Exploring the new model of medical innovation and entrepreneurship talent training based on biodesign in eastern China

Abstract

With the trend of economic globalization, innovation and entrepreneurship have become critical strategies for national development. College students, particularly, are a primary focus for cultivating awareness of innovation and entrepreneurship, which is essential for implementing national development strategies. The institution in eastern China has developed a program aimed at fostering medical innovation and entrepreneurship through the Biodesign framework. This study aimed to evaluate the effectiveness of this training system by surveying 479 medical students using a questionnaire designed around three stages: “identify,” “invent,” and “implement”. Factor analysis, descriptive statistical analysis, and T-tests were employed to assess the effectiveness and development pathways of the Biodesign-based cultivation of medical innovation and entrepreneurship talents. The results indicate significant improvements in students’ abilities in demand identification, demand screening, concept generation, concept selection, strategic identification, and business planning (p < 0.001), with the most notable improvement in demand identification (t = 6.383). Additionally, students have achieved notable success in writing and publishing papers and patents, as well as securing provincial and national-level awards. Particularly remarkable were the achievements in student competitions, with the number of national-level awards rising from 32 in 2019 to 66 in 2023. In conclusion, the Biodesign-based cultivation model for medical innovation and entrepreneurship has proven effective and merits further promotion among medical students.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12909-025-06870-z.

Introduction

In China, as the “mass entrepreneurship and innovation” strategy continues to deepen, the country is working to integrate innovation and entrepreneurship education reforms at all levels of the higher education system [1, 2]. This approach not only supports the implementation of the innovation-driven development strategy but also serves as a measure to promote economic structural upgrading and improve the quality and efficiency of economic development [3]. In the field of medicine, a vital sector concerning population health and safety, there is an urgent need to cultivate versatile talents who possess both a solid foundation in medical expertise and innovative entrepreneurial capabilities [4, 5].

To gain a comprehensive understanding of the forefront of development and research hotspots in the field of innovation and entrepreneurship education, relevant literature from the past decade was searched in four English databases, PubMed, Web of Science, Cochrane, and Embase, using “innovation and entrepreneurship” and “education” as search terms. After manually removing unqualified literature and using CiteSpace for deduplication, a total of 2324 pieces of literature were visualized and analyzed. As shown in Fig. 1, the key rankings are engineering education entrepreneurship education, technological innovation, educational innovation, circular economy, curricular modules. The research on the negative aspects of innovation and entrepreneurship education for college students mainly focuses on engineering, education, economics, and to a certain extent, lacks attention to innovation and entrepreneurship education in the medical field.

Fig. 1.

Literature clustering diagram

Table 1.

Whitelists

ClusterID	Size	Silhouette	Mean(year)	Label (LLR)
0	48	0.795	2019	engineering education(21.3,1.0E-4)
1	41	0.769	2020	entrepreneurship education(33.27,1.0E-4)
2	30	0.793	2020	technological innovation(21.51,1.0E-4)
3	23	0.843	2020	educational innovation (29.34,1.0E-4)
4	20	0.94	2017	circular economy (13.86, 0.001)
5	20	0.891	2016	curricular modules (14.63, 0.001)

Theoretical research and practical activities in innovation and entrepreneurship education at colleges and universities are highly active, yielding significant results. However, college students often lack a clear understanding of innovation and entrepreneurship due to the absence of introductory courses, the lack of a coherent training system, and limited coverage. To address this issue, universities should strengthen their efforts in innovation and entrepreneurship education, offering students more comprehensive and systematic training [6, 7]. By providing additional introductory courses on innovation and entrepreneurship, students can gain a clearer understanding of the basic concepts, significance, and value of innovation, which will stimulate their interest and motivation. Comprehensive training should encompass various aspects, including entrepreneurial mindset, skills, and practice, helping students build a solid entrepreneurial foundation. Therefore, cultivating innovative medical talents has become an urgent priority in the national strategic agenda. This requires not only strengthening education in basic medicine, clinical medicine, and medical research but also fostering students’ innovative abilities and critical thinking, preparing them to take on key roles in future medical and healthcare advancements [8, 9].

