The need for entrepreneurship education in medical school and residency training

November 7, 2018

In this month's Innovation Column, Drs. Steve Xu and William Ju discuss the need for entrepreneurship education in medical school and residency training.

Physicians played a central role in the discovery and development of nearly every transformative medical tool or therapeutic used today (e.g. imatinib, VEGF inhibitors, Herceptin, coronary artery stents, statins).1 Since physicians represent a critical source of medical innovation, limiting their ability to translate ideas into products or services and start new enterprises may be detrimental to future medical innovation.2 Medical education trains us to associate, question, observe, and experiment – these all happen to be core entrepreneurial skills.3 However, formal entrepreneurship – the pragmatic transformation of innovative ideas into commercial products – is classically taught in business schools and an expanding presence on undergraduate campuses. Thus, entrepreneurship education is yet to be incorporated meaningfully into medical school and residency curricula. Given that recent graduates start new technology companies at an order of magnitude rate greater than faculty with no demonstrable difference in company quality, there is an impetus to provide medical students and residency trainees an opportunity to learn the skills necessary to act on opportunities.4  Medical school represents a chance to expand beyond case-based learning and teach problem-solving skills at a systems level, while residency serves as a unique opportunity for practical training in addressing complex issues at the front lines of patient care. 

The challenges facing dermatology and healthcare in general needs more physicians that are trained in entrepreneurship. The rapid proliferation of disruptive technology present imminent challenges to physicians that a traditional basic and clinical sciences education does not address. As of 2016, only thirteen medical schools have acted on that notion, offering entrepreneurship certificates, concentrations and paths of excellence across seven educational themes: innovation, entrepreneurship, technology, leadership, healthcare systems, business of medicine, and enhanced adaptability.5 Case Western Reserve University School of Medicine continues the trend, debuting this academic year a Pathway Program in Healthcare Innovation and Entrepreneurship that involves biweekly meetings during preclinical years and a mentored project. Northwestern University Feinberg School of Medicine offers NUvention, an interdisciplinary six-month course designed to introduce students to the process of developing medical technologies. Enhancing surgical innovation motivated the creation of University of Michigan’s program.6 Entrepreneurship education as a tool to train medical students in complex problem solving and solution design is expanding but still represents a small fraction of the broader medical education enterprise.5

While medical school offers the opportunity to train an entrepreneurial mind, residency is a time for entrepreneurial action. Residents are on the front lines of patient care, and have the direct clinical exposure necessary to recognize needs and implement changes in healthcare delivery. They understand what clinical problems are worth solving in their specific fields. They enter their respective specialties as new physicians exposed to new problems; fresh perspectives and ideas afford residents a unique chance to engage in problem-driven innovation. Tackling problems that affect their patients prompts residents to examine issues that originate in healthcare system, cultivating a broader level of analysis that will make them an asset to any current or future healthcare organization. While residents are in a unique position to see and impart change, they often lack sufficient education, time and funds to develop solutions. Although the Accreditation Council for Graduate Medical Education has formalized some training for all residents in quality improvement, a national vision for innovation education has yet to materialize.

Individual specialties and academic institutions have created specific initiatives to involve residents in entrepreneurship education. In dermatology, Advancing Innovation in Dermatology launched an innovation curriculum, virtual Magic WandSM, in March 2017 to instruct residents and trainees in dermatology in key entrepreneurial areas including clinical needs finding, FDA regulation, and intellectual property basics inspired by the original program launched at Massachusetts General Hospital for clinical faculty.7 Over 90 dermatology residents have attended the Dermatology Innovation Forum, the organization’s annual entrepreneurship conference over the past four years, indicative of a strong interest in dermatological innovation among trainees. Internal medicine residents at Duke can partake in Management and Leadership rotational program, which offers experience in the business of medicine, not entrepreneurship specifically.

Physicians are trained from day one to develop three core abilities-the capacity to learn, the confidence to operate with uncertainty, and domain expertise in an area of healthcare. While these attributes are entrepreneurial in nature, addressing challenges in healthcare will also require creative problem-solving, risk-tasking, and technical and business literacy – skills and experience that should be cultivated through education in entrepreneurship early in a trainees journey.


References Cited
1. Xu S, Kesselheim AS. Innovation Then and Now: Perspectives of Innovators Responsible for Transformative Medical Advances. Medical innovation then and now: perspectives of innovators responsible for transformative drugs. J Law Med Ethics. 2014 Winter;42(4):564-75.
2. Smith SW, Sfekas A. How much do physician-entrepreneurs contribute to new medical devices? Medical care. May 2013;51(5):461-467.
3. Dyer J, Gregersen H, Christensen C. The Innovator’s DNA. Harvard Business Review. December 2009.
4. Astebro T, Bazzazian N, Braguinsky S. Startups by recent university graduates and their faculty: implications for university entrepreneurship policy. Research Policy. 2012;41(4):663-677.
5. Niccum B, Sarker A, Wolf S, Trowbridge MJ. Innovation and entrepreneurship in US medical education: a landscape review and thematic analysis. Medical Education Online. 2017 Aug; 22(1).
6. Cohen MS. Enhancing surgical innovation through a specialized medical school pathway of excellence in innovation and entrepreneurship: Lessons learned and opportunities for the future. Surgery. 2017 Nov; 162(5):989-993.
7. Garibyan L, Anderson RR. Increasing Clinical Faculty Engagement in Problem-Driven Research: The "Magic Wand" Initiative at Massachusetts General Hospital. JAMA Dermatol. 2017 May 1;153(5):375-376.

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