The waiting room — that unloved mainstay of medical offices — won’t be part of the University of Texas Dell Medical School’s same-day surgery center, a sign the school does not intend to do business as usual.
Instead, patients and their companions will go to a private room with a touch-screen monitor that can be used to access medical records, insurance information, a list of the patient’s caregivers, perhaps even a movie. The same nurse will keep tabs on the patient from arrival to departure instead of passing the person off to a series of handlers.
“We’re going to treat you like a guest as opposed to a mechanism for generating revenue,” said Stacey Chang, executive director of the Design Institute for Health, an unusual collaboration of the Dell school and UT’s College of Fine Arts.
Officials of the Dell school say they want to infuse every aspect of the enterprise — whether it’s how they enroll students, conduct clinical training or care for patients — with innovation.
Yet, when the school’s first 50 students start classes July 5, they will join peers across the nation in an evolving culture that seeks to put patient needs ahead of the convenience of health care providers — and, more broadly, that aims to reinvent medical education.
Indeed, the field is undergoing perhaps its biggest makeover in a century.
A medical school building boom is underway that is unlike any seen since the 1960s and ’70s when federal aid was in the mix. It’s being fueled by doctor shortages, economic development potential and the prestige medical schools bring to communities. In the past decade, 27 new schools have either opened or begun the years long journey to full accreditation. And virtually all of the newbies, including Dell, aim to transform the way doctors practice and are educated and trained.
Many long-established medical schools are joining in, overhauling practices that haven’t changed significantly since the last medical education revolution, in 1910. At the same time, schools are scrambling to adapt to an emerging health care payment model that seeks to reward providers who keep patients healthy.
In the midst of this, the Austin school wants to stand out as a leader. UT is the first sitting member of a prestigious group of research institutions, the Association of American Universities, to establish a medical school since Michigan State in 1964. And nowhere else have voters agreed to raise property taxes to support a medical school, channeling $35 million a year into the Dell school and creating a special obligation to give back to the community, said Clay Johnston, a neurologist and the inaugural dean.
“We need to rethink everything,” Johnston said. “Really, we’re about being an entirely new type of medical school and taking an entirely new approach to academic medicine and driving forward Austin as a model healthy city.”
The medical school — a decades long dream nudged to reality in an effort led by state Sen. Kirk Watson of Austin — will put more emphasis on problem-solving in class and less on lectures. Medical students will work in teams with peers and students in other health professions. Just one year, rather than the usual two, will be spent on science instruction.
Consequently, students will be exposed to patients earlier than the traditional third year. They will learn alongside local doctors. They will spend more time acquiring leadership skills and less time memorizing facts. They will get time to complete a project — research into the challenge of obesity in Austin, for example — or earn a master’s degree. And they will do all this in the usual four years.
Johnston isn’t worried that the students he’s admitted will shy away from the challenge. “My concern is students are going to get exhausted,” he said.
What’s in Dell’s DNA
Building a medical school from the ground up means that the novel aspects of the teaching and training will require continual tweaking, as well as close monitoring of students and a can-do attitude on their part, Johnston said.
Other new and existing schools are trying a mix of approaches.
Florida International University’s medical school, which opened in 2009, assigns students to the homes of disadvantaged South Floridians, enabling them to follow the families for four years and get a firsthand view of their struggles. Hofstra North Shore-LIJ School of Medicine, which opened in Hempstead, N.Y., in 2011, requires new students to train on ambulances as emergency medical technicians.
And students at Texas Tech’s Paul L. Foster School of Medicine in El Paso, which opened in 2009, learn anatomy, biochemistry, physiology and other subjects based on how they would diagnose a patient, such as one suffering chest pain. The goal is to get them to “think like a doctor” early on, officials said.
The third-year curriculum at the Dell school stands apart from the field, experts say. Students will have nine months for independent study and discovery concerning a key aspect of health care or for pursuing a master’s of public health, business administration, biomedical engineering or educational psychology.
Dell’s DNA also includes a focus on transforming care for the needy by better coordinating services at a lower cost with its partners, Central Health, a taxing authority that is Travis County’s hospital district, and the Seton Healthcare Family, which is contributing faculty and financial support. Students and recent medical school graduates undergoing additional training, called residents, will see patients in the Central Health-affiliated CommUnityCare clinics.
