As I read through the current issues of the surgical literature, familiar themes continue to permeate the pages. Two themes represent much of the research we as academic surgeons devote a significant amount of time to designing, conducting, and publishing. The first goes something like this: “A study of ABC clinical problem in the LMNOP population, a retrospective review using the XYZ important database”. No doubt important (I have a degree in clinical research after all), these retrospective or prospective descriptive studies illuminate many clinical problems and the real-world effectiveness of the treatments we utilize. Plus, they are relatively easy to conduct given the correct variables are recorded, and what busy young surgeon doesn’t like quick and easy? The second study is the basic science study: “The variable expression of Gene ABC during cellular injury/cancer/organ development/(insert your disease process here) is modulated by Random Molecule You Never Heard Of”. These studies are also important to understand what causes the disease processes we see clinically every day and illuminate possible targets for intervention. These studies take months to years to conduct and require larger teams of dedicated laboratory researchers.
So, what’s missing? Though these two themes are noble in their intentions (describe a clinical problem, define the cause of said problem), there is currently an inherent gap in helping our patients right now. Today. Immediately. The thing that drove many of us into surgery, the immediate and tangible impact on our patients’ lives, currently represents a minority of the research we are pursuing.
Innovation is something that needs to be re-invigorated in the surgical field, and it needs to start with residents and young surgeons. We need to concentrate on translating the tomes of basic and clinical research on the problems we treat into tangible devices, treatment modalities, and medications that can change the lives of our patients.
As surgeons, we have a unique perspective that is currently underdeveloped in the innovation process. Clinical and basic science literature in our field is produced by diverse groups with differing backgrounds and training. We see the clinical problems daily and have the training and ability to lead these diverse teams in pursuit of disrupting advances in practice. Devoting time to sit down and collaborate with engineers, molecular and cellular biologists, and pharmacologists can create fruitful partnerships that can lead to real innovation and change in medicine. Partnering with computational modelers and programmers can turn your retrospective review into a functional model that can drive real technological change in how patients are identified, treated, and managed. We are uniquely positioned to be the hub of medical innovation; we simply need to put in the time and effort on these high-impact projects. May that mean a few less publications every year, and a bit more frustration coordinating large and complex teams? Yes, it can, but the reward is that you can achieve a direct, tangible, lasting impact on patient care. Isn’t that why we wanted to become surgeons in the first place?
There are certainly skills that can make this easier. Skills in translational research and medical product innovation can be refined with formal coursework or developed with dedicated time in the innovation laboratory environment. Intellectual property, in vitro to in vivo translation, first in human study requirements, and regulatory issues require mastery. The investment in developing these lesser-emphasized skills will return more impactful, fruitful research for our field.
It’s time for us as a field to start thinking outside the box again. Innovation was the key to developing the clinical science of surgery. It is our duty to focus our efforts once again on surgical innovation that can advance our field and enhance the care received by the patients we serve.