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Received September 6, 2019, accepted October 30, 2019, date of publication November 9, 2019

Analysis of IFMBE-CED 2017 Worldwide Clinical 
Engineering Survey 
By L. Nascimento1, S. Calil1, T. Judd2, Y. David3

1 Department of Biomedical Engineering - School of Electrical and Computer Engineering. University of Campinas, Brazil
2 Chair, IFMBE Clinical Engineering Division. Associate Editor, Health Technology and Quality, The Permanente Journal
3 Biomedical Engineering Consultants, LLC, University of Texas School of Public Health

ABSTRACT
Background and Objective: Clinical engineering (CE) professionals are fundamental to the deployment of healthcare 
technology and the management of its life cycle. As the role of technology grows in healthcare, so does the need for trained 
CE practitioners and the dynamic nature of the domain requires them to maintain their skills. However, the skills and 
activities required from clinical engineers around the world are not homogeneous, so the CE Division at IFMBE promoted 
a global survey to identify a common body of knowledge and body of practices for the profession.
Material and Methods: This survey, based on a previous one conducted by the American College of Clinical Engineering, 
was aimed at collecting data about clinical engineering practices and the importance of certain competencies for their 
practitioners. 
Results: Survey results indicate the profession still maintains certain traditional characteristics, such as the predominance 
of professionals with a background in electrical, electronic, or mechanical engineering and the prevalence of hospitals 
and clinics as employers. Some patterns in the perceived relevance of certain kinds of knowledge among different regions 
were also identified. 
Conclusion: Overall, the survey seems adequate to reveal which skills and activities CEs considered the most relevant, 
but more responses are required before a solid Body of Knowledge and Body of Practice can be defined.
Keywords – 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
To reap the full benefits of deploying technology in 

healthcare delivery, healthcare programs require compe-
tent clinical engineering professionals to manage its life 
cycle. As the technology’s role rises over time so does the 
need for trained clinical engineering practitioners. Clini-
cal Engineering (CE) is today one of the most dynamic 
professions in the world.1 This dynamic state challenges 
CE professionals to maintain their skills and stay current 

with the continuous progress of healthcare technologies. 
From the early stage of innovation throughout the rest 
of the technology life cycle, clinical engineers not only 
have to keep a constant update of their knowledge and 
expertise needed to develop their activities but also to 
periodically add, adapt, and learn new competencies and 
methodologies due to introduction of new and innovative 
technologies. Clinical engineers must sustain and further 

http://www.globalce.org
http://globalce.org
http://globalce.org


Nascimento, Calil, Judd, David: Analysis of IFMBE-CED 2017 Worldwide Clinical Engineering Survey

J Global Clinical Engineering Vol.2 Issue 1: 15-22 ; 2019  16

build their contribution to safe, efficient, and optimal life 
cycle stages and patient outcomes.2

While Maintenance Management, Equipment Specifica-
tion, and Acquisition composed the basic set of knowledge 
for clinical engineers in the seventies and eighties, the 
current basic set is composed of more than 18 subjects 
and it is still growing. Table 1 compares the increasing 
number of subjects during the last 18 years. 

There are very few recent studies describing world-
wide activities developed by CEs. Most surveys were 
either done a long time ago3,4 or are recent, but regional. 
To our knowledge, there are no recent publications on 
surveys conducted to investigate CE activities worldwide. 
In 2004, a comprehensive CE survey5  was developed to 
address two points via two questionnaires. The first one 

investigated the structure, personnel, responsibilities, and 
resources of the CE departments all over the world. The 
second questionnaire was to investigate trends and cur-
rent CE practices. To identify such practices, respondents 
were requested to check a list of several activities such 
as equipment management, quality control, risk manage-
ment, education, and training. The resulting analysis from 
the 174 valid answers received, indicated that the main 
problems were lack of highly qualified personnel (because 
of the lack of quality academic programs), limited funding 
for technical training to maintain staff competencies for 
all equipment types and continuous pressure to reduce 
costs by increasing department efficiency. Additionally, 
the authors also concluded that despite the efforts for 
activities harmonization among CEs regarding the man-
agement of healthcare technology in hospitals all over 
the world, this subject remains non-uniform, with great 
variations in terms of structure, personnel, responsibili-
ties, resources, and outcomes. 

