Latest / Voices of Otolaryngology / Innovation by Design: Turning Clinical Problems into Real Solutions

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Innovation by Design: Turning Clinical Problems into Real Solutions · Voices of Otolaryngology

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Welcome to the Voices of Otolaryngology podcast series, where we spotlight
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diverse perspectives and insights within the field of otolaryngology.
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I'm your host, Rahul Shah.
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Let's jump into it.
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Welcome to the Voices of Otolaryngology.
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As you know, one of my favorite quotes is “sometimes we just get lucky,”
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and today's one of those days.
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Super excited to be with Doctor Santa Maria.
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Peter. Welcome.
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Doctor Shah, it's a pleasure.
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I'm really excited to be here talking to you.
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And you can be honest, because I like to have fun here.
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Have you listened to any of the episodes?
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I have not.
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I've only just found out about it.
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So I'm - Thank you for making me aware of them as well,
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because I'm really excited to learn about the content that you’re providing.
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Well, I appreciate you joining us.
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What I've learned through my travels is
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I’m blessed to be able to learn from our otolaryngologists.
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But this platform allows us to connect with those
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that might not be able to make the meeting.
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Don't have the role that I do.
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Your name has come up over and over and over
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in terms of innovation, pioneering, pushing our field forward.
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Tell me a little bit about your history. Why don't our members get to know you?
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Where are you based out of Doctor Santa Maria?
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Yeah.
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So hopefully my name is always mentioned in a positive
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way, not causing trouble because that's what I like to do.
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But. So, I'm, I'm based in Pittsburgh, Pennsylvania.
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I'm, the my clinical role here is, the, chief of otology and neurotology here.
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And I'm, I consider myself a clinician/scientist/innovator.
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So all those hats.
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And so my clinical practice is obviously otology/neurotology here, but
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I spend about half my time running a lab and doing, you know, innovation type work.
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My hats here include the director of faculty innovation,
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helping running the Pitt SPARK program, and the CREATE fellowship here.
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All my training, as you kind of alluded to, if
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if the listeners can't tell already, my, my, I was born and raised in Australia.
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I did all my clinical training, in Australia, residency in Australia.
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And I came, to Stanford for, for fellowship.
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And it was a sort of a fellowship slash postdoc.
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And that's where I really had my eyes opened to this world
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of entrepreneurship and innovation, where I did, the Stanford Biodesign class.
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I did the SPARK program.
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I ended up taking on a leadership role in the SPARK program.
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Was associate director there for seven years.
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And then ran the global program
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for two years actually had the, privilege of leading the,
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the Committee for Medical Devices and Drugs, the American Academy.
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And I think that's, probably something that you could feedback to.
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We could feedback to the listeners that if you really have an interest in this,
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that's one
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the committee
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that you really want to get involved in, because I think that's
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one of the most exciting committees to be involved in for this sort of work.
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That's fantastic.
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Thank you for that journey.
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I've never been to Australia, so anything I comment on is simply ignorance.
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Okay. With like a little bit of humor.
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So is your home more like California or more like Pittsburgh?
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When we go back to where you grew up in Australia?
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Yeah.
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So my, I grew up, in Western
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Australia, in Perth, and that's if you drill a hole through Pittsburgh.
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That's pretty much the exact opposite side of the world.
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So you could fly east or west and probably take the same amount of time
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to get back to my original home.
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But definitely my home now, is in Pittsburgh, Pennsylvania.
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Been here for 18 months.
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And I like to consider us near the Silicon Valley of the 20s.
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You know, that's what we were the center of the worlds a century ago.
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And there's lots of innovation that happened here.
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Obviously, there's different centers that it moved to, but it's
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I think there's a lot of work here that's being done.
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An incredible university, and an a great budding area
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of, of entrepreneurship
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that sort of resurrected itself from the 80s, from the steel industry.
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So I think it's definitely my home now is, is Pittsburgh.
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Yeah. Pittsburgh's amazing.
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I live in Washington, DC, and I can still see when you cross over that bridge
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and you see Pittsburgh
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and you think the city has done an amazing job of revitalization
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moving from the coal industry, then I'd say in the 80s
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and 90s to health care, it became a dominant health care.
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And you weren't kidding when you said innovation and Silicon Valley really is.
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I mean, big tech is recruiting from, Pitt in that ecosystem.
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So you're the right person to carry the otolaryngology innovation flag.
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Do you still have your family back in Australia, in Perth?
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No, they're all here.
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Yeah, probably see a photo here.
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My wife is actually in otolaryngology, she's an otolaryngologist.
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Just so you know, together we're we're a team.
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You know, she's, she did, voice fellowship.
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And now she's a practicing otolaryngologist.
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And, you know, she's a very much a, an active Academy member.
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Not so much in the innovation space. You're looking for most of that to me.
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Then. Do you mind introducing her?
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What is her name? Chloe Santa Maria.
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You know, cook for the same name, but, Chloe.
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And so she's, you know, she's a fantastic physician.
