The integrated innovation training pathway
Publication: The Bulletin of the Royal College of Surgeons of England
Volume 105, Number 1
Abstract
Can a new surgical training pathway bridge the knowledge gap for the next generation of surgeons?
Innovation is a broad term that encompasses anything new. In surgery, there are currently two predominant forms of innovation: product innovation (the introduction of new technology, such as robot assisted surgery and smartphone applications) and system innovation (the application of new ideas and methods to improve patient care, such as virtual clinics and virtual skills training). These innovations are developed through complex innovation cycles that can take significant time to achieve widespread adoption into clinical practice. An innovation pathway starts from idea generation and product development, and progresses through to translation and adoption in a healthcare system (Figure 1). Healthcare professionals play a key role throughout the entire innovation cycle, from identifying problems that exist in the workplace to adopting and using new technologies to provide the best care for our patients.
In the UK, trainees can choose between three integrated clinical training pathways: academic, medical education, and leadership and management. However, despite its importance in advancing our ability to treat and care for our patients, innovation is yet to be an essential skill that clinicians can learn. In this article, we propose the integrated innovation training pathway (IITP), a new career path integrating innovation and entrepreneurship into traditional clinical training for our future healthcare workforce.
The Unmet Needs
The unmet needs include:
•
a digitally capable workforce that is prepared for a technology enhanced future;
•
a generation of trainees who are skilled in navigating different aspects of the complex innovation cycle;
•
a pathway that recognises the skillset of these innovation trainees and encourages the retention of clinical innovators in the NHS.
A New Knowledge and Evidence Base
A technology enhanced future for surgery and surgical practice is inevitable. The 2018 Future of Surgery report1 and the 2022 Future of Surgery: Technology Enhanced Surgical Training (FOS:TEST) report2 outline how technological advancements will affect our roles as surgeons. They highlight a pressing need to upskill our workforce to prepare for this inevitability. As new technologies are introduced in our practice, clinicians (including surgeons) need to understand the evidence base and explain the technology available to patients. Ensuring that patients receive good communication about these technological advances is crucial to maintaining clinician integrity and trust. Developing a standardised education programme about key technologies that will influence our future practice over the coming years is essential to meet the expectations of our patients.
End-User Input into Innovation Cycles
We need clinicians who are prepared to take up the role of a clinical innovator. Clinical innovators range from those who have an aptitude for early stage innovation and create new technologies to those who are more talented in regulation and research looking to evaluate and adopt new technologies into practice. Unfortunately, trainees interested in this field go unrecognised in the current training pathways, meaning they often have to develop innovation and entrepreneurial skills in their own time or leave training altogether. With increasing numbers of UK graduates leaving training,3 addressing those who are leaving to develop careers in medical technology may help with workforce retention and the retention of this innovative talent in the NHS.
The FOS:TEST report highlighted that the continued, rapid development and deployment of innovation needs to be more organised, with many groups calling for structured frameworks for appraisal, regulation and adoption into practice.2, 4 With technology becoming so prevalent in our careers, we need a future workforce that can understand and implement these frameworks, and appraise and adopt technologies at local, regional and national levels to ensure equitable and sustainable access for our patients and those training in the system.
The Proposal
Clinicians and other frontline healthcare professionals are crucial to driving clinical innovation as well as adopting efficient and effective technologies at scale. The IITP provides a career path that offers the scope, geographic distribution and seamless integration with current clinical training systems for professionals who will lead innovative change in healthcare (Table 1).
