Digestive Diseases

April 17, 2021

"The glory of medicine is that it is constantly moving forward, that there is always more to learn." — Dr. William J. Mayo

Elizabeth Rajan, M.D., a gastroenterologist at Mayo Clinic's campus in Rochester, Minnesota, has been involved in innovation and research in gastrointestinal endoscopy for the last two decades. The focus of Dr. Rajan's research career is the development of devices and techniques to diagnose and treat multiple gastrointestinal diseases using minimally invasive endoscopic procedures.

While serving as director of Mayo Clinic's Developmental Endoscopy Laboratory, Dr. Rajan has also mentored and encouraged physician-investigators seeking to transform care in the field of endoscopy through device and technology innovation projects. Since its inception in 1998 by Mayo Clinic gastroenterologist Christopher J. Gostout, M.D., the laboratory has pioneered new technologies that have advanced the field of minimally invasive endoscopy.

Dr. Rajan drew upon her unique career experiences, with a special focus on considerations for women pursuing careers in innovation, in a review article on this topic that was published in Techniques and Innovations in Gastrointestinal Endoscopy in 2020. In this Q&A, we ask Dr. Rajan to recap some of the key points she shared in that article.

What led you to research and write about this topic now? Are there any specific events or recent observations that triggered your interest in sharing this info?

We are at a moment in time where the interest in advancing and supporting innovation is intensifying. Writing a review article on this topic was a great opportunity for me to compile my thoughts and experiences in this field. I also discovered that there is a dearth of published information on the topic of innovating in gastroenterology and endoscopy.

What triggers innovation, and what are some common traits that people engaged in innovation possess?

Successful innovators are often spurred into action when they encounter or identify a problem or an unmet need. Innovators are often people who are eager to improve the status quo and find solutions. This type of work often requires a mix of traits, including creativity, patience and a willingness to fail. And in medicine, patient needs must remain at the center of an innovator's focus and motivation.

How can we train physicians to become innovators?

While some individuals possess innate talent and a drive to innovate, I believe that the desire and skills required to innovate can and should be cultivated. Including formal innovation training programs within the three-year gastroenterology fellowship and establishing an independent fellowship dedicated to endoscopic discovery are options to consider. This type of structured training would teach trainees to recognize and identify existing deficiencies and obstacles in our practice, and to encourage the development of creative solutions to these challenges. Encouraging trainees to adopt a mindset that sees obstacles as opportunities is an essential part of cultivating innovation.

What role do leaders and mentors play in supporting and encouraging innovation? Did you have a mentor who influenced your own work and interest in innovation?

Leaders and mentors clearly play an essential role in nurturing and developing innovative abilities in physicians. Leaders can demonstrate that commitment by developing and sustaining a workplace culture and organizational structure that support innovators. They can ensure access to funding, protected time and other resources.

In my own career at Mayo Clinic, the mentorship that Dr. Gostout provided was instrumental in supporting my interest in endoscopic innovation. Dr. Gostout's innovative force inspired me to identify deficiencies in our day-to-day clinical practice, to imagine boldly and to create solutions.

What advice about obtaining funding and financial support can you share?

As you work through the steps from idea generation to commercialization and implementation, it's important to understand that many traditional funding sources are less likely to favor high-risk creative proposals. Pursuing grants from your own institution, from national gastrointestinal societies or the National Institutes of Health may be an option. But physicians engaged in innovation may also need to consider alternative funding sources.

Identifying medical device companies that are actively engaged in emerging technologies can be worthwhile and potentially lead to licensing agreements. A more complex approach is putting together a startup company that often needs capital investment and interaction with regulatory agencies. It is important to protect your technology through a nondisclosure agreement, and by applying for or receiving a patent. Connecting with philanthropists or philanthropic organizations that support innovation also can help generate the capital needed to start and sustain a project.

What type of strategic partners should innovators seek, and what roles do these partners play?

Ideally, your core team should include a research fellow trained in endoscopy, an endoscopy nurse and a study coordinator to support and advance your initiatives. You will also need to form strong strategic partnerships with staff who can assist with technology transfer, engineering and veterinary medicine. Technology transfer team members can help you navigate protection and disclosure of your ideas, patent application, and licensing opportunities. Engineers can provide the skills and experience needed to convert device concepts into functioning prototypes. And veterinary medicine staff can oversee the appropriate care of any animal subjects.

What kind of laboratory equipment should investigators acquire, and what's the best way to obtain it?

An animal laboratory should be equipped with endoscopes, processors, endoscopic ultrasound, fluoroscopy and training models, and have workspace in which investigators can create devices. In general, medical device companies no longer donate equipment, so it's a good idea to look for used or refurbished equipment that's been cycled out of clinical practice.

What forms of marketing should those who are interested in innovation pursue?

Attending national gastroenterology conferences and other medical meetings can help you stay aware of current trends and technology advances and provide additional opportunities for networking with potential collaborators and promoting your expertise. Creating a website or brochure focusing on your interests also can be helpful in raising awareness.

I'd also like to urge anyone interested in conducting innovative research to overcome any hesitancy to engage in self-promotion and marketing. Research has shown that women, due to gender and cultural influences, are often hesitant to sell our successes. It is important to highlight your value and what you can contribute to endoscopic innovation. One way to do this is by communicating directly with company leadership and confirming your role as the driver of innovation on any given project.

What do trends in medical school admissions and gastroenterology fellowship applications tell us about the future for women who wish to be involved in innovation in gastroenterology and endoscopy?

We know that the number of women entering gastroenterology fellowships within the United States is rising, and that women now outnumber men in medical schools. As we move closer to achieving gender balance in medical schools and among gastroenterology trainees, women can and should become significant influencers in the practice of endoscopy. I am also hopeful that these trends will encourage medical device companies to engage with more women in their product assessment and development efforts. Empowering more women as leaders and role models today will help encourage more women to pursue careers as innovators in gastrointestinal endoscopy.

For more information

Developmental Endoscopy Laboratory: Elizabeth Rajan. Mayo Clinic.

Rajan E. Women in innovation in endoscopy: Pitfalls and tips for success. Techniques and Innovations in Gastrointestinal Endoscopy. In press.