HEALTH TECHNOLOGY ASSESSMENT BMJ Innov: first published as 10.1136/bmjinnov-2019-000400 on 5 October 2020. Downloaded from ORIGINAL RESEARCH Healthcare hackathons: fostering medical education through innovation in a developing country: a case study from Pakistan Waqaas Akmal Butt,1 Qurratulain Shahood,2 Walid Hussain Farooqi,1 Kulsoom Ghias,3 Saniya Sabzwari,4 Asad Mian1,5 ► Supplemental material is ABSTRACT INTRODUCTION published online only. To view, Background Hackathons aim to develop The term hackathon is a juxtaposition please visit the journal onlin (http:// dx. doi. org/ 10. 1136/ solutions to preidentified problem domains of the root words ‘hacking’ and ‘mara- bmjinnov- 2019- 000400). and catalyse startup cultures. Recently, the thon’—an event initially brought into 1 teaching and learning potential of hackathons existence by software and hardware Critical Creative Innovative 1 Thinking Forum, The Aga Khan has also been documented. In this study, we developers. After its introduction by the University Hospital, Karachi, make the case for utilisation of hackathons as Massachusetts Institute of Technology Sindh, Pakistan an alternative teaching and learning tool geared in 2011, the healthcare hackathon has 2Medical School Graduate, The Aga Khan University Hospital, towards entrepreneurship and as an opportunity gained increasing popularity for its func- Karachi, Sindh, Pakistan for interprofessional integration. tionality in identifying potential problems 3 Department of Biological Methods This research study followed up and then creating concrete solutions via and Biomedical Sciences, Aga 2 3 Khan University, Karachi, Sindh, with participants from the third hackathon at multidisciplinary collaboration. Pakistan the Aga Khan University in Karachi, Pakistan. With a 3- year experience of conducting 4 Department of Family Medicine, Hack MedEd was about solutions to problems hackathons at the Aga Khan University The Aga Khan University http://innovations.bmj.com/ Hospital, Karachi, Sindh, Pakistan of undergraduate and postgraduate medical (AKU) in Karachi, Pakistan, we have 5Emergency Medicine, The education with an emphasis on low-income to identified its potential in significantly Aga Khan University Hospital, middle-income countries. Participant evaluation improving interdisciplinary collabora- Karachi, Sindh, Pakistan data were filled at the end of the hackathon and tion and formulating relevant solutions Correspondence to gathered from three focused group discussions to problems faced by both patients and Dr Asad Mian, Emergency (FGDs): immediately before and after the event, healthcare professionals.4–6 Through its Medicine, The Aga Khan a delayed follow-up after 11 months was dynamic problem- solving approach in University Hospital, Karachi, Sindh, Pakistan; asad. mian@ recorded. proposing implementable ideas, the hack- aku. edu Results Of 116 participants, the majority (71%) athon model has shown great capacity to were under 30 years old, and over half were accelerate outcomes. on December 2, 2020 by guest. Protected copyright. Received 4 October 2019 Revised 24 June 2020 female. The evaluations provided by hackers The utility of a hackathon lies in Accepted 31 August 2020 were positive overall with a mean score of 4.37 converting a linear process of production out of 5 on a Likert Scale. During the FGDs, into a circle that continually undergoes a participants spoke positively of the process and cycle of change under perspectives from felt that, by the end of the hackathon, they had different fields.7 In the context of health- learnt something new. In the delayed follow- care, it puts the healthcare professional at © Author(s) (or their up FGD, teams that had undergone incubation the forefront of innovation, and together employer(s)) 2020. No expressed that they had gained a critical and with other professionals, enables him/her commercial re- use. See rights simple skillset that they might not have acquired to arrive at a solution that works most and permissions. Published by otherwise. appropriately in a setting he/she under- BMJ. 8 Conclusion Hackathons business incubation stands best. This ‘cross-pollination’ To cite: Butt WA, Shahood Q, programmes may be considered an alternative approach—leading to ‘disruptive innova- Farooqi WH, et al. BMJ Innov Epub ahead of teaching and learning tool—especially for tion’—is fast- becoming a hallmark of the 1 print: [please include Day individuals studying or working within the hackathon. Month Year]. doi:10.1136/ healthcare discipline within low-r esource The utility of the hackathon model as a bmjinnov-2019-000400 settings. tool for integration of medical education Butt WA, et al. BMJ Innov 2020;0:1–6. doi:10.1136/bmjinnov-2019-000400 1 HEALTH TECHNOLOGY ASSESSMENT BMJ Innov: first published as 10.1136/bmjinnov-2019-000400 on 5 October 2020. Downloaded from and other fields was first proposed by Aungst in 2015.9 Table 1 Demographic characteristics of the 116 participants In this paper, we seek to gauge the hackathon’s poten- (hackers) at the third hackathon, Hack MedEd, at the Aga Khan tial as a model for integration of different professionals University, Karachi, Pakistan, 17, 18 and 23 February 2018 working at our University Hospital, and its utility as N (%) an educational tool for technical and entrepreneurial skills, in the context of our participants’ experience of Age distribution the first undergraduate and postgraduate level medical <20 years 8 (6.9) education hackathon of its kind in Pakistan. 