Chronic disease is one of the biggest public health challenges people in the U.S. face—more than 60% of people 18 to 34 years old have at least one chronic condition. Helping people change behaviors and make healthier lifestyle choices is an integral part of managing chronic disease.
In fact, for Conrad Vial, MD, this was something that was not a focus in the curriculum in medical school.
“Physicians still don't receive enough training in behavioral science or health literacy. That's a significant gap in our healthcare system with broad public health implications,” said Dr. Vial, president and executive vice president of Sutter Health, a not-for-profit integrated health delivery system based in California.
Bioethics is another area where education is lacking. Most medical schools include ethics courses, but they're often taught in a theoretical way. Students don't always have opportunities to apply those principles in real-world clinical settings, he observed.
This is why Sutter Health is teaming up with Santa Clara University to introduce a new “learning health system” model for physicians in training. As the first new MD-granting medical school in the San Francisco Bay Area in more than a century, the Mark & Mary Stevens School of Medicine will address whole person care with technology, ethics and science within an integrated healthcare network.
Behavioral science, health literacy, biomedical ethics and even practice management are all areas that deserve greater emphasis alongside traditional clinical training, said Dr. Vial, inaugural chair of the board of directors for the new school. “Those are gaps we intend to address in our curriculum."
Sutter Health is a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Jesuit values guide new curriculum
The partnership between Sutter Health and Santa Clara University is rooted in shared values, particularly a commitment to humanistic, integrated health system care, said Dr. Vial. The university’s Jesuit principles of serving communities and promoting the common good align closely with Sutter's mission.
Healthcare extends beyond hospitals and clinics, requiring physicians to engage with patients in their homes and communities to promote health, not just treat illness. Those shared values, he said, make the organizations well suited to educate the next generation of physicians.
Jesuit teachings also focus on caring for the whole person, said Lindsay Mazotti, MD, Sutter Health’s chief academic officer, and planning dean of the new school.
"Thinking about how we teach humility and empathy and how we teach learners to establish trusting relationships with patients—that humanity-centric part of medicine is also very central to what the Stevens School of Medicine curriculum will be designed around," explained Dr. Mazotti.
Where physicians train often influences where they ultimately practice. By creating a medical school that's embedded within a large, integrated health system, Sutter Health is also building a pathway of future physicians who understand their patients and communities and who may choose to stay and practice here, she said.
Integrated system opens new doors
Most physicians train in university settings. When you're in a primary tertiary center, sometimes you don't have the same experience around care across the continuum—meaning being deeply embedded in primary care or understanding responsibility for population health, preventive care, acute care and home care, said Dr. Mazotti. “That's all part of our care continuum.”
An integrated delivery system affords opportunities that might be different from the types of projects students experience at a tertiary care center, particularly related to operations and the day-to-day care of populations of patients, safety and quality.
Sutter Health cares for 3.6 million patients across California, “and that's a very different number than most university settings,” said Dr. Mazotti. Caring for patients across that care continuum—and then sometimes in the hospital and then back out—changes how physicians see episodes of illness.
“I also think it changes how you think about prevention as part of care,” she said.
Specialty silos won’t work
Dr. Vial specified that training should take place across physician specialties and alongside other healthcare professionals, rather than in the isolated departmental structures that have traditionally defined medical education. He used his own profession of cardiac surgery to illustrate his point because cardiologists and cardiac surgeons used to work separately for the most part.
“I was training in an environment where you had a division of cardiology and various subdivisions that were sitting in a department of medicine that was siloed off from a cardiothoracic surgical division within a department of surgery,” he recalled.
Patients might see one specialist and then another, and research and innovation happened within individual specialties. Today, innovations such as minimally invasive heart valve replacement demonstrate how collaboration between disciplines leads to better care and faster medical advances.
For example, procedures like transcatheter aortic valve replacement have required cardiologists and surgeons to work together.
“I started seeing patients referred to me who might have been candidates for surgery together with my interventional cardiology colleagues,” Dr. Vial said. “That was a while ago. But it positioned us to be able to participate in research and teaching and proctoring in this space.”
That collaborative model has since accelerated patient care, research, teaching and innovation.
The new medical school will expose students to that interdisciplinary, team-based model from the start, helping them develop the communication, and behavioral and technology skills needed to lead modern healthcare teams, he summarized. It will also prepare future physicians to deliver evidence-based, compassionate and human-centered care across rural, suburban and urban communities.
Students who learn that way of thinking will be exposed to one of the most important prerequisites for success in the future of medical practice: how to combine people's skills and talents in a new, more efficient way.
This involves partnering with nurse practitioners, physician assistants, pharmacists, psychologists and clinical social workers to compose an interdisciplinary team that optimally benefits the patient, said Dr. Vial. “You have to have an attitudinal predisposition to that, but it's also a learned skill.
“Even if you have that character logic predisposition to want to work through and with interdisciplinary constructs, there are behavioral skills, analytical skills, and also technological tools that need to be brought into that equation,” he advised.
