Launch, Learn, Pivot, and Scale: Evolution of the Medical Innovators Development Program

Abstract

Medicine requires physician-leaders trained in interdisciplinary problem-solving and in responding to complex adaptive systems. The rapid pace of technological change poses an unmet need for physicians who have aptitude in engineering, informatics, systems design, entrepreneurship, and other creative problem-solving tools to improve the health of society. The Medical Innovators Development Program (MIDP) is a MD candidate training program that was designed to meet this growing need. MIDP blends various frameworks including Design Thinking, Biodesign, Lean Six Sigma, the Business Model Canvas, and others into a 4-year curriculum that is integrated into the core MD curriculum. The capstone experience is a 3-month immersive team-based course in stakeholder discovery, design prototyping, and pitching solutions to address clinical needs identified during clerkships. The MIDP offers a roadmap for MD students to gain skills in and apply innovation and design fundamentals to self-discovered clinical needs. MIDP students have seen success in various ways: presentations to the Board of Trust, participation in the prestigious I-Corps program, multiple entrepreneurial pitch competition wins, institutional pilots, and to date, four technology transfer intellectual property disclosures. MIDP's next steps focus on scaling impact. Specific aims include building internal infrastructure for further development of promising “orphan” ideas after students graduate, facilitating interprofessional opportunities for undergraduate and graduate student collaboration, maintaining an active alumni network, and inspiring other similar integrated MD programs.

Introduction

Healthcare faces many challenges as a practice and as an industry, including increasing rates of burnout, expanding health disparities, defining a role for rapidly evolving artificial intelligence technologies, and addressing the impact of climate on health. These are wicked problems: complex and systemic problems that lack universal or elegant solutions. ¹ These problems require physician leaders trained in innovation and interdisciplinary problem solving and who are well-equipped to employ adaptive expertise. ²

Competency-based medical education (CBME) develops learners on patient-centered outcomes. The introduction of such competencies in quality improvement (QI) and other systems-based practice skills has helped medical educators emphasize the importance of broader systems on the lives of patients. However, these efforts have faced many obstacles.^3,4 Common frameworks for QI such as Lean Six Sigma and the Institute for Healthcare Improvement (IHI) Model for Improvement represent only a portion of the approaches to solve complex problems, with methods primarily stemming from manufacturing. With new technologies transforming medicine, there exists a need for practitioners with aptitude in engineering, entrepreneurship, informatics, systems design, and other creative problem-solving approaches.

To meet this need, medical schools are adding innovation frameworks to their curriculum.^5–8 Our Medical Innovators Development Program (MIDP), ⁹ launched in 2016, is one such example. This perspective outlines eight years of iterative curriculum design in MIDP, showcasing innovative approaches, major pivots, successes, and lessons learned. All solutions described were implemented by the program leadership with input from institutional leaders and students.

Body

Program Overview

MIDP is a longitudinal, team-based medical school curriculum curated to train physician-innovators via experiential learning. The curriculum employs problem-solving techniques from fields of design, engineering, manufacturing, process improvement, education, and entrepreneurship. The current leadership team is made up of four faculty members and one administrative staff member. The faculty includes two physicians, one speech & language pathologist, and one engineer. Their combined innovation expertise includes training Lean & Six Sigma, Design Thinking & Systems Thinking, the IHI Model for Improvement, Biomedical Informatics, Biodesign, the Business Model Canvas, and the NSF Innovation Corps approach on top of clinical practice, research, curriculum design, and academic coaching.

The MIDP curriculum was originally designed to apply engineering principles to clinical problems with a strong emphasis on end-user experience by leveraging Design Thinking. Principles of Design Thinking have been taught for decades; however, this phrase was popularized in the 1980s by the innovation consulting firm, IDEO, which later partnered with Stanford's Hasso Plattner School of Design to formalize their approach into a curriculum. This approach was later applied to develop medical technologies through what is now known as Biodesign. MIDP blends many different problem-solving methodologies from manufacturing, engineering, entrepreneurship, policy, and social changemaking into a 4-year curriculum that is integrated within the core medical school curriculum.

Program Evolution

MIDP's five core values, as co-designed by early student cohorts together with program leaders, are to: (1) challenge the status quo, (2) respect and encourage all voices, (3) value human connection over data, (4) practice curiosity, and (5) embrace uncertainty. Whenever iterating upon our curriculum or program design, we frame discussions and debates around these core values. In 2022, we underwent a change in our program's structure that represented a significant challenge to our status quo. Our approach to this programmatic change involved embodying these other four values. Here we share these changes and our lessons learned so that others might learn alongside us as they innovate with their own educational programs. Table 1 illustrates an overview of MIDP as well the changes to MIDP made during this 2022 redesign.

