 However, this article only focuses on 
China, and aims to gain a preliminary understanding of 
the knowledge and practice system in clinical engineering 
through large-scale surveys. 

The remainder of this paper is organized as follows. 
The research materials and methods are described in 
Section II. The third section is the research results, and 
then the fourth section analyzes according to the research 
results. The fifth section is the conclusion.

MATERIALS AND METHODS

The purpose of this questionnaire is to collect differ-
ent relevant types of information from respondents to 
better understand the current knowledge system and 
practice system in the field of clinical engineering. The 
questionnaire is divided into four parts, each focusing 
on a specific aspect of the respondent's background and 
work experience.

The first part, titled "Basic Information," requests the 
respondent's name, gender, location, age, and contact 
information. This section is important for establishing 

basic demographic information about the respondents 
and their location.

The second part, titled "Occupational Background," 
is designed to gather information about the educational 
and work backgrounds of the respondents. In this sec-
tion, respondents are asked to provide information on 
their degrees, professional fields, working years, nature 
of work, and whether there is a clinical engineering (CE) 
registration and certification process in China. This section 
will help to provide a clearer picture of the educational 
and professional backgrounds of CEs in China.

The third part, titled "Knowledge," is focused on iden-
tifying the importance of 40 different knowledge areas 
in the respondents' work. Respondents are asked to 
evaluate the level of importance of each area according 
to their own situation, rating them as minor, moderate, 
high, or not important. This section will provide insight 
into the specific areas of knowledge that CEs find most 
relevant to their work.

The fourth part, titled "Work Activities," lists 8 cat-
egories of work activities that CEs commonly engage in, 
such as health technology management, service delivery 
management, and information technology/digital health. 
Respondents are asked to evaluate the percentage of 
time they spend on each category and provide choices 
for supplementary descriptions of other categories. This 
section will help to identify the specific work activities 
that CEs in China engage in and the relative amounts of 
time they devote to each one.

It is worth mentioning that this questionnaire utilizes 
an online questionnaire to collect data, benefiting from 
various advantages. The online format facilitates quick 
and easy questionnaire distribution to many potential 
respondents, increasing response rates. The online format 
eliminates the need for manual data entry, thereby reduc-
ing the potential for errors and enabling more efficient 
data analysis. Additionally, the online questionnaire al-
lows for the inclusion of skip patterns and branching logic 
to ensure that each respondent only answers questions 
relevant to their specific background and experience. 
Therefore, the online questionnaire is a practical and 
effective method to collect knowledge and work activity 
data of CEs in this study.



Tong, Zheng, Li: Analysis of 2022 Chinese Clinical Engineering Body of Knowledge and Body of Practice Survey

J Global Clinical Engineering Vol.5 Issue 3: 2023  22

RESULTS

Basic Information

The survey received strong support from CEs in 21 
provinces across China, with 178 valid responses received. 
Among them, 67 were from Zhejiang, 21 from Shanghai, 
17 from Sichuan, and none of the other provinces reached 
10 (Figure 1).

The age structure of the respondents is an important 
factor in assessing the long-term development potential 
of CEs. As shown in Figure 2, 32.58% of the respondents 
are aged 20 to 30, 28.65% are aged 31 to 40, 23.03% 
are aged 41 to 50, and 15.73% are aged 51 to 60. Of the 
respondents, 60% are under 40, indicating that young 
and middle-aged people have become the backbone of 
China's clinical engineering talent pool.

Among the 178 respondents, it is worth noting that 
women accounted for only 27% (Figure 3). Encouraging 
more women to join the clinical engineering talent team 
is a long way to go.

Occupational Background

The working years of CEs are an important factor in 
determining their level of professionalism, knowledge, 
and experience. In this survey, the distribution of respon-
dents based on their working years is quite diverse. More 
specifically, 23.03% of the respondents have 1 to 3 years 
of work experience, indicating many early-career CEs in 
the workforce. 10.11% have 3 to 5 years of work experi-
ence, while 14.61% have 5 to 10 years of work experi-
ence. These respondents can be considered to be in the 
mid-career stage and are likely to have more experience 
and expertise in the field.

