Introduction

There has been a decline over the past three decades in academic clinicians involved in problem-based biomedical research and innovation [1]. Physicians have a front-row seat to patient problems, placing them in a unique position to innovate. COVID-19 has further accelerated the need for new medical solutions to clinical problems. However, most physicians do not receive formal innovation training and, therefore, lack the skill set to embark on the process [2].

Engaging more clinicians in innovation would benefit both patients and society. Dermatologic products and technologies are quickly growing in popularity, especially via social media channels, and the market is ripe for interested entrepreneurs and investors. The Dermatology Entrepreneurship Conference, initiated by a nonprofit organization called Advancing Innovation in Dermatology, offered the first dermatology-focused hackathon [3]. Hackathons have also proven to be increasingly popular, though they often lack continuity and are not commonly attended by physicians.

The Magic Wand Initiative (MWI) was launched to educate and empower creative clinicians to identify and solve problems affecting patient care. The MWI was launched in 2013 by Drs. Rox Anderson and Lilit Garibyan in the Department of Dermatology at Massachusetts General Hospital, a Harvard Medical School teaching hospital [4]. The purpose of the program is to increase clinician involvement in problem-based innovation in dermatology. Due to the success of this program within dermatology, it has been expanded to other specialties such as general surgery, orthopedic surgery and anesthesia. This program expanded into a virtual format (Virtual Magic Wand program) in 2018 to allow clinicians across the country to participate in innovation training. This is done through monthly virtual seminars held over the course of nine months, during which clinicians identify, define and present on a problem worth solving derived from clinical care. Prominent dermatologists and thought leaders are invited to brainstorming sessions to help participating clinicians in the program vet and frame the problem worth solving. The course also provides didactic sessions on topics such as intellectual property and design thinking (Table 1). The program has grown from 7 participants in 2018 to 22 participants in 2022 from across the U.S. and Canada. Studies on the program have shown that the innovation skills taught during the VMW program reduce burnout and bring more joy to daily work [2]. To identify the impact of the VMW program on participants and decipher the potential benefits of this innovative curriculum, we conducted structured interviews of 12 alumni.

Table 1 Virtual Magic Wand sample syllabus
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Methods

Data collection

Qualitative research methods were selected for this study to interpret nuanced responses about the participants’ experiences. We used grounded theory, a method that derives theory as data is collected as opposed to conducting research to reject or accept a hypothesis, as a basis for the study. All recruitment and data collection procedures were completed by a trained research assistant (RA) from June through December 2021 (R.A.D.) We performed qualitative analysis of semi-structured interviews from past participants of the VMW program (12/33 alumni). The RA recruited participants via email and interviews were conducted via video call. The alumni interviewed were those who responded to our recruitment email. The participants represented a range of genders, current roles, and geographic locations (Table 2).

Table 2 Interviewee characteristics
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At the beginning of the video interview, we verbally consented participants. Each participant acknowledged that the interviews were voluntary and were asked if they were comfortable with being recorded. They affirmed understanding that the purpose of the interviews was research. The RA prefaced the interviews by stating the purpose of the data collection and her role in the research process. Interviews typically lasted 15–20 min and followed a standard discussion guide (Table 3).

Table 3 Standard discussion guide
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Data analysis

Audio recordings of interviews were fully transcribed and coded (R.A.D.) on Dedoose (SocioCultural Research Consultants, LLC, Los Angeles, CA), allowing emergent themes to be explored in subsequent groups. Interviews aimed to find commonalities between the experiences of dermatologists. The contents of the transcripts were confirmed by participants. Theoretic sufficiency, the point at which additional data sampling will not lead to additional information, was observed after 12 interviews. We utilized the 32 items on the Consolidated Criteria for Reporting Qualitative Research (COREQ) Checklist to ensure thorough reporting. We also used the Standards for Planning and Reporting Qualitative Research (SRQR). These checklists are available upon request.

Results

Decoding the study identified two major recurring themes which included (1) the benefits of the VMW program and (2) the barriers related to clinician-led innovation. It was found that the major benefits of the program were the network, the mindset shift that allowed participants to better identify problems, and the exposure to the innovation pathway. Regarding reasons clinicians do not engage in innovation as much as they would like, the most common reasons were lack of time, knowledge, and resources. All the alumni stayed engaged in the dermatology innovation ecosystem following the program’s completion.

