If biomedical science and clinical medicine are to advance, it is vital that we cultivate physicians’ capacity for innovation. Yet there are many features of contemporary medical education that fail to nurture – and in some cases positively undercut – the capacity to innovate.
One problem is the culture of conformity that grips many physicians in training. They are evaluated not by the quality of the new ideas they formulate, but by the degree to which they conform to competencies, guidelines, and policies.
Physicians in training quickly learn that the way to earn high marks is to answer correctly the questions posed by their instructors, not by formulating their own questions. To move biomedical science forward, we need to replace the culture of conformity with one of inquiry.
A related challenge concerns the attitude toward error. Because the consequences of mistakes can be so dire, partly for the career of the physician but even more so for the health of patients, many young physicians develop a strong aversion to risk taking.
The imperative never to err places a premium on avoiding undertakings that could result in failure. As a result, young physicians allow this apparent prohibition against mistakes to prevent them from ever attempting bold ventures with the potential to make big differences.
A third impediment to innovation is an excessive esteem for credentials. Academic programs and medical practices tend to look for candidates from prestigious institutions with high grades and test scores, rather than people who exhibit high degrees of curiosity and imagination.
To foster innovation, we must focus less on the degree to which young physicians have checked the same boxes as the other learners at their same stage of training, and instead focus more on their capacity to contribute new ideas.
A fourth challenge to innovation is rooted in a culture of control. The organizations that accredit medical education programs, including medical schools, residency programs, and continuing medical education, often base their evaluations on the degree to which they correspond to a single model.
Instead of fostering a bottom-up approach that prizes the distinct contributions of each learner and program, this centralized approach exacerbates the tendency toward conformity and risk aversion, with the result that educational innovation is often perceived as an excessively risky proposition.
Finally, physicians in training frequently get the message that their work is going to be assessed according to an assembly line model that emphasizes throughput, productivity, and revenue generation. They are told, in effect, to keep their noses to the grindstone.
In fact, however, innovation requires an outward-looking and inquisitive frame of mind grounded in a diverse range of experiences. Instead of hunkering down at the workstation, physician innovators need to be in the habit, figuratively speaking, of getting up and walking around.
Ultimately, the quality of biomedical innovation hinges on the quality of ideas we are able to generate, which in turn depends on the quality of conversations in which we engage on a regular basis. We need to help one another look at things from new and different perspectives.
From this point of view, the real locus of innovation is not the board room or the C-suite, but the front lines of patient care, research, and medical education. This is the zone in which medicine’s future innovators need to be focusing much of their time and attention.
Research funding, laboratory space, and information systems are all important resources for bio-medical innovation, but the ultimate challenge is a cultural one. If we are to unlock the full imaginative potential of future physicians, we need to nurture professional communities that prize innovation.
Dr. Richard Gunderman is Chancellor’s Professor of Radiology, Pediatrics, Medical Education, Philosophy, Liberal Arts, Philanthropy, and Medical Humanities and Health Studies at Indiana University.