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And and, you know, I forget everything outside the ear, so
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I really rely on her to fight to to keep me up to date
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with, to the to other areas of otolaryngology.
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Yeah. Well, thank thank you for that.
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And, thank you for all the contributions.
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I visited with Josh Makower and Stanford Biodesign.
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That was probably one of the best days I've had professionally.
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I mean, the ecosystem is unbelievable, and we're going to be all over the place
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if you haven't heard how these go, we just are all over the place.
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When did you get the innovation bug?
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Was it as a seven year old, a 17 year old?
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A 27 year old?
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Where did you get the bug for innovation?
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I think that's a really interesting question
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because it always comes down to the to the question,
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is it something that's inbuilt or is that something that you can teach?
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And and I don't know, I don't know the 100% answer to that.
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I'm leaning towards something that's inbuilt
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and I never really thought that I had that bug.
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I just I just always grew up, knew that I wanted to make
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a difference, that I was always uncomfortable with the status quo,
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that I really was frustrated every time something went wrong.
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I think I, I think overall I went into surgery because I like to fix things.
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And then, you know, when you're in surgery and things
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don't go right, like you have a complication or you have a
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you have something that didn't quite go your way.
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You know, I just don't want to accept that.
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I want to try and fix that.
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And I think that bug was always with me like I was
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I was uncomfortable with just accepting things the way they,
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But really, when I moved to Stanford for fellowship,
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I think that that that uncomfortableness for accepting things really was taken
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out of me, like by doing these real, systematic ways of educating.
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And you mentioned Stanford Biodesign.
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I think that's one of the, the critical things
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that changed the way that I think, all through surgery.
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And so, you know, if anyone has a chance to be embedded
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in that sort of teaching or training or ecosystem, I think I really recommend it.
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I mean, you don't have to go and live there, but really take courses or,
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or get some education that area, I think that can bring that out of you.
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And that's I think that's where it kind of started.
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I do found to did find that I really wanted to go back
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and practice in Australia.
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I never intended to practice in the US.
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But that bug really got me.
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And when I went back to practice in Australia,
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I really felt that reverse culture shock in a way that I
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if I was going to innovate and change, practice and improve things,
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then I needed to do do it here in the States
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through these various ecosystems that are so much more sophisticated.
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Yeah.
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Peter Mannus is on our board of directors,
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and he's our inaugural industry consultant and innovator as well.
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He'll be attending the Stanford Biodesign course.
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I'm so proud that the Academy's sponsoring him to attend that.
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And you all, you know how that works.
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You have to have a cohort.
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And we we didn't want to send a cohort.
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So we're just sending Pete and he's going to jump on with another team.
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But I can't agree more Peter, when we're trying to build that ecosystem,
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our board, our key leaders need to understand that ecosystem.
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Yeah, I 100% agree.
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And I think, you know, some of some people who do that
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or go through that training may end up innovating or things like that,
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but I think it also really solidifies the way that you think.
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And so it really helped me in my research.
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It helped me in my clinical practice.
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It really, you know, like, I think surgeons are generally very
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innovative and they they have a lot of ideas and, and,
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and they see problems all the time and,
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and they will have like a light bulb moment.
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I think a lot of surgeons have that.
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But I think programs like the Biodesign, actually sift through that noise and say,
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like, you know, which of those light bulbs should you be grabbing at?
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Peter, sometimes you get lucky.
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Look at this.
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How do I focus this in? Oh, yeah. That.
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Yeah. It's right.
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But that that is a very important book.
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Maybe I have the book here. Here we go.
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I like that that book can.
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Can we share our books here?
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We can have a meeting of the books.
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Yeah. With my weird background. All right.
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Here, hold on a second.
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I really want to show this book because it's it's really great.
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All right, so we have the meeting of the books.
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Give me a second. This is a great. You say. Here we go. Peter.
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I love this book.
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Love this book.
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For those that don't know.
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You know, one of the things that I don't like about this book
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is that the first edition had the cochlear implant and ENT innovation on it.
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The second second edition does not have any ENT innovation.
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There's some.
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No you're kidding.
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We it we gotta try to. Know that is.
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We're going to boycott it.
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Then for the third edition.
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This book is unbelievable.
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It's called “Biodesign.” I lost it there.
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But we will put it in the we'll put it in the tagline.
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“Biodesign: the Process of Innovating Medical Technologies.”
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Yock, Zenios, Mackower, Brinton, Kumar, Watkins and Denand.
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And they use a case study of a clarent to walk people through it.
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And it's not hard.
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I read it in about a month, but it's it's well worth your time anyways.
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Peter. So Stanford Biodesign.
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Now you have founded companies.
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You've won awards for two things.
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There's innovators.
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Then there's Peter Santa Maria.
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You're one of the top innovators in our field.
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You're humble but everybody mentions that.
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Can you tell us about some of your innovations and
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and companies and how you're driving our field forward?
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I know, but I'd love for you to share with our members.
