Motivating Medical Innovators: A Qualitative COM-B Analysis of Physician-Scientists Engagement in Biomedical Advancement in Chinese Academic Medical Centers.

BACKGROUND: Physician-scientists connect clinical care with knowledge generation, yet sustained engagement in medical innovation after entering clinical practice remains insufficiently understood. This study explored how motivation, capability, and contextual opportunity shape innovation engagement and how physician-scientists navigate dual clinical and research roles in Chinese academic medical centers. METHODS: We conducted a constructivist exploratory qualitative study involving 27 MD-PhD physician-scientists recruited through purposive sampling from six academic medical centers in Beijing, China, between March 2024 and February 2025. Data were collected through individual semi-structured interviews and analyzed using inductive thematic analysis informed by Braun and Clarke's framework. The COM-B model was applied as an interpretive framework to examine how capability, opportunity, and motivation shaped innovation behaviors. Conceptual saturation was achieved after analysis of the 27 interviews. RESULTS: Four interconnected themes emerged: (1) dual professional roles, characterized by dynamic movement between role accumulation and role conflict as physicians negotiated clinical and research responsibilities; (2) evolving motivational mechanisms, including prosocial goals, achievement orientation, status-related aspirations, and impression management; (3) innovation ecosystems, including institutional policies, organizational support, and collaborative networks that enabled or constrained engagement; and (4) capability development, including self-efficacy, resilience, knowledge, and research experience. These findings indicate that physician-scientists' innovation engagement was shaped by continuous interactions among personal motivation, professional capability, and environmental opportunity rather than by any single determinant. CONCLUSION: These context-specific findings support coordinated educational and institutional strategies rather than reliance on individual motivation alone. Priorities include formally protected research time, career and evaluation pathways that recognize dual clinical-research contributions, longitudinal mentorship and continuing research training, and transparent interdisciplinary collaboration mechanisms.