Starting in 2004, the BIOMEDEA project (a European-
wide initiative) promoted the organization of three meet-
ings aiming at the development and establishment of 
consensus on European guidelines and protocols for the 
harmonization and accreditation of high quality Medical 
and Biological Engineering and Science programs and 
for the training, certification and continuing education 
of professionals working in the health care systems.5 
The third meeting took place through an international 
symposium on an important issue of quality assurance 
in biomedical/CE: patient safety.

In 2005, a meeting co-sponsored by the University of 
Stuttgart and the International Federation for Medical 
and Biological Engineering – IFMBE,6 produced several 
documents, which included an “Agreement for Mutual 
Recognition of Qualifications for Clinical Engineers”. A 
white paper produced by the Clinical Engineering Division 
– CED/IFMBE7 described its contents. A further docu-
ment was also produced: the “Protocol for the Training 
of Clinical Engineers in Europe.”

Both were very important and valuable documents; 
however, some obstacles stopped the progress of such 
initiatives: 

TABLE 1. New Subjects Added to the Set of Knowledge of 
clinical engineering in the Last 18 Years (based on personal 
observations)

1970 – 1980 1990 – 2015

• Medical Equipment 
Management

• Safety
• Procurement
• Education
• Individual Product 

Management
• Individual Thinking

• Medical Equipment Management → 
Technology Management

• Safety → Risk Management
• Procurement
• Education
• Disaster Preparedness
• Cost Control (TCO. LCC)
• Technology Assessment
• Telemedicine (Homecare)
• Project Management
• Contract Management
• Mobile Healthcare (Events. 

Transports. Group Assistance)
• Home Care
• Quality Management
• Information Technology 

(Interoperability)
• Human Factor Engineering
• Forensic Analysis
• Artificial Intelligence
• Systems Integration And Management
• Soft skills (Writing. Communication. 

Supervision)
• Team Practicing

LCC = life cycle costs; TCO = total cost of ownership



17 J Global Clinical Engineering Vol.2 Issue 1: 15-22 ; 2019

Nascimento, Calil, Judd, David: Analysis of IFMBE-CED 2017 Worldwide Clinical Engineering Survey

1. There were no further discussions to carry on the work 
and the documents became just a source of consultation.

2. The documents were heavily based on the CE model 
adopted by the American College of Clinical Engineer-
ing (ACCE), meaning that it was an American model 
to be adopted in Europe.

3. The document aimed the CE in Europe and even though 
its development lacked further studies to understand 
the kind of CE activities practiced in many of the Eu-
ropean countries.

4. The document contents would serve only as a source 
of consultation for countries outside Europe and it did 
not fill the need to find a worldwide harmonization 
for knowledge among CEs.
Then, also in 2005, CED/IFMBE launched a survey aim-

ing to learn about the CE activities in different countries.8,9 
The objective was to identify and develop a worldwide 
network of CEs and understand their activities. This survey 
looked for characteristics such as age, time of experience 
in the CE area, type of employer, primary position and all 
the activities developed within the work. 

The results of this survey indicate some similarities 
among activities in several parts of the world. Figure 1 
shows the results of the 2005 survey and it indicated that 
Technology Management was practiced by a range of 55% 
(Asian CEs) to 85% (North Americans and Canadian CEs) 
of the respondents. As another example, risk management 
practices varied from 39% (Latin Americans CEs) to 70% 
(North Americans and Canadians CEs). Such similarities 
can be the basis for developing stronger international 
cooperation among clinical engineers and CE professional 
organizations. This set of activities can also be the basis to 
understand the core of CE practices worldwide and develop 
a core of knowledge to be taught by any academic unit 
that aims to train CEs. It can also be used by countries/
societies that already have or are planning to develop a 
CE credentialing or certification system.

This was, however, a primary set of data. To have a 
more reliable set of the knowledge needed by CEs to de-
velop not only their daily activities but to empower them 
to propose and develop advanced projects within the CE 
area, it was necessary to have a better understanding of 

the CE profile and practices worldwide. The results of the 
2005 survey are outlined in Figure 1.

Ten years later, in 2017, sponsored by IFMBE/CED it 
was possible to develop and launch a worldwide project 
called “Body of Practice and Body of Knowledge – BoK 
& BoP.” This project, led by senior CEs from around the 
world, developed data collection tool (a survey), included 
additional questions designed not only to identify the CE 
activities practiced at their place of work but also what 
set of competencies is important for better development 
and successful outcomes from such activities. 