The primary goal of innovation and entrepreneurship education for medical students has always been to identify the optimum nurturing model [10–11]. Even though project-driven learning, case analysis-based educational theories, and traditional teaching methods are widely employed today, they have significant limitations in terms of fostering medical students’ ability for innovation and entrepreneurship. Medical students frequently feel overwhelmed while diagnosing rare diseases because standard teaching methodologies concentrate too much emphasis on theory, making it difficult for them to identify practical concerns in complex medical situations [12–13]. Project-driven learning ignores the professional components of the medical industry and fails to provide medical students with comprehensive guidance while developing medical devices [14]. Due to case analysis-based education is based on out-of-date instances and cannot give students up-to-date industry information, it presents several challenges when it comes to putting creative ideas into practice [15]. To better cultivate the innovation and entrepreneurship capabilities of medical students, some medical colleges in China have begun collaborating with enterprises, medical institutions, and other social resources to promote the integration of industry and higher education. This collaboration provides students with greater exposure to real-world problems and opportunities to tackle practical challenges [1, 16, 17]. Internationally, the Biodesign medical student innovation and entrepreneurship program, led by Professor Paul Yock at Stanford University, has achieved significant practical value and garnered a strong social response. As illustrated in Fig. 2, the core of Biodesign lies in the innovative process, which spans from problem identification to technology invention and subsequent value creation. The innovation process consists of three key stages: “identify,” “invent,” and “implement”. These stages, advocated by Biodesign, are essential for cultivating exceptional medical innovation and entrepreneurship talent. The courses based on Biodesign break the traditional, unidirectional teaching model of medical education, fostering interdisciplinary collaboration among doctors, engineers, investors, and other stakeholders. The process encompasses discovering clinical problems, identifying clinical needs, inventing innovative technologies, designing products, and ultimately developing and implementing business plans to initiate projects. Biodesign is structured around student practice as the central focus, with the dominant discipline as the foundation, project processes as the support, and outcome delivery as the goal. It is guided by a mentorship platform. The aim of this model is to apply theoretical knowledge gained in university courses to innovative and entrepreneurial case practices, while also fostering innovative thinking, entrepreneurial skills, and team collaboration. Therefore, the Biodesign concept is highly applicable to medical student training and education.

Fig. 2.

The process of innovating medical technologies base on the idea of Biodesign

This model for cultivating innovative and entrepreneurial medical talent is implemented at the author’s institution, which is globally renowned for its “manual-style” medical innovation and entrepreneurship education, offering practical guidance through three stages. To implement Biodesign, our school has introduced relevant medical innovation and entrepreneurship courses and practical activities to guide students in applying Biodesign in real-world settings. By organizing clinical case studies, students gain hands-on experience in exploring how to apply Biodesign to solve practical clinical problems. Industry experts are invited to deliver lectures and share insights, enabling students to understand the latest industry trends and practical applications. Additionally, a selection process is conducted to form “research interest groups” for first-year medical students, with dedicated research mentors. In the medical clinical research practice, students’ ability to “invent” is honed through innovation and entrepreneurship in medical scientific research. More importantly, the university continues to collaborate with enterprises, medical institutions, and other organizations to jointly carry out medical research and innovative practical activities, providing students with more opportunities for clinical practice. This collaboration allows them to master the application of Biodesign during clinical internships and practical work. Based on major clinical issues and challenges, clinicians partner with medical colleges and universities to engage in innovative and entrepreneurial practices, such as the “Challenge Cup” series of disciplinary competitions. These activities are designed to address significant clinical challenges and complete the “development” process loop. This loop integrates the identification, invention, and implementation of innovative technologies, product design, and ultimately business planning and implementation, leading to project launch [18, 19]. By further improving the quality and accelerating the growth of innovative and entrepreneurial education for advanced medical students, it is possible to promote the innovative development of the global medical and pharmaceutical industries [20–22].

