Medical leadership and 3D-printed cartilage

The Elson S. Floyd College of Medicine at Washington State University emphasizes leadership as part of its curriculum for medical doctors. Founding Dean John Tomkowiak talks about why leadership training is so crucial as health care evolves into medical teams. Physicians who are prepared to be leaders could provide better care for people and take a stronger role in their communities.

Also in this episode:  

• WSU bioengineering researcher Arda Gozen studies another exciting advancement in medical and health sciences: 3D printing of cartilage. Additive manufacturing—3D printing—holds great potential for personalized medicine, treatment of osteoarthritis, and joint replacement.

Read more about the Elson S. Floyd College of Medicine’s first graduating class of doctors and about 3D printing of tissues in medicine.

Transcript

John Tomkowiak:

Leadership is a science in and of itself. It's a whole field of discipline. That is separate and you don't get exposed to that in your medical training.

Larry Clark:

The Elson S Floyd College of Medicine at Washington State University emphasizes leadership as part of its curriculum for medical doctors. founding Dean John Tomkowiak talked with us about why leadership training is so crucial. 

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Welcome to Viewscapes. Stories from Washington State Magazine, connecting you to Washington State University, the state and the world. 

Later in this episode, WSU bioengineering researcher Arda Gozen talks with magazine writer Allison Boston, about another exciting advancement in medical and health sciences, 3D printing of cartilage.

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Tomkowiak:  

I'm John Tomkowiak. I'm the founding dean of the Elson S. Floyd College of Medicine.

Clark:

Thanks for joining me today. 

Tomkowiak:

Happy to be here. 

Clark:

I have been fascinated by this idea of teaching leadership to medical students. And it's something I think is a hallmark of the Elson S. Floyd College of Medicine. So my first question to you is why teach leadership to medical students?

Tomkowiak:

I think that question really leads to an important question that we asked when we started this college, which was, what do our communities and our healthcare organizations across the state of Washington need in future health care practitioners. And when I got here in 2015, I actually did a tour of the state meeting with community leaders meeting with healthcare executives. And I asked that question. And at the top of everyone's list was this idea of we need our physicians to be better leaders. And that came through both from the community and from these healthcare executives. And when I dug in a little bit more, they said, you know, our current physician population, you know, we're constantly wanting to put them in leadership positions, whether it's in the clinic, or in the hospital, meeting, maybe leading a committee or leading an initiative, and they really don't have the leadership skills that we expect them to. And so it'd be great if we'd have a better trained workforce. And then, on the community side, it was sort of the same response is, you know, we often ask physicians in our community to step up and, you know, join a board or, you know, take part of leading an initiative in the community. And they are, you know, somewhat surprisingly, they're not very good at it.

Clark:

And I can definitely see how that would be a necessity then for, for education, not just an extra, but something that's integral to, to their education.

Tomkowiak:

Absolutely. And, you know, this is really an insight that I had, through a mentor of mine, when I was in the middle of my career, he suggested that I pursued some kind of leadership training myself. And I ended up landing in at Gonzaga at the Masters of Organizational Leadership Program, which they had just put online at the time. So I was in Florida, at Florida State University, and I took that program online, and it was literally transformational for me. And one of the first things that I came away from that program, it was super humbling. I think, as a physician, as you go through your training, it's such an intense training, you end up getting sort of a false sense of your abilities or capabilities in other areas. And one of the first things I realized taking that leadership program was leadership is a science in and of itself. It's a whole field of discipline, that is separate, and you don't get exposed to that in your medical training. So, you know, having the opportunity to go through that program, I suddenly looked around, I was like, wow, I wish I had this training way earlier in my career, because I would have done things differently. You know, I would have led teams in the hospital differently. I would have, you know, Ben, Ben, a different kind of leader. And so that was really part of the inspiration for making sure that our graduates of the Elson S Floyd College of Medicine would have some of those foundations, so that as they went off to further training and into their early careers, they would be a step ahead, and hopefully, you know, meeting the needs of the state as they bring these leadership qualities to the forefront.

Clark:

You know, in some of these things that you learned, maybe I can say, again, also through your career, what are some of those important lessons that you really want to pass on to the students at the LCS Floyd College of Medicine as they go into their careers? 

Tomkowiak:

I think everybody appreciates medicine is turning into more of a team sport, we're looking for all healthcare professionals to practice at the top of their license. And we need folks on the team who can help lead and facilitate the team to bring in the best care to patients. And one of the things I think is really important about leading teams is also understanding what it means to be a great team member or a follower. And so, you know, we talk about that a lot that, you know, if you want to be a great leader, someday, you have to learn how to be a great follower. And you know, understand what the needs of followers are, so that when you step into that leadership position, you can appreciate you know, how to take care of your team. So that's, that's a big lesson, I would say, the second lesson that we want to teach is, it's about relationships. And, you know, you can have a great vision, you can have a great tactical plan about how to achieve that vision. But if you can inspire or motivate people, or understand what their needs are, so that they can be ready to participate in, you know, whatever it is you would like them to do, then you'll likely fail. And the way you get to that, is you got to have great relationships. So that would be the second thing. And I would say the third thing is, you have to really understand yourself, not only as a leader, but as a human being in terms of, you know, what are your values? And what are your strengths? And what are your shortcomings because those come across in leadership scenarios all the time. And if you have blind spots, those are the things that you know, could lead to failure. And so we're constantly asking our students to, you know, do self assessments and, you know, approach every situation with humility, because that is that usually is a recipe for success.