Moreover, the survey results reveal that there are also 
many CEs with extensive work experience. Specifically, 
17.42% have 10 to 15 years of work experience, 10.11% 
have 15 to 20 years of work experience, and 24.72% have 
more than 20 years of work experience. This indicates 
that a significant number of senior CEs have accumulated 
a wealth of experience and knowledge throughout their 
careers. Overall, the diverse distribution of working 
years among respondents in this survey suggests that 
the clinical engineering field has both experienced and 
novice professionals.

FIGURE 1. Geographical distribution of respondents.

FIGURE 2. Age distribution of respondents.

FIGURE 3. Gender distribution of respondents.



23 J Global Clinical Engineering Vol.5 Issue 3: 2023

Tong, Zheng, Li: Analysis of 2022 Chinese Clinical Engineering Body of Knowledge and Body of Practice Survey

Older age is associated with more work experience 
(Figure 5), which seems to align with the objective law, but 
the trend of older practitioners with more work experience 
means that opportunities for professional development 
in clinical engineering are limited.

With the continuous and rapid progress of medical 
technology and the increasing integration of modern 
medical equipment into hospitals, the responsibilities of 
medical engineering departments in China have evolved 
from focusing on the maintenance of a single piece of 
medical equipment in the 20th century to covering a 
series of tasks such as preventive maintenance of medi-
cal equipment, regular repair and maintenance, quality 
control, metrological testing, technical evaluation, clinical 
evaluation, innovation, and improvement. This has led to 
an increase in the number of practitioners, and the level 
of education of personnel is gradually increasing to meet 
the needs of the role.3 

The survey also included questions about the educational 
backgrounds of the respondents. The results showed that 
the majority of the respondents had an undergraduate 
degree in an engineering area (46.07%), and a significant 
number of them had a Master's degree in engineering 
area (28.65%). However, there were also respondents 
with educational backgrounds in non-engineering areas, 
such as undergraduate degrees in other areas (9.55%), 
Master's degrees in other areas (6.74%), and PhDs in both 
engineering and non-engineering areas (3.93% and 2.25%, 
respectively). There was also one respondent who had a 
degree in another area not covered by the survey options. 

Figure 6 compares the educational background of 
respondents from the China Clinical Engineering Survey 
in 2021 and 2022. The results show a clear trend towards 
higher levels of education among CEs.

When asked about the main nature of their current 
position, above-average respondents chose Clinical/
Biomedical Engineer (58.99%), followed by Healthcare 
Technology Managers (12.36%), Medical Equipment 
Planners (6.74%), Technologists (5.06%), Technicians 
(10.67%), Professors/Educators/Researchers (1.12%), 
Consultants (1.12%), and Others (3.93%). However, this 
question reveals an interesting finding: Chinese CEs focus 
more on healthcare technology planning, assessment, 
management, analysis, education, and support (Table 1).

Finally, the survey led to a consensus among CEs in 
China that there is a registration and certification process 
in place for CEs in the country.

FIGURE 4. Working years distribution of respondents.

FIGURE 5. Working years of respondents in different age groups.
FIGURE 6. Educational background distribution of respondents 
in 2021 and 2022.



Tong, Zheng, Li: Analysis of 2022 Chinese Clinical Engineering Body of Knowledge and Body of Practice Survey

J Global Clinical Engineering Vol.5 Issue 3: 2023  24

Knowledge

The knowledge domains were classified based on clinical 
engineering background knowledge. Respondents were 
asked to rate the importance of 40 items related to their 
daily duties and responsibilities, using a 4-point scale: 1 
for not important, 2 for minor important, 3 for moderate 
important, and 4 for high important. The average score 
for each item was calculated, and the detailed results of 
the investigation are presented in Table 2.