This survey was based on a similar tool used by the 
ACCE to identify the profile and practices of CEs working 
in USA and Canada.10

METHODS
The topics and format of the questions were either 

extracted or modified from a survey kindly provided by 
the ACCE and Eng. Frank Painter. The original survey 
was used by ACCE to determine the current knowledge 
and skills needed for competent CE practice mainly in 
the United States and Canada. As the ACCE survey, this 
one was divided into five sections, aiming at collecting 
different pertinent types of information.

FIGURE 1. The results of the 2005 survey showing that, ac-
cording to the respondents, Technology Management is one of 
the activities practiced by a range of 55% (Asian CEs) to 85% 
(North American and Canadian CEs).



Nascimento, Calil, Judd, David: Analysis of IFMBE-CED 2017 Worldwide Clinical Engineering Survey

J Global Clinical Engineering Vol.2 Issue 1: 15-22 ; 2019  18

The first part of the survey – “Contact Information”, 
asked for identification and general data about the respon-
dent. such as name, company, country and email address. 
In this part, only the country’s name of the respondent 
was mandatory.

The second part – “Job Information,” was focused on 
acquiring data about the CE employer and educational 
background. It included questions about the type of 
employer, about how respondents describe their profes-
sion, the primary nature of their current position, their 
academic background (engineering or other), and about 
the existence of CE certification in the country.

The third section – “Knowledge”, presented a list of 
28 knowledge topics and asked the respondents to rate 
the importance of those topics (Minor, Moderate, or High 
Importance) in the development of their activities.

The fourth part – “Responsibilities,” presented eight 
classes of activities (Technology Management, Service 
Delivery Management, Product Development Management, 
IT/Telecommunications, Education, Facilities Management, 
Risk Management/Safety, and General Management). A 
list of multiple skills related to each one of these classes 
was then presented. and respondents were asked to rate 
how important (No, Minor, Moderate, or High importance) 
each skill is to develop each of the “Responsibility.”

The final section of the questionnaire – “Work Activi-
ties”, asked the respondents to indicate the percentage 
of time they dedicate to each one of the eight classes of 
activities presented in the previous part.

During the data analysis process, weights were assigned 
to the levels of importance indicated in the responses: for 
the knowledge topics where the answers had three rating 
levels; 0 (zero) was assigned for “Minor,” 1 for “Moderate,” 
and 2 for “High” importance. 

For the responsibility topics. where four rating levels 
were presented. 0 (zero) was assigned for “No,” 1 for 
“Minor,” 2 for “Moderate,” and 3 for “High.”

Though there are several ways to present the data in this 
article, it was decided to show the result by geographical 
region: Latin America, Oceania, Asia, Middle East, Europe, 
Africa and, USA and Canada. 

The survey was developed and presented to the invited 
participants with Google Forms and 574 invitations were 
sent by email.

RESULTS 
From the 574 invitations to respond to the survey, 199 

responses were received from 35 countries. From those; 
35% came from Latin America, 20% from Oceania, 14% 
from Asia, 11% from the Middle East, 10% from Europe, 
6% from Africa and 4% from USA and Canada. Though it 
was below the expected number of responses, the results 
can already present important information regarding the 
objectives of the BoK & BoP project. Due to the very low 
number of responses from USA and Canada (7 responses), 
here it will be left out of the resulting graphics but will be 
at a later point compared with the 2015 ACCE survey.8 The 
African Region also has few responses (12 responses) but 
is presented due to the very small number of CEs work-
ing in that region. The total number of respondents with 
an electrical/electronic/mechanical engineering (B.Sc.) 
degree is around 65%.

As identified in the 2005 survey, the vast majority of 
CEs (48%) are employed by hospitals or health clinics. 
Government agencies are ranked in the second position 
as employers according to 12.5% of the respondents 
(Figure 2).

FIGURE 2. Percentage of the types of employers of clinical 
engineers worldwide.

B.Sc


19 J Global Clinical Engineering Vol.2 Issue 1: 15-22 ; 2019

Nascimento, Calil, Judd, David: Analysis of IFMBE-CED 2017 Worldwide Clinical Engineering Survey

Respondents were also asked how they see them-
selves as professionals. Nine different names that could 
define the profession were given (including the options 
“Others”) and the question was presented as: “Which of 
the following names do you believe best describes your 
profession?” Around 48% describe themselves as CEs and 
18.1% as healthcare technology managers.