To evaluate the effectiveness of Biodesign in training medical innovation and entrepreneurial talents, this study focuses on the new model of medical innovation and entrepreneurship talent cultivation. A questionnaire based on Biodesign was designed to conduct a quantitative survey. Statistical methods, including factor analysis, descriptive statistics, and T-tests, were applied to examine the three key stages of “identify, invent, and apply” in the development of medical students’ innovation and entrepreneurship capabilities. The study involves excellent innovation and entrepreneurship teams from a medical university in eastern China, as well as students with and without relevant training. It also identifies the characteristics of high-level innovative and entrepreneurial medical talents, providing theoretical support and references for future talent cultivation in the field. The investigation analyzes the current state of entrepreneurship and innovation among medical university students based on Biodesign.

In November 2023, this study conducted a cross-sectional survey at a Chinese medical university, applying both domestic and international educational perspectives to assess the current situation of innovative and entrepreneurial talent education in medical majors. Finally, through interdisciplinary research methods, the study explores the cultivation model for innovative and entrepreneurial talents among Chinese medical students, offering a theoretical foundation for strategy development.

Methods

Implementation of biodesign

In 2020, we used Biodesign to train medical students in order to confirm its efficacy in fostering medical innovation and entrepreneurial talent. By concentrating on improving problem identification skills (“Identify” Stage), developing creative thinking skills (“Invent” Stage), and fortifying implementation skills (“Implement” Stage), we practice the fundamentals of Biodesign. Here is a short outline of adopting Biodesign measures: (1) We hold case-discussion courses throughout the " Identify " stage to help medical students discover medical challenges as well as underlying ethical, educational, and resource-related concerns from problematic cases across various disciplines. To enhance their ability to recognize unmet medical needs from the perspective of the patients, we also train them in patient-centered interviews. (2) We offer multidisciplinary workshops at the “Innovation” stage, when medical students collaborate with experts from many fields, to encourage creative thinking. We also encourage students to participate in certain medical innovation competitions. This motivates them to question conventional ideas and solve real-world medical problems. (3) During the “Implementation” stage of clinical rotations, medical students are given small-scale projects to assist them understand the practical requirements of putting theory into reality. Every medical student is also paired with a mentor. By using the mentor’s experience, students can overcome implementation challenges and make their innovative ideas a reality. This significantly improves the problem-solving, creative problem-solving, and execution skills of medical students.

Questionnaire design

Biodesign focuses on demand-driven innovation, comprising three primary stages: “identify,” “invent,” and “implement”. Each stage includes two sub-stages: needs finding, needs screening, concept generation, concept screening, strategic development, and business planning. To evaluate the effectiveness of cultivating medical innovation and entrepreneurship based on Biodesign, a Questionnaire Survey (QS) was designed [23–25]. Participants were explicitly informed of the anonymous nature of the questionnaire. No personally identifiable information was collected through the instrument. All items were systematically designed to maintain neutral phrasing. For instance, the item “How frequently do you engage in innovative activities?” was deliberately formulated instead of employing value-laden phrasing such as “Do you actively participate in innovative activities as expected of dedicated students?” This linguistic strategy effectively mitigated response bias toward socially desirable answers while maintaining evaluative rigor in measuring concept-generation competencies during the Invention stage. QS uses a 5-point Likert scale, with the following response options: completely agree (5 points), agree (4 points), uncertain (3 points), disagree (2 points), and strongly disagree (1 point). Importantly, the design, distribution, and data collection of the questionnaire do not involve personal privacy. The survey was conducted with the consent of participants (≥ 18 years old) and is intended solely for academic purposes, not for public distribution.

Through a literature review and drawing from research in related fields, the Workplace Basic Psychological Need (WBPN), Innovation Climate Scale (ICS), Entrepreneurship Competence (EC), and Career Success Scale (CSS) were utilized to conduct a cross-sectional survey and controlled study on the cultivation model of innovation and entrepreneurship talents among college students majoring in medicine. The questionnaire was designed to assess the impact of innovation and entrepreneurship training on the “identify,” “invent,” and “implement” stages of medical students, as well as to evaluate the innovation and entrepreneurship outcomes of these students.

