A Day in the Life

Mid-Year Reflections from 10th Class of Biodesign Fellows

Knowing is not enough; we must apply. Being willing is not enough; we must do.
– Leonardo da Vinci

The fellows are now over 4 months into the Biodesign Innovation Fellowship, and we have been striving to put Leo’s words into practice. Reading or just talking about how to innovate new medical technologies is not enough. We must do.

Each of us came into the program with a unique set of experiences and expectations. Reflecting on our progress thus far at about the midpoint through the year, the fellows were tasked with answering the following question:

In one paragraph: what was the most challenging aspect of transitioning from your previous life (engineer, physician, or researcher) to jumping into the Biodesign innovation process?

RED TEAM

Michael Ackermann, PhD: The most challenging factor for me was learning to work with a team that had both diverse experience and an egalitarian structure.  We came into the process with four problem solving approaches, and every decision was met with four different opinions.  I think it took a bit of learning, compromise and patience from all four of us to start functioning well as a group.  Now that we’re through the ‘storming,’ we have evolved (and continue to evolve) into quite a synergistic relationship.  I can honestly say that I really enjoy coming in to Biodesign each day to work with these guys.  We’ve got a great team.

Brandon Felkins: Coming into Stanford after working in industry for the previous 6 years was interesting and a little challenging at first. Industry and academia are completely different environments. Everyone at Stanford is so polite and I have never been paid to think about things for so long. It was novel at first but admittedly a little strange. Bootcamp was especially exhausting, and towards the end I would have welcomed the chance to knock out a few Solidworks drawings or build a catheter.

There was also some shock and awe in the beginning after listening to everyone rattle off their long list of accomplishments, but that soon wore off as we began to work together and got to know each other. The Biodesign process is novel enough that it kind of levels the playing field and everyone is essentially “starting over.” The shock and awe still creeps back in every now and then when a guest lecturer comes in to speak to us and we find out that they are a doctor/lawyer/engineer who already sold four companies and runs a $500 million VC fund because “they need something to do” when they aren’t managing their charitable foundation. Through these interactions we have built our network greatly. If ever we were seeking the aid of an attorney, we had a few names in our repertoire let us say.

I think the current challenge is remembering to value the skill set that each of us brought here and trust our own judgement as we make tough decisions to kill certain projects and move forward with prototyping other projects. Sorry, more than one paragraph, but I felt like typing and Julian [the d.shrink and team psychologist] suggested breaking the rules, so this is me being rebellious.

Victor McCray, MD: The most challenging part of transitioning from surgical residency to the Biodesign Fellowship has been learning a completely different way of thinking about clinical problems. Instead of approaching problems based on the “proven” methods that have been passed down from predecessors in the field, we are forced to think far outside of the box and question every bias and assumption that the clinicians have. I have enjoyed this change of perspective as I think it will make me a better clinician in the end. It has also been a challenge to be the “medical expert” on the team when we are working in a specialty that is far outside of my realm of expertise. Though a challenge, I have also enjoyed this aspect as it has forced me to expand my knowledge base.

Garrett Smith: The most challenging part for me was transitioning from an academic research position, where nearly everything I did was independent, to the full-on team-based environment at Biodesign. It did take some time to adjust to the new team dynamic—both from the standpoint of us collaborating effectively from our diverse backgrounds as well as how to best integrate our unique personalities and ideas together. We had some “false starts” and “junior varsity” performances in the beginning that we can all laugh about now. With that said, I feel that our team has grown together tremendously and that the team interaction experiences I’ve gained have been one of the most valuable parts of Biodesign.

SPECIALTY FELLOW

Ashish Nimgaonkar, MD: As a specialty fellow, one of the biggest challenges for me has been to navigate through the Biodesign process as a single-person team. While I do not have the advantage of gaining the perspectives and counterpoints that the other fellows can leverage on their multi-person team on a day-to-day basis, I have had the opportunity to get feedback and participation from my co-fellows during brainstorming sessions. At times, it does not seem to be such a terrible situation to be in as I am able to make relatively quick decisions without much discussion or deliberation. The other challenge, which I have been able to overcome for the most part, is to avoid becoming biased by my domain knowledge while identifying real clinical needs. I am also constantly reminded of an essential tenet of the Biodesign process: identify the clinical need without any bias towards potential solutions. The past few months for me have been a fascinating learning experience in an invigorating and goal-oriented, hands-on learning environment. It has dispelled many myths that I had about what it actually takes for an idea to go from concept to commercialization.