Asked about the primary nature of his/her present 
position, the three first positions selected worldwide 
were Management (45.7%), Service Delivery (15%) and 
Professional Support (14.1%). However, this question also 
raised interesting information: Management was the first 
position in all regions but it was placed second in Oceania 
(34.15%) and Service Delivery (41.5%) was placed first. 

Due to the small number of responses from each region, 
one can argue that such results lack reliability. However, by 
comparing this information with those obtained in 2015 
(the USA and Canada BoK survey,8 with 472 respondents), 
the picture regarding Technology Management is the same, 
being in the first position. According to the respondents, 
there are great variations for other positions depending 
on the region. This can be seen in Table 2 where Latin 
American CEs responded (70 responses) that Profes-
sional Support is the second position while in the Middle 
East (21 responses), as Oceania (41 responses). Service 
Delivery is the second position.

One of the most important questions and the one that 
directly helps to achieve the objective of this project asked 
respondents to indicate, in a list of background knowledge 
topics, the level of importance of each one for his/her daily 
duties and responsibilities. Three levels of importance 
were presented (Minor, Moderate and High Importance). 
To present the results, the data processing was already 
explained in the chapter “Methodology” previously.

Interesting observations can be made by looking at the 
results presented in Figure 3. Though not with the same 
level of importance, there are coincident “Knowledge” 
rating tendencies. All respondent regions rated General 
Medical/Nursing Equipment above moderate importance. 
The same happens to the “Knowledge” regarding Comput-
ers, Networking and IT. On the other hand, “Knowledge” 
regarding Telecommunications is below moderate to all 
regions. The same happens for Chemistry and Implants.

Other comments can be made about these results but, 
the most important one is to see that a primary profile 
of the Body of Knowledge for CEs all over the world can 
already be traced, based on the rate tendency.

This survey, as well as the 2005 survey7 and the 
one promoted by ACCE9, pointed out that the position 
of technology manager was the one held by most clini-
cal engineers worldwide. Presented with 20 different 

TABLE 2. Final Results of Option Comparison By Category

 Africa Asia Europe
Latin 

America
Middle 

East
Oceania

Management 41. 67% 42.86% 50.00% 54.29% 42.86% 34.15%

Research 0.00% 7.14% 10.00% 4.29% 0.00% 2.44%

Manufacturing 0.00% 0.00% 0.00% 1.43% 0.00% 2.44%

Teaching 25.00% 10.71% 0.00% 7.14% 9.52% 2.44%

Consulting 16.67% 14.29% 10.00% 8.57% 0.00% 0.00%

Service 
Delivery

8.33% 3.57% 10.00% 4.29% 28.57% 41.46%

Professional 
Support

8.33% 17.86% 10.00% 15.71% 14.29% 14.63%

Other 0.00% 3.57% 10.00% 4.29% 4.76% 2.44%

FIGURE 3. Level of importance of background knowledge for 
clinical engineers to develop their daily work activities.

PACS = picture archiving and communication system



Nascimento, Calil, Judd, David: Analysis of IFMBE-CED 2017 Worldwide Clinical Engineering Survey

J Global Clinical Engineering Vol.2 Issue 1: 15-22 ; 2019  20

activities within the scope of this position, they were asked 
to rate the importance of each activity (High, Moderate, 
Minor and No) to develop their work. The process used 
to present this information was already explained in the 
Methodology chapter. 

Again, Figure 4 shows a great number of coincident 
tendencies regarding the activities. Taking as an example 
the activity Life Cycle Analysis, all regions rated it between 
Moderate and High importance. On the other hand, the 
activity Clinical Trials Management is rated as Minor to 
Moderate importance within the responsibilities of their 
work. As mentioned before, despite the low number of 
respondents, the importance of the activities among the 
regions follow the same pattern.

 Figure 5 presents the percentage of time CEs spent on 
each work activity during the work. Confirming what was 
pointed out on Table 2, most of the CEs from the Oceania 
region spent their time on service delivery (30%) while 
CEs from other regions spent between 15% and 18% 
on this activity. Important work profiles can be noticed 
here; while CEs from the European region spent 11.7% 
of their time on Risk Management Safety, this percentage 

is reduced to 6.7% by CEs in the Middle Eastern region. 
Another activity that presents a great difference in the 
percentage of dedicated time is Education of Others. While 
in Latin America CEs declared that this activity consumes 
13% of their time, in the European and Oceania regions 
it drops to 8.5%.

