Association for Academic Surgery (AAS)

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Metrics that Matter – Academic Currency for Surgical Innovation

Academic surgeons are natural innovators. In the last century, significant advancements in medicine have been driven by surgeon innovators such as DeBakey and Fogarty.1 Despite the role of innovation in academic surgery, academic advancement criteria fail to align with measures of meaningful innovation. The traditional methods to evaluate success in academic surgery grossly underappreciate accomplishments in innovation – a corollary of historical efforts to discourage physician endeavors in innovation through low recognition in academic achievement.3 As a result, translating achievement in innovation into the currency required for success in academic surgery remains a significant barrier for both trainees applying for fellowships and faculty seeking promotion.

As a surgical trainee, I spent two productive research years in surgical innovation. When applying for fellowship, I struggled to accurately and fully represent all that I had accomplished within the confines of the pre-defined sections on my ERAS application. The only representation of my significant accomplishments in device development was in the (often overlooked) free-text of the “Experience” section. This included my immense work in: device design/prototyping, invention disclosures, development of business models and reimbursement strategies, development/implementation of device quality systems, establishing supply chains, execution of FDA regulatory submission, and pre-clinical/phase I clinical trial design. In attempts at translating my innovation work into ERAS, I included presentations to venture capital firms, at pitch competitions, and at innovation symposiums as “Oral Presentations.” The only section that would accommodate my executed patent was “Other Articles,” which, despite my best efforts, was not easily recognizable as hard-won intellectual property (IP).

Similarly, academic faculty often suffer from a perceived decrease in academic productivity when engaging in innovation-related endeavors. The skill sets required for traditional academic surgical work vs. innovation-related work, and as such the outcomes from these two endeavors, are vastly disparate. Thus, the traditional metrics of academic promotions – clinical productivity, research, teaching, and community service/recognition – cannot discern success in innovation.

Disparities are most apparent in:

  • Publications – Publications in innovation are infrequent but often high impact, such as clinical trial publications or patents. Most resource-intense innovation work, including regulatory work or product development, isn’t publishable. On the other hand, current academic promotions criteria value quantity of publications much more than the impact of the publications.4
  • Funding – Innovation work does utilize grant-funding, but the majority of funding actually stems from other sources, including angel investors, venture capital funds, and industry funding. In general, in current promotions criteria, there is no consideration given to success in funding from any sources except academic grants.
  • Community recognition – Despite a potentially large presence in many medical centers nationally and even internationally related to the process of commercialization, a limited presence at and involvement in field-specific national academic conferences decreases recognition from the traditional academic communities considered in promotions criteria.

Unfortunately, despite recognition of the need to modify academic admissions and promotions criteria nearly a decade ago, we are still doing a disservice to our trainees and faculty involved in innovation work.

Modern metrics to evaluate success in academia should be founded on merit, value, and impact. The ROI of each activity is the key to understanding the actual impact of one’s work. Quality over quantity is imperative. In addition to revamped metrics, admissions and promotions committees need to be updated to include members of multiple backgrounds and disciplines who can adequately and thoroughly evaluate candidates.

In conclusion, the pursuit of innovative endeavors by faculty has evolved from a “dirty business”1 to an expected academic behavior and natural extension of a surgeon’s skills. Innovation centers and surgical innovation training programs have now expanded immensely, with a heightened call for the full integration of teaching related to innovation into medical education.2 The time is now to amend the process of advancement in academic surgery to recognize the value of innovation-related achievements.

 

References:

  1. Jain M, Gewertz BL. Surgical innovation as the driver of change in academic surgery. Surgery.2019:166:717-720.DOI:10.1016/j.surg.2018.11.021
  2. Gonzalez G. 24 hospitals, health systems that launched innovation centers in 2021. Becker’s Hospital Review, 2021.
  3. Cohen MS. Enhancing surgical innovation through a specialized medical school pathway of excellence in innovation and entrepreneurship: Lessons learned and opportunities for the future. Surgery.2017:162:989-993.DOI:10.1016/j.surg.2017.06.012
  4. Klifto KM, Mellia J, Murphy AI, Diatta F, Fischer JP, et al. The 2020 Evidence-Based Promotion Ladder of Academic Plastic Surgery. Cureus.2021:13:e15221.DOI:10.7759/cureus.15221
Lauren Evans, MD

Lauren Evans, MD

Lauren Evans, MD is currently a clinical PGY-5 General Surgery resident at Cedars Sinai Medical Center. She attended medical school at Albany Medical College. After her PGY-3 year, she spent 2 years as a clinical research fellow at the UCSF Surgical Innovations program where she worked with Dr. Michael Harrison on developing a line of devices that create a magnetic compression anastomosis and Dr. Hanmin Lee on quality improvement and health equity in pediatric surgery.
Lauren Evans, MD

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Monica Jain, MD

Monica Jain, MD

Monica Jain, MD is a General and Endocrine Surgeon, Assistant Professor of Surgery, and the Surgical Innovation Officer at Cedars-Sinai Medical Center, as well as a Venture Partner at Wavemaker Three-Sixty Health. With a background in Biomedical Engineering and Healthcare Innovation, Dr. Jain is passionate about narrowing the divide between innovative technologies and their clinical applications. She drives strategic innovation partnerships, consults for and mentors healthcare startup companies, is a leader in several surgical and innovation societies, and works on leadership, education, clinical efficacy, human factors, and quality improvement projects.
Monica Jain, MD

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