Clark:

That's not something that definitely syncs up with things that I've read about leadership in the past to that ability to self reflect, and to look at one's own weaknesses and strengths with honesty, and transparency.

Tomkowiak:

And it's so hard to do. And, you know, there's been studies in the physician literature that show that doctors aren't really very good at that. And I do think it's a learned skill. And so that's what we want to do is, you know, we want to build these foundational skills for our students, so that they get inspired. And, you know, I hope they actually do more studies into leadership as they go on with their career, because I think it'll really benefit them.

Clark:

Yeah, certainly. So now that we've had some students, including our first graduating class in May, and congratulations, on that. Have you heard from some of the students that you've worked with, and now going into their practice? Have you heard from them about the leadership program and what's their response?

Tomkowiak:

We have, and what they say is they feel compared to their colleagues, let's say that are in the residency programs that they have joined, that they feel much more confident in being able to lead small teams to understand you know, the relationships that exist in the healthcare setting, not only with patients, but with other care providers, and you know, how to navigate those relationships and teams better. They feel comparatively much more comfortable in the workplace setting than they feel they would have otherwise had had they not had that leadership training.

Clark:

That's great. So our WSU College of Medicine’s really focused on community based medical education, it's one of our hallmarks. How does that intersect with leadership education?

Tomkowiak:

Well, I think it just makes so much sense as a community-based school, we really want our students to understand the communities that they work in. And, you know, that's one of the leadership principles that's really important: understanding your team. What are their weaknesses? What are their strengths? And what are things you can do to inspire them? And that's really the same, the same principles are true for our communities, we have to understand, you know, what are their risks in terms of health and wellness? And how can we motivate them to do better and also what are the challenges that prevent them from getting the care they need? So I think some of those same lessons that we learn and how to be a good leader for a unit or an organization are easily transferable to the communities that we serve. And so I just can't wait for our docs to eventually get out and start practicing in those communities, because I really think there will not only be a direct impact from their delivery of health care but I think there could even be a greater impact that they'll bring in leading communities to better health and wellness.

Clark:

That's really exciting. And I think that you're absolutely right. At the end of the day, we really want our communities and people to be healthy. And so if anything, this last year and a half, has really shown us the desperate need for good leadership in medical, in the medical field. 

Tomkowiak:

Absolutely. And, you know, I think a part of that, is gets back to this relationship building. And, of course, a part of good relationship building is trust. And, you know, you have to engage in trusting kinds of behaviors, to get folks to develop trust over time. And so that's one of the things we talk about with our students is, it's usually not one big thing that's going to make you a good leader, but it's paying attention to the details. And it's all of those little behaviors that establish trust, that improve relationships that oftentimes lead to, you know, great leadership results.

Clark:

Well, it makes me excited to see what what they do as doctors and medical professionals, in our communities around Washington and beyond. Is there anything else about this leadership education that you'd like our listeners to know about?

Tomkowiak:

Yeah, well, we're taking our leadership training of our medical students to the next level. Right now we have a certificate for them. So when they graduate, they get their MD and also certificate in leadership, which is 1/3 of a master's degree. But we're actually building out a whole master's degree in health care leadership that will be available, not only to our students who graduate, but any healthcare professional, who wants to improve their leadership skills, and we're looking to have this program be stood up in the next year or two. So we're very excited about taking this sort of our approach to our students, and also making it a resource for other healthcare professionals who want to improve their leadership skills.

Clark:  

Well, that is exciting. And right in line, I think, with what Washington State University is all about.

Tomkowiak:

Absolutely. You know, being a land grant institution, it's all about bringing solutions to this state, and certainly, I think improving the leadership capabilities of all of our currently practicing healthcare professionals who we know are incredibly passionate about doing the work that they do, that would be a great thing.

Clark:

Definitely. Well, thanks for joining me today. Really appreciate it.

Tomkowiak:

Happy to be here. Thanks for having me.

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Alysen Boston:

As we age, our lifestyle and history of injuries can catch up to us. Each year, more than a million Americans receive total knee or hip replacements. According to data from the American Academy of Orthopedic Surgeons, the average age of patients undergoing this treatment is getting younger. At WSU researchers at the Gene and Linda Voiland School of Chemical Engineering and Bioengineering are researching ways to use 3D printers to produce artificial cartilage. Deteriorated cartilage is the top cause for total knee replacement. Yet our bodies can't produce new cartilage on their own.

