Abstract
BACKGROUND: Traditional medical education models emphasizing didactic knowledge transmission inadequately prepare healthcare professionals for complex challenges in modern medicine. Innovation and Entrepreneurship Education (IEE) offers opportunities for fostering innovative thinking, yet limited research systematically examines how medical students experience entrepreneurial learning processes. Accordingly, this study applies Experiential Learning Theory (ELT) to examine how medical students engage with IEE and develop entrepreneurial competencies within healthcare contexts. METHODS: Semi-structured interviews were conducted with 35 medical students from four Chinese universities who participated in IEE programs (2019–2024). Data were analyzed using thematic analysis, following Kolb’s four-stage experiential learning cycle. FINDINGS: Medical students’ participation in IEE maps clearly onto Kolb’s ELT cycle, yet with adaptations shaped by their clinical training. In Concrete Experience phase, students encounter technical, market, and outcome uncertainty (e.g., students described struggling with product design due to limited entrepreneurial knowledge). During Reflective Observation phase, they assess failures as learning opportunities through clinical systems thinking; one team improved innovation by repeatedly re-evaluating unmet clinical needs. Abstract Conceptualization phase involves synthesizing insights into broader models through interdisciplinary dialogue, such as redesigning product materials through interdisciplinary dialogue and expert consultation. In Active Experimentation phase, students apply conceptual models while weighing career implications; for example, some plan to develop medical devices post-graduation, while others reframe their professional identity to include entrepreneurship. DISCUSSION: The integration of ELT with IEE addresses unique epistemological challenges medical students face when transitioning between evidence-based clinical reasoning and entrepreneurial thinking. Our adapted framework provides theoretical justification for navigating these contradictions through four interconnected stages connected by transitional processes of reflect, synthesize, apply, and iterate. However, institutional constraints including limited resources, technical capabilities, and regulatory barriers significantly impact learning effectiveness. CONCLUSION: This study makes three theoretical contributions: extending ELT through domain-specific adaptations for medical contexts, establishing a modified framework emphasizing transitional processes, and demonstrating how institutional contexts shape experiential learning outcomes. The integration offers promising pathways for developing innovative capabilities needed in contemporary healthcare by fostering graduates equipped to address complex challenges through entrepreneurial thinking and action. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12909-025-07804-5.