Want to learn more about Kaiser Permanente’s highly competitive tuition-free and lecture-free medical school program? [Show summary]
Dr. Willies-Jacobo describes the foundational values that are woven into the culture at Kaiser Permanente School of Medicine which accepted its first class in the midst of the pandemic. She also shares the challenges and adaptations that have come as a result of establishing a new program during the tumultuous past year.
KP Tyson: A unique medical school with a dedication to social equity and an emphasis on small group learning [Show notes]
Our guest today is Dr. Lindia Willies-Jacobo, Senior Associate Dean for Admissions and Equity, Inclusion, and Diversity at the Kaiser Permanente Bernard J. Tyson School of Medicine, which welcomed its first class in the summer of 2020 and in the midst of the pandemic. While the Kaiser Permanente School of Medicine may be new, Dr. Willies-Jacobo is not at all new to the field of Med School Admissions.
She earned her MD at UCSD and served as a professor of pediatrics from 1992-2019. For 22 of those years, she was also the Assistant Dean for Diversity and Community Partnerships and Director of the program in Medical Education, Health, and Equity.
Can you give us an overview of the Kaiser Medical School curriculum, focusing on the more distinctive elements? [1:55]
Absolutely, happy to do that. We just welcomed our inaugural class a year ago, last July, in the midst of a pandemic. We certainly did not anticipate that, but I think in terms of some unique features of the school, I think perhaps the most distinct one would be that we are a non-lecture based school. So we perhaps are, if not one of the only ones, the only school whereby all of our learning takes place in small groups of eight. Because we welcomed 50 students, there is one group of 10 students. So it is non-lecture-based, problem-based learning. It’s all integrated. As prospective students may have read, we’ve decided not to go with the sort of typical departments as there are at many schools. But instead, we have three pillars, our Department of Biomedical Science, our Department of Clinical Science, and our Department of Health System Science. So all learning is integrated across all three pillars.
The other couple of distinct features about our school is that we were really built on kind of the foundational principles of equity, inclusion and diversity, which means that it is fully baked into the fabric of the school. We also are teaching anatomy in somewhat of a future facing forward thinking way. We are not using, the students will not be or have not been, dissecting cadavers, but instead we’re leveraging technology so that anatomy is being taught by way of augmented and virtual reality. And then I’ll just close by saying that our school has curricularized well-being. So we have a pretty significant and robust well-being curriculum. It’s called REACH, which stands for Reflection, Education, Assessment, Coaching, and Health and Wellbeing. So every medical student is actually paired with a physician coach, who is helping them along their journey in terms of developing their professional identity. So those are a couple distinct areas.
In preparing for the call, I saw the three pillars. I also saw that there are four threads woven throughout the curriculum. According to the website, they were Equity, Inclusion, and Diversity; Health Promotion; Interprofessional Collaboration; and Leadership. Can you kind of unpack that? And I know you said that the three pillars are throughout the four years, how do the threads and the pillars come together? [4:20]
What we have done – and they really are threads, meaning that it is threaded across all four years – it’s also threaded across our three pillars that we’ve just described. So the equity, inclusion, and diversity thread, for example, that’s where students come together in somewhat of a didactic seminar, style, space and they really unpack issues of racism. It’s where a lot of our anti-racism work happens. It’s also where students think critically about biases and mitigating biases in terms of advocacy and leadership, much of that is threaded through the health system, science pillar or department again, where students really learn and unpack the structural and social determinants of health.
And then Health Promotion, as you’ve discussed, some of that is woven into the REACH curriculum. But in fact, we also have sort of these seminars or sort of more didactic sessions where students think about how we engage with communities. I’m going to use COVID-19 as an example, as we talk about vaccinations, for example. One would engage a community and patients in that way.
Then the Interprofessional Collaboration pillar. We are partnering with Western’s School of Nursing, and also USC School of Pharmacy. So there was a lot happening and again, it’s sort of all moving parts throughout the entirety of the four years that our students are with us.
Kaiser Permanente, the organization, the healthcare system has a tremendous focus on prevention and health maintenance, which it takes a systems approach to. Is that part of the health system science? [6:46]
It really is. It really is in fact where our students are really thinking critically about root causes of disease. It’s where students learn that there are any number of environmental factors or structural factors that do play a role, and whether patients and communities are able to remain well. So to your point, it has been wonderful being a school that is part of this larger organization that really has led the way and has been thinking about these issues for quite some time.