TABLE 1. Occupational Nature of Respondents 

Options Count Percentage

Clinical/Biomedical Engineer 105 58.99%

Healthcare Technology Manager 22 12.36%

Medical equipment planner 12 6.74%

Technologist 9 5.06%

Technician 19 10.67%

Professor/Educator/Researcher 2 1.12%

Consultant 2 1.12%

Other 7 3.93%

TABLE 2. The Importance of Each Background Knowledge 

Category\Options Not 
Importance

Minor 
Importance

Moderate 
Importance

High 
Importance Average

Medical Device Regulation 3 4 42 129 3.67

Maintenance Management 2 6 53 117 3.6

Quality Management 1 7 63 107 3.55

Computers, Networking, Information Technology 1 12 61 104 3.51

Data Management 2 10 66 100 3.48

Risk Management 2 16 56 104 3.47

Electronics (theory, design, analysis, etc.) 5 17 59 97 3.39

Facilities Management 1 22 64 91 3.38

Surgical Instruments & Devices 4 23 59 92 3.34

Medical Device Innovation 4 17 74 83 3.33

Interoperability of Devices and/or Systems 5 17 72 84 3.32

Procurement Strategies 5 18 72 83 3.31

Engineering Asset Management 2 24 74 78 3.28

Project Management 5 20 77 76 3.26

Respiratory Equipment 4 33 54 87 3.26

Hospital Engineering 7 23 67 81 3.25

Digital Health 4 23 81 70 3.22

Medical Imaging 0 35 73 70 3.2

Health Technology Assessment 7 25 73 73 3.19

Leadership or Executive Skills Coaching 9 25 74 70 3.15

Systems Engineering 5 32 76 65 3.13



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Tong, Zheng, Li: Analysis of 2022 Chinese Clinical Engineering Body of Knowledge and Body of Practice Survey

Category\Options Not 
Importance

Minor 
Importance

Moderate 
Importance

High 
Importance Average

Patient Safety User/Patient Training 14 33 56 75 3.08

Health Facility Planning and Design 9 37 65 67 3.07

Statistics 3 43 71 61 3.07

Consumables 9 39 72 58 3.01

Management (area/s other than those listed) 13 27 83 55 3.01

Sterilization 10 42 65 61 2.99

Physiological Monitoring 17 40 57 64 2.94

Telemedicine / Telehealth 13 40 72 53 2.93

Hemodialysis 19 43 54 62 2.89

Presentation Skills 10 48 75 45 2.87

Airborne Infection Control 16 47 61 54 2.86

Clinical Laboratory 14 53 57 54 2.85

Human Factors Engineering 19 47 56 56 2.84

Simulation and Modelling 21 51 60 46 2.74

Home care/Virtual care (remote patient monitoring) 23 46 67 42 2.72

Accounting and Finance 15 61 65 37 2.7

Radiation Oncology 28 58 45 47 2.62

Neonatal and/or Pediatric Care 33 52 45 48 2.61

Anesthesia 35 62 35 46 2.52

TABLE 3. Overall Time Spent in Each Group of Activities 

Activity\Percentage 0 1~25 26~50 51~90 91~100

Health Technology Management 2.81% 23.03% 29.78% 30.34% 14.04%

Service Delivery Management 5.62% 16.85% 22.47% 32.58% 22.47%

Development,Testing,Evaluation and Modification of 
Products 16.29% 38.76% 26.4% 12.36% 6.18%

Information Technology / Digital Health 9.55% 39.33% 24.16% 18.54% 8.43%

Education of Others 8.99% 39.89% 29.21% 16.85% 5.06%

Facilities Management / Infrastructure 8.99% 25.28% 29.21% 27.53% 8.99%

Risk Management / Security 0.56% 27.53% 28.09% 29.78% 14.04%

General Management 0.56% 17.98% 29.21% 37.08% 15.17%



Tong, Zheng, Li: Analysis of 2022 Chinese Clinical Engineering Body of Knowledge and Body of Practice Survey

J Global Clinical Engineering Vol.5 Issue 3: 2023  26

Work Activities

Table 3 displays respondents' estimated percentage 
of time in eight job categories. These categories include 
health technology management, service delivery manage-
ment, development, testing, evaluation and modification 
of products, information technology/digital health, educa-
tion of others, facilities management/infrastructure, risk 
management/security, and general management. Besides 
these predefined categories, respondents were also allowed 
to provide information about other job categories they 
worked in. Table 3 data is a valuable resource for gaining 
insight into the work activities of CEs. This information 
can inform workforce development and training programs 
in the field, ultimately leading to better-prepared clinical 
engineering professionals.