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Yeah, absolutely.
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There's a couple of companies, I think the most relevant one is an ENT company.
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At the moment, it's actually since we're doing a lot of show and tell.
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Yeah, yeah do it Peter let's do show and tell. What do you got for
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and remember there the
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disclaimer that I am part of this company and we had to do our usual disclosures.
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But yeah, this is this is a company called Earflo.
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And here's the device here, which I'll talk about in a little bit.
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So, there's a, there's, a group,
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when I was at Stanford, a group of engineers from Australia came,
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spend time with me, met an intern, who was absolutely superstars.
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And if you come to the Academy meeting, they'll be at the Earflo booth
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that we have there.
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And you can.
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I love you plugging the Academy meeting in LA.
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Thank you for that.
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Absolutely.
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And I'll be there, so please come and come and talk to me there. But,
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we have, yeah, they came spend time with me at Stanford
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and they went through the Stanford Biodesign process.
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So they went through the global faculty training.
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They immerse themselves in the clinic.
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They actually went through over 300 problems.
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They sit through these problems.
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And the number one problem that they landed on was the problem of,
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families that were going under watchful, waiting for ear tube surgery.
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And, you know, there's, you know, most of the people that we see
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with otitis media with effusion, we know are going to get better.
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But there's a group that don't.
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And those we don't really know
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at the moment who's going to get better and who who doesn't.
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So we put them on this track of watchful waiting.
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And so that there was this, frustration around watchful waiting.
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So, what what they they did and we work together
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was going through the, the need, needs based assessment, looking at stakeholders,
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all the, all the ideation that that Biodesign teaches.
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And then we came up with an idea of a Eustachian tube
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opening device disguised within a sippy cup for a child.
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And so what it does is, it it when the child drinks, there's a low flow
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air flow that comes from the nasal piece that forms a seal around the nose.
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It'll detect the swallowing of the child.
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And when it detects swallowing,
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it'll give a one psi a pressure up into the nasal cavity,
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which will which is opening the Eustachian tube.
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And so it it's sort of is different than other Eustachian tube opening devices
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in that it, it's timed with the swallowing so the child doesn't notice it.
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And it's very low pressure like a lot of other systems all over pressurize.
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I didn't have a setup for there actually is time with an app so that, kids can use
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it to, to be motivated to use it and also can train them how to use it.
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And in our, in a study that was just,
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published in the Academy's open access journal.
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It was it showed that about 90% of kids
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that had failed watchful waiting were able to not go on to have surgery afterwards.
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So a lot of them had converted from type B to C or A and all that sort of stuff.
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So one of the things that was really exciting was that is going through the FDA
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now, but it is like literally the Biodesign process from the end to end.
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Like it's like we didn’t - that we didn't, like, just make this thing up.
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It was like embedding in that ecosystem, seeing that needs and taking it
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all the way through the end.
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Back up.
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How long did it take from ideation?
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When did this idea come to you and when do you put it in your hand?
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Yeah.
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So we we met in 2018.
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That initial needs finding process.
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So you know, from very probably in about a year we had to kind of the idea
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and then it's about 20 late 2018 to 2019.
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But we went through like disgusting prototypes of which
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I think there's probably like one badly three 3D printed behind there.
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Yeah. Yeah.
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And so but the idea came to you when when did the idea come to you, Peter?
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Ten years ago?
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Five years ago? With your own children?
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When did the epiphany happen?
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Yeah. No. So it really was like in 2019.
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So what's that seven coming up to seven years ago.
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And it was really an ideation session, brainstorming session
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that happened around the, you know, the biodesign process.
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So it was. Wait, wait a minute, wait a minute.
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It didn't happen when you were on an airplane,
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when you were in the shower, you actually ideated through a process.
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Why don't you briefly try to encapsulate that in two minutes for our members?
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Because it's a very key part of Stanford Biodesign.
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Can you talk about that?
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Yeah, I think that's that's a lot of fun.
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So I think the first thing to do is that when you're
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about to have a brainstorming session,
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you have to have have to bring a lot of background knowledge to there.
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So, you're bringing, a lot of understanding of the problem,
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and understanding of the stakeholders are involved, a lot of understanding
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of the, the, the failures and success of the existing treatments.
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So there's a lot of background you bring into this session.
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Then what you do, you bring in a multidisciplinary team to that.
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So you know, it's not me brainstorming together.
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It's me bringing took brainstorming with other clinicians, other engineers
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and other scientists.
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And there's probably a group of about 5 or 6 of us
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that are having those brainstorming sessions.
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It is structure to that brainstorm, and it is in the Biodesign book
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should you want to read it.
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But there's a way of really generating
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like high volume, ideas.
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So, you know, hundreds of ideas, and then they teach you a process of how
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to sift through those ideas, to match your need.
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So when you're doing Biodesign, they teach you a method of,
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understanding, a need specification.
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To solve your problem, you need to define how are you going to solve the problem
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before you actually ideate.
