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\begin{document}

\title{An Elective Course for Med Students on Innovation and Entrepreneurship}



\author[1]{Josh Nicholson}%
\affil[1]{Authorea}%


\vspace{-1em}



  
  \date{May 27, 2024}


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Here we describe ``Innovation and Entrepreneurship in Medicine''
(IEMed), a short elective course that exposed medical students to
innovation and entrepreneurship in digital health.

\section*{Introduction}

{\label{731379}}

Entrepreneurial and software-driven technology companies, known as
``tech'', are reinventing established industries, including
transportation, national defense, and even healthcare. For the past
three years, investment in digital health - a broad category of tech
including analytics, biosensing, population health management, medical
records, and software-driven devices - has exceeded \$4B annually.
However, implementation of techology into clinical workflow has been
slow.

Medical students and young physicians are well positioned to contribute
to tech's foray into biomedicine for two reasons. First, they are
comfortable with technology, which permeates most aspects of their lives
as consumers. Second, they possess insight about unmet clinical needs
and care delivery.

Unfortunately, medical students are not exposed to opportunities in tech
even though industry efforts can represent ``translational research in
its rawest form''.

\section*{Approach}

{\label{470443}}

To address this problem, we created an elective course for second-year
medical students at our institution (a private medical school in a large
metropolitan city in the United States) called IEMed, which was held in
the fall semester and lasted three months. We developed the following
learning objectives:

\begin{itemize}
\tightlist
\item
  Assess a startup using the business model canvas as a framework.
\item
  Learn about healthcare economics and reimbursement.
\item
  Appreciate how behavioral economics assesses decision-making.
\item
  Review advances in digital health and health information technology.
\item
  Survey accelerators, incubators, and other startup resources.
\item
  Learn about patents and the fundamentals of intellectual property.
\item
  Understand the role of angel, seed, \& venture capital investors.
\item
  Meet like-minded students, clinicians, engineers, and startup
  founders.
\item
  See how academic clinicians collaborate with the tech industry.
\end{itemize}

Nine students enrolled in 2014, and ten students enrolled in 2015. Each
learning objective was explored through a lecture and Q\&A featuring a
guest speaker with relevant experience. Sessions were also accompanied
by suggested readings. We recorded videos of several sessions to provide
educational assets to a broader audience. The full course schedule,
reading materials, and videos of select sessions were available through
a course website.

Students also completed a project in teams of three. Each team selected
and evaluated a startup company using the ``business model canvas'': a
visual chart describing market strategy, value proposition,
infrastructure, customers, finances, etc. ( Figure 1). Each week, teams
focused on one component of the canvas, learned more about their startup
by conducting research online, or speaking with founders of the startup
and/or potential customers, and shared their findings with the class. We
also connected medical students with MBA students at our institution's
business school to provide input. At the end of the course, teams
presented their canvases and discussed clinical implementation and
business development strategies.

\par\null\selectlanguage{english}
\begin{figure}[h!]
\begin{center}
\includegraphics[width=1.00\columnwidth]{figures/fig1eric/fig1eric}
\caption{{Business Model Canvas
{\label{749105}}%
}}
\end{center}
\end{figure}

\section*{Outcomes}

{\label{848230}}

In the second year of IEMed, we administered a survey to enrolled
students immediately after the last session to obtain feedback for
subsequent course refinement ( Figure 2). This study was exempt by our
Institutional Review Board (IRB) as it fell under the category of
``research on the effectiveness of or the comparison among instructional
techniques, curricula, or classroom management methods''.

\par\null\selectlanguage{english}
\begin{figure}[h!]
\begin{center}
\includegraphics[width=1.00\columnwidth]{figures/Fig2eric/Fig2eric}
\caption{{Student Survey Results
{\label{638520}}%
}}
\end{center}
\end{figure}

Responders were asked to rate agreement with a statement using a Likert
scale of 1 to 10, where 1 indicated strong disagreement, 5 indicated
neutrality, and 10 indicated strong agreement. Ten students (100\%)
completed the survey, and 100\% of students recommended the elective for
future medical students.

The three highest rated statements were (mean \selectlanguage{ngerman}± standard deviation):

\begin{itemize}
\tightlist
\item
  I am interested in a minor in startups \& innovation (9.3±1.3).
\item
  I am interested in a one-month M4 elective on startups (8.6±1.6).
\item
  Rate the overall elective (8.6±1.0).
\end{itemize}

The three lowest rated statements were (mean ± standard deviation):

\begin{itemize}
\tightlist
\item
  I understand regulatory \& reimbursement aspects of health tech
  (6.7±1.3).
\item
  I will found or work at a startup (6.9±1.5).
\item
  I understand legal aspects of health tech (7.1±1.1).
\end{itemize}

When asked about career goals, students reported the desire to pursue
residency, practice clinically, and work with startups in advisory,
consulting, or collaborative roles.

Students also suggested ways to improve the elective, including
networking events with business, engineering, and law students, a more
detailed case study of a startup from idea to market, and lectures on
implementing technology in the clinic.

The business model canvas project was the least favored aspect of the
course; several students requested more in-depth guidance on using the
framework.

\section*{Limitations}

{\label{678342}}

Our survey faced several limitations. It was only designed to gauge
interest in specific topics within our elective. We measured perceptions
after the course and did not survey a control group. Furthermore, our
sample size was small and the survey results were self-reported. Aware
of these constraints, we simply utilized survey feedback to inform
future medical education initiatives.

\section*{Next Steps}

{\label{715631}}

To respond to student demand at our institution for further educational
opportunities related to technology and innovation, we are piloting a
new project-driven elective for fourth-year medical students. Over one
month, students identify unmet healthcare needs by speaking with
patients, providers, payers, and other stakeholders. Students also learn
from discussions with experts in engineering, information technology,
product development, and business. At the end of the elective, students
propose a product or process addressing the unmet need. This approach
has utility both as a didactic tool and an ideation method for quality
improvement projects. Creative problem-solving skills are important for
clinical care, research, and more directly translational work, yet
underrepresented in current medical curricula.

\section*{Discussion}

{\label{726284}}

Academia can do more to support medical student and physician
involvement in the creation and implementation of technologies that
improve patient care. Relevant topics in business, law, and engineering
should be available at least as an option in the curriculum without
increasing the time required to complete medical school. Students should
be encouraged to consult for, collaborate with, or intern at companies,
especially early-stage technology startups. Some academic institutions
have also supported startup incubators, i.e. programs to fund and guide
student, trainee, and faculty entrepreneurship. Examples include StartX,
associated with Stanford University, and Sling Health, a program started
at Washington University St. Louis and recently expanded to our
institution.

Unfortunately, medical students are tacitly discouraged from pursuing
endeavors outside of clinical work, basic science, or clinical research.
Changing this perception remains a major cultural challenge, yet also
presents an opportunity for academic medicine to define how technology
advances the delivery of healthcare. We believe medical schools should
support and facilitate the pursuit of such opportunities by medical
students.

\section*{Conclusion}

{\label{655637}}

In summary, the IEMed elective exposed medical students to topics at the
intersection of technology and healthcare, which are underrepresented in
medical curricula. The elective was well-received by all participants.
IEMed required only a few hours per week of faculty and/or teaching
assistant time, as it drew heavily on guest speakers with relevant
expertise. This model is simple, could be easily implemented at other
institutions, and may contribute to the professional development of
future leaders in healthcare technology and delivery.

\selectlanguage{english}
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