Table 1.

MIDP Core Features, Structure, and Evolution.

MIDP features and changes
	Current structure	Changes from 2022 to 2024
Leadership structure	Four faculty members: two physicians, one speech and language pathologist, and one engineer One administrative staff member	None
Selection process	Five students selected per cohort Students must be accepted to medical school prior to MIDP application 15–20 applications received annually from accepted student population Applicants submit CV and essay on desired professional identity 90-min collaborative design challenge involving teams of 4–6 applicants Selection based on complementary combination of skills, diversity of thought, and variety of lived, professional, and academic experience	Cohort size increased from 2 to 5 students per year Removed doctorate degree requirement Full-tuition scholarships relinquished to medical school's general scholarship fund Selection criteria expanded to focus on systems thinking and broader backgrounds Application timing changed: students previously applied to MIDP and medical school simultaneously; now apply to MIDP after medical school acceptance
Curriculum	Years 1–4: Weekly lunch forums with invited speakers across healthcare domains Year 2: Innovation, Activism, and Altruism (IAA) course alongside core clerkships; students catalog unmet clinical needs using Biodesign Needs Finding approach Year 3: Three-month IDEA Lab capstone course emphasizing stakeholder discovery, prototyping, and pitching; Curriculum Redesign Challenge Years 3–4: Intrapreneurship and Entrepreneurship (I&E) longitudinal course covering intellectual property, regulatory pathways, and concept-to-market roadmap planning Year 4: Industry Immersion internship (1–3 months) in startups, technology companies, regulatory agencies, or other industry organizations	Intrapreneurship & Entrepreneurship (I&E) restructured in 2024 from self-directed exploration to a structured course covering intellectual property, regulatory pathways, and concept-to-market roadmap planning
Program evaluation	Curriculum redesign challenge: 1-h observed design challenge at end of IDEA Lab MIDP Student Annual Report: open-ended survey on professional identity differentiation and skill application Milestone-based assessment approach across domains: Patient Care, Knowledge for Practice, Interpersonal & Communication Skills, Problem-Based Learning & Improvement, and Professionalism Standard course evaluations serve as secondary data	None

Cohort Selection

In 2022, our cohort size was increased from two students to five students per year. MIDP was designed initially as a PhD-to-MD path for doctoral-trained applied scientists to gain medical training as a path to medical innovation. Full-tuition scholarships were awarded. While this was an excellent recruitment tool, we were unable to scale the program without a significant funding increase. Across these early MIDP years, it was noted that execution of a cohort's capstone project often required knowledge or skill outside of the cohort's expertise, such as entrepreneurship or policymaking. Thus, in 2022, MIDP removed the doctorate degree requirement and relinquished the guaranteed scholarship back to the medical school's general scholarship fund. Selection criteria were expanded to focus on systems thinking and to seek students with a wider variety of backgrounds including design, art, and advocacy to broaden the field of applicants. The goal in selecting each MIDP cohort is to achieve diversity of thought, along with a combination of lived, professional, and academic experience to ensure problems are approached from a variety of perspectives. We believe it is only through these broad perspectives that wicked problems can be appropriately addressed.

MIDP receives 15–20 applications each year from our accepted student population. Prior to 2022, students applied to MIDP and the medical school simultaneously and would have to be accepted by both. Now, a student must be accepted to the medical school before applying to MIDP. One concerning area of uncertainty with this change was whether applications would drop after this dramatic decrease in our pool of applicants. This turned out not to be the case.

Students submit a CV and a short essay outlining how they hope MIDP can help them on their path to their desired professional identity. The flagship feature of MIDP's selection process is a 90-min design challenge. Teams of 4–6 prospective applicants work collaboratively to tackle a wicked healthcare problem which is crafted by third year MIDP students and program leaders. Examples from years past include improving ways to communicate with hearing-impaired patients in a busy emergency department, optimizing the operating room tool supply chain to enhance surgeon personalization and environmental sustainability, and reducing hospital-acquired debility. The problem is presented in the form of a patient case along with a package of hypothetical due diligence that includes stakeholder testimony and relevant data. The team is encouraged to access resources (e.g. literature, search engines, artificial intelligence, etc.) as they design a solution and craft a ten minute pitch presented to MIDP leadership. An additional ten minutes of Q&A follow, wherein team members explain their ideation process and justify their design choices.

