Immersive clinical training elevates engineering PhD programs
VISE alumni positioned to transform medical procedures
In working with clinicians, Winona Richey gained big-picture knowledge of workflow, patient experience and existing technology in the operating room. The interactions sparked ideas to improve tumor marking and surgery for breast cancer.
Carli DeJulius shadowed a rheumatologist and multiple orthopedic surgeons at Vanderbilt University Medical Center clinics and operating rooms, observing six joint replacement surgeries, and interacting with patients who have osteoarthritis and other joint diseases. Her research focuses on drug development for osteoarthritis.
She and Richey are biomedical engineering PhD students in an intensive training program supported by a nearly $1 million National Institute of Biomedical Imaging and Bioengineering grant. It is succeeding in its goal—to go beyond, far beyond, theory and spark ideas with the potential to transform clinical care.
Preliminary reports from the program show strong evidence that immersive levels of clinical contact resulted in significant improvements in the students’ understanding of procedural medicine and their ability to identify important questions that, if solved, would result in breakthroughs in clinical care.
“Technological advances to patient care in the next century will be better than any science fiction fantasy you find in your favorite books.”
Michael Miga, Harvie Branscomb Professor
Professor of biomedical engineering and VISE co-founder
IMMERSIVE CLINICAL CONTACT
In this first five-year grant cycle, improvements were assessed in trainees’ ability to pose important questions in surgery and intervention, knowledge of surgical technologies, and understanding of procedural medicine. According to a self-reported survey, trainees observed at least 15 procedures and had at least 48 hours of clinical contact. Significantly, the trainees reported a perceived improvement of 34% in their ability to pose important questions affecting human health.
“The engineering, surgery, and intervention ecosystem we have built at Vanderbilt is something wholly unique and with no parallels,” said Michael Miga, Harvie Branscomb Professor, professor of biomedical engineering, and co-founder of the Vanderbilt Institute for Surgery and Engineering. “Many institutions have engineers who collaborate with physicians; Vanderbilt is different, it’s much, much more.”
Clinical immersion for traditional graduate engineering education is not common, he said, but is essential to advance procedural medicine. “With such integration, the technological advances to patient care in the next century will be better than any science fiction fantasy you find in your favorite books,” Miga said.
He and Robert F. Labadie, professor of otolaryngology, head, and neck surgery and a VISE affiliate, reported on the program in Biomedical Engineering Education, the official educational journal of the Biomedical Engineering Society.
The five-year training program is for second- and third-year PhD students in biomedical engineering, electrical engineering, mechanical engineering, and computer science.
REAL DOMAIN EXPERIENCES
In the first of two courses in the program core, trainees attended lectures by 10 or more physicians who presented their procedural specialties interwoven with lectures on related engineering principles. A second course provides clinically mentored immersion experiences in the operating room or interventional suite, at clinical conferences, and in patient rounds.
Included are sessions with surgeons and interventionalists researching and treating a myriad of conditions that span procedural medicine, from brain tumor surgery and neuromodulation implants to robotic surgeries in the lung, prostate, and kidney, to arterial and ablation therapies in the liver and to radio-oncological procedures in breast and eye and more.
Miga calls this training approach real domain experiences.
“Too often, rather than beginning with observations of clinical barriers, trainees are either introduced to a research laboratory’s perspective or are integrated into a standardized design framework,” he said. Without these raw observational experiences, innovation may become inhibited and frankly we might lose out on some really exciting engineering ideas.”
Richey, for instance, wondered about breast cancer procedures after observing several of them.
“Almost all patients have biopsy clips implanted near the tumor, but most have a separate localization device implanted as well. Shouldn’t we be able to just leverage those biopsy clips for localization? If we could, that would eliminate a second, painful procedure for the patient, and for the clinic,” she said.
“The opportunity to work closely with clinicians throughout my training has provided me with invaluable knowledge in developing technology that will easily integrate into the operating room.”
Six engineering PhD recipients haven taken positions in startups, health care research, and medical device development. More than a dozen other trainees in the VISE program will graduate in the next few years. The graduates are:
Mechanical engineering, PhD ‘20
Lead mechanical engineer at EndoTheia, Inc., in Nashville, a startup focused on flexible endoscopy
Computer science, PhD ‘19 Siemens Healthineers, research and technology manager
Biomedical engineering, PhD ‘21,
MD expected ‘22
Medical Scientist Training Program, VUMC
Applying to neurosurgical residency programs
Biomedical engineering, PhD ‘20
Memorial Sloan Kettering Cancer Center, postdoctoral research scholar
Biomedical engineering, PhD ‘21
RIVANNA, ultrasound systems engineer. RIVANNA is a privately held designer, manufacturer, and distributor of medical technologies and services based in Charlottesville, Virginia.
Biomedical engineering, PhD ‘18
Hyperfine, clinical scientist. Hyperfine develops, manufactures, and distributes point-of-care MRI systems.