The reasons for such percentage differences in some 
activities may be due to the group of respondents within 
each region, interpretation of the question (Survey was 
done only in English) or cultural behavior. One may 
understand that Education of Others meant a short but 
formal lecture and others may understand that just the 
fact of orienting a new technician on repairing medical 
equipment is part of the time dedicated to education. 

The kind of activities the CEs develop for each work 
activity was also explored, as shown in Figure 5. A total of 
18 different activities composing the Risk Management/
Safety work activity was presented to be rated according 
to its importance to the development of the work. 

Figure 6 shows a few differences in the importance of 
each activity given by the respondents according to the 
region. While in the Oceanian and European regions the 
respondents considered Forensic Analysis as low impor-
tance, all other regions considered it above moderate. The 

FIGURE 4. The importance of activities for clinical engineers 
within the technology management domain.

EMI = electromagnetic interference; RFI = radio frequency interference

FIGURE 5. Percentage of time spent by clinical engineers on 
each activity during work.

EMI = electromagnetic interference; RFI = radio frequency interference



21 J Global Clinical Engineering Vol.2 Issue 1: 15-22 ; 2019

Nascimento, Calil, Judd, David: Analysis of IFMBE-CED 2017 Worldwide Clinical Engineering Survey

majority of other activities were rated between minor to 
moderate importance.

DISCUSSION
One of the most challenging tasks when designing 

mainly a worldwide data collection tool in the form of a 
survey is to develop a question that has the exact mean-
ing to all respondents. Due to language and culture dif-
ferences as well as different academic systems and job 
titles, people tend to respond according to the regional 
characteristics, which cause some distortions in the 
analysis of the results. Some of the data obtained can be 
corrected by a simple translation to English while others 
would be necessary to have a deeper understanding of 
the country’s academic system.

Adaptations from the ACCE survey were necessary to 
meet the objectives of this survey. It was not only to identify 
the CE body of practice and CE profiles worldwide but also 
to use the identified the body of practice to understand 
the body of knowledge required by CEs to successfully 
develop such activities. It is expected that in the near fu-
ture this set of knowledge would help to develop a scope 
of academic subjects necessary for graduating students 
to understand to optimally practice such activities. 

The structure of the survey allows a more detailed 
analysis of the data obtained. It is possible, according to the 
answers and number of responses, to have the profile not 
only of each respondent, but also the CE model practiced 
by the country, and the health unit he/she is working at.

No doubt that a higher number of responses from 
clinical engineers and other countries would make the 
information more accurate. However, it is already pos-
sible to devise a core of activities practiced by CEs all over 
the world. Regarding the needed knowledge for better 
developing their work, the results showed that though its 
importance varies according to the CE model practiced in 
the country/region, there is also a set of knowledge that 
is commonly needed worldwide.

There is a need to periodically update the information 
obtained in this survey due to the dynamic characteristic 
of the CE profession and the changing dependence of 
healthcare services on technology. For almost every new 
technology and procedure to be used in the health area 
there is an anticipated and required a new set of knowl-
edge for the practicing clinical engineers throughout the 
technology life cycle stages from innovation to disposal 
and replacement.

CONCLUSION
We hypothesized that a common body of knowledge and 

body of practice for CE would emerge from the analysis 
of a worldwide survey.

Despite some differences between regions, some pat-
terns of perceived relevance of different fields of knowledge 
and activity responsibilities within the areas are visible. 

This suggests that CE does have something in common 
around the world but more responses are necessary to 
define a solid worldwide Body of Knowledge and Body 
of Practice for the Profession.

ACKNOWLEDGEMENTS
The authors wish to thank Eng. Frank Painter for au-

thorizing the adaptation and use of an earlier version of 
the survey he developed.

FIGURE 6. The importance of each activity within the Work 
Activity Risk Management/Safety.



Nascimento, Calil, Judd, David: Analysis of IFMBE-CED 2017 Worldwide Clinical Engineering Survey

J Global Clinical Engineering Vol.2 Issue 1: 15-22 ; 2019  22

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