Theme 1: Benefits of the VMW program

Network

All participants (n = 12, 100%) spoke positively about the network the program gave them. Many alumni (n = 10, 83%) expressed that being exposed to leaders in their field and active innovators created excitement about innovating.

Many interviewees also cited the invaluable resource of working exclusively with other physicians in their specialty:

  • “The major difference between VMW and other innovation programs is the focus on people with the same background who see the same problems. During presentations, I understood exactly what the clinicians were talking about since I had the same problems myself. Talking to the same subspecialty and connecting with physicians who are more advanced and who have contributed to the field has been really helpful.” (Medical & Cosmetic Dermatologist, San Francisco, CA)

Ten participants (83%) expressed gratitude for the time donated by leaders who are innovators in dermatology and how it inspired them. Participants highlighted the benefits of being surrounded by program leaders and guest speakers who are experts in the field and who helped guide them in problem definition and articulation.

Changed mindset to identify problems

All but one of the dermatologists spoke about how the VMW program allowed them to see the world differently (n = 11, 92%). Specifically, they noted how they were more attuned to problems, more likely to collaborate with other departments, and more likely to believe in themselves as agents of change. When asked about finding time to innovate, one participant noted the act of innovating as a way to relax. She also felt it made her clinical duties feel more enjoyable, as she was seeking out problems worth solving, and felt she was a better clinician by being involved in innovation.

Many participants noted how part of their shift in thinking fostered their ability to become entrepreneurs:

  • “One of the nice byproducts of this was just seeing some of my classmates come up with new products and feeling like any of us can do it…it was very inspirational to be able to see people have an idea and then run with it.” (Dermatologist & CEO, Washington, DC)

Learned innovation techniques

After the benefits of connecting with like-minded individuals and a changed mindset, the instruction on the innovation process was the third most commonly mentioned benefit of the VMW program (n = 10, 83%).

One idea reinforced several times throughout the VMW course is the focus on problems rather than solutions. The authors appreciated many of the interviewees mentioning this concept:

  • “The biggest contribution the VMW program has had for me is how to think about problems. In the past I would have said: ‘Here's a problem I see but I can't do anything about it.’ Now I say: ‘What are the things that make it a problem? Why hasn't it been solved yet? How do I think through it? Why does the problem still exist?’ Thinking about that is key to moving forward to finding solutions.” (Medical & Cosmetic Dermatologist, San Francisco, CA)

Additional illustrative interviewee quotes demonstrating the gains the participants experienced can be found in Table 4.

Table 4. Table
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Theme 2: Barriers related to clinician-led innovation

Time

Over half of the participants (n = 7, 58%) noted time as the biggest barrier to innovation. Some feel an obligation to other duties, such as administrative tasks or family life.

Lack of knowledge

Half of the physicians (n = 6, 50%) felt they lacked the knowledge about entrepreneurship to go forward with the idea.

Lack of resources

Even if the physician had an idea and the commitment to dedicate the time to an innovative project, almost half (n = 5, 42%) of those interviewed felt that they lacked resources. Other physicians noted that employers often do not want to take on the risk of an innovative project when a stream of patients is a sure way to generate income for their shareholders.

Additional illustrative interviewee quotes demonstrating the prominence of the aforementioned barriers can be found in Table 5.

Table 5. Table
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After the VMW program

All alumni interviewed have stayed engaged in the field of biomedical innovation after their completion of the VMW program. Two (17%) participants have become leaders in the Magic Wand organization. One participant took on a leadership role within the dermatology innovation network and is mentoring dermatology residents interested in innovation. Four (33%) participants are currently working on an innovative idea. One is serving as a medical consultant for a startup, while another co-founded a medical environmental nonprofit. Another is implementing innovative projects within their academic medical care system. Two VMW alumni interviewed started their own startup companies. One of these founders noted how helpful the program was in the creation of his company:

  • “I think the idea…was significantly improved via the VMW program. Getting more eyes and brains on the idea refined the final product and I received guidance on the best way to take it to market.” (Dermatologist & Founder, New York, NY)

Several of the VMW alumni interviewed were residents when they were enrolled in the course and expressed interest in continuing their innovation work as they progress through their careers. Each participant took distinct lessons from the course and has created their own path in the years since.