As shown in Table 2, after a pre-survey with 104 students, the questionnaire was analyzed using reliability and validity factor analysis, as well as Confirmatory Factor Analysis (CFA). The results of the reliability and validity analysis indicated that the overall Cronbach’s α for the questionnaire was 0.981, with a KMO value of 0.972. The Cronbach’s α for the three stages (i.e., “identify,” “invent,” and “implement”) were 0.959, 0.976, and 0.970, respectively, and the KMO values were 0.933, 0.947, and 0.954. All values exceeded 0.9, and the significance (Sig) was less than 0.001, indicating that the questionnaire demonstrated strong internal consistency, stability, and high reliability. The reliability and validity of the scales met the specific specifications for the case study and were suitable for factor analysis. As shown in Table 3, in CFA, the Average Variance Extracted (AVE) for the three stages (i.e., “identify,” “invent,” and “implement”) were 0.704, 0.805, and 0.767, all greater than 0.5. Additionally, the Goodness of Fit Index (GFI), Normed Fit Index (NFI), Comparative Fit Index (CFI), and Incremental Fit Index (IFI) were all greater than 0.9, indicating high convergent validity for the questionnaire.

Table 2.

Reliability and validity of the formal survey scale

Variable	Cronbach α	KMO	Chi-square	Sig
indentify	0.959	0.933	5282.621	< 0.001
invent	0.976	0.947	7049.779	< 0.001
implement	0.97	0.954	5729.986	< 0.001

Table 3.

Confirmatory factor analysis (CFA) fitting indicator table of the formal QS scale

Variable	indentify	invent	implement	Criteria
AVE	0.704	0.805	0.767	> 0.5
AVE variance	0.815	0.976	0.97	/
χ2/df	8.432	5.823	5.374	< 3
RMSEA	0.107	0.098	0.092	< 0.10
GFI	0.927	0.953	0.931	> 0.9
NFI	0.946	0.973	0.943	> 0.9
CFI	0.952	0.977	0.949	> 0.9
IFI	0.952	0.977	0.949	> 0.9

Data collection

After validation, this study selected an undergraduate medical and health institution in eastern China and distributed questionnaires online for sampling in 2024. The institution is a medical specialty college offering majors in medicine. The inclusion criteria for survey respondents were: undergraduate students enrolled at the university who majored in medicine or medicine-related fields. Exclusion criteria included completion times of less than 30 s or consistent responses across all questions. The questionnaire collected basic demographic information, such as gender, year of enrollment, participation in innovation and entrepreneurship training, and a survey of innovation and entrepreneurship abilities based on Biodesign. It also gathered data on outcomes, such as the number of articles published in scientific research. A total of 498 completed questionnaires were collected, of which 479 data sets were considered valid. The recovery rate of valid questionnaires was 96.18%.

Data analysis

The analysis in this study was conducted in two stages: (1) descriptive statistics and variance test (2) regression analysis, which explored the relationship between a dependent variable and multiple independent variables. In the descriptive statistics stage, The demographic and baseline characteristics of the study population were presented using frequency distributions and proportional representations. To describe the data’s focused tendencies and variability, we used the mean, median, and standard deviation. This analysis helped assess the current state of innovation and entrepreneurship education in the medical field. To examine the association between demographic characteristics and research training participation, we conducted comparative analyses using appropriate statistical methods. Analysis of variance (ANOVA) was implemented to assess variations in student participation rates across different demographic groups, enabling the identification of significant intergroup differences and the determination of key demographic factors influencing science training enrollment. For pairwise comparisons between two independent groups, independent samples t-tests were performed, while one-way ANOVA was utilized for comparisons involving several groups. In the regression analysis stage, a correlation analysis of the three stages through a controlled study was performed, reporting standardized regression coefficients and p-values. This analysis explored the impact of innovation and entrepreneurship training based on Biodesign on the research growth of college students majoring in medicine. All analyses were conducted using SPSS 25.0.

