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Smalley, Robert John

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Robert John

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Smalley, Robert John

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    Building a Better Babcock: A Memoir of Innovations Pursued at Harvard Medical School
    (2018-05-15) Smalley, Robert John
    Introduction: I entered Harvard Medical School at considerable short-term cost. As a mid-career military officer working at the Pentagon, I was accustomed to a standard of living somewhat above the typical medical school entrant. The reason for this decision was the promise that Harvard was a research playground, and Boston was a medical innovation incubator second to none. Over the course of four years at Harvard Medical School, I had the opportunity to build, patent, and secure funding for a new surgical device. I wrote a technical note describing a new intraoperative technique with the hope that other neurosurgeons would adopt it. I also examined a previously disseminated medical innovation, a new chemotherapeutic, and described how surgical practice changes regarding patient selection should now occur. The success of all these changes remains to be seen; this project is not meant to provide evidence of their widespread adoption. Rather, this is meant to serve as a memoir of three experiences, viewed through the lens of innovation theory, and paired with a scientific product that resulted from each project. Methods: The overall project consists of three chapters describing my experiences and involvement in the development and attempted dissemination of a portable sterile surgical field, the use of multimodal intraoperative imaging during glioma resection, and the performance of prognostic models in a population of patients with colorectal cancer liver metastases who are receiving the chemotherapy regimens FOLFOX or FOLFIRI which did not exist when the prognostic models were developed. In particular, I examine how my attempts at dissemination adhere to the theory laid out for innovation in general by Rogers, and for healthcare innovation in particular by Berwick. Conclusion: Bringing innovations to become standard practice requires a tailored approach, with each set of adopters requiring a greater demonstration of efficacy and scientific rigor. In surgery in particular, an adequately scientifically rigorous evidence base can be difficult when those who typically conduct rigorous trials have already fully adopted an innovation.