Discussion

This qualitative in-depth interview study revealed the noteworthy benefits of the VMW program and the barriers commonly experienced by clinicians who want to engage in innovation. The participants most commonly mentioned the importance of the network that the VMW program provided, as well as shifts in their attitudes toward innovation training and toward their capacity as innovators. The participants noted that lack of capacity, information, and means were the main obstacles that hindered their desired engagement in innovation work.

The VMW program connected participants to fellow dermatologists who were also interested in innovation; featured prominent speakers from diverse areas of innovation; and introduced participants to topical conferences, hackathons, and job opportunities. Despite going through years of education, many of the participants had never been taught the process of innovation and often did not know where to start, even when they had a great idea for a solution to an unmet need. The physicians had not previously encountered the VMW program material in their higher education coursework. Besides technical knowledge, many physicians did not realize that they had the ability to integrate innovation and entrepreneurship into their careers. The medical school curriculum sets physicians up to start their own private practices or pursue a career in academia, but rarely does it show future doctors they have the skills to become innovators. Many interviewees talked about how they dreamed up better ways of solving problems from a young age but did not think that clinicians could go down the path of becoming a founder or CEO prior to VMW. In addition to educational resources, the VMW participants also cited that they lacked resources from their employer, including protected time and funding, A dermatologist noted that the time spent applying for grants encroached on her allotted time to work on her idea.

We found many similarities between the experiences of the dermatologists during and after the VMW program, despite their different ages, genders, locations, and current roles. The Magic Wand Initiative team has acknowledged benefits of the program and will work to emphasize these helpful aspects as we expand our reach. Even without the VMW program, the network aspect can be implemented in other ways (i.e., social media). While the network can be provided easily and for free, buy-in from large institutions is needed to truly promote innovation that has the potential to change patient outcomes. Solutions are not required to be completely novel, as physicians have the clinical expertise to apply current solutions in innovative ways.

Many of the barriers spoken about can be overcome through educational interventions like the VMW program. Leaders in healthcare organizations can reduce physician workload or allow protected time for innovation. In terms of lack of knowledge and resources, medical education institutions should take note of the benefits of innovative work and offer learning opportunities for students. Medical schools have vastly expanded their curriculum in recent decades to offer a more holistic view of medicine, and innovation can be the newest addition. Several schools have already started innovation programs, like Vanderbilt School of Medicine’s Medical Innovators Development Program, Vagelos College of Physicians & Surgeons’ Innovative Medicine Program, Harvard Medical School’s HealthTech Fellowship and Course, and George Washington School of Medicine’s Clinical Practice Innovation and Entrepreneurship Track [5,6,7,8]. These programs all encourage clinically trained professionals to think deeply about the healthcare problems surrounding them and to apply innovation principles to ideate solutions to these problems. Even national professional organizations, such as the American Medical Association and the American Academy of Family Physicians have begun creating networks for practitioners interested in innovation [9, 10]. One recent study confirmed our findings that young clinicians are interested in biomedical innovation but require additional training to pursue entrepreneurial endeavors [11]. Physician burnout is a pressing issue in our country, especially after the COVID-19 pandemic, and expressing creativity through clinician innovation may be a needed respite. One physician asserts that, “the role of academic medical centers is not only to take care of patients but also to advance healthcare by bringing these innovations to the bedside” and that “entrepreneurship may be one of the most exciting opportunities in the twenty-first century” [12]. The momentum to integrate innovation and entrepreneurship curriculum into medical training has begun, and the outlook for better patient outcomes, happier physicians and an improved healthcare system is promising.

Limitations

First, all participants were dermatologists. While we anticipate that similar barriers to innovation exist in other specialties and among other clinical personnel, more research should be conducted in different fields with a variety of clinical roles. Second, only clinicians who volunteered were interviewed for this project. These participants may have experiences and opinions that differ from physicians who did not respond to our interview requests. Finally, due to our small sample size, we may have missed additional barriers or benefits. Although we reached thematic saturation, our sampling could have been broader.

Conclusion

VMW program encourages innovation by creating a network of like-minded individuals, teaching the innovation process, and shifting the way physicians think of themselves and their work. The biggest barriers to clinician-led innovation are lack of time, knowledge, and resources. Medical educators should reevaluate their curriculum to include teaching innovation, and department chairs may consider allowing their physicians protected time to innovate. More research is needed to examine the longitudinal effects of innovation instruction and benefits to other specialties.