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So you look to what's called a needs specification, which is a criteria
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of of things you need to succeed to do to, to to innovate and to meet that need.
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So when you have those needs criteria and you have 300
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or you're sitting at 100 ideas, you then a value evaluate those ideas against
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those needs criteria and whittle it down to, you know, 5
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to 3 ideas before you then take forward your lead solution.
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So it really is a a systematic way of ideating,
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both through the needs criteria and that that ideation phase.
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That you talked about the Earflo.
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Can you talk about one of your other innovations?
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Yeah. So, this is another one.
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I here.
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So, this also came through the Stanford Biodesign process.
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So, one of my colleagues who often comes to the Academy meetings,
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she's a neurologist. She's an otoneurologist, Dr.
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Steenerson at Stanford.
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And, she's she's incredible.
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But, we, together formed a team, and we came across the problem of,
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you know, actually a personal frustration of both of us,
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of dizzy patients coming into the clinic,
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and they take forever to take a history from.
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And they're very hard to talk to because they just feel sick.
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They vomiting everywhere.
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And you're like, I just just trying to figure out
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whether or not you have Ménière’s, or if it’s a migraine or BPPV or whatever.
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And so we said, what?
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Wouldn't it be awesome
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if we had a way to measure those dizziness attacks in the home?
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So the we went through the Stanford Biodesign process, that same process
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that I talked to you about with Earflo and we came up with a wearable patch
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that patients could wear in the home, when they're having dizzy attacks.
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So the idea is that if a patient comes to, you said, I'm having episodic vertigo,
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you fit them with a patch similar to the Zio patch
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that's on the front page of the Biodesign book now, and it measures
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the, electro/occular reflex.
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So the EMG, the, the old electrical, measure of the cornea,
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retinal potential around here and also measures the, the head
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position, when, when the patient's having an attack.
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The patients
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who are having severe attacks or for having attacks more than two weekly
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so they could wear this patch, it could get a recording of that,
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it could go back to the company, which could send it to the doctor of,
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hey, yes, you're having attacks that are lasting one minute
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that are associated with head position.
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Are you likely BPPV?
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Or you're having slow phase vertical nystagmus, that are lasting hours, i.e.
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vestibular migraine, things like that that we can characterize and help
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help diagnose.
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So I brought this because this is one of our
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early prototypes that we're working on.
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And it's it's a patch where it can fit
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and record electrical, monitoring around here.
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And we can capture that EOG that happens.
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So, that's another, thing.
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It's called, DizzyEX.
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And that's a company that's just launching, as a team that's
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launching that.
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But that came out of the same, process that you, that you mentioned
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the the Stanford Biodesign project process study from the needs finding
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that needs specification ideation.
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So I really I think what, what you mentioned
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is that I don't think there's anything too special about,
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you know, people I think there's really a successful process,
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that everyone who's interested can get involved in.
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And if you commit
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a little bit of time to that, I think anyone could be successful in that.
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But I think the hard challenge for us is finding time to do do that.
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That's with that's why I'm very fortunate to have both protected time for it.
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And I also see it as a hobby.
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So I spend a lot of my spare turns like this.
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Well.
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Makes me think. And Dr.
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Makower probably uses this word so I won't claim copyright
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to this phrase, but it's “intentional innovation.” It's not imaginary.
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It's not accidental.
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Does he use that word intentional innovation?
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If not, I want to claim it.
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I think you both can claim it.
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And I also like the word systematic,
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because it really is a system and it's a process.
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And he follow the process, then it's hard to go wrong.
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But I think,
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I also like, also want to say that there's other ways that it can be used.
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So I think surgeons more typically come up with an idea.
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And that's really what they try and teach against
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is like starting with the idea first.
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But you can use the process to evaluate that idea to see if it's useful.
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And, you know, we have incredible
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innovators, that just come up with really good ideas.
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But if you have this systematic way
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of evaluating it, you can then determine, hey, look, if this is useful or not,
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should I go on to my other good idea or not?
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Yeah. Yeah.
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It's let me try to paraphrase something you said.
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There's a process, but I'm going to say
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it's hard, it's deliberate, it takes time.
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It's easy to romanticize innovation and say, oh, I'm out there surfing.
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And I figured out how to transcribe mRNA, you know, that apocryphal story,
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or I'm just driving on the road and it came to me, but it is hard.
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And you said yourself to have an ideation session requires a lot of prep work.
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Yeah, absolutely.
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So, I, I've say almost all the light bulb moments that have become
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anything significant have come out for those ideation sessions.
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I mean, I, I think most of us have in the shower
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as might pull them home with whatever they do driving in the car.
21:37
But I think the ones that have led to most things have been
21:41
the intentional and systematic approach to it.
21:44
Yeah, which is hard work.
21:46
We all want to think,
21:46
if I just shower more or drive more or surf more, I'll have the epiphany.
21:51
Tell us about
21:54
well, let me ask you the question.
21:55
Do you do tangential
21:58
innovation?