WHITE TEAM

Joëlle Barral, PhD: The first challenge for me was to admit to take action despite incomplete data. When I face uncertainty, my academic training taught me to identify the right questions and find ways to answer them. In the Biodesign process, it is still important to ask the right questions, but getting all the answers is not always a prerequisite for moving forward. Second, I learned to fight my natural tendency to favor exciting basic science projects, full of unanswered questions. In general, these basic science projects are quite bad Biodesign projects! Last, in a time-constrained process, it is critical to assess when something is “good enough”—that can also be frustrating! Biodesign has given me additional tools to think and work, and I am still learning!

Ravi Pamnani: “The Biodesign Fellowship is what you put into it,” an alumni fellow shared with me recently. This principle has been on my mind since we started in August. Not that this wasn’t true in my previous life as a product development engineer. In that role, what I achieved was definitely the result of the effort I put in. The same was true for my side role as a part-time graduate student. However, these two roles both had clearly defined objectives and endpoints. At work, the company needed projects completed to meet its revenue growth and quality goals; at school, my teachers needed to know whether I learned the course material and grade me appropriately. In the fellowship, it’s not so clear-cut. We as a team define the objectives and endpoints. We determine which projects to do. And in the end, we grade ourselves. The faculty of course play a huge role, helping to guide us and make sure we are on the right track. But how do we really know when we have succeeded in learning? It feels like there is endless opportunity to keep learning, that there is always more knowledge out there (especially here at Biodesign, and especially since I know so little to begin with). We just need to put in the time. But although the opportunities are endless, our time is not. Figuring out where to draw this line—how to be efficient and laser-focused—has been the most challenging part of the fellowship for me. And probably the most valuable.

Michael Schaller: About a month ago Ravi, Sid and myself went to the Stanford Sleep Center at night to shadow the technicians who set up and monitor sleep studies.  As we were vacuuming sensors to Ravi’s head (to understand the patient’s perspective), I realized how different this year has been from my previous role as an R&D engineer.  The decision to leave hadn’t been completely easy.  I loved the projects I worked on and the teams that I worked with; on top of that I felt proficient at what I was doing.  Biodesign has been a “fire-hose” of new and unfamiliar roles, the biggest of which is choosing what project to work on.  As an engineer you are handed a problem and then you work at the solution.  Now that my team and I are the ones deciding which problems to focus on, I have learned to appreciate the science (or maybe more the art) of needs filtering. The balance between being persistent on difficult problems versus efficiently using your resources on attainable projects is delicate.  For me, needs filtering has been not only the most challenging but also the most important activity I’ve been able to experience so far.  I am certain that whatever I do in medical devices in the future will benefit tremendously from having gone through the process of doing diligence, determining risk, and analyzing potential markets to make sure that we are solving the right problem.  And most importantly, at least I got to glue things to Ravi’s head.

Sidhartha Sinha, MD: One of the most challenging parts of the fellowship was “starting over”—learning a new field and further realizing the volumes about medtech that I don’t know.  After finishing residency, I was beginning to feel reasonably comfortable with managing patients with common internal medicine diseases.  Going from that to a relatively foreign field has been challenging, but an enriching experience as well.  I have had a great time learning with my co-fellows and look forward to doing some good things with these folks.  Like Mike, I also look forward to gluing as many things to Ravi’s head as possible, but like everything on or in Ravi’s head, nothing seems to stick…bada boom.

PS.  Mike Schaller has an odd fondness for peppermint patties, so if you ever want to do something nice for him, see how many you can stuff in his desk drawer.  He’ll love it!

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For more information on the Biodesign Fellows, see the Biodesign Fellows website.