From inception to pitch, MIDP leadership observes each applicant's team participation through the lens of MIDP's five core values. Applicants are not scored quantitatively, but rather qualitatively, as the leadership team looks for specific instances where applicants embody the program's core values noted above. As the design challenge format mirrors the format of the third-year team-based capstone course, known as Innovation Design Experience & Application (IDEA) Lab, MIDP leadership and current students assess how each applicant might complement a future team. Students’ CVs, essays, and design challenge performance are considered as the MIDP leadership team selects the cohort based on which five candidates may provide the most complementary and dynamic combination of skills.

Curriculum

Across all 4 years, MIDP students and leadership attend weekly lunch forums with invited speakers spanning various healthcare domains such as industry, entrepreneurship, academic research, venture capital, and technology transfer. These forums serve as a source of interclass community-building as well as a way to introduce first year students to the multiple problem-solving methods that are applied across the MIDP curriculum. As our program expanded, it was very important to all our stakeholders that this space for human connection remained.

Second year students enroll in a year-long course known as Innovation, Activism, and Altruism (IAA) alongside their core clerkships of medicine, surgery, OBGYN, neurology, psychiatry, and pediatrics. Within each clerkship, students catalog at least five unmet needs observed on the wards or in clinics. Monthly, each student then selects a problem to present to peers and leadership in a classroom setting. They analyze each problem leveraging a Biodesign Needs Finding ¹⁰ approach to determine if the need is incremental or blue-sky, how big the market might be, what the clinical impact would be if solved, and many other criteria. Students are then invited to brainstorm “nonobvious” solutions that seek inspiration from industries outside of healthcare (e.g. biomimicry, science fiction, art, etc.). Students identify specific needs criteria required to solve the problem based on market landscape, existing solutions, stakeholder opinions, and other angles of analysis. Ultimately, students have a framework for “needs selection” that ensures the work they do complements their desired professional identity. At the end of the clerkship year, students collectively narrow their combined list of needs to one problem that they will explore collaboratively in the third year.

The three consecutive month third-year capstone course is called Innovation Design Experience & Application (IDEA) Lab. Built on a foundation of stakeholder discovery, students conduct interviews to understand existing pain points, learn technical concepts from experts, and understand the perspectives of various stakeholders and key opinion leaders. These multidisciplinary insights are essential to finding intervention opportunities, as interfacing among professionals with expertise across domains such as business and engineering is critical for successful implementation. Students meet with MIDP leadership for 4–6 office hours per week. While this course is primarily experiential, they do receive didactic content on recruiting, conducting, and analyzing discovery interviews, root cause analysis, designing small iterative validation experiments, market analysis, project management, and entrepreneurship tools such as the business model canvas. Students directly apply these didactic lessons to their broad discovery insights to conceptualize solutions that achieve desirability, technical feasibility, and financial viability at scale. They design prototypes or pre-totypes ¹¹ of their solutions to test and validate their value proposition. Finally, they present pitches to convince others of their value proposition and seek feedback from institutional leaders and industry experts.

In the post-clerkship period of our medical school (third and fourth year), students participate in a longitudinal course, Intrapreneurship & Entrepreneurship (I&E). I&E was formerly a self-directed opportunity to explore topics of individual student's choosing. However, based on student feedback and a programmatic desire to focus on research competencies, in 2024, I&E became a structured course that covered intellectual property (IP), regulatory pathways, and concept-to-market roadmap planning. These roadmaps contain plans for clinical trials to help achieve FDA approval.

The fourth year also includes a minimum of a month-long internship, called Industry Immersion. Students can extend Industry Immersion up to 3 months by using general elective time. Students work with MIDP leaders to secure these internships in startup companies, tech giants, regulatory agencies, or another industry organization that fits their interest. A student's roles in industry immersion vary based on student skills and industry needs. Past examples include research and development at Fortune 500 technology companies as well as grant-funded startup development through the NSF I-Corps program. The not-so-hidden curriculum of Industry Immersion includes the networking skills that are required to explore industry career opportunities.

MIDP courses are designed to creatively embed competencies such as research and QI within the context of physician-led innovation. MIDP courses are crafted to replace other courses in the traditional medical school curriculum, such as dedicated research and QI curricula, and students therefore, do not require additional coursework.

