As demonstrated by the COVID-19 pandemic, the healthcare system relies heavily on medical innovation for solutions to critical healthcare problems. Despite this, the pandemic has revealed innumerable shortcomings across the healthcare and public health systems in responding dynamically to needs that must be urgently addressed, stretching an already inundated community of healthcare workers tasked to address these problems. Mobilizing qualified people to contribute to medical innovation is necessary to resolve burgeoning healthcare needs.

University students are an underutilized resource for innovation. During the pandemic, students had few opportunities to apply their emerging skills toward internships, work or contributions related to combatting the crisis. Students were eager to use their skills and energy, but their lack of training, experience, financial stability and support structures presented daunting hurdles. Although some academic institutions offered mini-grants and fellowships for faculty to develop COVID-related solutions1,2,3, little was available to foster interdisciplinary collaboration or experiential opportunities for students to address urgent pandemic issues.

Multiple organizations recognized this gap and attempted to connect students with opportunities to innovate. Numerous hackathons, including those hosted by the Johns Hopkins University, the Massachusetts Institute of Technology and Hack the Crisis, successfully mobilized thousands of students and professionals to create solutions4,5. However, these programs were each held over the course of a weekend, and thus provided only short-lived structure, financial support, mentor feedback and educational resources. For students without innovation experience, these shorter programs may not teach the fundamentals needed to start from scratch or provide the momentum to sustain technology development following the program’s conclusion.

Innovation methodologies such as “design thinking,” “biodesign” and “lean startup” have frequently been used to spark change in healthcare, education and entrepreneurship through a user-centered design and rapid iteration mentality6,7,8,9. Upon implementing these frameworks, some users have shown promise in virtually supporting the collaborative nature of innovation teams while acknowledging difficulties experienced with remote activities10,11,12,13. For example, the Jugaar Innovation Challenge in Pakistan exemplified an extended three-week hackathon but lacked a core innovation curriculum that might have increased the proportional success of its participants11.

Here, we describe the structure and outcomes of our one-month, international, multidisciplinary “virtual innovation bootcamp” that empowered students to remotely develop solutions for the COVID-19 pandemic while also preparing them to address pressing clinical problems throughout their careers. Inspired by established design frameworks, this program was created and organized within four weeks by Sling Health, a national student- and volunteer-driven biomedical incubator currently established across 14 institutions14. Students who participated in this bootcamp would likely not have otherwise received any formal innovation and entrepreneurship education. As such, we aim for this program to serve as a framework for others to educate and engage diverse talent in rapidly developing sustainable solutions for pressing problems requiring innovation.

Bootcamp basics

This was a four-week, immersive virtual innovation bootcamp that incorporated small-group-based experiential learning focused on healthcare innovation and entrepreneurship using online videos, virtual office hours and design reviews, along with a capstone pitch competition. It was developed for any undergraduate or graduate student, but primarily focused on healthcare professional students and engineering, business and other arts and sciences students interested in healthcare.

The bootcamp aimed to improve understanding in five core-knowledge-focused objectives: (i) performing market research; (ii) developing a solution/prototype for a specific problem; (iii) business plan development; (iv) pitching/presenting an idea; and (v) working on a multidisciplinary team through the design and entrepreneurship process. Additionally, there were several objectives designed to impart interprofessional training through innovation and entrepreneurial experiences: (i) foster relationships that demonstrate how to collaborate on a multidisciplinary team to promote health; (ii) impart experience with healthcare technology, innovation and entrepreneurship; (iii) enable a sense of contribution to healthcare during the pandemic; (iv) provide a better opportunity for sustained learning compared to the weekend ‘hackathons’ common across university environments; (v) provide opportunities to work with students from other disciplines, universities or regions of the world; (vi) achieve participation from women and minority students that is representative of our healthcare communities; and (vii) advance innovations designed to improve health in the pandemic.

Preparation

We hosted the bootcamp between 11 May and 5 June 2020. Given the rapid acceleration of the pandemic, we spent four weeks before the start of the bootcamp developing the curriculum and collaborative platform. Eight Sling Health volunteers organized and ran the program.

Recruitment strategy

Sling Health leveraged its nationwide network of innovators while engaging in outreach to related organizations. Promotional materials were sent to all chapters to use in further advertising the event to their respective institutions. Through national and chapter partnerships (for example, with the American Medical Association, national hackathon organizations and professional affinity groups), the bootcamp received additional exposure to students with aligned interests. Advisors were contacted at universities across the country to disperse information. The bootcamp value proposition drove recruitment: connection to peers with similar motivation, access to diverse mentors, a cogent learning structure and abundant resources to actualize the COVID-19 solutions developed. Prospective participants, who could join either individually or with an established team, completed an online application for consideration (Supplementary Note, Appendix A). We also recruited experts and professionals to serve as mentors for teams by distributing a sign-up form to chapter mentors and community partners (Supplementary Note, Appendix B). Mentors were chosen based on their field of expertise and availability. Ultimately, 26 experts actively served as mentors throughout the four weeks—a mentor-to-student ratio of roughly 1:3.