21:59
You're focusing on vestibular ear hearing.
22:02
That's your expertise.
22:04
Do you innovate in other areas?
22:05
Do you want to wait outside of medicine?
22:07
Do you innovate with orthopedics with the left big toe?
22:10
Yeah.
22:11
It's been
22:12
I've only really talked about the ones that are involved, me
22:14
and say because, the relevance but no, I did.
22:17
So I have a, have a, company that's in anesthesia.
22:20
It's a patient warming device that actually also came out.
22:24
That was our class project.
22:26
Stanford Biodesign class project.
22:28
And I did that in 2014.
22:30
That's, that's a company that's, I'm just about to go through
22:33
FDA evaluation, but it's a it's a, a wearable device
22:37
that you wear on your legs to prevent perioperative hypothermia.
22:42
So patients get cold during surgery, and we have this challenge of, like, well,
22:46
how do you keep patients warm when, when when the whole body is exposed?
22:51
Like cardiac surgery or abdominal surgery.
22:53
So we looked at ways that could heat, peripherally.
22:57
And we found that if you heat at the arteriovenous (AV) anastomosis
23:02
at the bottom of the feet
23:03
and the popliteal fossa, and you combine that with leg compression,
23:06
you could drive over 70% of the chronic volume peripherally.
23:09
And if you heated that at the same time you can act like a peripheral pump.
23:12
So it ended up being a sleeve that we created.
23:17
Oh yeah.
23:17
We here we go.
23:18
There's another one.
23:22
I had to check it was in the back there, but
23:24
it's a sleeve that that that you create and that you wear around your lower leg.
23:28
And so is the heater that fits around the bottom of your foot,
23:33
and another heater that goes behind your popliteal fossa.
23:36
And it's combined.
23:38
In the middle is a SCD that acts like a pump and provides warmth to your core.
23:44
And again, we we ran a clinical study, that was at that time
23:48
that it was at Stanford.
23:49
I think the other thing is that to realize is that with that is like, that's
23:54
you think that's a really hard study to, to, to run.
23:57
But we managed to get some heating devices that were in the lab.
24:01
We got some wiring from Home Depot.
24:03
We put it together with bioengineering at Stanford and got it
24:06
through an IRB managed testing clinic and a clinical study.
24:10
So it was a a quick and dirty way of like testing our hypothesis live.
24:14
So that's just one example.
24:16
I think, you know, do do things that are outside of ENT
24:20
but I think
24:21
one of the things that you know, you that people realize
24:25
is that when you get into this space, you have so many different
24:29
competing interests and different ideas and you like, oh, you know, which of these
24:32
do I choose to work on?
24:34
And so almost all of the ones that I continue to work on, the
24:36
ones that I feel like,
24:39
you know, I could, I could speak for, they're going to change my practice
24:42
or change the practice of people around me.
24:43
And that's why most of them end up being in ENT.
24:46
Yeah, I, I really appreciate that.
24:48
Two more questions and then we're going to start thinking
24:51
about how we bring you back again to keep talking about your work.
24:55
What do you see in the future for our specialty?
24:58
I'm a little bit older than you in training, I think a decade ahead of you.
25:02
And I never would have envisioned some of these innovations,
25:06
but then some of them are “a-ha!” moments and make a lot of sense.
25:10
But the the vestibular, the DizzyEX - wonderful
25:13
use of technology, feedback loops, etc..
25:17
Where is our specialty going?
25:20
What excites you within Otorhinolaryngology?
25:25
I think the whole reason why I got into Otorhinolaryngology
25:29
was because of the horizons that were there.
25:32
It really excited me, as you know, the the therapeutic and the device frontiers
25:37
that exist there is I mean, me is an otologist/neurotologist.
25:42
The reason I got into that was that
25:43
there were very little drug treatments for for hearing, hearing loss.
25:47
And I really think that there's going to be
25:49
and we are on the cusp, as you can see, with autofill and
25:52
and other things like that, that we're on the cusp of a therapeutic
25:55
explosion, as well as a device explosion.
25:58
I think ophthalmology
25:59
is a little bit ahead of us in what they've just achieved in this specialist.
26:02
And I think that shows us what our next 5 to 10 years a going to be be like.
26:07
There's going to be, you know, gene therapies,
26:09
there's going to be new devices.
26:10
There's going to be a lot of technology.
26:12
I mean, clearly AI is having an impact in all areas that we do.
26:15
And wearables
26:16
are those sort of things I think look at us specialty also interestingly,
26:20
that I think as, as you know, I'm a big Star Trek fan
26:25
and I think that we really are going to hit that.
26:27
I think people are going to look back
26:28
on, especially in 100 years, and go, I can't believe they operated on that.
26:32
Like, why do they who are these people like?
26:34
These guys?
26:34
Guys are butchers, like their surgeons
26:36
just could just like we looked at 100 years ago, the things that that
26:39
that people were doing.
