Kaiser medical school leans into '3rd pillar' of education

The Kaiser Permanente Bernard J. Tyson School of Medicine, which opened in July 2020 in Pasadena, Calif., graduated its first class in May and received full accreditation in June. This milestone coincided with the appointment of John Dalrymple, MD, as the school's dean and CEO. Dr. Dalrymple, a physician and educator, previously served as senior associate dean for medical education at Harvard Medical School in Boston.

In an interview with Becker's, Dr. Dalrymple discussed the medical school's mission, its curriculum, and strategies to address the physician shortage and enhance patient care.

Editor's note: Responses were lightly edited for length and clarity.

Question: What strategies will you employ to ensure the curriculum stays ahead in preparing future physicians for value-based and patient-centered care?

Dr. John Dalrymple: Our take on medical education goes beyond teaching medical knowledge and clinical skills. We really see this as a transformative process where we help our students develop their professional identities and help shape them into future physicians who are going to be ready to meet the future needs of health and healthcare in America. And we want to make sure that they are able to care for the patients and the communities down the road, recognizing that healthcare is constantly evolving.

With that in mind, we focus on integration and thinking about not only the traditional areas of biomedical science and clinical care, but the integration of a third pillar, which I think is a unique aspect of our curriculum, which is centered on health system science. By combining biomedical science, clinical science and health system science, and doing so in a very intentional way, it allows us to think about the future needs of physicians that are centered on a patient-centered approach, ensuring that the quality of the care meets the needs of the patient, that it's of high value, and that it's equitable and accessible to everyone, all the patients and communities, no matter where our graduates go.

We've just completed four years of our school. And so our curriculum is still new, and as such, we embody an approach that includes continuous quality improvement. Recently, we conducted what we call our curriculum-as-a-whole review, where we looked at our entire boarding curriculum and did a comprehensive review to see what is working? Did our blueprints help meet the mark in terms of our innovative approach? Are we actually meeting the needs of our future physicians?

Our health system science approach to medical education is fairly unique, and I think it is an approach that is revolutionizing how medical educators think about the future education of physicians. As such, we have really taken that on boldly. Within that is certainly a focus on value-based care, coupled with the fact that we are embedded in the Kaiser Permanente healthcare system, where value-based care is central to everything that they do. By positioning our students in that clinical environment, we are really putting our students at the forefront of how medicine and healthcare can be delivered in a meaningful way.

On top of that, teaching intentional skills such as patient safety, quality, community health and health policy, which are really central to our healthcare compliance curriculum. We aspire to ensure that our future graduates are primed and ready to deliver the care for their future patients, no matter where they are, in a sort of future-facing approach. 

Q: How will you foster collaborative learning experiences among students from different healthcare disciplines to improve patient outcomes?

JD: In general, collaboration is key and central to everything we do in medicine. It really is the future of healthcare. And thinking about collaboration across different backgrounds, different specialties, different identities, is really essential.

At the medical school, we are deliberate in building a culture where interdisciplinary learning is really the norm. It's not an exception; it's really how we approach everything we do. We recognize that in medicine and in the future of healthcare, it really relies on teamwork and working across disciplines and across backgrounds. That's the only way that we're going to be able to deliver effective, comprehensive, patient-centered care.

So with that, we build intentional learning opportunities in our curriculum. This interprofessional collaborative approach allows our medical students to come in close contact and work alongside students from other disciplines, specifically pharmacy students and nursing students from other programs. We bring them all together and allow them to work in sort of realistic patient-care scenarios, simulation settings, that allow them to practice and develop those skills working across backgrounds and disciplines.

We do it sort of in the simulation setting, and of course, we know in the actual patient-care setting, our students are out in the clinical sites scattered across the Kaiser Permanente medical centers in Southern California. Our students are working alongside physicians who are in the KP system, who themselves are working alongside nursing, pharmacy, allied health, social work, everywhere that healthcare is delivered.

