1. Introduction
Change is inevitable, compelling individuals and organizations to evolve for survival. Healthcare in the 21st century has undergone tremendous transition from a hospital-centric, physician-driven model to patient-centered, technology-enabled model of care grounded in multidisciplinary collaboration. Today, a doctor’s role extends beyond a ‘healer’ to a ‘leader’ of healthcare team, who governs both finance and human resources [1]. To keep pace, the focus of medical education has shifted gradually from knowledge to skills, and competencies such as critical thinking, problem solving, communication skills, and interpersonal skills rather than rote learning. Despite these reforms in medical training, some lacunae prevail. This article argues for the integration of entrepreneurial competencies within medical curriculum, preparing medical graduates to navigate the rapidly changing healthcare landscape.
2. Re-examining medical education in an evolving healthcare landscape
Today, healthcare delivery is revolutionized by digital technology, nanomedicine, and biotechnology, opening newer avenues for future medical graduates [2]. Physician-led-startups can design medical devices and therapeutics that address real-world challenges and are truly beneficial to the end-users. To embrace the wider aspects of their role in contemporary healthcare, future doctors need skills beyond clinical proficiency. Sadly, research findings reveal contemporary medical graduates lack nascent entrepreneurial behavior required to harness these opportunities effectively; exposing serious gaps in skillsets [3]. One of the major attributable factors could be sparse incorporation of entrepreneurial training into undergraduate medical curricula worldwide [2-5].
Anchored in the conventional notion that medicine is a discipline devoted to patient care, medical education has often neglected the cultivation of non-clinical skills. Especially, innovation and entrepreneurship are regarded by some as antithetical to medical science [2]. Consequently, doctors entrusted with management roles in a hospital, express low job satisfaction. Medical students with entrepreneurial aspirations are left to imbibe new skills, scan for resources, and establish networks on their own, with very little support from university. The theoretical foundation for entrepreneurial training is provided by the theory of planned behavior by Ajzen [6] which posits that most of human behavior are purposeful and preceded by deliberate intent. Accordingly, scholars argue that entrepreneurial training in medical schools instill entrepreneurial intention, even if it does not culminate in immediate startups [3]. With artificial intelligence poised to fully or partially replicate several functions of doctors in foreseeable future [7], there is an urgent need to rethink how medical education prepares future doctors to close these emerging gaps in competencies.
3. Entrepreneurial competence and its distinction from medical competencies
Entrepreneurial competence is defined as the ability to transform ideas into action, and creating value (financial, cultural, or social) for others [8,9]. To guide curriculum designers for formal entrepreneurial training, Bacigalupo et al. [8] in 2016 provided entrepreneurship competence framework (EntreComp) which is a broad-based tool with competencies graded across eight proficiency levels from foundation to expert, with three areas, and 15 competencies.
To examine the alignment of these competencies with those stated in established medical education frameworks namely the Canadian Medical Education Directives for Specialists (CanMEDS), the Accreditation Council for Graduate Medical Education (ACGME), and the General Medical Council (GMC), a comparative table has been developed (Table 1). Entrepreneurial and medical competences demonstrate areas of overlap in certain domains while diverging in their underlying aims and scope. Despite grounding in distinct value systems, several entrepreneurial competencies are either explicitly or implicitly embedded within leadership and professionalism domains of medical educational frameworks. Among them, CanMEDS explicitly accommodates most entrepreneurial competencies making it suitable to frame entrepreneurship-embedded medical education curricula. However, some entrepreneurial competencies such as creativity, visionary thinking, opportunity recognition, risk taking, and financial literacy are partially represented or absent. While these gaps reflect prioritization of patient safety, equity, and professional integrity over entrepreneurial venture creation, closing these gaps could offer substantive benefits. Creativity fosters innovative ideas to address patients’ problems. Likewise, opportunity recognition, risk taking, and financial literacy prepare students to translate scientific ideas into commercially viable healthcare innovations as physician-innovators as well as improve their ability to sustain as self-employed doctors. Thereby, provide viable options for medical students who are looking for alternative careers beyond patient care [3].
Table 1.