Kaiser has taken a distinctive approach to medical education, what about the admissions process? What’s distinctive about the admissions process? [7:51]
We’ve also engaged in admissions in ways that are intentional. Again, I started by saying that equity, inclusion, and diversity are foundational to the school. That is exactly the lens through which we developed our admissions process. So we are holistic, and I know that’s a word we hear frequently across the board.
It has multiple meanings to multiple people. Every student who applies to our school really does have a chance. We ensure that we’ve structured the system or the process so that we are really broadening the lens through which we see every single student who applies to the school. So we take into account their lived experiences of which we know there are many. They’re varied. We take into account any number of other attributes, and then of course, we do balance all of that against their academic metrics, namely GPA and MCAT. And when we think about a holistic process, what that should mean to applicants is that we are not setting minimum GPAs, minimum MCAT scores. We are not having a computer system that does the filtering for us. We are laying eyes on every single file that gets to us. And so there are any number of factors that will play a role into whether a student is accepted. We are thinking more about students who are mission aligned.
I noted in MSAR for your site that in 2020 you received over 10,000 applications. I’m going to guess that in this application cycle that number was significantly higher. So somebody reads and looks at every single application, primary and secondary? [9:46]
We actually do. So just to unpack that piece a little bit, in order to seat our 50 students we did get over 10,000 applications. It’s quite a heavy lift. And I will say, we have a lot of file readers and file reviewers. Now, the over 10,000, that’s the primary MCAT application, about 80-85% of those students will fill out a secondary application, which is a school-specific application. So the number dwindles down a little bit. Ultimately, I think about 8,500 students did in fact complete the secondary application for the school. And yes, we are reading files on a daily basis, we are distributing files through our various file reviewers, and every file gets looked at and gets screened. It is a lot of work. It is quite a bit of human resources that are required to do so. But we are fully committed to doing that.
What do you hope to learn in the secondary that you don’t learn from the primary? [11:15]
The primary application introduces us to the students. What the secondary application allows us to do is really look critically for mission alignment. And for that reason, every school’s secondary application is a little bit different because it is really structured alongside the specific mission of that school. So that’s where we are really able to get a sense of whether this is a student who knows anything about the school. We are also able to discern whether the student seems to be aligned with what we have to offer here at the school.
Many times I hear from applicants, I read the school’s mission statement, and they all seem the same. [12:07]
Yeah. I think that’s right. When I go out to do recruitment and I meet with prospective applicants and students, I like to encourage them in addition to reading the mission statement to comb through the entirety of the website. Because to your point, I think there are many words that are going to look quite similar in every school’s mission statement. The other piece though that I do encourage students to do is I often refer to admissions offices as an underutilized resource. I always, always encourage our students with whom I engage, to really connect with Admissions Counselors and even Admissions Deans, we are always available to meet with prospective applicants.
If there are any specific questions that folks are really interested in learning a little bit more about, I think that’s where those deeper conversations can be had. I often will have students send me emails saying, “Hey, I see that equity, inclusion, and diversity are part of your mission statement. What exactly does that mean?” So reaching out is also something I do encourage prospective applicants to do.
You mention equity, inclusion, and diversity – most people talk about it as diversity, equity, and Inclusion. I’m sure there’s a reason for the distinction, would you mind sharing? [13:34]
When I arrived it was EID – equity, inclusion, and diversity. In my former institution, it was equity, diversity, and inclusion. But the one area I will focus on in that sort of alphabet soup of three letters is the equity piece. And the equity piece is so, so important, and I feel that it’s been the most overlooked piece of diversity and inclusion. I mean there was a time whereby we talked only about diversity and then we added inclusion. So people flip those letters ID or DI, but the equity piece was really missing for a long, long time. And when one looks at what equity really suggests, it’s sort of the recognition that everyone has to start in life at a different place. It’s ensuring that we are making the appropriate adjustments for that. I don’t know that the ID or the DI in terms of how one flips them is as important as that equity piece or at least as we see it as a school.