In the real-life setting, our students are exposed to that as well as working with doctors and healthcare professionals from other subspecialties. They also work alongside residents. So it's really core to how we teach systems, like many other medical schools do, of course. But I will say that we initiate these principles on day one in how we provide classroom teaching.

Our curriculum instruction is really focused on small-group, case-based learning such that the students learn from each other. They work together in teams with other students and with their faculty, and that's how they learn medicine, how they learn the biomedical sciences, the clinical sciences and the health system sciences. They learn that approach to team-based learning, which we hope will then continue into the clinical setting and ultimately into their practice moving forward.

Q: What strategies do you have in mind to address physician shortages and encourage graduates to work in underserved areas?

JD: We are absolutely committed to addressing this topic area. I think the latter one — ensuring that our graduates are up to date on underserved and under-resourced communities — is one that we take on front and center.

In fact, it really aligns with our mission. Our mission is to provide a world-class medical education that ignites a passion for learning, a desire to serve, and here's the key part: an unwavering commitment to improve the health and well-being of patients and communities. When we say that last part, we mean all communities.

With that, we are very intentional about ensuring that our students, again through our partnership with Kaiser Permanente, are provided a robust network of opportunities to work in community health settings. Specifically, we have built in a service-learning curriculum, specific activities, and partnerships with federally qualified health centers that every one of our students engages in. Through this, they have direct opportunities to learn about community health, the provision of care and support in under-resourced areas.

We know that those who choose medicine do so because it's a calling. Yes, it is a profession, but it's also a calling. Our goal is to support our students who are inspired to go into medicine, meet them where they are, and give them the chance to learn all that they can. We want to equip them with the tools they need to make an impact. By doing so, we hope and aspire to ensure that our students graduate with the ability to approach the delivery of healthcare in any community, including those that are underserved if that's the area they choose to work in.

The physician shortage is tricky. There are many approaches to that. Certainly, there has been a plethora of new medical schools over the past decade in the U.S. Obviously, we're a new school. We're a bit on the small side with 50 students a year. The topic of increasing class size or expanding the school, I think, is on every school's mind, certainly on ours. Eventually, this will sort of get to the part about addressing physician shortages.

But there are other ways to think about addressing access to physicians, especially in under-resourced areas. That includes thinking about technologies, thinking about collaborative care. We talked about interprofessional collaboration. How can we bring other healthcare providers and physician extenders together to allow physicians to work at the top of their license while others provide care in the community?

Q: Given the ongoing discussions about physician burnout and the role of digital technology in improving workflows, what lessons or strategies from the medical school's model and curriculum do you think health system executives could adopt to enhance care delivery, improve patient outcomes and address workforce challenges?

JD: The great thing about our school being new is that we embrace innovation — not just for innovation's sake, but to really think about how we can move the needle on medical education and, ultimately, physician development and delivery of healthcare.

Certainly, Kaiser Permanente, as a healthcare organization, is at the forefront of thinking about enhancing technology and digital health and other mechanisms to improve the physician experience and the patient experience. They were at the forefront of the electronic health record and other ways of providing asynchronous virtual care and other approaches.

I think for us at the school, we certainly want to think about ways to innovate in how to deliver our curriculum, but also how to ensure that our graduates continue to take that approach and be lifelong learners as they move into practice.

We have to think about ways to integrate technologies such as artificial intelligence and how we can leverage that in a way that helps make the delivery of healthcare on the physician side more efficient and more meaningful. We want physicians to be freed up from too much administrative work and focus instead on the part that technology can't replace: the human touch, the human compassion, the human connection.

There are other ways technology can make our lives easier. We certainly don't want to make it more complicated, and we certainly have to think about the ethical uses of technology. But I think those are some of the approaches we're thinking about at the school on how to integrate that into our curriculum so that way, our medical students can take those learnings and move them into practice and into healthcare programs and communities. That way, they can live productive, meaningful lives as doctors and deliver the best care to their patients and communities.

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