26:40
And I think that we are going to be, on the cusp
26:43
of therapeutic device advances, minimally invasive
26:46
things, things that we operate now and we never going to operate on again.
26:50
And I think we're going to be pushing that as a field.
26:53
And so I really believe that that, we're with it
26:56
to make ourselves extinct in the future.
26:59
Wonderful, wonderful, statement.
27:02
I'm already thinking and I'm going to put you on the spot
27:06
because in my role, if I say something wrong, sometimes I get in trouble.
27:09
But you can say anything you want.
27:11
So what?
27:12
What's become questionable during your and my career in otolaryngology?
27:16
We've seen such evolution
27:18
and you say, wow, you know, I didn't know we used to do this.
27:21
We certainly don't do it now. Something's come to my head. Maybe.
27:24
What comes to your head when you think of neutotology/otology/skull based surgery?
27:28
Yeah, absolutely. Definitely.
27:30
Things that are two things that have impacted on our field.
27:32
So when I did my initial training, we operated on everything.
27:35
And then the advent,
27:36
the advent of of stereotactic radiation really changed that.
27:40
Yeah.
27:41
You know, it really changed it.
27:43
So we we operate on a lot less.
27:46
And then what actually found then it was a lot of, long term
27:50
outcome work that, that our specialty did looking back and said, you know what?
27:53
Like we don't need to even operate or irradiate these things
27:56
because a lot of people do okay
27:57
if you just keep an eye on them, particularly
27:59
if you just observe them in the first situation.
28:02
So I think we went from maybe operating on people 80% of the time
28:06
when we first saw them.
28:07
Like if you had a tumor, it came out, to being like, well,
28:10
you know that two thirds of the people now we, we, we observe on first
28:16
visit and then
28:17
if they go through, then I'm thinking it's probably that 50%, depending
28:21
on other things that we might go into, whether or not they get surgery
28:26
or radiation.
28:26
So I think radiations, stereotactic radiation,
28:29
the experience of it and the, the, the, the technologies now
28:33
making it, frameless, doing robotic ways of doing that.
28:37
I think that really has just really changed surgery.
28:40
In, in at least neurotology.
28:43
And so I think that's one significant, thing, obviously
28:46
the gamma knife of being invented in, in the latter
28:50
half of the last century in the CyberKnife being,
28:53
invented at Stanford in the 90s.
28:55
I think those things have really, really changed the neurtological practice.
29:00
Yeah.
29:00
I don't know where you were, but I remember
29:03
literally as an intern that transitioned from open cholecystectomy
29:07
to laparoscopic and those laparoscopic, they would take six hours.
29:12
And I was sitting there holding the camera because the surgeons
29:14
were trying to learn it.
29:16
And then in med school, I was fortunate to see the transition from open
29:22
sinus surgery to endoscopic and seeing that evolution
29:26
at academic centers, that moving on to the private practices,
29:28
so very similar, I’m sure, for you.
29:32
Absolutely.
29:33
And I think, I think there's, there's like different types of innovation
29:36
and that we've, we've talked about that there's there's, I guess,
29:40
incremental things that we can see a specialty change over decades.
29:43
And then there's like leaps that just happen.
29:45
And one of them you alluded to from, from the book,
29:48
which was the, the claret, and the balloon sinoplasty.
29:51
Which, yeah, you know, it changed all the way one day.
29:54
And now there's have been a little bit pull back from our rhinologists
29:56
that are now finding where that balance is.
29:58
And I think those sort of leaps are happening and, all the time.
30:03
But bringing that balloon technology to otorhinolaryngology, airway,
30:07
pediatric airway, adult airway, then Eustachian tube, just like the Earflo.
30:11
So really interesting.
30:13
Yeah absolutely. And yeah you mentioned that.
30:15
So I do eustacian
30:16
tube balloon dilation I I'm now picking up to doing it in the office.
30:20
And so for me that's an exciting alternative to to, to
30:24
these two dependent patients that I have.
30:26
So I think, you know, there's this there's lots of things in the way that,
30:29
that are making leaps and bounds in our specialty.
30:32
Absolutely.
30:33
You know, I've got to ask you this question.
30:35
I don't I don't mind embarrassing myself.
30:36
So does Doctor Chloe ever get mad at you and say you're the otologist.
30:41
You have two ears. Your job is to listen. She's a laryngologist.
30:43
Her job is to talk. Does she say that in the house?
30:48
She doesn't say that, but is the first question.
30:50
Does she get angry at me? Yes.
30:53
But that's obviously we're still together.
30:55
Is still happy.
30:55
So somehow if you.
30:56
Tell Doctor Chloe that I think she she gets the interpreter to speak,
31:00
and you have to listen as the otologist in the house.
31:03
What advice do you give to doctors?
31:07
And I want to segment this because this is really what I wanted
31:09
to get to you in the next 5 to 10 minutes, and then we'll wrap it up.
31:13
They are.
31:15
Now let's focus on two groups.
31:16
We have trainees and the future.
31:18
And then we have current.
