The founding leaders of the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell are ready to make their case for more collaborative medical education. They just needed the product first.
David Battinelli, MD, the school’s dean and New Hyde Park, N.Y.-based Northwell Health’s physician-in-chief, and Lawrence Smith, MD, founding dean emeritus, welcomed the first class at Zucker School of Medicine in 2011 with a blank slate and a radical premise: that physicians learn better when treated as collaborators rather than competitors, evaluated on clinical judgment rather than test-taking, and put in front of real patients on day one.
Now, 15 years later, those first students are in faculty roles — and the results are documented in a new book, “Revolutionizing Medical Education: Proven Blueprint to Transform Curricula and Prepare Future-Ready Physicians,” published in April by Wiley.
When the founding deans first began explaining the model across the country, they were met with both interest and skepticism.
“It was very clear that nobody was going to be able to listen, even though we’d been visited by over 50 medical schools, until our graduates were out performing extraordinarily well in graduate education programs and as faculty,” Dr. Battinelli told Becker’s. “We waited patiently until we got to this point, and then felt it was time that we could write about it.”
Zucker, based in Hempstead, N.Y., was founded jointly in 2008 by Hofstra University and Northwell Health, which is now the largest nonprofit health system in the Northeast with 28 hospitals. From the start, the school eliminated grades and class rank, replaced multiple-choice exams with essays, oral assessments and high-fidelity simulations and required first-year students to complete accelerated EMT training and respond to emergency calls. Students log hundreds of clinical hours — in obstetrics, surgery, psychiatry, pediatrics and internal medicine — before completing their second year.
Critics predicted the heavy clinical load would dilute the science and leave graduates underprepared. The early skepticism was predictable: Put students in clinical settings too early, the argument went, and the foundational science would not stick. The deans disagreed.
“What we told them was, ‘No, you don’t understand,'” Dr. Battinelli said. “‘Everybody learns that way. You just don’t teach that way.'”
The outcomes have answered the skeptics, according to the leaders. Zucker graduates match into top residency programs across every discipline nationally. On standardized licensing exams, students perform a full standard deviation above the national mean. Residency program directors surveyed on Zucker graduates rated them above the national cohort in every category and subdomain. More than 50 medical schools worldwide have visited Zucker to study the model.
Less anxiety, burnout
The model has also produced an unintended benefit. When alumni are asked how they compare to peers from other schools during residency, they report feeling just as prepared when it comes to medical knowledge and clinical skills — and consistently report one additional edge: They are significantly less anxious when facing uncertainty. The deans attribute it directly to how students are trained: working through ambiguity for four years and more than 10,000 hours until it stops feeling threatening.
“We think that what we’re doing has helped them be better learners,” Dr. Battinelli said. “Everybody says, ‘I want to make lifelong learners,’ and then they give you a bunch of multiple choice question tests that you’ve been doing your whole life. Once you leave school, no more multiple choice question tests. We make that transition a little bit earlier.”
Another signal came from physician families. For the students who are children of physicians, the deans have heard repeatedly from those parents — not about grades or board scores, but about something harder to measure.
“We are hounded by their parents to try to figure out what’s going on here, because their children are so much happier in medical school than they were,” Dr. Battinelli said.
That dynamic traces back to the school’s founding culture of collaboration over competition.
“We told them they were co-creators of the medical school, and they took that on more aggressively than I ever would have dreamed of,” Dr. Smith told Becker’s. “They saw themselves in that role, and it was an important role to them. So when they came to us and told us we got it wrong with this particular thing we had inserted into the curriculum, we listened really carefully to them.”
That culture is not a byproduct of the model — it is the model. Eliminating grades and rankings was a structural decision about what kind of environment produces better physicians.
“If you want people to collaborate and work together and help each other, you cannot grade them and score them and rank them against each other,” Dr. Battinelli said. “That’s a contradiction.”
The book arrives at a moment when healthcare workforce leaders — not just medical educators — are searching for answers on physician burnout, disengagement and retention. The deans say the culture Zucker has built — less competitive, less anxiety-inducing, more collaborative — points to what a different kind of training environment can produce. The resistance to change at other institutions runs deep, they say.
For schools interested in replicating the model, the deans say smaller institutions may have an unexpected structural advantage. Zucker capped its class at 100 students — a deliberate choice tied to the resource intensity of its assessment model — and Zucker’s leaders believe smaller schools are better positioned than large ones to follow suit. The harder prerequisite, they say, is not resources — is starting without the weight of existing faculty culture. That, more than anything, is what Zucker had that most schools do not.
“Some places will never let progress interfere with 100 years of tradition,” Dr. Battinelli said. “We didn’t have a tradition. We had a blank slate.”
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