Alignment of Entrepreneurial Competencies with Common Competency Frameworks in Medical Education
| Entrepreneurial competency framework | CanMEDSa) | ACGMEb) | GMC | Implication |
|---|---|---|---|---|
| Area 1: Ideas and opportunities | ||||
| Identification of opportunities | Implicit (leader) | Implicit | Implicit | Focus on identifying problems rather than opportunities |
| Creativity | Implicit (scholar) | - | Implicit (innovation in practice) | Creativity is not assessed |
| Vision | - | - | - | Long term vision is absent |
| Valuing ideas | Implicit (evidence-based framing) | - | Implicit (patient safety) | Clinically validated ideas are valued |
| Ethical and sustainability thinking | Explicitly addressed (professional & advocate) | Explicitly addressed (professionalism) | Explicitly addressed (professional values) | Strongly aligned |
| Area 2: Resources | ||||
| Self-awareness and self-efficacy | Implicit (scholar) | Implicit (PBLI) | Implicit (reflective practice) | Aligned |
| Motivation and perseverance | Implicit (professional) | Implicit (professionalism) | Implicit (fitness to practice) | Resilience is emphasized. Though not for new venture creation |
| Mobilization of resources | Implicit (collaborator) | Implicit (systems-based practice) | Implicit (leadership) | Focus is mainly on human resources |
| Financial literacy | - | Implicit (cost awareness) | Implicit (resource stewardship) | Focus on cost control and sustainability |
| Mobilizing others | Explicitly addressed (leader) | Explicitly addressed (ICS) | Explicitly addressed (leadership) | Strongly aligned |
| Area 3: Into action | ||||
| Taking the initiative | Implicit (leader) | Implicit (PBLI) | Implicit (professional responsibility) | Initiative under supervision is encouraged |
| Planning and management | Implicit (leader) | Implicit (systems-based practice) | Implicit (leadership) | Clinical planning and not venture planning |
| Coping with uncertainty, ambiguity, and risk | Implicit (medical expert) | Implicit (patient care) | Implicit (patient safety) | Preference to risk aversion |
| Working with others | Explicitly addressed (collaborator) | Explicitly addressed (ICS) | Explicitly addressed (teamworking) | Strongly aligned |
| Learning through experiences | Explicitly addressed (scholar) | Explicitly addressed (PBLI) | Explicitly addressed (reflective practice) | Strongly aligned |
CanMEDS: Canadian Medical Education Directives for Specialists, ACGME: Accreditation Council for Graduate Medical Education, GMC: General Medical Council, PBLI, Practice-Based Learning and Improvement, ICS: Interpersonal and Communication Skills.
a)CanMEDs 2015 Physician Competency Framework. b)ACGME Core Competencies IV A. 5.
4. Pedagogical approaches for developing entrepreneurial competencies
In recent years, there is a growing body of literature acknowledging the importance of entrepreneurial training in medical schools [2-4,9-12] and examining entrepreneurial readiness among medical students [13]. Despite this recognition for entrepreneurial competencies, medical professional organizations and regulatory bodies have failed to standardize its curricular structure, implementation, and evaluation [2,5]. Nevertheless, diverse pedagogical models for entrepreneurial training in medical schools have been reported. These range from student-centered extracurricular initiatives, such as seminar series covering innovation, leadership, clinical entrepreneurship, healthcare systems, and financial literacy [4], to teacher-paced approaches delivered through structured online courses [10]. Experiential and community-based project learning [11], as well as innovative strategies like gamification and hackathons have been implemented to foster entrepreneurial competencies [12]. In some institutions, formal dual degrees in medicine and business are offered [4,5]. Despite utilizing varied pedagogical models, most studies have reported favorable outcomes [4,10-12].
To suit their primary role as healthcare providers, entrepreneurial training for medical students must include digital health technology, innovation, intellectual property, patent laws, medical ethics, fundamentals in healthcare business, financial literacy, and clinical entrepreneurship [2]. Innovation must be woven into ethical framework of medical education to foster a mindset that aligns invention with societal needs. In this regard, strategies like experiential problem-solving projects addressing global healthcare problems and university-level business proposal competitions for affordable healthcare products can be utilized.
5. Challenges to implementation of entrepreneurial training in medical education
The concept of entrepreneurial training in higher education is not new, having emerged in the 1940s–1950s. However, its progress into medical education has been rather slow, with numerous challenges hindering its implementation. The absence of an existing, mature entrepreneurial training model suitable for medical field which can be replicated or sustainably executed is a major challenge. Secondly, it is difficult to reduce entrepreneurial learning to pre-set learning outcomes as creation of value cannot be foreseen in abstraction [8]. Embedding entrepreneurial competencies into an already dense academic and clinical curriculum presents another significant challenge. Further, regional disparities in economic development have created differences in the availability of resources such as entrepreneurial centers at university, funds ear-marked for grants, and university-affiliated venture capital. In addition, medicine is a highly specialized field with rigid faculty structure. Teachers in medical schools have no formal training in entrepreneurship and few training programs in innovation and entrepreneurship are available for the professional development of physicians [11]. Thereby, need for trained manpower from a wide array of backgrounds such as engineering, medical science, business, and law to teach entrepreneurship and innovation poses another challenge.
6. Is it ethically justified?
The inclusion of entrepreneurial competencies into medical education is certainly not a shift from altruism towards commercialization of medicine. Instead, it is a strategy to foster creativity, resilience and problem-solving among future doctors. Entrepreneurial education grounded in public health ethics can generate solutions to combat health inequalities, affordability, and system inefficiencies. By equipping medical students to identify opportunities, innovate, and translate ideas into sustainable solutions for healthcare needs of local communities (especially the underprivileged), it would help align medicine with its broader ethical commitment of service to society.
7. Conclusion
To embrace the opportunities offered by the technological revolution of 21st century and broaden the scope of career options for medical graduates, it is axiomatic that entrepreneurial education be incorporated into the medical curriculum. A clearly articulated medical entrepreneurship curriculum is needed to systematically guide educators in curriculum design, implementation, and evaluation. From a personal standpoint, cultivating entrepreneurial competence is more than an academic enhancement as it ensures tomorrow’s doctors can lead with vision, adaptability, and social accountability in an increasingly complex healthcare ecosystem.
Footnotes
Acknowledgements
None.
Funding
No financial support was obtained.
Conflicts of interest
No potential conflict of interest relevant to this article was reported.
Author contributions
The first author was involved the conception and drafting of this article while, the second and third authors have critically revised and approved the final draft.
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