The American Medical Association, the nation’s largest physicians’ group, is impressed. It included Dell in a round of grants awarded to medical schools it sees as innovators.
“Dell, I think, is very special,” said Susan Skochelak, the AMA’s vice president for medical education. “We found Dell before Dell found us.”
The AMA reached out to Johnston after he was named dean but was still associate vice chancellor of research at the University of California, San Francisco, a leading health science center.
“Here was a school poised to be an innovator right from the very beginning,” Skochelak said, citing its location on the UT campus in a city nourished by technology, creativity and aspirations to spawn a biotechnology hub.
“We thought, ‘Really, a medical school at UT-Austin? This will be interesting.’”
The AMA awarded the school $75,000 last year. It’s one of 32 medical schools in the association’s Accelerating Change in Medical Education Consortium. Another is the UT-Rio Grande Valley School of Medicine, scheduled to open July 25 in Edinburg, with a goal of turning out students who communicate effectively with individuals and diverse groups. (A third Texas medical school in the pipeline is in Fort Worth, a collaboration between Texas Christian University and the University of North Texas Health Science Center. It plans to open to 60 students in 2018.)
Asked about the exploratory nature of the consortium schools, Skochelak said she doesn’t consider the programs experimental.
“It is cutting edge,” she said, adding that the AMA will monitor for “drift” in students’ and residents’ test scores. The first graduating class will provide a good measure, and within a few years, the verdict will be in, she and others said.
Skochelak expects the Dell school to perform at a high level. It has a strong leadership team, she said, and attracted more than 4,500 applicants for 50 seats. “They’re in this enviable position of having an embarrassment of riches,” she said.
Designed for compassion
Speaking of riches, the medical school benefits greatly from a state higher education endowment, a charitable donation and its partnership with Seton.
The UT System Board of Regents authorized bonds backed by the Permanent University Fund, a multibillion-dollar endowment, and construction of the $350.6 million project is on track, with the education building scheduled to be finished first, by May 31.
The regents also committed at least $25 million a year in endowment proceeds, plus $5 million annually for eight years to buy equipment. The school bears the Dell name because the Michael & Susan Dell Foundation pledged $50 million.
But the school never would have become a reality if Travis County voters had not approved the tax hike. Separately, Seton, the region’s largest health care system, is underwriting and raising funds for a $310 million hospital on leased UT land that the Catholic-affiliated Seton will own and operate as the school’s primary teaching hospital.
Skochelak and other observers also said they were impressed by UT’s Design Institute for Health, led by two veterans of IDEO, a design and innovation consultancy based in Palo Alto, Calif.
The institute, with 10 employees and growing, is not in charge of selecting floor tile and paint colors. Rather, its mission is to come up with a more compassionate atmosphere in clinics and ways to engage patients in their own care.
To that end, institute officials have met with a homeless blues musician, a pregnant teenager, immigrants here illegally, doctors, administrators, civic leaders and people from other walks of life. And they have created mock-ups of clinical spaces to see what configurations satisfy the needs of patients and health care providers alike.
“We’re not going to change how a hip gets put into you,” said Beto López, the institute’s managing director. “What we have to change is the way in which people have their expectations set, the way they’re treated and the way they are helped after surgery to support them in their recovery.”
First class seats
Not everyone is as sanguine about the Dell school’s nontraditional ideas.
Cory Smith, a senior at UT majoring in biology, said he applied to seven Texas medical schools and ranked Dell fourth. He wasn’t offered admission to Dell but will attend a school that he ranked higher and that is closer to his relatives, UT Southwestern Medical Center in Dallas, generally regarded as the state’s top public medical school.
“On one hand, I don’t have doubts that the (Dell) school will be successful and highly regarded in a short amount of time, but I also knew the road to that, especially for a founding class, would be anything but smooth,” Smith said. Dell’s plan to shave a year from the science curriculum is “extreme,” he said.
Dell school officials said they have eliminated redundancies and obscure material that can be found online.
“I’ve never used my memorization of the Krebs cycle since medical school,” said Johnston, referring to a series of chemical reactions that provide energy in cells.
For Jessica Reynoso, a member of the medical school’s first class, the prospect of having a role in shaping an innovative program is precisely what drew her to it.