Results

The 479 valid questionnaires were analyzed by variance test, and the results are summarized in Table 4. Most of the survey participants were women, accounting for 51.77%. A total of 205 students (42.80%) had participated in Biodesign training. The gender distribution was relatively balanced overall. In terms of grade distribution, the survey participants were primarily first-, second-, and third-year students, with fewer fourth- and fifth-year students. This may be due to graduates being occupied with job searches, preparing for postgraduate exams, or applying for study abroad opportunities, preventing their participation in the survey. Regarding professional distribution, 92.07% of the participants were medical students, with a small proportion from Engineering, Literature, and Management. This reflects the nature and academic focus of the surveyed medical university.

Table 4.

Basic situation of the survey objects

Variable		Participating (n1 = 205)		Not participating(n2 = 274)		p value
		Statistics	Percentage (%)	Statistics	Percentage (%)
Gender	Male	99	48.29	132	48.18	0.98
	Female	106	51.71	142	51.82
Grade	2023	88	42.93	146	53.28	0.267
	2022	70	34.15	69	25.18
(Year of enrollment)	2021	19	9.27	26	9.49
	2020	26	12.68	31	11.31
	2019	2	0.97	2	0.74
Specialty	Medicine	186	90.73	255	93.07	0.166
	Engineering	3	1.46	7	2.55
	Literature	8	3.9	5	1.82
	Management	8	3.91	7	2.56
Year of participation	2023	100	48.78	274		/
	2022	68	33.17
	2021	26	12.68
	2020	8	3.9
	2019	3	1.47

Results and analysis of QS

Investigation results of identify stage

The data from the sampling survey on the “identify” stage of medical students were analyzed, and the results are presented in Fig. 3. The “identify” stage is assessed from the perspectives of needs finding and needs screening. Regarding needs finding, students who received Biodesign training showed a significant increase in their sense of identity. The most notable improvement was observed in their ability to seek help when the team encounters difficulties.

Fig. 3.

Description of differences in identify stage. Note Q1: Having someone to talk to about research and innovation. Q2: There is someone to talk to about academic research. Q3: In a research team, everyone must follow the rules of research, no exceptions. Q4: Mentors don’t dictate every step of the process. Q5: You know your own research growth path. Q6: You know exactly what skills you need to acquire and what skills you need to learn in the future. Q7: Your mentor will support and assist you in realizing your research ideas. Q8: Your research partners will be active in giving you advice and suggestions. Q9: Mentor will respect or tolerate your opinions and disagreements. Q10: Mentors often offer material or moral rewards for your innovative ideas

Investigation results of invent stage

The data from the sampling survey on the “invent” stage of college students were analyzed, and the results are presented in Fig. 4. The “invent” stage is assessed from the perspectives of concept generation and concept screening. Students who received Biodesign training showed notable proficiency in both concept generation and concept screening. They also made significant progress in effectively allocating the resources required for scientific research.

Fig. 4.

Description of differences in invent stages. Note Q11: Able to meet relevant requirements. Q12: Know all the requirements. Q13: Know who to turn to when encountering problems. Q14: Know the specific process of Invent creation. Q15: Have a clear understanding of Invent creation. Q16: Satisfied with the ability to produce patents. Q17: Satisfied with the ability to produce papers. Q18: Satisfied with the ability to participate in competitions. Q19: Positioning the ability to create Invents accurately. Q20: Ability to rationally allocate required resources

Investigation results of implement stage

The data from the sampling survey on the “implement” stage of college students were analyzed, and the results are presented in Fig. 5. The “implement” stage is assessed from the perspectives of strategic development and business planning. Students who received Biodesign training demonstrated proficiency in both strategic development and business planning. They also gained a deeper understanding of the process involved in translating scientific findings into the development of medical products.

Fig. 5.

