Reporting on Innovations in Academic Medicine

Editor’s note: The opinions expressed in this editorial do not necessarily reflect the opinions of the AAMC or its members. Innovation brings forward new and better ideas. In the field of academic medicine, innovation improves human health by creatively addressing knotty problems encountered by scientists, teachers, learners, clinicians, community stakeholders, leaders, and policymakers. Our journal has long published research studies and articles to elevate innovations that not only document their intentions and implementations, but also are “reflective, analytical, and scholarly.”1 Two recurring questions thus arise for our authors and our editors: What is an innovation? And what innovations merit publication in our journal? In simplest terms, an innovation is a creative solution to a stubborn problem of genuine significance in the field. An innovation requires thinking or doing something differently and tackling something that matters. By its nature, innovation sits in the space of problem and solution. In other words, inherent in the notion of innovation is the expectation, based on theory and evidence, that it should make a difference. In terms of the second question on publishing innovations, many submissions received by our journal, as noted by Kanter,1 show what we already know or fully anticipate, namely, that faculty are capable of implementing “a novel project or procedure that leads to participants’ satisfaction and/or learning.” Publications that focus on innovations should convey and accomplish more, suggested Kanter, who articulated several criteria for innovation reporting. The problem should be clearly and thoroughly described, and it should be characterized with respect to its generalizability and relevance for different stakeholders. An array of potential solutions should be recognized, and the rationale for a particular approach should be articulated. The implementation of the innovation should be detailed, including its feasibility and whether it has been continued beyond its first introduction. The authors should put forth a careful and critical analysis of the innovative solution and provide a sense of its sustainability. Finally, there should be some assessment of the potential influence and value for the field. Academic medicine comprises many health professions and academic disciplines, and innovation occurs across our missions of scientific discovery, education and training, clinical service and systems, community engagement, and leadership and policy. The work of academic medicine, moreover, takes place in resource-intensive quaternary care settings to resource-spare frontier settings, and in each place, innovation is critical to advances that will help with the overall goal of improving human health. While most innovations reported by Academic Medicine have focused on specific issues in education and training, our scope of interest is quite broad. Our journal is interested in learnings from innovations that meet the criteria outlined by Kanter above and can include many professions and disciplines, diverse missions, and a range of settings. Innovation Reports Just over a decade ago, Academic Medicine introduced a new feature, the Innovation Report (IR), to encourage authors to share promising new ideas and methods and to accelerate the adoption of those ideas and methods in the field.2 IRs play a key role in bringing visibility and critical evaluation to early-stage innovations. IRs proffer novel approaches that may be tested and used in different settings, building upon current paradigms and improving outcomes that matter. The IR feature has a unique structure that centers on a problem, a novel approach, outcomes, and next steps. Since 2020, our journal has published, in round numbers, 30–40 of the IR submissions it receives annually, and space in each journal issue is dedicated to these compact, impactful communications. A study3 focusing on our early experience with the IR feature of Academic Medicine was performed in 2018 and found that over one-third (36%) of 920 submissions from October 2013–May 2018 were sent by editors for outside peer review, and a small proportion (16%) of all submissions were ultimately published. The average rate of citations for these published IRs was 4.3, and the average Altmetric Attention Score was 14.3, placing the articles in the top 20% of those published in the journal. The IR feature was seen as an important outlet for publishing scholarship by most (88%) of the authors who responded to the study survey (n = 85, 57% response rate), and nearly all respondents (96%) indicated that publishing an IR promoted their individual career growth. While some IR authors commented on the lengthy review process and the limitations of the format, most described how their publications led to collaboration and expanded scholarship, opportunities to present their work, professional recognition, and, in some cases, grant funding. The IR feature has been of interest to authors since it was launched. Between October 2013 and October 2024, Academic Medicine received 2,939 IR submissions. In a similar pattern to the rate of submissions for our journal overall, the highest annual number of IR manuscripts were submitted during the throes of the pandemic in 2020 (n = 42) and in 2021 (n = 43). Since 2013, the annual acceptance rate has ranged from 9% to 30%, and IRs are among the more commonly cited articles in our journal. The potential value of IRs is