31:19
Let's focus on current doctors.
31:21
I am impressed by the desire for innovation.
31:26
I see it across the country.
31:28
Our private practice docs, you know, they see a lot of stuff out there
31:32
and they have great ideas and they innovate.
31:34
And we've had some wonderful success stories.
31:36
I see our academic doctors similarly.
31:40
What advice do you give to people like you and I?
31:42
You know, we're we're a couple years out, five, ten years out.
31:45
We're in busy practices.
31:47
We want to fix a problem. Just as you said.
31:50
We have the calling that Peter Santa Maria does.
31:52
What advice do you give to those doctors, our peers in otolaryngology?
31:57
Yeah, I think the first thing we already alluded
31:58
to, that if you can have the if you tend to,
32:01
if you can afford the time, try and get some formal
32:03
training in that it really just with that.
32:06
Where can we get that.
32:07
So Stanford Biodesign, where else could we go for that formal training?
32:11
Yeah. As Stanford Biodesign I
32:14
think is fantastic.
32:15
Obviously, the other program
32:16
that I went through with Stanford Spark, I think it it I think Stanford Biodesign
32:20
really takes the ideation face forward and the implementation.
32:24
I think Stanford Spark really excels at, they've, for whatever reason,
32:28
have allowed it to be more one more device and one therapeutic.
32:32
But they really have similar feelings of thinking along a spectrum.
32:35
So I don't really want to quarantine like that.
32:37
I think it just teaches that way.
32:38
I think formal training is a good way.
32:40
The second thing is,
32:41
I think obviously get involved in groups that are similarly thinking.
32:45
That's why I mentioned the the, the Medical Device and Drugs Committee.
32:49
That's where I mentioned, if we can get back to ENT face off,
32:52
that we, that we used to run at the Academy that I love to get back up,
32:56
that was kind of like we had the, it was almost like a science
33:00
fair of entrepreneurship.
33:01
And I think to talk it, I think, it's and I feel very fortunate
33:05
at a big academic center because there's lots of people around
33:08
I can talk to, but people in private practice might not have that available.
33:11
So I think trying to get involved in this ecosystem, certainly
33:14
if you're around the Pittsburgh ecosystem, you can embed yourself in here.
33:18
We do do a lot of community teaching that is involved in innovators,
33:22
but I think other ecosystems are similar for that.
33:25
And so I think doing bringing yourself into an ecosystem, even in a small way,
33:31
getting some training, and I think the other way is,
33:35
I have like so
33:36
many ideas that, that, you know, I can't do it.
33:39
A lot of us have ideas that we don't have enough time to deal with it.
33:42
I think that I think what you want to do is filter those ideas,
33:45
the ones that you're actually going to act on, but one ones
33:48
that you're actually not going to act on and don't leave those inside your head.
33:51
So if you think something's a really good idea
33:54
and you know in your heart that you never going to do anything about it,
33:57
why don't you tell someone about it? Why don't you tell?
33:59
You know, if if you know, if, talk to cochlea or Amidala
34:03
or other companies and implants and I will just tell them,
34:05
hey, look, this is a really good idea that I think
34:07
could actually change your implant or your practice.
34:09
I'm not going to form a company and build it like I just need to you
34:13
if you if you if if you want to act on it,
34:15
if you'd like me to help fund it, that's all you.
34:16
So I think sharing your ideas is really important, but I guess
34:20
not sharing ideas that you want to take forward is, is is is is is also important.
34:25
So learning that balance of like what what are you going to do.
34:28
How are you actually going to practically do it.
34:31
And, and, and don't be shy to share your ideas that you,
34:34
that you got to that you may not have time to, to, to act on.
34:38
One of the
34:38
most exciting things in my job is I see awesome success stories from private
34:43
practice, academic otolaryngologists taking their ideas and moving it through.
34:47
So thank you for inspiring them.
34:49
What advice do you give to our trainees?
34:52
Probably not the medical students, but the residents and fellows
34:55
that say, when I grow up, I want to be like Peter.
34:58
I hopefully they want to be like Doctor Shah.
35:01
But, they, they, they and I think,
35:05
I think one thing with residency is it's very the residency is brutal and it's hard
35:10
and you sleep deprived and, and you've got to
35:14
you've got to be a good surgeon and you got to be a good clinician.
35:16
I think that your number one priorities.
35:18
But I think there's a small, small gap in there for something else.
35:22
And, and I think residents and trainees
35:25
who are committed to find that something else, can find it.
35:31
And because, you know, you're working 80 or more hours
35:34
a week, it really has to become a passion and a hobby.
35:37
And I think there is maybe, I don't know, maybe about 10% of residents have fellows
35:41
that have made it the kind of life that they seem to be in to, to be like that.
35:44
And I think that's where if you're a medical student looking for
35:47
residency programs that seem to, seem to bring that out of you.
35:52
So there are a lot of residency programs that have excellent innovation,
35:56
either curriculum or mentors or some sort of way to do that,
36:00
do that as part of your training. I think look for that.
