Hofstra Magazine

Hofstra and North Shore-LIJ Reinvent Education of 21st-Century Physicians

By Leila Zogby

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"All medical schools are trying to improve,” Dr. David Battinelli explains. “We have the advantage at Hofstra of starting with a clean slate. We don’t have to spend time breaking out of established models and can go right into implementing the best practices we’ve found."

While the debate on health care reform captures the public’s attention, Hofstra University is establishing a medical school that may have a part in revolutionizing the education of tomorrow’s physicians.

Subject to receiving preliminary accreditation and state approval, the Hofstra University School of Medicine in partnership with North Shore-LIJ Health System, is scheduled to accept its first students in fall 2011. The School of Medicine has been simultaneously working its way through the accreditation process and designing an integrated curriculum that will put medical students in patient care settings from Day One. The traditional medical school model places students in life and medical science classes during the first two years and then offers clinical training in the final two years.

Patient interaction from the start

Hofstra’s entering medical students will be trained during their first few months as emergency medical technicians (EMTs) and will take shifts riding the ambulances of the North Shore-LIJ Health System. North Shore-LIJ is the nation’s third largest nonprofit, secular health care system (based on number of beds) and is partnering with the University in establishing the medical school.

“The purpose of the EMT training is to give students hands-on skills early to give them the opportunity to understand how patients interact with their environment,” says Dean Lawrence G. Smith, M.D. “Equally important is the fact that by experiencing the ER, they’ll be able to discern the difference between books and reality, a good thing to understand early on.”

The medical school’s curriculum was developed by the Educational Program subcommittee, chaired by Senior Associate Dean for Education David Battinelli, M.D., after visiting and consulting with more than a dozen medical education institutions in the United States and abroad.

“All medical schools are trying to improve,” Dr. Battinelli explains. “We have the advantage at Hofstra of starting with a clean slate. We don’t have to spend time breaking out of established models and can go right into implementing the best practices we’ve found.”

Why a new approach?

The United States is facing an anticipated shortage of U.S.-trained physicians in the 21st century, a trend that has spurred the opening of new medical schools. To review the nation’s medical education practices, The Josiah Macy, Jr., Foundation in 2008 gathered leading medical educators who concluded that medical education needs to be brought into better alignment with societal needs and expectations.

Accomplishing this requires preparing physicians to manage such contemporary realities as the accelerating pace of scientific discovery, the calls for more public accountability, the unsustainable rise in health care costs, the well-documented shortfalls in quality of care, racial and ethnic disparities in health and health care, and the increased burden of chronic illness and disability.

The School of Medicine curriculum aims to prepare physicians to address these issues. For example, health care increasingly will be delivered through inter-professional teams as a way to improve quality and control costs. The EMT experience immediately will immerse students in the world of health care teams. Classes also will be designed on the team model, with most classes offered in small groups as opposed to large lectures. Scientific training remains the foundation of medical education. Students will learn how to apply the concepts they learn in the classroom to real-life situations. The basic sciences will be team-taught so that the interrelationship among subject areas will be evident.

This means that rather than learning normal versus abnormal structure and function of a certain part of the body separately and, perhaps, months or years apart – as has been the tradition – students will take an integrated approach. For example, students exploring the human shoulder will learn the anatomy and physics involved, study how the shoulder works normally, learn what can go wrong, and then, in a clinical setting, observe how these conditions are treated.

Students will benefit from the latest simulation technology, available at North Shore-LIJ’s Patient Safety Institute (PSI). PC-based, digitally enhanced mannequins can be programmed to simulate countless medical scenarios, such as stroke and heart attack, so that students can learn to diagnose and manage treatment without risk to real patients. PSI also offers clinical education facilities that can replicate for training purposes situations in a critical care unit or an operating room. Cultural literacy is an essential component to understanding and affecting population health. The New York metropolitan area offers Hofstra School of Medicine students exposure to a myriad of cultures, particularly as they train in North Shore- LIJ’s facilities in Queens, the most ethnically diverse county in the nation.

Doctors with broader perspectives

As patients, we travel through a continuum of care: home, clinic or physician’s office, hospital, nursing or rehabilitation facility. Controlling costs and improving outcomes depends on 21st-century physicians understanding and managing every phase of this continuum. With its 14 hospitals, 18 long-term care facilities, three trauma centers, five home health agencies, a hospice network, dozens of outpatient centers and the world- renowned Feinstein Institute for Medical Research, the North Shore-LIJ Health System exposes medical students to a full range of experiences. The University – with its schools of Business; Communication; Education, Health and Human Services; Law; and Liberal Arts and Sciences – offers students a wealth of academic and interdisciplinary exposure.