Description of differences in “implement” stage. Note Q21: The team thinks I create value. Q22: It was easy for me to find a job. Q23: Satisfied with the progress of my new research skills. Q24: Think my results can be translated into commercial products. Q25: Believe that research training can facilitate the translation of research results. Q26: Very clear on the pathway to translating research results into medical product practice. Q27: Satisfied with my ability to write Business Plannings. Q28: Satisfied with my decision-making and organizational skills when solving problems. Q29: Writing a Business Planning anticipates problems in the translation of medical products. Q30: Improved my ability to recognize key points in a Business Planning

Multiple regression analysis of each stage

The comprehensive mechanism of various factors in the entrepreneurship education system is complex. In this study, the three stages from the student QS and their satisfaction were statistically analyzed using regression analysis. As shown in Table 5, the results indicate that the three stages significantly impact student satisfaction (p < 0.001). Additionally, multiple regression analysis was conducted to examine the relationship between the three stages and student satisfaction.

Table 5.

t-test for the 3 stages

Variable	x ± s		t	p value
	Participating (n1 = 205)	Not participating(n2 = 274)
indentify	37.97 ± 8.67	32.53 ± 9.63	6.383	< 0.001
invent	34.59 ± 9.77	30.2 ± 10.67	4.613	< 0.001
implement	34.35 ± 9.54	30.53 ± 10.12	4.191	< 0.001

Investigation results of achievements

The data from the sampling survey on the differences in outcomes were analyzed, and the results are presented in Fig. 6. The findings indicate that students who participated in the training showed improvements in their outcomes. Notably, the most significant improvement was observed in students participating in competitions at or above the provincial level.

Fig. 6.

Description of differences in outcomes. Note Q31: Number of papers prepared (including participation). Q32: Number of competitions participated in competitions above the provincial level. Q33: Number of patents obtained (including participation). Q34: Number of published papers (including participation). Q35: Number of awards won in competitions above the provincial level (including participation)

After receiving Biodesign training, students have achieved more impressive results in writing and publishing papers, obtaining patents, and earning provincial and national awards. Notably, their performance in student competitions has also shown significant improvement. According to the “White Paper on College Students’ Competitions” published by the China association of higher education (hereinafter referred to as the “White Paper”), which includes major events such as the China International “Internet⁺” College Students’ Innovation and Entrepreneurship Competition, the “Challenge Cup” National College Students’ Extracurricular Academic Science and Technology Works Competition, the “Challenge Cup” China College Students’ Business Plan Competition, the National College Students’ Mathematical Modeling Competition, the China College Students’ Computer Design Competition, the National College Students’ Life Science Competition, the China College Students’ Medical Technology Skills Competition, and the Blue Bridge Cup National Software and Information Technology Professional Talent Competition, among others, the number of national-level achievements has risen from 32 in 2019 to 66 in 2023 (data from innovation and entrepreneurship offices of Nanjing medical university and China association of higher education, Fig. 7), reflecting significant progress.

Fig. 7.

2019–2023 white paper competition national award winners

Discussion

The application of Biodesign in training innovation and entrepreneurship talents within the medical field in economically developed areas has led to several important insights, offering significant practical implications for medical education, policy development, and professional practice.

From the perspective of the “Identify” stage, similar to Biodesign’s methodology, enhancing the incentive mechanism for innovation and entrepreneurship in medical education in economically developed areas has proven effective. By establishing appropriate evaluation criteria and encouraging student participation in various activities, students become more attuned to unresolved challenges and potential innovation opportunities in the medical field. For instance, during competitions and routine studies, students become more aware of unmet medical needs in clinical practice, motivating them to explore innovative solutions. Additionally, increasing awareness of innovation and entrepreneurship among medical undergraduates through lectures and clinical exposure helps students understand the value and significance of medical innovation from a professional perspective. Collaborations with hospitals provide a direct channel for students to identify real-world problems and strengthen their problem-identification skills, thereby laying a solid foundation for future innovation and entrepreneurship endeavors.