further signaled by the growth of this type of format in other journals. In the past decade, several other medical education and health professions education journals have introduced features that are related to fostering innovation. Perspectives on Medical Education has their Show and Tell series,4 and the Journal of Graduate Medical Education has Educational Innovation articles and the New Ideas series.5 Recognition of the potential contribution of innovation in academic medicine can be traced back to Boyer’s concept of the scholarship of teaching.6 Such scholarly contributions can change the world, Boyer suggests, through discovery, integration, application, teaching, and engagement. Informed by this concept, IRs within our journal seek to contribute to the world by laying bare the methods by which great education can be accomplished within a specific context. Early innovations focus on localized solutions to specific educational or clinical problems, but often have a broader reach and seek to influence practices on regional, national, or even international levels. Consequently, innovation must be more than a mere “good idea”—it must be grounded in theory and evidence, allowing others to replicate or build upon the work, and it must have some initial observations of effectiveness. And, as articulated by Rogers7 in his landmark book on diffusion of innovation in society at large, to be broadly embraced, innovations must not only be novel but also demonstrate utility, applicability, and benefit. For these reasons, IRs will outline their underpinnings in theory and evidence, provide adequate detail on methods, and offer initial evidence of feasibility, utility, and outcomes. The journal provides clear guidance on the IR format.8,9 The first element is the Problem. Authors should provide a clear contextual framework for why the innovation is needed. This brief section should include a discussion of existing challenges or gaps in the field that the innovation seeks to address. The second element is the Approach. In this section of the manuscript, authors should outline the theoretical foundations and evidence that support the innovation. Authors should clearly describe how the innovation was developed, what it comprises, and the rationale for unique decisions shaping it. The third element is Outcomes. In this section, authors should briefly explain the ways in which the innovation was evaluated and the results. The authors should provide an overview of data, focusing on the outcomes of the innovation itself rather than a comprehensive evaluation implemented for an entire program. When more detailed data should be presented and article length is a constraining factor, the findings can be included as supplemental content. The fourth and final element focuses on Next Steps. In this section, authors should describe how the challenge that prompted the innovation could be expanded, scaled, and evaluated, or further evaluated, in the future. IRs should keep to a 2,000-word limit and have no more than 10 references and no more than a total of 3 tables, figures, charts, lists, or appendices. It is important for authors—and reviewers who expertly and generously help us to assess IRs—to distinguish between IRs and Research Reports, which are different in purpose and in journal requirements. Research Reports typically present formal, hypothesis-driven studies that generate robust data and lend themselves to analysis. IRs, on the other hand, introduce early, promising ideas that arise in response to an emerging need, accompanied by initial findings. This focus on early-stage innovation means that the emphasis is on conceptual strength rather than large-scale outcome or evaluation data. Accordingly, IRs are not simply presentations of underdeveloped, narrow, or preliminary research. Rather, they must be built from the ground up as reports of projects developed to serve a specific purpose but with potential value beyond the single context. The intrinsic logic of an IR allows for replication by other early adopters,7 ensuring that the innovation can be disseminated and replicated. Therefore, a strong conceptual innovation may not need robust data to justify its publication, while a smaller or more opportunistic innovation may require more robust data to gauge its usefulness. In either case, the emphasis should be on the clarity of the purpose of the innovation, its components, and the potential for diffusion. (For those seeking to publish more in-depth program evaluation scholarship, the Article feature8 of the journal is more suitable.) Looking Ahead As we move into the second hundred years with our journal, Academic Medicine, and look to the next decade of experience with IRs, we join earlier editors and authors1–3,10–12 in highlighting the value of innovation in shaping a better future across the broad and interdependent missions of academic medicine, including scientific discovery, health professions education, clinical care and services, and community engagement and leadership. IRs are an especially important feature of our journal, which elevates scholarship that “generates valuable discussion, reflection, and often self-critique, giving rise to changes in our field that may be aspirational, necessary, or both.”13 Jonathan M. Amiel, MD Associate Editor, Academic MedicineTeresa M. Chan, MD, MHPE, MBA Associate Editor, Academic MedicineLaura Weiss Roberts, MD, MA Editor-in-Chief, Academic Medicine

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