What can applicants to Kaiser Permanente who are invited to interview expect? [15:09]
We’re planning on interviewing roughly the same amount this cycle (last cycle was about 718 people). Now, last cycle we pivoted to virtual interviews, because of the pandemic. With all of the uncertainty and the unknowns, although things are looking much brighter, I suppose we have decided to continue on with a virtual process. So we remained committed to a hybrid model, what that means is that the students will engage in both a multiple mini interview as well as a traditional interview. The one thing we changed about that when we had to pivot from in-person to virtual is we did decrease the number of stations because it’s all virtual. So we’ve had to make a few adjustments to ensure that we’re thinking about Zoom fatigue, and also thinking about ways of streamlining a process. We’ve learned a lot from last cycle having been virtual, and we also learned that we were able to successfully complete it. So we’re planning on doing it quite similarly to how we ran the last cycle.
Do you anticipate at some point returning to in-person interviews or offering the option of in-person interviews? From what I understand, this year you’re just doing virtual but when COVID is under control, do you see yourself going back to in-person or not?
That is the plan. We have a brand new building, we have multiple interview suites that we built specifically for admissions interviews and we are really eager to use them. We are eager to bring our candidates back in person. There is no replacement for that. There were benefits to virtual engagement, I think one of which was decreasing the cost for students in terms of traveling out to schools and staying in hotels, etc. But I think our plan, if things progress and continue on in the ways that they have been, the plan really is to return to an in-person interview process in 2022. The other thing I’ll add is that we had to conduct second-look weekend virtually as well, this past spring. Again, we are hopeful that we can conduct that second look event in-person in 2022 as well.
One applicant told us that you actually had over 20,000 applications this past cycle. Is that correct? [17:56]
That is not correct, we didn’t quite hit that goal. We increased by about 11%, so we had almost 12,000.
That’s good to have that corrected. Even so, as I said, you got 10,478 applications in the primary. You say about 8,500 ended up completing the secondary. You’ve interviewed 718, so that’s less than 10%, and you matriculated 50, which is again less than 10%. How on earth do you narrow it down? [18:23]
It’s difficult. I’ll say this and this is something I say to every student with whom I engage who plans on applying to us or to any medical school. I would argue that any student who gets an interview really has an opportunity. So I always say to students, think about the application process as kind of a marathon, almost an ultra marathon. Because at every step, you’re just trying to get to the next step. And what I mean by that is you’re trying to get a secondary application, you’re trying to get an interview, and I think of the interview really as where the door opens up. Because our interviews are also structured with mission alignment in mind, a lot of how students present themselves to us is taken into account – How much do you know about the school? Are we just another school on your list? Is the message that we get from you that you really, really want to be part of the school and part of the community? It’s really interesting that we can often tell just based on engaging with students which ones are really, really interested in the school, and really appear to have mission aligned goals and values.
Now, having said all that, and knowing there are 155 accredited schools in the country, what I will say to that is, we are all also cognizant that there’s talent tenfold over every single year. We know that 40% of all applicants get into med school, but among the 60%, who don’t, there’s a lot of talent there too. So I say all of that to be encouraging and to say to applicants, “If you didn’t make it the first year, don’t be discouraged. Try again.” And I’ve seen so many success stories upon the second try, or the third try. So it requires our students to really reflect and dig deep and think about how important it is for them ultimately to become physicians. Because it’s a difficult journey, and it’s easy to get discouraged, but my message is, don’t be discouraged, try again.
I know Kaiser is very focused on mission alignment but I would suspect that you have a little bit of an additional attraction because you offer such generous terms. Tuition is free for the first five graduating classes and students receive a stipend. Do you think that makes it harder for you to discern that mission alignment? [22:10]
I think you make an excellent point. I think what it allows us to do is really think critically, as we’re reading through applications, and even in the way we’ve designed our interview questions to sort of try to be discerning in that way, because I think you make a great point. Like every other school that offers tuition remission and stipends, I do think it definitely is something that is in the back of our minds when we’re engaging with applicants and ensuring that folks are really interested in the school for what the school offers and not just the tuition remission.
Now, there’s absolutely nothing wrong with also taking that into account. Medical education is expensive, the whole debt reporting was just released by the AAMC a few days ago, and it’s pretty astonishing what kind of debt medical students graduate with. So I think that most med students would factor that into their decision making. So I think that is okay. But as we see it, we want folks who, yes, that’s been factored in, but there are other aspects of the school, the curriculum that is equally attractive to them.