In the “Invent” stage, optimizing the curriculum for fostering innovative medical talents and exploring effective talent cultivation models play crucial roles. Incorporating various assessment methods and integrating innovation and entrepreneurship knowledge into daily instruction, along with teaching strategies such as Problem-Based Learning (PBL) and Case-Based Learning (CBL), stimulates students’ innovative thinking. This encourages them to develop new technologies, methods, or solutions when faced with clinical challenges, mirroring the “invent” phase in Biodesign. The formation of experienced experimental teams and participation in clinical and research projects, through partnerships among medical schools, affiliated hospitals, and pharmaceutical companies, provides students with opportunities to apply their knowledge and create novel ideas and techniques in real-world settings, aligning with Biodesign’s focus on technological invention.

Regarding the “Implement” stage, a comprehensive incentive mechanism for innovation and entrepreneurship fosters a competitive environment that accelerates the application of identified problems and innovative solutions. Increasing investment in innovation and entrepreneurship training, along with providing dedicated funds, supports students in translating their innovative ideas into practical actions and the commercialization or clinical application of their inventions. With optimized curriculum systems and talent cultivation strategies, students can effectively implement their innovations in collaboration with hospitals and enterprises, thus realizing the value of innovation and enhancing practical outcomes in the medical field.

However, as the study indicates, the most significant improvement was observed in the “Identify” stage, followed by “Invent,” while changes in the “Implement” stage were relatively less pronounced. This may be due to the fact that progress in “Invent” relies on the achievements of “Identify,” and “Implement” requires both “Invent” and “Identify” as prerequisites. It is also related to the long duration of medical student training and the time required for medical product development. Nevertheless, the overall training of innovative and entrepreneurial medical students under the Biodesign framework has achieved notable results, encouraging students to embody the qualities and mindset of innovation and entrepreneurship. Furthermore, the generalizability of these findings is primarily limited to economically developed regions. It is imperative to emphasize that the applicability of this study’s outcomes is predominantly constrained to well-resourced areas, which substantially differ from less developed regions in terms of educational infrastructure, innovation ecosystems, and student demographic profiles. Consequently, significant modifications and context-specific adaptations would be essential for implementing the biodesign-based agricultural approach in resource-constrained settings. It is worth noting that the long-term sustainability of the Biodesign-guided training model warrants further investigation, it holds great potential for expansion and success in medical education in economically developed areas and the medical industry.

Limitations

This study has several limitations that must be acknowledged. First, social desirability bias is a potential limitation. Since self-reported questionnaires were used to collect the data, participants might provide answers they consider more socially acceptable, which could affect the accuracy of the findings. Future studies could incorporate objective measures or utilize multiple data collection methods to mitigate this issue. Second, the study was conducted at a single institution in eastern China. The region exhibits a robust economic infrastructure, substantial educational resources, and an innovation-conducive environment, thereby providing optimal conditions for implementing the Biodesign. However, in economically underdeveloped regions, resource constraints present substantial challenges, hindering the replication of Biodesign initiatives and potentially limiting the generalizability of the research findings. To mitigate this limitation, we have delineated potential implementation strategies tailored for economically disadvantaged areas in the Recommendations for Future Practices. Expanding the study to include multiple institutions across different regions would also enhance the external validity of the results. Third, the study’s short-term evaluation does not fully capture the long-term effects of Biodesign-based training. A longitudinal design would provide a more comprehensive understanding of its lasting impact. Fourth, despite efforts to control for various factors, unmeasured confounding variables may still exist and influence the relationships between variables. Future research should identify and account for these potential confounders. Lastly, while the validated questionnaire provides valuable insights, it may not encompass all aspects of medical innovation and entrepreneurship. Refining and expanding the questionnaire based on further research would be beneficial.

Recommendations for future practices

The implementation of biodesign initiatives in economically disadvantaged regions is anticipated to face substantial challenges in the foreseeable future. We hypothesize that these barriers can be systematically mitigated through three primary approaches: the establishment of resource-sharing mechanisms, the optimization of communication infrastructure, and the formulation of context-specific solutions. The proposed intervention strategies are comprehensively outlined as follows:

Identify stage: Through strategic collaborations with affiliated hospitals, medical institutions in developing countries may implement structured field immersion programs, facilitating student visits to rural healthcare facilities. Preceding these field engagements, comprehensive preparatory training modules should be administered, focusing on the epidemiology of region-specific medical conditions and systemic healthcare challenges prevalent in underserved areas. This experiential learning approach enables students to develop a nuanced understanding of the distinctive healthcare disparities and unmet clinical needs characteristic of resource-constrained settings.

