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Investigating capacities and barriers of Iranian medical universities in developing entrepreneurship in terms of educational experts: A content analysis study

Background: Entrepreneurship leads to an increase in national income by creating new jobs and plays a role as a positive factor in economic growth by serving as a bridge between innovation and the market. The aim of this study was to identify the capacity and barriers existing in the medical universities of Iran to develop entrepreneurship from the viewpoint of some of the officials and academic experts. Methods: This qualitative, descriptive-analytic study was conducted to explore threats and opportunities in educational entrepreneurship at medical universities. The sample consists of medical universities' deputies of education across the country, attending the national meeting of education deputies. A questionnaire containing 10 open questions was tailored and given to the participants. After returning the questionnaires, the responses were evaluated using the content analysis method. Results: The issues related to the strengths of the medical universities in entrepreneurship development can be summarized in 3 categories: human factors, organizational and infrastructure factors, and technical and technological factors. With regard to the existing weaknesses while developing entrepreneurship in the context of medical universities, there are 3 general categories: education and research barriers, state-legal-political, and economic-managerial shortcomings. The barriers to entrepreneurship development among medical graduates can be categorized in 4 groups, including education and information, cultural and social factors, financial barriers as well as structural and infrastructural drawback. Conclusion: The most important movement toward entrepreneurship development in medical universities could be making structural revisions in transforming into third-generation universities. This important issue is being pursued and implemented by the government in the form of Plan for Development and Innovation in Medical Education.

2 social and economic mechanisms are organized to transform resources and situations into the acceptance of risks and failures and to orient the marketplace (1). Policy makers in Europe and the United States argue that entrepreneurship not only leads to an increase in national income by creating new jobs but also plays a role as a positive factor in economic growth by serving as a bridge between innovation and the market (2). Entrepreneurship is a critical notion in organizations and institutions, including universities (3). The experiences of various countries of the world, both developed and developing, have indicated that the best option for preparing the educated individuals for future employment in the labor market is to create an appropriate framework for self-employment and entrepreneurship in the context of academia (4).
The entrepreneurial university is a theoretical perspective highlighted in the 20 th century, which draws special attention to the highly interactive role of universities with the society. Therefore, the higher education system should be coordinated with business development and labor market by making changes in educational programs (5).
In this regard, the topic of entrepreneurship has been considered in the Development and Innovation plan in Medical Education by the Ministry of Health and Medical Education. This plan has been developed in the form of 11 packages, one of which is moving toward third-generation universities. The target areas of this package include the structural reengineering of medical universities in moving toward third-generation universities, promotion of entrepreneurship, and creating knowledge-based wealth in medical universities.
According to this policy, universities must try to educate entrepreneurs and familiarize the faculty members and medical students with the entrepreneurial and business skills to institutionalize these concepts in the community (6).
In its global higher education perspective in the 21st century, the UNESCO has defined the modern universities as the place where entrepreneurial skills in higher education are developed to facilitate graduates' capacities and assist them to become entrepreneurs (7).
Many graduates do not obtain the entrepreneurial skills needed to enter the job market because of the lack of right training in the education system. With regard to the number of educated young people and the lack of job opportunity, entrepreneurship education and the creation of entrepreneurial culture in higher education institutions may be a valuable way of developing entrepreneurial thinking and, consequently, reducing the unemployment, which is a serious concern of the society (8).
With over 19 000 faculty members in more than 60 medical universities in the country, Iran's Health System trains around 200 000 students and produces one third of knowledge and training of the specialist staff. Researchers and faculty members of the medical universities of Iran produce about one-third of Iran scientific papers on a yearly basis. Therefore, in the current situation, the country needs creative and innovative students who can use theoretical understanding of a subject to generate knowledge and create wealth and social welfare.
Considering the importance of entrepreneurship and the role of medical universities in its development, it is necessary to identify the existing capacities and obstacles. In general, the models and frameworks of entrepreneurial universities can be classified into 2 approaches: A. An attitude focused on the entrepreneurship aspects of entrepreneurial universities.
B: An approach that emphasizes the factors affecting the formation of entrepreneurial universities (9).
In this study, the second view was taken. The first step in creating and developing an entrepreneurial university is to investigate the influential factors and barriers of entrepreneurship in universities. Based on this, the present study was designed and implemented to identify the capacity and barriers existing in the medical universities of Iran to develop entrepreneurship from the viewpoint of some of the officials and academic experts. It seems that collecting these views and classifying them at different levels can provide policymakers with the necessary information to provide groundwork for the realization of the third-generation universities or entrepreneurial universities more than ever.