What a learning health system looks like in practice
A learning health system means that you're constantly assessing how well you're delivering care, working to improve it and then looking again. It's this ongoing cycle, noted Dr. Mazotti. "Clinical care, education and research improvement are all intentionally connected.”
Ideally, when medical students are embedded in a learning health system, they're seeing early on that systems improvement is part of the work they do day to day. It's not just about memorizing or taking care of one patient, she added. “It's actually thinking about the system from the get-go.”
The goal is to embed health system science content in the curriculum. Physicians will be doing real projects related to improvement of the system as early as their first year of medical school.
Faculty members are already doing this work, and it changes the game when you have to teach what you're doing in terms of improvement.
“It almost enhances or amplifies the importance of the work that I'm doing when I'm teaching someone else how to do it,” said Dr. Mazotti. “It’s good for faculty, too, because it makes the work more intentional.”
How the curriculum could shape better physicians
Physicians need to lead teams and be collaborative members of teams. For this reason, “we think there needs to be more leadership development and leadership training embedded in medical school, as well as health system science—understanding insurance, understanding policy and understanding advocacy—things that traditionally have not been part of the medical school curriculum,” said Dr. Mazotti.
Courses in ethics and humanities, deep work and reflection, responsible use of technology and AI, and coaching around patient communication, including watched and coached interactions with patients, will be important too.
“We need to have very deliberate training around communication,” said Dr. Mazotti. This is not just about knowing how to take a history, but to understand the therapeutic principles of how you connect and help patients with guided decision-making.
One advantage of the partnership is Santa Clara University's Markkula Center for Applied Ethics, the largest university-based ethics center in the country, noted Dr. Vial. The goal is to bring together the strengths of both institutions to give students a more complete understanding of how to apply ethics in patient care.
Most physicians come out of medical school without a connection to the business of medicine or what physicians can do outside of specifically clinical care, said Dr. Mazotti. At the new school, students will have early coursework in innovation and clinical research and understand how to connect to industry and the work that physicians do in technology, research and innovation.
Dr. Mazotti would also like to see students immersed in service opportunities to do systems improvement, either within the health system or the communities Sutter serves. From the beginning, they’re learning how problems are identified in care delivery and then working on teams to solve them. They don’t have to wait until they're done with residency to learn these things, she said.
Training doctors in tech skills of the future
Combining this humanistic approach and commitment to whole-person care with medical and information technology sectors represented in the core geography where the school will be situated—the heart of Silicon Valley—offers a tremendous opportunity, said Dr. Vial.
The goal is to encourage usable applications of technology in care decision support, but also do it in a way that amplifies the qualities of compassion and care, and a holistic perspective on patients and their communities.
“I see those attributes not only being amplified but also being differentiating for this school,” said Dr. Vial.
Technology plays a part, but physicians need to learn how to use technology responsibly in medicine, noted Dr. Mazotti. This means being part of how medicine changes in response to things like augmented intelligence and virtual care, and how these changes affect how care is delivered.
Addressing shortages and expanding the workforce pathway
California is a net exporter of physicians, both at the medical school level and in residency. People tend to stay where they finish training.
Sutter Health is thinking very deliberately about the future of care for its communities—urban, suburban and rural—across the Northern California footprint.
“If we want to make sure that we have physicians to care for future generations, we're investing in growing our own,” said Dr. Mazotti.
That means expanding graduate medical education programs across the footprint, helping strengthen the healthcare workforce and expand access to care across California and beyond.
"Learning how to be doctors in the places they're from and the places they intend to stay means they're caring for their own communities,” she said, emphasizing “it's an incredible pathway.”
“We take care of people who live in some of the richest ZIP codes, most affluent ZIP codes in the country, and some of the poorest and most marginalized ZIP codes in the country,” said Dr. Vial. Social drivers of health have a tremendous bearing not only on the quality of healthcare, but the ability to promote healthful practices in communities.
“We know that those determinants or drivers of health play out differently depending on the context, if it's rural versus urban,” he said.
The new school will expose students to all those practice environments and community contexts. In doing so, “we are very hopeful that we can encourage more physicians to be well educated and be able to derive the opportunity to practice in a very fulfilling fashion in our state and within our footprint,” encouraging them to practice in rural environments that the Sutter Health footprint covers, said Dr. Vial.
California is known to have primary care deserts in its northern and central regions, he continued. For that reason, this isn’t just about physician retention. It’s about providing people with training environments that may inspire them to practice in challenging and vulnerable areas.
“And our system's breadth and depth give us the opportunity to do that. We're pretty excited about it,” Dr. Vial said.
Preparing for the practice of tomorrow
Ultimately, the goal is to expose students to real-world scenarios, Dr. Vial emphasized.
Medicine has evolved to a point where if you’re not using interdisciplinary team-based care delivery in the real world, it's going to be very difficult to deliver on today’s or tomorrow’s best practices.
“What it takes to really confront real world problems across the continuum of care is so dense and so deep that no one practitioner can possibly on their own practice consistently at that top of licensed standard,” Dr. Vial said.
Physicians who practice in real-world environments, who are involved in active teaching and learning environments will yield a better result and hopefully a better experience for the patients themselves, said Dr. Vial.