Communication tools

Web-based virtual collaboration and video conference tools were used for the bootcamp (for example, Slack, Google Sheets and Zoom). Virtual workspaces on Slack were created for team communication, announcements, deliverable deadlines and mentor collaboration. Participants were given online access to a high-level view of the program, submission links with due dates for deliverables, direct links to educational resources (for example, patent application support) and sign-up sheets for design reviews and mentor chats (Supplementary Note, Appendix C; names removed for privacy).

Team formation

Team formation began three days before the bootcamp started. A Slack channel dedicated to the formation of teams offered a space to post introductions, search for teams to join, or seek talent to build existing teams. Participants were encouraged to be proactive about seeking teams where their skills could be well used, as well as to include students from various disciplines (healthcare, engineering, business, etc.) and institutions. Ultimately, students were given complete autonomy in forming teams.

Structure

The bootcamp was inspired by Sling Health’s eight-month program that uses biodesign and lean-startup principles and is designed to emphasize rapid development, engagement and access to feedback14,15. The bootcamp started with an onboarding meeting at which participants were introduced to the communication tools, resources and program timeline (Fig. 1). The educational curriculum focused on five core objectives (performing market research, developing a solution/prototype, constructing a business plan, pitching/presenting an idea and working on a multidisciplinary team) and progressed in a weekly fashion (Fig. 1).

Fig. 1: Design and innovation framework of virtual innovation bootcamp.
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Flow chart depicting the different stages of team progression during the Virtual Innovation Bootcamp from a curricular and resource standpoint. Dark gray boxes define weekly goals and objectives. Illustration provided by A. Dicks and A. Robinson in association with InPrint at Washington University in St. Louis.

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The Sling Health executive team guided students through the program. At the beginning of each week, an executive member hosted a program-wide check-in to outline goals and events. Additionally, teams were paired with a Sling Health liaison to streamline communication, ensure team progression through bootcamp milestones and discuss relevant resources.

Finally, weekly design reviews (DR) were held, with a panel of two to four mentors and participating teams concluding each week’s programming. The teams received feedback and guidance based on the week’s milestones (Fig. 1). Each DR was 30 minutes in length, with 15 minutes reserved for presentation and 15 minutes for mentor feedback. These DR sessions were organized within larger 90-minute blocks, in which mentors attended three consecutive sessions. Requiring teams to attend the full 90-minute blocks meant that teams could learn from their peers, contributed to a sense of community within the program and helped build inter-team relationships that could extend beyond the confines of the bootcamp. Recommended deliverables for each DR were given to students in the orientation guide (Supplementary Note, Appendix D).

Resources

An educational orientation guide describing the overall goals, with details about program milestones, served as the backbone of this learning experience (Supplementary Note, Appendix D). In partnership with the Entrepreneurship for Biomedicine program funded by the US National Institutes of Health16, instructional videos were curated to explain innovation and entrepreneurship concepts to support students without a background in the field. Additional lectures from experts in healthcare, venture capital and startup accelerators, and entrepreneurship were curated from YouTube and prepared students for their next steps after the bootcamp (Supplementary Note, Appendix C). The bootcamp also provided in-kind and financial services to support the projects. Teams could apply for support for up to $500 in prototyping expenses per week, awarded based on merit and development needs determined using an online application (Supplementary Note, Appendix E). Additionally, over $2,000 in prize money was awarded to the top three teams to support development after the bootcamp. In partnership with a cooperative that connects patients with healthcare innovators, teams could conduct patient surveys to gain first-hand insights on their problem of focus. Partnerships with a law firm and a startup company that facilitated automated prior-art searches provided teams free provisional patent submissions and understanding of the patent landscape, respectively.

Program evaluation

At the program’s conclusion, we conducted a cross-sectional program evaluation and survey of all matriculated participants. We collected demographic information, participant academic background data, education metrics, participant satisfaction and opinion data, and team achievement and outcome data (Supplementary Note, Appendix F). Participants’ pre- and post-program self-proficiency ratings for educational objectives were collected on a five-point scale (1 = unfamiliar, 5 = can lead a team on this task) and analyzed using paired, two-tailed t-tests in Microsoft Excel. A P value of <0.01 was considered significant. This research was deemed a programmatic evaluation by the Institutional Review Board at Harvard University and did not require approval.

Results

Demographics and participant background

From an applicant pool of 115 students, 84 (73%) matriculated into the program. Of these, 76 (91%) participants, distributed across 17 teams, fully completed the bootcamp, and 52 (68%) completed the optional exit survey. Participants came from 15 states in the United States, along with Bangladesh, Canada and Pakistan. Thirty-five (67%) of respondents were female, and the majority identified as Asian (n = 31, 62%), followed by White (n = 11, 21%), Black (n = 7, 14%) and American Indian (n = 2, 4%). Participants came from diverse educational backgrounds (32 undergraduate students (62%), 16 graduate students (31%) and 4 recent graduates (7%)) and disciplines (11 in medicine (21%), 27 in engineering (52%) and 13 in business, arts and sciences (25%)). Additionally, 35 (67%) indicated that this was their first entrepreneurial experience.

