By: Felix Ankel, Daniel Cabrera
Medical education is in the middle of another wave of change: AI adoption, the push for CBME, the promise of precision health, and the rise of precision medical education. Our relationship to knowledge, professional roles, and structure is shifting. These changes are disorienting, and creating a map to give meaning and make changes actionable is necessary.
We are educators and we’re good at innovating. We create new philosophies, outcome competencies, accreditation, and certification standards. We guide learners, help build professionals, launch careers, publish papers, give presentations, and build promotion portfolios. The academic currency is based on doing new things.
But what about letting go of the old? Where are the understanding and framework for not doing things, for letting things go? Where is the academic currency for exnovation?
How do we let go of milestones when we adopt EPAs? How do we move past time-based education to implement true CBME? How do we retire old regulations when new accreditation and certification standards come online? Should every innovation center also be co-located with an exnovation center?
Below are three spaces where exnovation might help us move forward, along with a framework—Theory U—that might help us do it.
Innovation without exnovation is just academic hoarding
1. Exnovation and Medical Knowledge: From Vessels of Knowledge to Navigators of Wisdom
Traditionally, physicians lived in the information-to-knowledge space. Patients brought information, doctors processed it with knowledge, and, through expertise, created value.
Now? AI and widespread access to information are automating much of that path. The physician’s value is shifting to the knowledge-to-wisdom domain—a shared space with patients, families, teams, the public, and machines. The value, and we prefer to say the meaning, of the clinician is on the wisdom of understanding the complexity of the advanced technologies, the ability to explain them to patients and peers, the power to “unplug the machine”, and the ability to be the human in the loop between technology, patients, and society.
Wisdom is less binary. It’s collective, messy, and deeply human.
What do we need to let go of to get there, and how do we know we’re making progress?
Knowledge is power. Wisdom is shared.
2. Exnovation and Professional Roles: More Quantum, Less Binary
Medicine has always been binary. You’re a doctor or you’re not, a specialist or not, in or out. You know this or not, you can do the procedure or not. There is always now or not now, never the chance of transition.
But the future feels more quantum. Physicians can exist as both particle (keeper of knowledge) and wave (navigator of shared wisdom). Less gatekeeper, more guide. Less “sage on the stage,” more “companion on the journey.”
If that’s true, what parts of our professional identity do we let go? What rituals and celebrations get retired? How do individuals and organizations adapt when the old markers of identity shift?
The next generation of physicians won’t just know—they’ll navigate.
3. Exnovation and Structure: Fewer Hierarchies, More Networks
Established centralized institutions—medical schools, hospitals, accrediting bodies, and certification boards- traditionally defined medical education. These institutions created boundaries for entry, preserved authority, and provided order, coherence, and durability. They’ve always told us when we’re “ready.”
But we’re moving into an exponential world. What happens when organizations offer micro- and meso-credentials, on-demand and at scale? What old workflows, communication channels, and planning models do we need to retire?
If structure doesn’t bend, it breaks.
Theory U: A Framework for Letting Go and Moving Forward
Otto Scharmer’s Theory U links exnovation, innovation, and transformation. The journey is U-shaped: starting at the top left (letting go), moving to the bottom (presencing), then rising back up the right side (creating the new).
- Co-Initiating: Open your mind and heart. Listen deeply. Create shared intention.
- Co-Sensing: Immerse. Observe with fresh eyes. Exnovate old preconceptions.
- Presencing: Hit pause. Connect with your highest future potential. Let go of the past.
- Co-Creating: Prototype innovations. Test. Run small, rapid experiments instead of waiting for grand plans.
- Co-Evolving: Scale what works. Let systems shift.
Exnovation is the discipline of saying goodbye so innovation can say hello.
Questions to consider
- What’s your exnovation philosophy?
- What’s your exnovation discipline?
- Do you pair innovation with exnovation—or are they siloed?
- How could exnovation reshape your relationship with knowledge?
- With professional identity?
- With the structures that frame medical education?
References/Further Reading
Scharmer, C. O., & Senge, P. M. (2009). Theory U : leading from the future as it emerges : the social technology of presencing (1st ed.). Berrett-Koehler.
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