Methods
This study was an applied research in terms of purpose and a descriptive-analytic in terms of data collection, which was conducted both quantitatively and qualitatively to investigate the capacities and existing barriers in the medical sciences universities of Iran for the development of entrepreneurship.
The research population included deputies of education at medical universities across the country who attended the national meeting of deputies of education, each with an employment background of education, management, counseling, policy-making, and executive responsibilities.
In order to collect information based on the objectives of the study, a questionnaire containing 10 open questions was tailored and was given to the participants. The survey questions included the definitions of entrepreneurship in the field of health, strengths and weaknesses of medical es in a line by line fashion, extracting main concepts and sentences, forming categories and primary classes, and axial coding, including classification of data, specification of subclasses, and formation of final classes. Data were entered into the excel software. Further to qualitative evaluation, these codes were statistically analyzed using a descriptive method.

Results
A total of 66 questionnaires were distributed among the participants, and objectives of the study were explained to them through written and oral instructions. Finally, 29 questionnaires were returned. On average, medical education managers had 9.25±7.24 years of experience. A participant from Isfahan University of Medical Sciences with 23 years' experience had the most experience in our sample. Of the respondents, 24.2% were full professors, 37.9% associate professors, and 37.9% assistant professors. On average, universities were founded 41.5 years ago, with Tehran University of Medical Sciences, with 83 years of run time, being the oldest.
Based on the findings, the issues related to the strengths of medical universities in entrepreneurship development can be summarized in 3 categories: human factors, organizational and infrastructure factors, and technical and technological factors (Table 1).
Concerning the existing weaknesses, while developing entrepreneurship in the context of medical universities, there are 3 general categories: education and research barriers, state-legal-political, and economic-managerial shortcomings ( Table 2).  4 The barriers to entrepreneurship development among medical graduates can be categorized into 4 groups: including education and information, cultural and social factors, financial barriers, and structural and infrastructural drawbacks (Table 3).