Does Kaiser Permanente have any plans to either waive the MCAT or go test optional? [24:13]
We talked about that extensively last cycle, especially as there were cancellations by the AAMC and they did a great job in terms of catching up so that many, if not most applicants were in fact able to take the MCAT at least once. One area that we discussed extensively was what that would do in terms of looking at candidates holistically. And what I mean by that is, as we’re looking at other metrics, that is part of the holistic review system, that’s sort of a third area that we assess, it would almost mean that students would almost have very little wiggle room in other areas, it would almost demand that students be exceptional in every single area.
And when we think about equity, and I know this is a sort of a hot debate topic, we weren’t completely convinced that waiving the MCAT, or going MCAT optional at this point, would have been entirely helpful to students in the ways in which we’re thinking about our evaluation and assessment of students. But it’s an ongoing conversation. We’ve seen what’s happened with the ACT across the country, certainly, many of the California schools. It’ll be interesting to see whether that sort of filters up into MCAT and there are all kinds of interesting things happening with exams. So I think the jury is out, for this cycle we are still requiring that students take the MCAT.
One of the things I know drives applicants nuts, it’s not so much this time of year but more so in the fall is silence. How do you view letters of intent or correspondence from applicants whom the silence is driving them nuts or who were interviewed or who are waitlisted. I assume you have a waitlist. [27:04]
We do have a waitlist. We had this past year, just as we did our first year, a very robust waitlist. And the silence is tough from an applicant’s perspective.
I love the timeline you have on your website. [27:38]
We’ve tried to at least remain semi engaged in that way. One area that we’re toying with for this cycle is just to send these types of updates. I mean, even if we’re saying, “By the way, you’re still under review,” or “XYZ,” showing that we are very cognizant that the silence can be tough on applicants. We have wonderful admissions counselors who try to remain engaged when candidates engage with them. One of the things we started this past year, we are now doing weekly office hours. It’s interesting that we often will have folks who are in the pool, who will come to office hours to say, “What’s going on with my application?” But we do try to remain engaged as much as possible.
When candidates send us letters of intent or letters suggesting interest in the school, we do just attach that to the file and it actually ends up being helpful, especially if those are the same candidates that are on the waitlist, because as we’re sifting through, we’re often looking, again, always keeping in mind mission alignment, et cetera. But we also want folks who really are saying we want to be at your school.
How does Kaiser view applicants who have dealt with emotional illness? [29:08]
As I shared earlier, our school has a pretty significant focus on well being. So when candidates write about these issues on their application, we read them with, I think, through the lens of developing a deeper understanding of the candidate but also getting a sense of how they approach that particular challenge and what they’ve learned about themselves in that process. We in no way use that negatively against our candidates, we actually embrace that. And there’s something about that level of transparency and vulnerability that for us is a definite plus. Not only do applicants write about it, but often when they come out to interview, they’ll talk about these issues. Again, I think for us, and the kind of school that we are, displaying that level of vulnerability is always going to be a positive thing.
How does Kaiser view applicants who have an academic infraction or perhaps a criminal issue on their record? [30:28]
Again, when we’re reading through those now, there are schools as you may know who filter all those out, we don’t. We look at them, we read them. And what we’re really trying to understand from the applicant is A: What happened?, B: Was there accountability?, and C: What did you learn as a result of that? So that’s the context in which we’re reading that. In terms of things like felonies, et cetera, I think much of it is going to depend on what is going on there. But we read through those. There’s no filtering out people who’ve had this done as I think many applicants are aware that part of most schools, post admissions, or actually as they get admitted to schools, many of the post admissions require a background check.
So it is nice if there’s something on the application, and that it matches what maybe on the background check. But I think the issue that could arise is, is there a significant discrepancy? Because again it really comes back to just transparency and truthfulness on the part of the applicant, but we are a school that I would like to believe grants a lot of grace.
Would distance and time from the academic infraction or action, or from the criminal event, the conviction, if there was a conviction, would that play a role? [32:04]
Absolutely. That’s such a great question because that’s often part of the journey. We sometimes will see this in non-traditional students. Students who’ve been away from an academic setting or environment for a decade and they actually may write about this, and it ends up being just part of the journey, often part of what informed their decision to pursue medicine in the first place. So that absolutely matters.
