Entrepreneurship in 3D: U of T trainees create new knot-tying board

Surgical knot tying is a foundational skill in medical training. 

The technique was also a catalyst to develop a new knot-tying board, for University of Toronto learners Tiffany Ni and Marco Istasy.

Ni is a first-year resident in diagnostic radiology, and Istasy is a third-year medical student. They first met through the 3D Printing in Medicine club at U of T’s Temerty Faculty of Medicine.

Istasy had been looking for a knot-tying board to practise his skills, after finding that commercially available boards were expensive (starting at about $80), bulky and impractical to carry in a backpack. 

He had also vowed to avoid purchasing plastic items and make them himself instead, as a 3D printing hobbyist. So, he and Ni designed a board that would be affordable and more able to meet the needs of medical learners.

“Surgery and procedural skills can be daunting for medical students to learn. A lot of us want extra tools to help us practice,” says Istasy. 

The new board is compact. It features suction cups for securing to flat surfaces, a bar to hold elastic bands and string, and a set of cylinders users attach to the board to practise tying knots at various depths and cavity widths. A trio of pegs also allows users to practise knot tying at different tensions. 

The duo shared a prototype board with their mentor Andrew Brown, a professor of medical imaging at Temerty Medicine. Brown is a vascular and interventional radiologist at Unity Health Toronto’s St. Michael’s Hospital, with an interest in making health care more efficient through machine learning and artificial intelligence. 

“Innovation can democratize the cost of learning tools. Increasing their affordability will help students and, further downstream, the people they’ll treat as patients one day,” says Brown, who also focused on 3D printing during his Master of Business Administration studies at the Massachusetts Institute of Technology.

“Beyond Toronto, the benefits can be even greater as there are many places where medical education is more expensive,” he adds.

With Brown’s encouragement, Ni and Istasy shared their board prototype with Mark Wheatcroft and Eliza Greco, both professors of surgery at Temerty Medicine and clinicians at St. Michael’s Hospital.

Wheatcroft asked to use the boards at an annual training event for first-year residents in vascular surgery from across Canada, to enable the learning of specific surgical skills.

“To see our board help with the learning objectives that day was fabulous,” recalls Ni. “We could see the learners practise a particular firm knot that uses gentle tension critical in vascular surgery.”

“It’s fulfilling to know that a solution that felt personal can be helpful to others, too. We’re excited to see where it leads us in the future,” Ni says.

Last September, the pair presented the board at the Royal College of Physicians and Surgeons of Canada’s International Conference on Resident Education in Ottawa. 

Ni says the moderator’s first questions afterward were, ‘Where can I buy this board, can I buy it from you, and how much does it cost?’ Ni and Istasy, who had filed with the United States Patent and Trademark Office one month earlier, made their first sale right then.

That success helped fuel creation of their start-up company, RISE MD, which stands for Research, Innovation, and Simulation in Education. The company’s mission is to make affordable, modular medical education tools tailored to their end-users' needs.

“The response has been overwhelming. When Tiffany and I first sat down to discuss this board, neither of us ever thought it would take off like this and become both a valuable educational tool and the foundation of a company,” says Istasy.

Istasy is also part of the first cohort of the medical innovation and technology program at Temerty Medicine, which equips future physicians with business skills and helps learners hone their entrepreneurial skills. 

The RISE MD founders are now discussing how to incorporate the board into curricula across Temerty Medicine and at medical schools across Canada, as they continue to grow their company.