Invent stage: Establish innovation clubs in neighboring medical institutions to facilitate student collaboration on creative projects and promote interdisciplinary idea exchange. These platforms can integrate online educational resources and leverage expertise from visiting faculty members, thereby exposing participants to advanced concepts and emerging technologies. For instance, these innovation clubs could implement structured workshop programs focusing on medical device prototyping, enabling students to acquire fundamental technical skills while developing prototype models of their innovative medical concepts using cost-effective materials.

Implement stage: Local governments are inclined to offer financial support and legal incentives for student-initiated innovation projects. For example, small subsidies are provided to students to enable them to develop prototypes of medical gadgets. Local medical enterprises are also likely to offer valuable guidance and testing platforms for these projects. Enterprises can assign experienced engineers or researchers to mentor students, which helps students refine their ideas and ensures the feasibility of the projects. This is expected to facilitate the transformation of innovative ideas into practical applications.

In addition to the application areas, we are also determined to improve the design of the QS. To further boost the data quality in subsequent research, we plan to adopt reverse-coded items and indirect questioning tactics. To tackle significant survey factors, we will devise several reverse - coded items. For instance, the statement “I rarely come up with creative solutions in group projects” is reverse-coded. Moreover, as a part of our indirect questioning approach, students will be required to elaborate on how their peers would react in diverse innovation and entrepreneurship scenarios. This unique perspective will decrease the probability of students giving socially desirable answers.

Conclusion

Based on the Biodesign, and with strong support from school leadership, teaching and research institutions, and affiliated hospitals, the author’s institution has developed a comprehensive, three-stages teaching and training system encompassing “Identify,” “Invent,” and “Implement.” To evaluate the effectiveness of cultivating medical innovation and entrepreneurship talents based on Biodesign, this study designed a questionnaire covering the three stages, “Identify,” “Invent,” and “Implement.” The results revealed improvements in various areas, including demand identification, demand screening, concept generation, concept selection, strategic identification, and business planning. Among these, the most significant improvement was observed in demand identification. In terms of student competitions, the most notable achievements were observed, with the number of national awards rising from 32 in 2019 to 66 in 2023. In conclusion, the Biodesign-based cultivation model for medical innovation and entrepreneurship has yielded promising results and is worth further promotion among medical students. However, due to the limitations of this study, further applications of the Biodesign in medical student education are anticipated, along with expanded research to explore its broader impact.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Author contributions

Zhang Tao conceived the ideas, Xu Chenchen, Zhang Zhihao, Wang Lizhu and Zhang Tao research on the topic, data collection, data statistics and wrote the main manuscript. Ji Xin, Yue Yue and Liang Xurui assisted the experiment. Han Yufei and Hou Jiqin prepared figures and tables. Zhang Tao and Xu Chenchengave the funding. All authors reviewed the manuscript.

Funding

This work was supported by the National Natural Science Foundation of China (12275135), Nanjing Medical University High level Talent Introduction Initiation Fund (NMUR20210003), General Project of Philosophy and Social Sciences of Colleges and universities in Jiangsu Province in 2023 (2023SJSZ0132), Nanjing Medical University’s 2023 Annual Educational Research Project (2023LX002), and the key project of “13th Five-Year” Plan of Jiangsu Provincial Education Science (B-a/2018/01/40).

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

All procedures performed in the study involving human participants were in accordance with institutional and/or national research council ethical standards and in accordance with the 1964 Declaration of Helsinki and its subsequent amendments or similar ethical standards. All participants signed an informed consent form. All experimental protocols were approved by the Ethics Committee of the Nanjing Medical University.

Consent for publication

Not applicable.

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