DISCUSSION

Although the survey had a broad geographic scope, 
with respondents from multiple provinces in China, the 
fact that a large proportion of the responses (67 out of 
178) came from a single province, Zhejiang, could poten-
tially introduce bias to the data. Given that Zhejiang is a 
relatively affluent province and is home to many well-
known medical device manufacturers, the experiences 
and knowledge of CEs in this region may not fully repre-
sent the wider population of CEs in China. Therefore, it 
is important to interpret the survey results with caution 
and avoid overgeneralizing based on the experiences of 
CEs in Zhejiang alone.

The survey results indicate that the clinical engineer-
ing community in China is relatively young, with limited 
work experience. However, it is encouraging to note that 
practitioners with more than 20 years of experience are 
still active in similar numbers as young practitioners. This 
balance between new and experienced professionals bodes 
well for the future of clinical engineering in China, with 
promising human resource reserves and team-building 
prospects for the younger generation.

The survey results also indicate that the vast majority 
of respondents, 97.75%, held at least an undergraduate 
degree, with many pursuing engineering-related studies. 

This finding highlights Chinese clinical engineering prac-
titioners' solid professional knowledge base. It is worth 
noting that this trend of increasing education among do-
mestic CEs in China is not unique, as global survey results 
suggest that China is among the countries with the highest 
percentage of highly educated CEs. In fact, while 80% of 
CEs worldwide have a bachelor's degree or higher, the 
figure for China is 97%. However, the low representation 
of women in the field, accounting for only 27% of the total, 
is a cause for concern. Efforts to encourage more women 
to pursue careers in clinical engineering must be made.

In addition to the issue of job diversity, there is also 
a concern about limited opportunities for professional 
development within clinical engineering, especially for 
older practitioners with more experience. China has a 
well-established registration and certification process 
for CEs, indicating the profession's maturity. However, in 
situations with limited avenues for professional develop-
ment or lateral transitions, experienced practitioners may 
face the challenge of stagnation, potentially hindering 
their ability to bring novel ideas and unique perspec-
tives to their work. To address this issue, it is crucial to 
promote continuing education and training opportunities 
for CEs. Establishing a body of knowledge (BoK) and a 
body of practice (BoP) in Clinical Engineering can also 
facilitate their continuing professional development, 
allowing them to expand their knowledge and expertise 
and stay up-to-date with the latest developments in the 
field. Providing opportunities for continuing education 
and interdisciplinary collaboration can help experienced 
practitioners maintain their effectiveness and innovation, 
ultimately leading to a more dynamic and effective clinical 
engineering profession.

The issue of the main nature of work in clinical engi-
neering sheds light on the various roles that practitioners 
play in the healthcare industry. In China, most CEs identify 
as clinical/biomedical engineers, focusing on planning, 
evaluation, management, analysis, education, and medical 
technology support. The position also includes functions 
such as healthcare technology managers, medical equip-
ment planners, clinical engineering technologist, clinical 
engineering/biomedical equipment technician and others. 
Practitioners must possess diverse skills and knowledge 
to effectively carry out their responsibilities. Additionally, 



27 J Global Clinical Engineering Vol.5 Issue 3: 2023

Tong, Zheng, Li: Analysis of 2022 Chinese Clinical Engineering Body of Knowledge and Body of Practice Survey

many respondents were identified as healthcare tech-
nology managers and medical equipment planners. As 
time progresses, the work of CEs is no longer limited to 
the maintenance and repair of medical equipment. By 
combining their understanding of clinical needs, they 
can effectively provide hospitals with beneficial and 
appropriate configurations, management, and medical 
equipment planning.4  The diversity of reported positions 
also reflects the wide range of expertise required in clini-
cal engineering, from technical proficiency to leadership 
and management skills.

Regarding the importance of knowledge, three parts can 
be roughly divided. Medical device regulation, maintenance 
management, quality management, data management, risk 
management, facilities management, and implementation 
methods such as computers, networking, and information 
technology rank highly in the clinical engineering industry. 
Among them, medical device regulations are considered 
to be the most important as a factual basis. This highlights 
the significance of regulatory compliance and the proper 
management of medical devices in clinical engineering. 
Clinical engineering work in China is mainly focused on 
managing and maintaining hospital operations, which 
is also reflected in the main nature of the work of CEs. 
Today's medical activities development in China greatly 
depends on medical devices' safety, reliability, and stability. 
CEs effectively ensure the normal operation of medical 
devices through evaluation, maintenance, quality control, 
measurement, etc., to ensure the normal development of 
medical activities.5 China promulgated the "Regulations 
on the Supervision and Administration of Medical De-
vices" on January 4, 2000.6  After two revisions, the latest 
version was implemented on June 1, 2021. It shows that 
medical devices must follow risk management principles, 
whole process control, scientific supervision, and social 
governance. This is a guide for all CEs in China. 