36:03
Same with fellows.
36:04
If you're resident,
36:04
you're looking for fellowships, look for institutions or programs
36:07
that might have a little bit of a twist to it
36:10
that that might, might give you that background.
36:12
Of course, you know, reading the materials
36:14
that we already talked about, it's a good start.
36:17
But really trying to, embed a little bit of your time
36:21
into the formality of that, of that education and training is,
36:24
is really, really worthwhile and, and all the opportunities
36:26
that we just mentioned for private practice also exist for residents of fellows.
36:31
That was very articulate.
36:33
I encourage the residents and trainees to listen to that again.
36:36
I love what you said. Find something else.
36:38
And I wrote that down.
36:39
Doctor Santa Maria’s something else is innovation.
36:42
My something else is a passion for business and organizational development.
36:47
So I got my MBA. I took leadership courses.
36:50
I took business courses on how to construct an
36:54
organization to be like an organism and thrive.
36:57
Your something else is innovation.
37:00
You took courses, you took formal training,
37:03
and now you take devices and you move them to thrive.
37:05
I mean, that's a wonderful statement.
37:07
I'm sure you probably give that advice to your trainees.
37:10
Absolutely.
37:10
And I think that's how I, when I mentor, residents,
37:16
that's the one thing that I say is that
37:18
I think the training in the, in the US is incredible.
37:21
You're going to be an excellent surgeon and clinician,
37:24
but what else are you going to be?
37:26
Are you going to be an innovator?
37:28
Are you going to be a scientist?
37:29
Are you going to be a teacher?
37:30
Are you going to be an administrator?
37:32
That you have to be an excellent something else.
37:34
And so that's going to set you up the apart from other people
37:38
is that something else.
37:39
And so, you know, you don't have to be an innovator,
37:41
but you have to do something that's going to be that's
37:44
that's going to be your, the cherry on your cake.
37:47
Yeah. I think that's amazing.
37:48
I see a lot of our practitioners lead their state medical society,
37:51
lead their county medical society, be chief of staff.
37:55
So there's you're right.
37:56
There's a lot of different ways to find that something else.
37:58
That's a wonderful quote, Peter.
38:00
How old were you when you came over here?
38:02
More formally, how old were you?
38:04
I'm going to ask a goofy question, but I can ask you anything.
38:08
It seems like a lifetime ago.
38:10
I where I say I have to do some backward math,
38:14
but I could tell you the years, so I came, I finished my residency in 2011.
38:19
And I did,
38:22
what was called a surgeon/scientist residency,
38:26
which I think the rough equivalent would be like a T32 here, where I did it.
38:30
But I did an extra three years of research. So.
38:32
So 2011 was when you came over from.
38:35
Okay. Correct.
38:35
So is it true that the water spins the other way in Australia?
38:40
Absolutely. Yeah.
38:41
You so, like, when you brush your teeth and shave every morning,
38:44
you actually see the water going counterclockwise?
38:47
Oh yeah. Absolutely.
38:48
So if you, if you don't have to go to Australia
38:50
to find out if that's true, but, absolutely.
38:53
And so does that affect fluid dynamics?
38:56
And I'm serious about this.
38:58
Tell me, why does it affect, you’re an otologist/neurotologist fellowship
39:01
trained.
39:02
Why doesn’t it affect the cochlea and other fluid dynamics?
39:05
Yeah.
39:06
Look the I think the you know, the you know, we did the the code opposite
39:09
what I'm saying, those fluid dynamics of movement in the ear still hold true.
39:12
So unfortunately our ears spin the same way in, in in either hemisphere.
39:17
Okay, good.
39:18
That's that's what I was really wanting to find out today.
39:20
Doctor Santa Maria, kudos on your innovation.
39:23
When I go around the country, I hear your name over and over.
39:26
Thrilled to connect with you.
39:28
I'm going to let you close with anything you'd like to say to our members,
39:31
to our specialty.
39:33
We have about 5,000 - 10,000 viewers for these podcasts.
39:36
Thank you.
39:36
Thank you
39:37
for all you're doing for our specialty and being a friend of otolaryngologists.
39:40
Any any final words?
39:42
No, I think I just wanted to thank you.
39:44
And I really wanted to hopefully a few people
39:46
who would watch this and be inspired in some way to do something.
39:50
But I also really wanted to emphasize what I, what I finished
39:53
on before: is that you don't have to be an innovator.
39:56
You don't have to be a scientist.
39:58
But I think really try and do something that's going to make
40:02
a difference in a society or a subspecialty or a specialty.
40:06
Try and be difference maker and and find a way to do that.
40:09
And I think when you do that, you'll just have a lot more fun in
40:12
your life, in your career.
40:14
Doctor Santa Maria, thank you very much.
40:17
Thank you Dr. Shah.
40:18
we hope today's episode sparked some fresh ideas.
40:21
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40:25
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40:26
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40:28
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40:31
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40:35
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