From clinician to clinician-innovator: Designing a surgical innovation fellowship

Ramos at Boston Children’s Hospital’s 3D printing facility (Photos: Katherine C. Cohen/Boston Children’s)

Gabriel Ramos, MD, is a second-year general surgery resident from Puerto Rico, is Boston Children’s Hospital’s first Surgical Innovation Fellow.

I have devoted considerable time and training to become a surgeon. But I recently took a detour from my surgical education to pursue a research fellowship at Boston Children’s Hospital. I originally applied for a basic science research fellowship, but Dr. Heung Bae Kim – director of the Pediatric Transplant Center at Boston Children’s — described a new Surgical Innovation Fellowship. I decided to apply.

The early-stage nature of the fellowship meant I would not only learn about healthcare innovation, but also shape its future at Boston Children’s Hospital. The idea of learning more about the intersection of innovation, business and surgery was fascinating to me.

I was about to stop thinking as a surgeon – and start thinking as an innovator.

The Surgical Innovation Fellowship at Boston Children’s

As a Surgical Innovation Fellow, I work with multiple mentors. Dr. Kim and Dr. Salim Afshar, attending surgeon in Plastic and Oral Surgery, provide clinical and medical mentorship. Carla Small, Senior Director of Innovation at the Innovation & Digital Health Accelerator (IDHA), provides business and commercial mentorship. Peter Weinstock, MD, and Stephen Wilson, BSME, in the Simulator Program (SIMPeds) provide prototype design and engineering mentorship.

Ramos reviews his planned device prototype with simulation engineer Katie Livingston.

During my first month, we evaluated innovation fellowship curricula from a variety of U.S. programs. We learned that many programs bring together multiple fellows, each contributing a different type of expertise (business, medicine, engineering, etc.), and learning from each other. My mentors and I decided to pursue a different strategy, providing each Surgical Innovation Fellow with first-hand experience in all areas of innovation.

The lack of a formal curriculum enabled me to create a truly cutting-edge program, navigating through Boston Children’s Hospital to identify the key departments and people. I created a mentoring network, drawing on experts in areas such as business, innovation, engineering and medicine.

The power of observation

Boston Children’s Hospital’s Surgical Innovation Fellowship: A Q&A
Heung-Bae Kim, MD is director of the Pediatric Transplant Center at Boston Children’s and surgical director of the Kidney Transplant Program and the Liver, Intestine and Multivisceral Transplant Programs. Peter Weinstock, MD, is director of the hospital’s Simulator Program (SIMPeds).
Why did you decide to create the Surgical Innovation Fellowship?
Kim: We have found that young residents and medical students can have out-of-the box ideas that are creative and innovative, but that they often have no way of pursuing those ideas. My vision is to create an environment that allows young surgeons to identify healthcare challenges that they can overcome, using innovative solutions that result in improved patient care.
Why is this especially needed at a children’s hospital?
Kim: Pediatric surgery is a field comprised of orphan diseases. It does not usually attract the attention of investors who are interested in innovations that can be more quickly scaled. My hope is that the Surgical Innovation Fellowship can help fill this gap and allow for the early prototyping and testing that are so often difficult to accomplish in orphan disease product development.
How does simulation contribute to the Surgical Innovation Fellowship?
Weinstock: The SIMEngineer InventorSpace at Boston Children’s offers expertise, equipment and know-how in rapid prototyping, necessary to make great ideas in pediatric surgery a reality. The Simulator Program also houses high-fidelity training facilities, providing a safe “batting cage” for surgeons to develop, design and hone their surgical techniques.
What is your vision for the future of this fellowship?
Kim: I do not believe that these types of experiences should be limited to surgical residents. My hope is that we will eventually gain the funding to accommodate healthcare providers from any discipline.

The early months of my fellowship were purposely dedicated to observing a variety of surgical procedures in the operating room. This may seem like an inefficient use of time, especially after so many years of structured, curriculum-based academic experiences. But it is a key part of improving the experience of our clinicians, researchers, administrators and patients. Being involved with clinical research and quality improvement projects and taking call for the Surgery Department provided further opportunities to observe “pain points” in need of innovative solutions.

In observing, I started to realize something astonishing. Many of the procedures and processes that we perform daily — and which I’ve spent countless hours learning and practicing — are highly inefficient and in dire need of innovation.

The mentorship of Drs. Heung Kim and Salim Afshar was crucial during this phase. They offered unique perspectives on the most pressing needs in surgery and how to better tackle the problems. I used their guidance to compile a list of clinical needs, which we curated together to determine the most pressing and commercially promising opportunities. We reviewed a spectrum of ideas, mainly medical devices, but also some digital health concepts.

Solving the inefficiencies I observed wasn’t nearly as straightforward as I expected. I soon learned that I would need a skill set and modality of thinking beyond the scope of my training as a clinician.

Idea development and vetting

Our next step focused on vetting ideas. I wrote down more than 25 ideas and designs in a notebook over the course of my first several weeks as a Surgical Innovation Fellow. When I eventually evaluated each idea with my mentors, we decided to pursue just three, including surgical dissection and percutaneous feeding devices.

This provided a surprisingly helpful lesson. The best ideas balanced multiple perspectives – including business viability, clinical application and impact and engineering feasibility.

As part of my training, I attended several Opportunity SPRINTs hosted by IDHA. Each sprint brings together a variety of experts from across Boston Children’s to provide intensive feedback to innovators. Experts might include business strategists, subject matter experts, technologists and clinicians. Meetings follow the “SPRINT deck,” a format crafted by the IDHA team to capture a problem, the proposed innovation’s unique value proposition and the competitors, market trends and economics pertaining to the idea.

Later, IDHA provided extensive support to help vet my own ideas as potential commercial ventures and design commercialization strategies for our devices and products.


3D device prototyping

The engineers at SIMPeds helped us design the initial prototypes of our devices and iterate until we achieved a minimum viable product. Their top-of-the-line 3D printing capabilities allowed us to move quickly from one version to the next and work out the kinks in our design. Steve Wilson’s mentorship was key in understanding from a design standpoint how to improve our device.

On the business side, collaboration with our Technology and Innovation Development Office, especially with Rajinder Khunkhun, has been key as we strive to finalize patents and partnership agreements.

The Surgical Innovation Fellowship has allowed me the opportunity to look at surgical procedures through a different lens. Is there a formula for successful surgical innovation?  Check out my other post.

6 tips for surgical innovators