The important knowledge areas that follow are some 
of the more specialized and precise subdivisions of day-
to-day management work, such as surgical instruments 
& devices, procurement strategies, engineering asset 
management, project management, hospital engineering, 
statistics and health technology assessment, etc. Mastery 
of these areas can help bridge the knowledge gap for 
Chinese CEs, allowing them to ensure high-quality, safe, 

and efficient healthcare operations. Knowledge of surgi-
cal instruments and equipment is crucial for ensuring 
the safety and success of medical procedures, while a 
procurement strategy is necessary to obtain the neces-
sary resources while maximizing the budget. Engineering 
asset management involves the management of complex 
systems, requiring expertise in monitoring, maintaining, 
and optimizing equipment. Project management is criti-
cal to coordinating resources, managing timelines, and 
communicating effectively with stakeholders. Moreover, 
hospital engineering encompasses various technical dis-
ciplines, including electrical, mechanical, and structural 
engineering. Effective CEs must be able to design, main-
tain, and optimize complex systems to ensure healthcare 
facilities' safe and efficient operation is another essential 
knowledge area for CEs. A solid understanding of statisti-
cal analysis is crucial for evaluating the performance of 
healthcare systems, identifying areas for improvement, 
and measuring the impact of interventions. Health 
technology assessment (HTA) is an emerging field that 
is becoming increasingly important in healthcare. It sys-
tematically evaluates health technologies' safety, efficacy, 
cost-effectiveness, and social impact, including medical 
devices and equipment. HTA provides valuable informa-
tion for healthcare decision-makers, helping them make 
informed decisions about which technologies to invest in 
and how to allocate resources effectively. 

Finally, the knowledge categories in the lower part 
share a common feature: they overlap with the expertise 
of other occupations in the hospital. For example, steril-
ization is generally responsible for nurses, anesthesia is 
generally for anesthesiologists, and accounting and finance 
are generally responsible for professional accountants. 

This rule also continues in the survey results of time 
spent on practical activities. Activities related to the clinical 
engineer's primary task—ensuring clinical applications 
for the medical device business (e.g., service delivery 
management, general management)—are more time-
consuming and therefore ranked high.7 Conversely, less 
relevant activities (such as education of others, develop-
ment, testing, evaluation and modification of products) 
take up less time and therefore ranked lower. This shows 
that Chinese CEs may be more inclined to the direction 
of traditional clinical engineer functions. However, CEs 



Tong, Zheng, Li: Analysis of 2022 Chinese Clinical Engineering Body of Knowledge and Body of Practice Survey

J Global Clinical Engineering Vol.5 Issue 3: 2023  28

play a bridge role in developing medical device products. 
They are integrators of medical technology, guardians of 
equipment safety, evaluators of instrument applications, 
and communicators between hospital construction and 
industrial development. To promote the further develop-
ment of China's clinical engineering field, it is necessary to 
attach importance to industry-university-research-medical 
cooperation and knowledge sharing, and incorporate it 
into the strategic career development plan.

CONCLUSION

Under the new requirements of hospital-refined man-
agement and modern medical technology, the development 
of clinical engineering in China is facing new challenges. 
Strengthening the construction of the BoK and the BoP 
is an important measure for adapting to environmental 
changes and improving comprehensive strength. This 
survey may not cover the scope of all clinical engineering 
personnel and may not fully reflect the knowledge needed 
for clinical engineering in China, but the research results 
have predicted a set of knowledge required for clinical 
engineering in China.

The BoK and BoP in clinical engineering still require in-
depth research, and determining key knowledge requires 
the consensus of numerous authoritative experts and 
stakeholders. Unless the BoK defined, relevant practices, 
research, and scholarly teaching information are collected, 
and consensus is reached, the clinical engineering knowl-
edge system framework will be incomplete. It should be 
noted that the systemic nature of the knowledge system 
must be established based on verified evidence.

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