“I’m an adventurous person. I view this as a once-in-a-lifetime opportunity,” said Reynoso, 25, whose work as a registered dietitian at Meals on Wheels and More in Austin inspired her to apply. “I think I’m going to be able to gain experiences I wouldn’t be able to get at other places.”
Classmate Woody Green, 37, a paramedic with Austin-Travis County Emergency Medical Services, likes the “flipped classroom” approach, with students reading on their own and class time devoted to discussion and other activities. When he heard Johnston give a talk about reforming health care, he was sold.
“EMS winds up being an unintentional safety net for people who fall through the health care system. It was exciting to hear him talk about working on some of the stuff we’ve been frustrated with. I really wanted to be part of that,” Green said.
He, Reynoso and Smith said the daylong interview process at the Dell school was challenging, and, for the most part, enjoyable.
Applicants underwent two 30-minute interviews, one focusing on their motivation to become doctors and the other on some aspect of their life that would contribute to the overall class; five “mini-interviews” in which they had to respond to an ethics-related scenario; and a group interview in which they had to address a problem.
“The problem itself is not the most important thing,” said Joel Daboub, director of admissions. “We look for things like how collegial they were to each other, how they interacted with their peers.
“That is a unique day. No other medical school that we know of is doing all three of those things together,” he said, referring to the long, short and group interviews.
Not quite from scratch
Austin has had some elements of a medical school for decades, although they weren’t attached to the flagship campus until recently.
Doctors affiliated with Seton have trained third- and fourth-year medical students and residents at the public safety net hospital University Medical Center Brackenridge under the leadership of the UT Medical Branch at Galveston and, later, UT Southwestern. Most of that oversight has shifted to UT-Austin, and that process will be completed early next year.
“People talk about how we’re starting from scratch. We have a system in place,” said Greg Hartman, Seton’s president of external and academic affairs. “We have to deconstruct some of the stuff that was built there. That’s complicated.”
While administrative positions, department chairs and other key jobs are being filled and funded by UT, Seton will continue paying most of the rank-and-file clinical faculty. To date, Seton has hired 243 clinical faculty members, in addition to 40 or 50 community physicians not in Seton-owned practices. Seton also funds a large share of the 261 resident slots for a total investment of $47.5 million this fiscal year, Hartman said.
Physicians associated with St. David’s HealthCare, the second-largest health system in Central Texas, have had little involvement with the medical school, except in one key area. St. David’s, which has no religious ties, educates students and trains residents on sterilizations, which the Catholic Church forbids Seton to do because of strict birth control rules.
The only other involvement of St. David’s is that of a cardiac electrophysiologist, Andrea Natale, executive medical director of the system’s Texas Cardiac Arrhythmia Institute, Johnston said.
Most doctors affiliated with St. David’s don’t expect to have clinical faculty roles, said David Kessler, a colleague of Natale’s. Kessler said he would like to teach but could only do it as a volunteer. He has a common contract stipulation that says if he left St. David’s, he could not work for a year for another health care entity within 25 miles of his office, he explained.
Johnston, who said in a June 2014 interview that he was most concerned about navigating potentially choppy waters with local physicians, has spoken to groups at St. David’s and would like to have its doctors play a greater role. But rivalry between that system and Seton has been more intense than he expected, he said last month. Another challenge has been persuading some skeptical, change-resistant Seton physicians to get on board. Some have opted out, Hartman said.
UT officials say they don’t know of another public medical school in the nation whose primary teaching hospital is Catholic. One candidate to head the women’s health department at the Dell school withdrew out of concern that she would not be able to pursue her abortion research, Johnston said.
Many high-priority programs, including cancer and mental health, are still in formative stages, but Johnston sees a bright future for the Austin area and the university, thanks in no small measure to stable resources, including the taxpayer support.
“It gives us a kind of grounding that’s fabulous,” he said. “It’s both a great reminder of why we exist and it’s also incredibly enabling. We’re entrusted by this community to bring new models of care, particularly to the underserved. That’s our job. And that helps us to work with all kinds of different partners to get it done.”
Dell Medical School's first class, by the numbers
- 50: students in first class
- $19,292: annual tuition and fees for a student from Texas
- $32,392: tuition and fees for students from out of state
- 261: residents (students and medical school graduates undergoing additional training)
- 53: faculty members hired by UT so far
- 13: trees successfully transplanted to accommodate construction