Physicians increasingly will be called upon to participate in public discussions regarding health and health care. “Medical decisions need to be made in societal context,” says Veronica Catanese, M.D., M.B.A., senior associate dean for academic affairs. “They must address improving the health of the entire population. We plan to equip our students with a background in the social sciences, as well as with root-cause analysis skills and other techniques commonly used in the business world, so they can be part of finding solutions.”

From Weight Rooms to Classrooms

By next summer, the renovation of the former New York Jets football team training facility on the North Campus will be completed, and the building will become the interim home of the School of Medicine.

Designed as a microcosm of the permanent home that will be built on an 11-acre parcel in the northeast corner of the North Campus, the interim building will emphasize small classrooms conducive to group study and maximum class interaction and will offer students various communal areas for study and socializing. This utilization of space reinforces the team building and integration of subjects at the heart of the school’s innovative curriculum.

Administrative offices will be located alongside classrooms to facilitate interaction between students and faculty. The interim building also will feature a lecture hall, an anatomy lab and a medical library that will contain primarily documents in digital form, in keeping with the current trend in academic publishing.

Every effort has been made to reduce the building’s environmental impact. A more efficient heating and cooling system has been installed, and new furniture and carpeting meet the Leadership in Energy and Environmental Design (LEED) Green Building Rating System standards developed by the U.S. Green Building Council.

“In designing the interim building,” explains Joseph Barkwill, Hofstra vice president for facilities and operations, “we emphasized the concept of a living and learning environment. We’ve created in miniature what we will carry over to the permanent building, which we expect Veronica Catanese, M.D., M.B.A. to complete in 2014.”

Tapping into Hofstra’s resources

Medical schools often are located on their own campuses, separate from the academic centers of their parent institution. That will not be the case at Hofstra, where the medical school and medical student residence will be on Hofstra’s North Campus.

“The University made the conscious decision to integrate the medical school into the larger campus,” explains Provost and Senior Vice President for Academic Affairs Herman Berliner. “We want to share faculty and resources and to create collaborative programs.”

For example, the curriculum anticipates partnering with the School of Law and Hofstra College of Liberal Arts and Sciences’ Department of Drama and Dance to help medical students improve their communication skills. Better communication will lead to better care, but, equally important, it will help doctors understand how to influence patients to change lifestyle habits that contribute to the rise in chronic illnesses, such as diabetes and heart disease.

School of Law faculty, who were represented on the medical school curriculum design group, will help teach bioethics courses. And an innovative exhibit has been proposed for the Hofstra University Museum to showcase the “art” of designing prosthetic devices.

There is a broader context for the choice to integrate the new school into the larger Hofstra world, according to Hofstra President Stuart Rabinowitz. “Hofstra has made progress in enhancing its national reputation for excellence,” President Rabinowitz says. “We believe that significantly expanding our science programs is the next logical step on that journey, and the medical school will be a catalyst for expanding that expertise.”

The benefits are already evident. Also in partnership with North Shore-LIJ, a new master’s degree program in medical physics is awaiting approval, and planning is underway for the creation of a Ph.D. in molecular medicine, in collaboration with the Feinstein Institute. A Master of Public Health is being designed with Hofstra’s School of Education, Health and Human Services, a school that will likely see more of its health professions programs expand as the School of Medicine grows.

And then there is the potential economic impact on Long Island. “North Shore- LIJ and Hofstra already are major players in Long Island’s economy,” says President Rabinowitz. “The medical school partnership can be a driver for biotech and biomedical sciences companies. There are many examples nationwide of academic science centers stimulating this type of economic growth, and there is no reason to believe it would not happen here.

Next steps

The Hofstra University School of Medicine in partnership with North Shore-LIJ Health System faces its first critical step toward accreditation this spring with the official visit of the Liaison Committee on Medical Education (LCME), the nationally recognized accrediting authority for medical education programs leading to the M.D. degree in the United States and Canada.

During the past 18 months, more than 250 people from Hofstra and North-Shore LIJ have contributed to preparing the school’s preliminary proposal. Subject to receiving preliminary accreditation, the School of Medicine will become Nassau County’s first allopathic (M.D. degree-granting) institution and the first medical school on Long Island in 35 years. The first class would enter in fall 2011. The School of Medicine administration also will begin exploring ways to raise monies for scholarships and financial aid. “We need to make it possible for academically qualified students to enter medicine who otherwise could not afford to do so,” says Dean Smith.

“Right now, more than 80 percent of medical school graduates carry a debt burden of $130,000 on average,” the dean continues. “Not only does this discourage students from low-income families from pursuing careers in medicine, but also it steers young doctors away from less well paying, but potentially more socially responsible careers. We are hopeful that the community will help us to address these important issues by expanding financial aid opportunities.”

Dean Smith’s enthusiasm for the medical school and its innovative curriculum is irrepressible as the dream moves closer to reality. “I can see a day, not too far off, when residency directors will covet our graduates. They will say that Hofstra School of Medicine grads have learned how to care for patients competently and how to think clearly.”