Discussion
This research was conducted with the aim of investigating the existing capacities and barriers in the medical universities of Iran for the sake of entrepreneurship development from the viewpoint of the academic experts. The main strength of this study could be attributed to gathering the views of a number of experts who are simultaneously responsible for the education department of medical universities. All participants, in addition to their faculty membership, were well acquainted with the strengths and weaknesses of the university and the obstacles in the development of entrepreneurship by virtue of their organizational position.
An entrepreneurs university provides opportunities for the formation of creative entrepreneurship and profitable business models through raising the level of entrepreneurial knowledge, implementing creative ideas and solutions, advancing the students' research towards entrepreneurship, training competent and expert entrepreneurs in the field of health, as well as planning and delivering entrepreneurship topics in the curriculum of all majors of medical sciences, increasing research in the health system, promoting the proper interaction between the university and the health-related goods and services bodies, and, finally, providing appropriate supportive mechanisms (ie, financial, legal, equipment, etc.) (10).
The realization of the third generation of universities requires the provision of entrepreneurial education in all disciplines and faculties. Perhaps the main mission of the university is merely the transfer of a series of academic concepts, namely, research and knowledge transfer, but in the present era, the university is no more just a place to learn a series of academic concepts and to perform industrial and commercial projects, but it is a place to educate innovative and creative graduates who are perceived as a major source for investment and development of the community. Such individuals create business opportunities through employing their knowledge besides conducting applied research (11).
Since the establishment of an entrepreneurial university in all medical universities is not possible in the short term, it is possible to prepare the necessary structure for an entrepreneurial higher education institution through examining the obstacles and capacities of the universities. Doing so, an entrepreneurial environment could be prepared aided by health-related professional teams, information support, financial advisory, and facility provision (11).
One of the main implications of this study is the abundant competencies of the universities of medical sciences in the development of entrepreneurship, which suggest that by proper management and the timely and proper use of these capabilities, we can soon witness the development of entrepreneurship among the alumni of medical universities (12).
Our study showed that from the perspective of academic experts, economic and managerial factors are one of the important weaknesses of medical universities in the development of entrepreneurship, which is consistent with Ehsanifar et al's study. They proposed some strategies for the development of entrepreneurship among which are the following: reforming government policies and regulations, educating and promoting entrepreneurship, providing material support, such as granting tax incentives and lowinterest loans, and, ultimately, providing nonmaterial sup- 5 port, such as launching the business incubators and providing amenities and physical facilities (13).
Moghadasi et al have also concluded some factors affecting the entrepreneurship of medical universities, among which one can name prioritizing entrepreneurship in the strategic planning of the university, entrepreneurship management in higher education, organizing training courses for entrepreneurship, providing financial resources, promoting the spirit and culture of entrepreneurship, encouraging entrepreneurs' alumni associations, providing facilities and extracurricular activities, and inclusion of entrepreneurship in the academic curricula. Each of the aforementioned factors has been emphasized in the viewpoint of respondents in the present study (14). Amini et al also conducted a research on the strengths and weaknesses of university entrepreneurship wherein they investigated 6 factors: political forces; financial and economic contexts; cultural and social backgrounds; support; institutions; networks and interactions; and human capital. Further, they introduced institutional supports as well as networks and interactions as the most important strengths and support factor as the rarest strength point in the path to academic entrepreneurship. In addition, political forces and financial and economic contexts were interpreted as the most important barrier and support factors as the least important in the course of the creation of university entrepreneurship (17).
The results of this study to identify the weaknesses of medical universities in entrepreneurship development is consistent with those of Jafarinejad et al (18), Samitowska (19), Ayodeji (20), Chowdhury et al (21), and Atif Bashir (22).
In the present study, among the strengths and weaknesses of universities as well as the leading factors, the academic scholars have made no reference to intellectual property rights, commercialization, family role, and the curriculum revision. This is while Hamilton has emphasized on intellectual property laws and commercialization practices as an important organizational factor (23). In addition, Casillas have pinpointed to the family involvement as an underlying factor in the success and development of entrepreneurship (24). Dundar &Merc also drew the attention to the necessity of changing and reviewing the curriculum (25).

Conclusion
The results of this study showed that to encourage entrepreneurship behavior, universities must first highlight the benefits of expanding capabilities and seeking opportunities and then continue with realizing the opportunities.
Finally, given the fact that universities in Iran are not in a proper position in terms of entrepreneurship, it seems that by looking at the results of this study, it would be possible to come up with solutions to realize this mission in medical universities.
Due to the large number of apprenticeship programs in medical sciences, it is recommended to establish a strong link between the apprenticeship programs and entrepreneurship goals through the formulation of related regulations.
Also, by organizing conferences and workshops and visiting entrepreneurship activities, the university can strengthen the motivation, training, and entrepreneurship skills among students.
As with other universities in developed countries, entrepreneurship and innovation activities are considered as one of the key indicators in the assessment process of faculty members. It is also necessary to provide the necessary facilities for the presence of faculty members in the industry and to facilitate their communication with organizations outside the university to reflect research and educational needs.
Along with all these measures, the most important movement toward entrepreneurship development in medical universities could be making structural revisions in transforming into third-generation universities. This important issue is being pursued and implemented by the government in the form of the Plan for Development and Innovation in Medical Education (26).