Arda Gozen:  

My name is Arda Gozen and I'm an associate professor at mechanical engineering at WSU and my research focuses on 3D printing. A part of it is 3D bioprinting, which is using 3D printing for life sciences. Basically, the general goal of the project is to be able to produce artificial articular cartilage. Basically the cartilage that goes into your knees, unlike most tissues in your body, go cartilage is not able to cure itself essentially, because there are no you know, blood vessels going into it. It's basically a thin membrane, but it has so many different functions. When it comes to tissue engineering, you still have to start from something be it stem cells or actually mature cells. I mean, the combinations of those, our collaborators look into that for instance, but essentially there has to be compatibility. Can we print essentially what we call a bioconstruct. People call it “scaffold,” such that we essentially deposit the necessary materials and cells into those distinct regions, right. So these three distinct regions, such that the construct we make is not just like, you know, homogenous blob, if you will, but it's an organized structure that mimics the natural tissue.

Boston:  

Articular cartilage can be broken down into three zones, each one responsible for a certain task: load bearing, friction reduction, and water resistance. To form cartilage for each of these zones, cells have to experience specific stressors that trigger them to differentiate.

Gozen:

But the idea is, you know, if your final tissue needs to be stiff and hard, then that environment needs to sort of match that so that cells can essentially adapt to that environment when they're growing and proliferating. The natural cartilage, when you're walking, the loading pattern on your knee, take a step, you have a load increase, and then it goes down. There's this oscillating pressure that the cells feel. And then the cells feeling that stress, they feel like, okay, I'm in my natural environment. So I can turn into a natural cell.

Boston: 

Gozen says the biggest challenge is replicating a complex structure on such a small scale. But as osteoarthritis affects younger and younger people, the demand for personalized long lasting medical intervention is increasing.

Gozen:

There's quite a bit of strength in personalized medicine. Again, using your body, but essentially enabling stuff that your body might not just be able to do it by itself, because it's not a part of its natural process, right? The cartilage cannot regenerate itself. But we can intervene, essentially, do something outside the body, and put that in essentially, you know, replace your cartilage. There's this growing demand for personalized medicine, personalized anything, is an emerging market. It's marketable, because doesn't it sound much better that you will have a drug that might have minimal side effects, designed for your needs for your body?

Boston: 

3D printing, also called additive manufacturing, started out as a quick and easy way to produce prototypes in the 1980s. But as early as the late ‘90s, researchers at WSU were studying ways to make finished products with artificial materials, and even living tissue. 3D printing opened the door to realizing highly complex designs that simply couldn't be made by hand.

Gozen:

So 3D printing has really interesting novel stuff to offer to different markets. Right? It's quite bottom up. Because you know, when we think about the technique to manufacture something, right, just look back at history, usually, you know, that technique is first employed in industry, with experts and all that stuff, right. But with 3D printing, before it was even taken seriously in industry, people had 3D printers in their homes, so that it's a very reverse type of evolution of technology. But that doesn't mean that it's going to die. I mean, people thought that because all the manufacturing engineers, because I'm in that communities, I know the old guns, and they're like, these are kids playing games, right? All of which have shifted their research entirely into additive manufacturing. So there's something to it, definitely. 

But you still need to be cautious. I mean, one of the main issues with 3D printing right now is that bottom-up nature of it, even though it's exciting, the term that people use is democratizing manufacturing. They don't have to, you know, 3D printers are getting really, really cheap, they start cheap and all that. But at the same time with many manufacturing methods that make them reliable and usable by large populations, those products that we make, essentially, are standardization, right, there are these institutes that establish standards as to how to run certain processes, how to design products to match such processes, so that your quality is high. And I mean, high and standard and robust, right. So when things start bottom up, actually, it's quite hard to establish those standards because everybody's doing something. It's so hard to consolidate when it’s top down, you sort of start at a singular point, then you enlarge. So that's a challenge. And that's sort of one of the one of the reasons of hesitancy for this technology to move from essentially desktop user like common user to industry, but I mean, it is happening, research is going on. Standards are being drawn up aerospace industries, investing enormous amounts of money to 3D printing, and then obviously, this bioprinting stuff. I guess that the comparable conventional manufacturing industries, you know, again, you know, medicine, manufacturing and all that. It's getting into that domain, and it's making a very strong impression there too. I mean, they're the number of bioprinting companies, companies that sell bioprinters or companies offer bioprinting services. The number is like uncontrollably growing, I just I used to be able to keep track of the players now I'm not like I have to almost check every day. Right. So it is successful. There's definitely indications of it being successful. But I mean, there needs to be caution with every emerging technology, right, so we'll see where it's gonna end up. But all indications point out. I mean, even I was a little bit of a skeptic, but I think it definitely, you know, exceeded expectations in terms of its staying power. Let's put it that way.

Boston:  

While their research is still in its early stages, Gozrn and his collaborators are making strides that will not only support other projects in their field, but also improve the lives of Americans living with chronic pain.

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Clark:

Thank you for listening to Viewscapes.

 Music is by Greg Yasinitsky.

You can read more about health care, engineering, and many other WSU stories at magazine.wsu.edu.