Program Evaluation

As MIDP is focused on exploring new frontiers, defining measures of success is inherently challenging. Students are encouraged to explore boundaries that might lead to surprising and unpredictable outcomes. We are acutely aware of, and train our students, on the dangers of Goodhart's Law—when a measure becomes a target, it ceases to be a good measure. The impact that our program aims to have on our students’ careers and the field of medicine requires several years of lead time during which countless confounders will be introduced. Furthermore, an objective evaluation of our programs’ impact would require us to control for sampling bias as we are already selecting for students who embody our core values. With these limitations in mind, we offer our perspective on evaluating programs designed to challenge the status quo.

To start, the primary focus of our evaluation strategy is continuous improvement, not measuring success. The former allows us to avoid the trappings of Goodhart's Law and reset our targets whenever a new frontier is identified or broached. While MIDP courses are evaluated favorably by students on standard course evaluations, we actively engage our students in implementing their feedback into the syllabus and learning objectives of each course. The most formal of these experiences is a Curriculum Redesign Challenge that occurs at the end of IDEA Lab. The team engages in a one-hour observed design challenge, where they apply skills learned during the course to reimagine the course. As such, formal course evaluations, while valuable, serve as secondary data in the continuous curricular improvement cycle.

To evaluate the impact our program is having on our students’ career trajectories, we have implemented what we call our “MIDP Student Annual Report.” This brief open-ended survey allows our students to submit how the MIDP curriculum has helped them differentiate their professional identity and how skills learned in MIDP have helped them achieve greater impact in other curricular or extracurricular experiences. As our students move from third year to fourth year, we send their submissions back to them to help with building their residency applications. While the volume of comments in this form would not be enough for a formal qualitative study, we will share some of the ways in which our students have regularly identified new frontiers for our program.

MIDP students have produced four disclosures to our technology transfer office in the past two years. Disclosures only started after MIDP students pioneered a process to be treated similarly to faculty inventors under the university IP policy. Whereas it may seem counterintuitive for students to grant IP rights to the university, MIDP students often grow to appreciate the considerable time and effort required to commercialize their ideas throughout the curriculum. Thus, many prefer to employ existing infrastructure at our institution to further the development of their ideas. MIDP teams have seen financial windfalls, including acceptance into the NSF I-Corps Program, ¹² a $50,000 award, and three NSF “microgrants.” They have been invited to participate in TigerLaunch ¹³ and have been finalists in the Tennessee Pitch for Good. ¹⁴ Additional evidence of their impact includes three MIDP student projects that have been translated into Biomedical Engineering Undergraduate Senior Design projects. One project, aimed at hospital gown redesigning with a focus on patient-dignity, resulted in an undergraduate coordinating a fashion exhibit and winning a prestigious university award. At present, only one MIDP graduate has completed residency. This graduate is the first physician member of a highly innovative global engineering lab. Another MIDP alumni has launched a social movement to advance equitable representation in medical research.

To look further upstream at student knowledge and skill development, we use a milestone-based assessment approach that mimics the competency-based assessment system in our clinical environment. Milestones in Patient Care, Knowledge for Practice, Interpersonal and Communication Skills, Problem-Based Learning and Improvement, and Professionalism have all been adapted to assess innovation behaviors. Whether interviewing with empathy, developing a differential, or practicing evidence-based shared-decision, milestone wording has been adjusted to focus on the students’ ability to solve a problem for an entire system, rather than a single patient. However, even these means of program evaluation are confounded. We are not assessing non-MIDP students on this same basis, and all our students perform very well on these evaluations as they receive direct coaching through frequent contact hours in our curriculum as they develop their projects.

Conclusion

In 2022, the MIDP underwent a structural redesign; however, challenging the status quo is paradoxically the norm within our program. MIDP's yearly iterative model aims to benefit current students while continuously exploring future possibilities and addressing new problems we encounter along the way. One key challenge is how to address “orphan” projects—great ideas that sit on a metaphorical shelf while graduates move on to the long hours and demands of residency. Although our unique disclosure process has catalyzed new teams to pursue orphan projects, we plan to scale our efforts in additional ways. For example, we seek to grow MIDP's impact by building interprofessional opportunities for students from undergraduate and other graduate programs across the university. Additionally, while our program is small and intensive, there may be an opportunity for broader reach with more general topics to the entire MD class.

With the elimination of the PhD entry requirement, MIDP students are eager to explore opportunities that might have otherwise appeared less desirable such as dual-degree programs and year-long industry internships. We are building the capacity to personalize experiences without disrupting the cohort-based nature of MIDP. Finally, as more MIDP students graduate and our alumni begin their post-training careers, a formal and robust alumni support program will grow MIDP's impact on the field of medicine, communities, and society at large.