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Published On September 15, 2021

POLICY

They Opened a Medical School During a Pandemic. What Could Go Right?

The new, tuition-free school from Kaiser Permanente opened last year with a mission of community engagement. Dean Mark Schuster explains how it went.

Kaiser Permanente—the largest integrated health care network in the United States—announced its plans in 2015 to open a new medical school. Its focus would be on community health, health equity and patient-centered care, and to attract students the school announced that it would waive tuition for its first five classes.

When its first class arrived in July 2020, however, the world had drastically changed. The pandemic had changed the ground rules for in-person training, and as voices across the country protested racial inequality, the new social mandates for medicine shifted. Kaiser had also been rocked by the untimely death of its CEO, Bernard Tyson, a champion of the new school.

The new dean of the Kaiser Permanente Bernard J. Tyson School of Medicine, Mark Schuster—a former chief of general pediatrics at Boston Children’s Hospital and the William Berenberg Professor of Pediatrics at Harvard Medical School—speaks about an eventful first year, the real face of experiential learning and how schools can promote equity from the start of medical careers.

Q: You had a job in Boston. What was the allure of this program?

A: I got totally caught up in the mission. We were going to emphasize person-centered care, population and community health, health disparities and underserved communities. I couldn’t say no.

Q: How does that kind of ambitious agenda translate into a curriculum?

A: We have a case-based learning model. It integrates biomedical science, clinical practice and a knowledge of how health systems work. If students are studying, say, the cardiovascular system, they’re not only learning how to prevent, diagnose, and treat hypertension. The case doesn't end when they figure out the right medication to give the patient. Did they ask about whether the patient has a copay? Can the patient afford the copay, or do they plan to take the medication every other day to try to stretch it out? If the doctor tells a patient that they need to exercise, is there a safe place for them to run when they get home at night? Maybe there’s a park near their house, but it has no lights. You don’t just think, “well, someone should take care of that.” You’ve got an M.D. at the end of your name—you can get through to someone in parks and recreation or your city counselor about getting lights. The idea is that if you are focused on your patient's total health, you're an advocate for them and their community.

Q: Kaiser, like the medical school it runs, is a nonprofit. The organization has a long history of initiatives in community health, including efforts to build affordable housing and reduce homelessness. For your medical school students, what did community engagement look like during a pandemic?

A: Our students start in the clinic in the third week of their first year. They spend a half day a week in family medicine or internal medicine, and they're with the same physician for the entire year. It's called a longitudinal integrated clerkship. That continues for a second year, with additional clerkships in OB/GYN, pediatrics, psychiatry, and surgery,  plus emergency medicine shifts. We were able to have the clinical experiences in person last year, with all the proper PPE. Students also have a required service-learning experience. They spend time in a local, federally qualified health center for a half day a month. We were able to do that last year, too.

Q: What are students doing in those federally qualified clinics?

A: They're learning how to support patients in settings that more often than not have limited resources. They also learn how to navigate the community supports—the nonprofits, the government agencies, and other infrastructure—that can help their patients. Our students are working with a federally qualified health center to set up a student-run clinic. Of course, many of our students also volunteered to give COVID vaccines.

Q: For many schools, the 2020-2021 school year was virtual. Yet you made the decision to have mostly in-person classes.

A: We spoke to a lot of deans and medical education folks who all said, if you can do it in person, you should. Luckily the new building was designed for more than 200 students, but only the first class—50 students—were here, so we had the space to implement the proper distancing. We had masking and screening and the right cleaning protocols. That opened the door to hallway conversations, to running up to the teacher after class and asking a question, to conferring with fellow students—all six feet apart, of course—which are critical elements of an intense learning environment.

Q: How has the school taken on the calls for more diversity and inclusion in medicine?

A: In our first class, 36% of the students are from groups underrepresented in medicine—Black, Latinx, Indigenous, and Pacific Islander. In our second class, 40% are from underrepresented groups. That’s very high compared to the national med school average. We've worked very hard to create a diverse board and leadership team, too. All of our search committees have bias-mitigation training, and we have a group that reviews the whole curriculum for potential bias. We don't want a curriculum where every patient who's identified as black is on public insurance, or where the only time you learn about a gay man is if he has HIV. We want to represent a broad array of people—in our leadership, in our student body and in the patients we learn about.

Q: Kaiser’s medical school is tuition-free for now. How does that change the experience for students?

A: I hope that we can raise resources to continue tuition-free after the first five classes. Many of us have seen students who showed up at med school wanting to go into pediatrics, infectious diseases, psychiatry or other areas of medicine that are relatively lower paid compared to other doctors. And you'd see them in third year really looking at their loans and having that guide their career decisions. If they discover in their third year that they want to be an orthopedic surgeon or a dermatologist, that's fantastic. But I don’t want them to make a decision purely economically.

Making medical school more affordable is something that I think we should work on across the country. In some sense that is happening. Even at some schools that don’t offer free tuition, there's a lot more free education out there than you’d imagine—through need-based scholarships or tuition waivers and merit scholarships. That’s great. I hope it helps students consider working in environments where there’s a real need for them.