Guest Q&A — Thomas Krummel, MD, Fogarty Institute Chairman

by | Sep 5, 2015 | Fogarty Innovation, Thought Leadership

Dr. Krummel is one of those rare individuals who has seen and experienced medical innovation from every front — as an academic, surgeon, writer, startup adviser and administrator. He served as Emile Holman Professor and Chair of the Department of Surgery at Stanford University School of Medicine for the past 16 years, as well as Susan B. Ford Surgeon-in-Chief at Lucille Packard Children’s Hospital, and is one of the Co-Directors of the Stanford Biodesign program.

During his distinguished career, Dr. Krummel has been a pioneer in the application of information technology to simulation-based surgical training and robotics, has received countless awards for his work, and perhaps most importantly, has been a mentor and inspirational educator to numerous innovators and medical device startups.

This summer, our Lefteroff interns were treated to an informal Q&A with Dr. Krummel to discuss the secrets behind his successful career and future of the medtech industry.

Q. What would you consider failure, and how does it change or make you better?

A. Success is built on failures.

For me personally, I struggled in medical school. Medical residency is tough, and there were many days that I wanted to drop my beeper in the trashcan, but I bounced back.

And then as a surgeon, I think it’s a natural tendency to think more about the patients you were not able to help, rather than those you did. But to succeed in the medical world you need to persevere and think of the greater good. And that’s what I did.

When you look for solutions to a difficult problem, you have to be creative when you find that the standard answer doesn’t work. Study all the attempts and failures — when you think differently, that is when a major breakthrough can happen.

Here’s a perfect example: kidney transplants. It used to be unconceivable that you could transfer an organ from a dead body with a beating heart to a live person.

It was thanks to an innovative and persistent young Dutch physician named Willem Kolff, who is considered the father of dialysis, that the first successful kidney transplant took place in 1954. It took Kolff almost 20 years to see his technology come to fruition, and his path was ripe with failures and challenges, including the need to hide the progress of his work from the Nazis.

To be successful, you have to discover how something doesn’t work – that’s how you find out what will work. Samuel Beckett perhaps says it best in his quote: “Ever tried. Ever failed. No matter. Try Again. Fail again. Fail better.”

Q. Can you share the beginning of your career path — you didn’t really know what you wanted to study when you went to school, and yet ended up being so successful.

A. I believe that educational institutions should be a place for exploration. As a student, you should be surrounded by faculty who are there to help expose you to different things, to help you find your passion. The result is a graduate whose brain has been challenged and is ready for lifelong achievements.

Take Larry Page and Sergey Brin. They founded Google while they were Ph.D. students at Stanford. Their mission was to organize a seemingly infinite amount of information from the web, and their mentors encouraged them to pursue their ideas. Their first Google computer at Stanford was housed in custom-made enclosures constructed from Lego bricks. Now that’s thinking outside the box.

The message is that you shouldn’t be afraid to explore — or to tell people that you are exploring. That’s how you are able to figure out where your strengths are, and then you can hone in on them.

Q. How do you come to terms with the responsibility surgeons have over patients and their families — is that a process or something that is learned?

A. That was my fear of pursuing medicine when I was in college. My mom thought I should go to medical school, but I thought it was too much responsibility. However, once I started, I began following the path and realized it was fun to deal with difficult problems. It was fun to get it right and help people. There’s an enormous sense of satisfaction that comes from contributing to the health and well being of patients.

That’s what I experienced, and what I share with my students at Stanford. You train a group to trust themselves and learn to fail better and quickly.

Q. What is the largest unmet need in the medical world right now?

A. Continuing to attract and inspire bright, talented young people to the healthcare profession. There is some pessimism around the ways that healthcare is changing. But there is no better privilege than helping someone in a moment of need. If we keep attracting bright young minds, new devices and technology will be developed and new medical solutions will be found.

Q. What is your interest in virtual reality and robotics in medicine— what role do they play in medicine and why aren’t they more prevalent?

A. I have always had a strong interest in tinkering with mechanical things. With virtual reality, you can fail, and if you kill a virtual patient, it’s no big deal. The freedom to fail and quickly learn from your failures is key to medical advancement.

Virtual reality has its roots in the aviation industry. In World War II, the mortality rate associated with learning how to land an airplane on a carrier was in the double digits. The pilots were very motivated to learn quickly. Thanks to Edwin Link, who invented the first aviation simulation device, 70 to 80 percent of lives were saved.

The notion of feeling comfortable failing and failing safely is at the heart of how we train the next set of physicians and surgeons. It doesn’t replace learning on the human body, but it expedites the learning process. Medical device innovators use simulators and technology to train surgeons how to use their tools.

The other piece of this is the robotics side. I did a lot of work on robotic development at Penn State. Think of it as R2-D2 — robots are great at repeating the same task consistently. One of the most innovative and inspiring computer science and robotics centers is located in Strasbourg, France, the IRCAD Training Center. What they are doing is truly impressive — a surgery and computer science think tank that is now also expanding into distance learning, offering the most extensive library of surgical videos.

The key takeaway is that no one has a lock on anything. Innovation can happen anywhere. There is always someone who is worth meeting and learning from.

Q. What does the next generation of healthcare provider look like? Will there be a stronger shift towards technology, and how can this need be met?

A. The younger generation brings a lot of technology savviness. Our running joke is that electronic healthcare currently only exists thanks to interns who know how to use the system.

Technology is a great way to learn. I am here to learn from the younger generations — that’s how education really becomes effective, when we learn from each other.

A recent Economist cover story, Planet on the phone, stated that by 2020, 80 percent of the population will have a supercomputer in their pocket. The implication is that someone will probably take a social media concept and develop a way to match patients with physicians globally. Sohila Zadran, founder of Igantia, one of our startups here at the Institute and former student in the Stanford Biodesign program, is looking to use social media to resolve and better understand hot flashes. I would never have thought of that. She knows how to use online tools to plumb a condition that we don’t know anything about — to me this is a tremendous opportunity.

Q. You have mentored hundreds of students. Who were some of your early mentors and how did they impact you?

A. I was lucky I had high expectations set at school and at home – my parents taught me everything important before I went to school, and some of my early teachers taught me the value of hard work. If a project was done poorly, I was encouraged to “step it up.”

Dr. Salzberg and John Waldhausen were strong influencers when I was at Penn State, teaching me how to become a department chair. I think of mentorship as the story of Ulysses — we only have a single spear. You have to have high expectations and devote time and energy to distinguishing casual acquaintances from those who have a meaningful impact.

Q. What is the biggest roadblock for bioscience?

A. Fifty years ago, Gordon Moore created “Moore’s Law:” he made the observation that every 18 months to two years, the number of transistors that could be placed on a microprocessor would double. The law has proven to be correct.

In healthcare, we have reverse Moore’s Law. Every two years, the cost of bringing technology to market doubles. This isn’t a good prognosis. It stifles investment. It is up to people like us, who care about healthcare, to find and create solutions. The Fogarty Institute, for example, is very capital efficient, which allows the next generation of tools and technology to be developed despite strong challenges.

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