For physicians who perform bariatric surgery, one of the big challenges is postoperative complications. Surgical site infections are a particularly burdensome problem because the wounds must heal from the inside out, requiring a painful and somewhat gruesome process of unpacking and repacking the wound with gauze twice a day until the healing is complete. While some patients tackle the complex process at home, others return to the hospital to have it done by nurses.
Recently, a team of Stanford students led by senior bioengineering major Chris Mathy looked for a better way. After dismissing solution ideas around oxygenation and other biologic ways to prevent infections as too large scale to implement, they began thinking about ways to simplify the wound-care process. Ultimately, they created an absorbable, removable hydrogel for wound packing. Dubbed Gel-Aid, the hydrogel is superior to the standard of care (gauze packing) at absorbing fluids that drain from the wound, keeps the wound open as it heals from the inside, and can be managed by the patient at home because it is easier and less painful to insert and remove. “It was incredibly empowering to realize that we – a group of students – had the tools to develop a solution that could really make a difference to patients,” said Mathy.
Mathy and team were just some of the roughly 150 students who have participated in the Bioengineering Senior Capstone Design program since it began eight years ago. The program helps prepare undergraduate engineering students for career success by giving them the opportunity to participate in an experiential, project-based course solving real-world problems in health care. Course instructor Ross Venook says the goal “is to give these students a culminating experience that reinforces and integrates much of what they’ve learned in their core classes while also preparing them for what it’s really like to work as an engineer.”
Along with co-instructor Kara Rogers and other faculty from the schools of Engineering and Medicine, Venook guides students thorough an accelerated version of the Stanford Biodesign innovation process, a proven approach to health care innovation that involves identifying important unmet medical needs, inventing technologies to address them and then preparing to implement those solutions into patient care.
To start, the students read several short scenarios that describe realistic health care challenges. The students then form teams around the scenario they find most interesting and immerse themselves in the problem through research and interviews with clinicians, patients and other health care stakeholders. Although each scenario focuses on a particular need area, they are multifaceted enough to give the teams flexibility in terms of the specific problems they uncover and the type of solution approach they choose to pursue.
The extent to which the students define the problem they will be working on for themselves and their freedom to develop a solution across the full range of disciplines that make up Bioengineering are signature elements of the Capstone experience that both appeal to the students and characterize a real-world work environment.
This approach also gives the teams the opportunity to understand the many different stakeholders involved in designing health technology. “This is a differentiator for our students,” says Venook, an experienced medical device innovator and the assistant director of engineering for the Stanford Byers Center for Biodesign. “They learn to appreciate not only the engineering aspects of a problem, but also the needs and desires of the patients, doctors, hospitals and health care systems, among others.”
After identifying and researching multiple problems within their clinical scenario, the students use a screening process to winnow down to a single compelling need that has the greatest potential to improve patient care. Next, they dive deeper into the research to define the key characteristics that a solution must have to effectively address the problem. Finally, they work to invent, prototype and gather proof-of-concept evidence for a potential solution.
Because the students are tackling real problems in health care, at some point during the course, nearly every team gets stuck and asks the instructors: “How should we do this?” Venook says the answer is: “I don’t know, because as far as I know, no one has ever solved this problem.” Venook stresses that getting past this point is an essential part of the Capstone experience: “We want them to be able to reach out to experts who have suggestions, but not necessarily answers, and then learn to rely on their own judgment to chart a path forward.”
Given the complexity of the problems, failure is common, so the instructors build in time for teams to go back, revisit their assumptions and even re-direct the whole project based on their early learning.
One of the big goals in the course is team cohesiveness, and the interpersonal communication skills that underlie it. To help, the teaching team brought on Douglas Rait, a clinical professor in psychiatry and behavioral sciences, to coach students on team dynamics and conflict resolution. With the tools and guidance Rait provides, teams hold weekly check-ins to proactively address concerns and resolve problems, a practice that visibly facilitates better outcomes. “We learned to use terms like ‘I wish’ and ‘I like,’ in order to share our opinions constructively,” recalled Maria Filsinger Interrante, a bioengineering student who participated in the course last year. “Because ultimately the team is less productive when that input isn’t shared.”
Another goal, says former Bioengineering Department chair Norbert Pelc, is to give students an opportunity to develop and refine skills in an unscripted yet supportive setting and to gain critical experience in team-based environments. “Their accomplishments prove they are poised to become leaders and make it clear that we need to continue pushing the limits of open-ended course experiences,” he says.
For students like Mathy, the need to continuously make decisions based on incomplete or imperfect information is a push out of their comfort zone, and teaches essential lessons about innovation. “High-achieving students tend to get nervous when they can’t find the right answers quickly,” Pelc says. “They’re uncomfortable with ideas that fail, and don’t want to take the time to mull things over. But this course makes it clear that innovation is an active process of discovery that takes the right people, the right resources and asking the right questions at the right time.”