To Teach Entrepreneurship: See One, Do One, Teach One

As a career academic surgeon, I was trained, like all my colleagues, under an apprenticeship educational system that dates back to the guilds of the Middle Ages. As a result, I was expected to perpetuate the system when I became a professor and attending. The mantra is "see one, do one, teach one," which, in fact, reflects adult learning theory in that we all learn much better by doing rather than just watching. And, if you really want to learn how to do something, then teach it to someone else. The goal in medical education, like the apprenticeships of old, is to give graduated, supervised levels of responsibility to students until they are autonomous. Unfortunately, for many reasons, fewer and fewer graduates of medical residencies, particularly in surgery, are autonomous when they finish.

Joseph (Jay) Zwischenberger, MD, FACS, developed a model at the University of Kentucky, Lexington, to aid in the training and assessment of his residents to achieve operative independence. The goal of the so-called Zwisch model is to provide both faculty and residents with specific stages of supervision allowing for adequate, safe training in a graduated manner to develop fully trained surgeons.

The four stages of the Zwisch model of supervision are as follows:

• Show and tell
• Smart help
• Dumb help
• No help

It would be useful to consider adapting elements of this model in teaching biomedical and clinical entrepreneurship to doctors. Here's why:

1. It would use a system that is familiar to both physician teachers and learners

2. Bioentrepreneurs would be given graduated levels of responsibility

3. It would give entrepreneurs-in-residence/mentors/sponsors guidelines and techniques to promote bioentrepreneurial autonomy

4. It would focus on learning objectives at a given stage of company development

5. It would identify opportunities for improvement in an individual professional develop plan

6. It requires that teachers and learners come prepared to learn and teach and that they assess the effectiveness of interventions during a debriefing session, similar to the BID model used in surgical education (Briefing preoperatively, Intraoperative supervision, Debriefing postoperatively)

7. It would define a "basic science" body of literature that should be mastered prior to engaging the clinical business or startup world e.g. intellectual property, business model generation and testing, reimbursement issues, regulatory affairs, biotechnology law and building high performance teams.

8. It would clarify expectations between students and teachers and narrow the student-teacher performance assessment gaps.

9. It could potentially improve the success rate of startups or technology ventures and, through a self-reflective process, weed out those who have not attained sufficient autonomy to move forward to accept other people's money

10. It has the potential to accelerate the process of developing business clinical judgement and better "case selection", thus leading to fewer complications venture mortality

A major hurdle in all this is finding the right teachers, since, like medicine, effective bioentrepreneurship "attendings" are not hired because of their proven teaching abilities. In addition, particularly recently, bean counters think teaching is easy and thus should be considered a privilege and done for free. It is an unfunded academic mandate and foreign to the culture of most medical schools. The issue has taken on increasing importance given recent NIH and NSF iCorps funding initiatives launched to create more impact from project teams and SBIR/STTR recipients.

Bioentrepreneurial education programs are still in their early stages and faculty, students, and administrators are constantly experimenting with models that offer combinations of education, experiential learning and supervision. See one, do one, teach one may be coming to a program near you.