| Stage of training | Requirements | Recommendations |
|---|---|---|
| Undergraduate and foundation training | Students should graduate with: • an overview of the innovation pathway; • the ability to identify problems in their clinical practice; • the knowledge of whom to approach to start solving problems; • a basic understanding of the important technologies highlighted in the Topol Review (robotics, artificial intelligence, digital technologies, genomics).8 During foundation training, innovation trainees should: • gain experience working with industry; • develop their network of contacts; • explore their immediate innovation landscape while developing their basic skills as foundation doctors. | • Innovation or technical modules integrated as part of the spiral curriculum – this may be different parts of the innovation pathway or regarding specific technologies. • Student selected components or projects with an innovative focus (eg robotics or artificial intelligence). • Intercalated degrees involving innovation, interdisciplinary collaboration or industry – some universities may consider a year-long internship with a medical device company. • Specialised innovation foundation programmes with four months of dedicated time to pursue supervised innovation projects or to work in industry. |
| Core and early training | As trainees progress, they should: • build their independence along the innovation pathway; • experiment with ideas to create value; • attempt to act on ideas with the support and supervision of senior clinical innovators; • interpret and use data available to drive their innovative activities. | • 25% full-time equivalent dedicated innovation time – focus areas may include identifying innovation needs, building entrepreneurship skills and networks, running innovation pilot studies, creating business cases or otherwise working towards gaining experience for out-of-programme training. • An option for out-of-programme experience for up to 3 years with dedicated time for experiential learning (eg taking an MBA degree, working in industry, carrying out an innovation fellowship or developing a startup) – the critical consideration here is to provide adequate recognition and incentive for trainees to return to innovation training and complete their clinical innovation training. |
| Higher specialty training | Higher specialty innovation trainees should: • find their clinical innovation niche or interest, whether it be a specific type of technology (eg robotics or artificial intelligence) or a specific component of the innovation pathway (eg product development, regulation or policy); • be critically aware of the barriers to technology implementation and adoption; • understand how to assess new technologies to ensure the best patient care. | • 50% full-time equivalent dedicated innovation time in a clinical area of interest. • Associate clinical innovation director schemes. • Consultancy work in startups. |
| Post-Certificate of Completion of Training (CCT) | • After CCT, innovation trainees become recognised clinical innovators (clinicians capable of driving change, growth and innovation in healthcare). They may be either intrapreneurs or entrepreneurs who bring their vast experiences back to the healthcare system and who can contribute their leadership, financial literacy and commercial strategy to participate in NHS innovation. | • Clinical director of innovation. • Industry or technology experts. • Lead strategists for NHS trusts, academia or the government. |
Learning from the Walport report,5 which proposed the integrated academic training pathway, the IITP must have a transparent career structure, offer flexibility to balance both clinical and innovation training, and have both structured and supported posts on completion of training (Figure 2).
Next Steps
Given some of the recent reflections on digital transformation according to the NHS Long Term Plan,6 it is evident that successfully creating a new training pathway requires central coordination as well as a clearly defined and high quality implementation and financial strategy. This necessitates the engagement of all stakeholders (including trainee, academic, industry, government, financial and management representatives) at every stage of development.
Over the past 12 months, this proposal for an IITP has been updated and refined through discussion with key stakeholders. Specific points of debate were raised through the IITP panel at the Association of Surgeons in Training Innovation Summit at the 2022 Future Surgery Show with trainee, clinical innovator, academic and industry representation (Figure 3).
Summary
Innovation is a necessary component of future surgical practice and fundamentally, all surgeons should be able to appraise and adopt new technologies into their practice to provide the best patient care. There is a pressing demand for innovation and technology skills training to prepare our healthcare workforce for a technology enhanced future. Current innovation skills training is decentralised and variable in structure and quality, and it often requires trainees to learn in their free time on top of their clinical commitment. The new Royal College of Surgeons of England Innovation Hub may help to address some of these issues.
There is a need for a centralised and unified training pathway for clinicians to develop the required innovation skills and facilitate the future key clinical innovator. The IITP would help to achieve this. Further discussion with key stakeholders is needed to ensure that an IITP is evidence-based and robust.
Acknowledgements
The authors would like to thank Mr Alan Davies, Mr Iain Henessey, Dr David Rawaf, Ms Louise Glanvill and Dr Amanda Begley for contributing to this work.
References
1.
Future of Surgery Commission. Future of Surgery. London: RCS England; 2018.
2.
FOS:TEST Commission. Future of Surgery: Technology Enhanced Surgical Training. London: RCS England; 2022.
3.
General Medical Council. The State of Medical Education and Practice in the UK: The Workforce Report 2022. London: GMC; 2022.
4.
Ives J, Birchley G, Huxtable R, Blazeby J, Hiding behind ‘innovation’: the case for regulated risk assessment in surgery. Br J Surg 2022 Oct 17. [Epub ahead of print.]
5.
Modernising Medical Careers, UK Clinical Research Collaboration. Medically- and Dentally-qualified Academic Staff: Recommendations for Training the Researchers and Educators of the Future. London: DH; 2005.
6.
National Audit Office. Digital Transformation in the NHS. London: NAO; 2020.
7.
AHSN Network. MedTech Landscape Review. https://www.ahsnnetwork.com/wp-content/uploads/2019/02/MedTech-Landscape-Review-AHSN-Network.pdf (cited December 2022).
8.
Topol E. Preparing the Healthcare Workforce to Deliver the Digital Future. Leeds: HEE; 2019.
Information & Authors
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Published In
The Bulletin of the Royal College of Surgeons of England
Volume 105 • Number 1 • January 2023
Pages: 10 - 13
Copyright
Copyright © 2023 Royal College of Surgeons. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
History
Published online: 22 December 2022
Published in print: January 2023
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