Survey results

Although only 35 of respondents (67%) entered the bootcamp on a team, 50 (96%) ended on a team. Additionally, 47 (90%) indicated (agreed or strongly agreed) that this bootcamp helped them connect to other students and mentors, and 45 (87%) stated that the bootcamp enabled them to engage with people they would not otherwise have met or had access to. This was further demonstrated by the fact that 9/17 teams (53%) had students from more than one institution. Forty-eight respondents (92%) agreed that the bootcamp was a valuable supplement to their education during the pandemic, and 43 (83%) believed that it helped them contribute during the pandemic. Compared to hackathons, respondents rated the bootcamp as better or the same in providing opportunities regarding funding, educational resources, feedback, connection with mentors and team building.

Forty-eight (92%) of respondents indicated that the bootcamp improved their understanding of the design and entrepreneurship process. On average, participants noted a statistically significant increase in their proficiency in all five targeted education competencies after the bootcamp (Table 1). Additionally, 48 (92%) recommended participation to other students and 31 (60%) indicated that they would participate in a similar experience if it were extended over the course of the year. Based on requests for open-ended feedback on strengths and weaknesses, participants suggested that the multidisciplinary teams, mentor experience and support and design reviews were strengths of the program, while identifying scheduling conflicts, lack of assigned mentors and lack of structured feedback as the greatest weaknesses.

Table 1 Student response to education objectives
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Team achievements and program metrics

The student retention rate was 91% (n = 84), and of 18 initial teams, 17 (94%) submitted their final deliverables (final video pitch/executive summary). In just four weeks, teams together completed 62 design reviews, created and developed 13 prototypes and submitted two provisional patent applications for COVID-related solutions. Most respondents (n = 47, 90%) also indicated that they would continue working on their projects after the bootcamp ended. There was a broad range of clinical areas of interest and innovative technology types developed by participants for these problems. Example solutions included health IT (for example, an on-demand service that connects nurses with patients to close the home healthcare gap), medical device (for example, a mask to capture aerosolized droplets to minimize disease transmission during high-risk extubations), diagnostics (for example, repurposing CRISPR for point-of-care COVID testing) and education (for example, a virtual laboratory that enables professors to build and teach experiments for laboratory classes). Even though we made funding and other resources available to all teams, as well as prize money, our cost per participant was limited to $67 through strategic partnerships with external organizations.

Conclusions

With over 76 participants from four countries and 15 institutions, the bootcamp was the first COVID-related program to combine design thinking education with fully remote multidisciplinary collaboration at this scale and duration. The bootcamp served to connect a diverse group of participants and focus an untapped pool of talent toward COVID-19 problems. Furthermore, as evidenced by respondents, the bootcamp served as a valuable educational tool that used experiential learning to enhance students’ education in a creative way. Overall, the four-week bootcamp was successful in meeting most of the stated objectives. Resources provided for self-learning, the experiential learning fostered by the bootcamp and the multidisciplinary nature of teams that enabled peer-to-peer learning and interprofessional competence likely all contributed to this success. Participants benefited from finding collaborators with diverse backgrounds in sex, race and training, enabled by this virtual setup. Interestingly, participants also reported favoring the bootcamp design compared to traditional hackathons, which have previously been shown to be an effective model of promoting the diversity of people, ideas and solutions to stimulate innovation17.

Analysis of the program was limited due to its cross-sectional nature, lack of control group and dependence on self-assessment for evaluation of educational impact. For future iterations, incorporating pre- and post-program assessments and long-term team follow-up would enhance understanding of program impact. Based on insight from participant feedback, we also suggest improving the bootcamp by assigning teams a dedicated mentor, curating interactive sessions, establishing more inter-team engagement and establishing more rigorous program evaluation, long-term follow-up and exit strategies for teams. One challenge with this program structure is its intensity and time requirement, with half of students reporting that they spent more than six hours per week on the program. Although this immersive experience was necessary to foster education and technology development in such a short period, it may be less feasible when students are also required to complete regular coursework.

This program was ideated, developed and executed all within a few months of the onset of the pandemic, after we recognized the underutilization of a major talent pool and a lack of connection between members of this talent pool and mentors, resources and funding. The bootcamp acts as a model to educate, connect and empower students to be healthcare innovators. With hands-on and collaborative learning that reduces barriers via virtual connection, this program also serves as a replicable model for further improving the accessibility of a wide variety of healthcare education outside of biomedical innovation (for example, in clinical care, ethics, and quality improvement and patient safety) that is relevant to many professional training programs. We hope that others can use or improve this model to inspire collaboration and connection in order to inform, educate and elevate students and similarly underutilized talent pools to develop urgently needed solutions to the world’s pressing issues.