Health care is changing, and we’re shaping its future. Technical advances enable less invasive procedures. Outpatient surgeries in ambulatory care have replaced overnight stays in the hospital. New discoveries, and a new field of medicine, are emerging from our clinical research and labs.
As health care advances, so too must the education of future healthcare professionals. A decade ago, leaders from across Hofstra University and Northwell Health came together to establish a new school of medicine, now named the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, honoring the lifetime giving of the Zuckers. In 2017, the Zuckers donated $61 million in transformational gifts to Northwell Health.
Radical medical school curriculum, built from scratch
In 2008, Dr. Lawrence Smith, physician-in-chief, Northwell Health, and founding dean of the Zucker School of Medicine, toured the country with colleagues to learn from other medical schools. They observed few curriculum changes since the 1960s, yet the way medicine was being practiced 50 years later was very different.
“In 1965, 98 percent of all surgeries in this country were probably done as inpatient hospital surgeries,” says Dr. Smith. “And by 2000 well over 50 percent were ambulatory. That’s a pretty radical change. Yet, the educators didn’t seem to mind that medicine was changing rapidly and education wasn’t.
“Daring medical schools were breaking the mold and everyone else quickly copied what they could, fixing a piece of their curriculum. But no one was trying to blow up their medical school curriculum. We were going to build the curriculum of tomorrow.” Students at the Zucker School of Medicine are responsible for patients from day one, with increasing responsibility as their skills mature.
“You can’t become a doctor if you don’t believe you could harm a patient if you don’t do it right,” says Dr. Smith. “That emotional risk taking and knowing the buck stops with you, even if it’s only for a small piece of the care, is essential to that transformation from layperson to physician.”
Jumpstarting clinical confidence in first-year medical students
In early discussions on creating the Zucker School of Medicine, leaders remembered that many medical students and doctors they encountered throughout their careers cited being an EMT as one of the most formative experiences prior to attending medical school. Northwell Health owned 100 ambulances.
“We needed something to jumpstart students’ clinical skills and clinical confidence so that, even in the first year of medical school, they could have some real responsibility for patients,” says Dr. Smith.
Working with New York State, Northwell received approval to augment the existing EMT curriculum with science and physician clinical training. Nine weeks into medical school, our students are certified as New York State EMTs. Additionally, patient communications and physical diagnosis were worked into a comprehensive course. At traditional schools, those areas are sprinkled throughout the first two years.
“By the end of their first course, our students are very comfortable talking with patients,” says Samara Ginzburg, MD, associate dean for case-based learning at Zucker School of Medicine. “They have the skills to stabilize and care for critically ill patients in the field. They can begin working with other healthcare providers and understand the team dynamic. They’ve taken patients into the emergency departments and gotten out into the surrounding communities. We want to imprint all that in their minds as they begin this journey and transform into physicians.”
Putting medical knowledge into action through experiential learning
In this digital age, all students — and patients as well — have the same access to information. So in creating the Zucker School of Medicine, “we took the stand that we would not be about memorizing information but about putting knowledge into action,” says David Battinelli, MD, senior vice president and chief medical officer, Northwell Health, and dean of medical education at the Zucker School of Medicine.
Our student-centered learning model requires students to demonstrate proficiency through standardized patient experiences, simulations, oral exams and essay exams — never through multiple-choice tests.
“We decided early on that we would focus on how young doctors learn rather than how old doctors teach,” says Dr. Battinelli. “We told professors we were less interested in their teaching than in understanding proper learning objectives. Then we designed an experience that accomplishes those objectives better than traditional, passive lecture teaching.”
That’s how the structure lab was born. “We took science courses, typically taught separately, and created an integrated unit that students experience every week,” says Dr. Ginzburg. Students work in groups of six to eight and experience various cases. It’s a student-centered approach, led by faculty, with stations where students may encounter a specimen and imaging then study and determine the problem.
“We also created problem-based structure, which occurs once per course, where students create the case for other students to solve, and they utilize specimens and imaging,” says Dr. Ginzburg. “Students facilitate these stations, rather than faculty.”
At the same time as the medical school was being created, so too was the Patient Safety Institute at the Center for Learning and Innovation (CLI), Northwell Health’s corporate university that offers continuous learning programs to improve patient care and develop future leaders. Our medical students visit CLI more than 15 times throughout their four-year education. They encounter clinical scenarios of various illnesses portrayed by patient actors. They learn at first by taking medical histories and later, as they mature in their schooling, from assessments of how they diagnose and manage patients. Students meet with faculty coaches to debrief video-recorded encounters and together create a plan for areas of improvement.
“The data is really clear. Lectures are efficient only for checking boxes. That is a teacher-centered model. We decided to involve the students from day one in the care of patients,” says Dr. Smith. “Everything we do is in the service of students learning.”
Philanthropy fuels the future of medicine
Along with ensuring our students are armed with training to be the best providers of health care, we are focused on finding students from diverse backgrounds and supporting their pursuit of the medical path of their choice, while minimizing the financial strain.
Zucker School of Medicine students have had the lowest graduating debt of any medical school in New York State since we’ve come into existence, and we are in the top 20 percent nationwide. A $50 million endowed scholarship gift from Donald and Barbara Zucker will further alleviate the financial burden students encounter for generations to come.
Another $10 million created and endows the Barbara Hrbek Zucker Emerging Scientists Program at the Feinstein Institute for Medical Research, and $1 million supports scholarships for Hofstra Northwell School of Graduate Nursing and Physician Assistant Studies.
“I made a promise when I first was dean to only ask for money for scholarships. I never wanted a student to not be able to go to medical school because of a financial situation,” says Dr. Smith. “A reasonable debt level that doesn’t frighten a person into perverting their career choices is really the goal.”
“I’m financing my entire education with loans,” said Sara Abrahams, when she was a second-year student at the Zucker School of Medicine and a scholarship recipient of a previous gift from the Zuckers. “To learn that I was the recipient of the scholarship was a huge relief toward a lot of the anxiety I was feeling about graduating with such a huge amount of debt.”
“From the inception, the medical school has been close to our hearts,” says Donald Zucker. “Barbara and I feel it is incumbent on us to help young people achieve their dreams to be physicians. Future doctors can decide what they are passionate about in medicine, not what is necessary to pay back a loan. And that’s why we did this, and we are lucky to be able to do it.”