Alastair Darwood, Jan 2018
From prosthetic valves to pacemakers, cardiopulmonary-bypass machines to joint replacements, surgeons have a prolific reputation as medical device inventors and innovators within their field. Surgery is by nature a personal affair requiring dynamic thinking and necessarily tactile interventions. Each patient is unique in their own way demanding real-time innovation no matter the surgical complexity. A surgeon must physically interact with a patient’s anatomy in order to carry out a fixed, well defined task. These characteristics create a fertile space for innovation to flourish as surgeons not only see problems first hand, but are trained to dynamically problem solve with the tools they have available.
This physical interaction with a patient’s anatomy and physiology creates a special case in healthcare innovation. In the medical field, revolutionary advances over the last few decades often take the form of new drugs requiring the research and development might of multinational corporations. In contrast, surgical interventions allow even individual inventors with a laptop and kitchen table the potential to create genuinely new ideas and devices as seen throughout the history of surgery.
If this is the case, where are the vast swathes of surgical trainees and consultants jostling to present their latest innovations or the university technology transfer offices sagging under the weight of this constant workload?
I believe we are seeing a fundamental problem in surgical training and education that has genuine ramifications on the pace of clinical progress.
In my own experience, the skill sets and knowledge base required for successful medical device development are largely excluded from both UK medical schools and speciality training curriculums. Conversations with junior doctors, speciality registrars and even consultants further confirm this with understandably sparse knowledge in areas such as intellectual property, prototyping skills and the device design and development process.
In addition, academic surgery seems to strongly emphasise scientific research rather than innovative design and development of hardware and software. From junior house officers to the most senior of registrars, research projects and PhD’s tend to focus primarily on data capture and analysis rather than the development of new devices and technologies. Researchers work to understand the science behind surgical interventions generating a wealth of vital data with huge untapped potential for subsequent innovation.
Sadly, in academic institutions development work maybe left to pure engineers and designers relegating surgeons to a supporting role of ‘clinical advisor’. At worst, many surgeons leave the device development process to faceless corporations and simply buy and use the resulting products as end consumers.
This skill set and knowledge gap is a huge hindrance to the progress of surgical device innovation. Trainees and consultants should be armed with the tools they need to conceptualise, prototype and assess any invention they may conceive, whether a new intraoperative device or software utility.
The process of inventing and innovation has drastically changed over the last few years. From new prototyping modalities such as 3D printing to accessible CAD/CAM software, the tools available to surgeon inventors today would be the envy of their peers from yesteryear. There has never been a more exciting time to put on an inventor’s hat, and to question the status quo of the existing surgical landscape.
In little more than a century, surgery has gone from a barber shop side-line, to the cutting edge of technological and physiological sophistication. To fuel this wave of innovation we urgently need to democratise medical device development, equipping existing and future surgeons with the skills they need to take charge of the innovation process.