20–30 years 74 (63.8) 31–40 years 20 (17.2) MATERIALS AND METHODS 41–50 years 8 (6.9) Study design and setting >51 years 3 (2.6) We conducted a mixed methods (quantitative and Unknown 3 (2.6) qualitative) study on the third hackathon organised Total 116 (100.0) at AKU in February 2018, a major quaternary-care Gender teaching hospital in Pakistan. The event’s name was Male 52 (44.8) Hack MedEd, with the theme to hack medical educa- Female 64 (55.2) tion, and the purpose to target both undergraduate Total 116 (100.0) and postgraduate level medical programmes at AKU. Organisational affiliation The event was attended by participants from AKU and From AKU 89 (76.7) other institutes. External to AKU 27 (23.3) Total 116 (100.0) Main outcome AKU, Aga Khan University. Our main outcome was assessing participants’ responses. We achieved this through analysing imme- diate postevent evaluation survey responses and their expectations and impression after the 2- day tabulating them as quantitative data. We triangulated rigorous activity. these data through three qualitative focused group After the event, the participants were also required discussions (FGD)—immediately before, after and 11 to fill in evaluation forms. Table 1 outlines the ques- months after the event. These discussions attempted to tions asked. Participants were expected to score each assess the impact of the hackathon on individual expe- statement on a Likert scale (1=most unfavourable; rience and growth of participants. 5=most favourable). Data pertaining to participants’ demographics, affiliations and experience of the hack- Inclusion and exclusion criteria athon, were recorded and served as the quantitative http://innovations.bmj.com/ All participants (‘hackers’) at Hack MedEd who end- process description of the hackathon and how it completed the postevent survey were included in the impacted the participants, that is, postevent individual study. For the FGDs, only those who volunteered after appraisal. an email was sent out to all participants, were then A third FGD was held at an interval of 11 months called in. Participants who were also simultaneously to gauge progress of teams whose projects underwent taking part in the event organisation were excluded business incubation. All FGDs were dual moderated from the study. mini FGDs, that is, they consisted of 2–5 participants and the discussion was aided by two facilitators (SS Study procedure/protocol and KG). Each lasted an hour and was recorded and, on December 2, 2020 by guest. Protected copyright. Hackathon 3.0, Hack MedEd, was a 2- day event later, transcribed. The quantitative data gathered from that was organised by the Critical Creative Innova- hackathon evaluations serve as the primary outcomes tive Thinking forum that originated at AKU with the of our study. The findings of both FGDs are presented mission to channel innovation through creativity, crit- as qualitative data, and these served as the secondary ical thinking and collaboration, along with faculty leads outcomes of our study. The questions asked of the of the undergraduate medical programme. After a call participants in the three FGDs can be found in the for participation, individuals who signed up for Hack online supplemental file. MedEd attended the hackathon. The first day consisted of participants forming groups and working on a set of Data analysis problems, with the help and guidance of their mentors. Data were entered and analysed by using SPSS statis- On the second day, the groups finalised the solutions tical package V.21. Participant demographics and to their chosen set of problems. This intense 2- day professional affiliations were analysed using frequen- mental exercise was punctuated by scheduled bursts of cies for categorical variables. The posthackathon fun and food, to keep energy levels upbeat. survey scores for each question are presented as means The FGDs were conducted with the partici- and SD. The FGD transcripts were read independently pants—one before and one after the event, to assess by two authors and relevant content included in 2 Butt WA, et al. BMJ Innov 2020;0:1–6. doi:10.1136/bmjinnov-2019-000400 HEALTH TECHNOLOGY ASSESSMENT BMJ Innov: first published as 10.1136/bmjinnov-2019-000400 on 5 October 2020. Downloaded from being directly involved in medical education. We had a Table 2 Occupational or professional distribution of the 116 participants (hackers) at the third hackathon, Hack MedEd, at the few faculty members from different departments, resi- Aga Khan University, Karachi, Pakistan, 17, 18 and 23 February dent trainees, directors, Information and Technology 2018 (IT) professionals and company founders.