What advice would you have for applicants interested in applying to Kaiser Permanente in this 2021/2022 application cycle? It’s now July, are they late? [32:56]
Great question. So I always, always, always encourage applicants to apply early. You’re not yet late, we will get applications. This cycle opened up on May 27th. We will get applications on June 25th. File reviews will begin as you pointed out sometime in early July and they’re not late. I do encourage applicants though, to get those primary applications out by no later than the end of July. Obviously, some will be a little bit later and the main reason for that is there is sort of this four to six weeks verification process that AAMC has to go through. So I point out to applicants that until that is completed, you wouldn’t yet be ready to get your secondary application. So every week past the last week of July, will take you further along in the application cycle.
The other important thing is we talk a lot about how competitive medical school is. And I do try to also highlight for applicants that part of the reason it is so competitive is there are, on a relative scale, enough slots for all the talent. All the talented folks who apply to medical school. But the other big issue is schools run out of interview slots. So even if you are an amazing candidate in every single way, if you’ve applied and your primary goes out in September, chances are you’re not getting a completed application until sometime in mid to late October. So you’re already taking yourself out of the running for that cycle, not because you’re not amazing, but because the interview slots are filling up. [READ: When Will Medical Schools Give You an Answer?]
What about those planning to apply in future years? In other words, they’re not planning to apply for this cycle. They’re planning to apply for the 2023 matriculating class or the 2024 matriculating class. What should they be doing? [35:02]
A couple things I always, always highlight. One is to ensure that you’re meeting with your pre-health advisors, at your home institution or your mentors, if you are someone who has been out of school for a while. Part of meeting with your pre-health advisors/mentors is ensuring that you are getting yourself ready for med school. And part of knowing when to apply is having that overall readiness.
The other thing I would encourage students to do is try to attend as many pre-health events as you can. AAMC has now pivoted to about two big virtual fairs every year. It tends to have a ton of schools across the country who are fully engaged in those. So that’s going to be important.
The other piece is to try to really think about what doctoring means to you, and creating your own list of values. And with that beginning to look through the MSAR and start perusing schools.
You have a few years to do so, try to engage in office hours at different schools, if there aren’t at all just pitch hours. In our school, we do have weekly Wednesday office hours. So get into those virtual spaces where there are counselors and other folks who will actually have sound advice. I don’t know how popular my next comment would be, but stay out of studentdoctor.net. Try to really get a lot of your more data driven questions answered through the AAMC or directly through different admissions offices. So that would be my advice book for folks who are soon going to apply, but also those who may be a couple years out from applying.
Speaking of studentdoctor.net, I was in the forum a couple of weeks ago, and there was a hot and heavy discussion about shadowing. Is it required that pre- meds have shadowing before they are accepted? And what about virtual shadowing, is that acceptable? Again, it was being very hotly debated. [37:19]
So shadowing is almost, and I say this very cautiously, it’s almost falling by the wayside for a number of reasons. One is that many physicians have just gotten so, so busy, especially as the world has changed in the last year. The whole shadowing in person was almost a thing of the past during the pandemic. And it’s only now that students are perhaps being reintroduced and allowed to enter into the clinical spaces with physicians.
The other thing though, and this preceded the pandemic, this conversation that a lot of us in the admissions community have been having is, how much information do we get about a student because they’ve shadowed a doctor? And how beneficial has shadowing been to any individual student? I think it’s variable. I think there are students who’ve had more active engagement during shadowing, and then there are those who just literally shadow.
One of the experiences that I’ve encouraged students to engage in more than shadowing or alongside shadowing is scribing. I think that’s a much more active way of getting a sense of what doctors really do. You get a sense of kind of terminology and you get the opportunity to really observe that doctor-patient interaction in ways that you are almost fully engaged in. There’s nothing particularly wrong with shadowing but students may think that they’re getting a ton of brownie points because they’ve shadowed. And it’s not necessarily viewed as robust and experienced as perhaps it had been five to seven years ago. Because we’ve been in primarily a virtual world in the last year, a lot of students have been doing virtual scribing or those sorts of things.
What would you have liked me to ask you? [39:57]
So I guess how we’ve done this year in light of a pandemic?
I will say that, given all of the challenges with COVID-19, I feel that we were able to pivot pretty seamlessly because of how our curriculum is structured especially during times when we had to either have hybrid engagement or all virtual engagement. So we did quite well. We had two unrelated COVID-19 positive folks at the school but no one else became positive. And again, we do not think there was any connection in those two cases. We ended up going virtual after the holidays in light of the cases rising in LA County.
We resumed in March in person. We did learn that though we can do it virtual, using a virtual platform, in-person is a lot more effective. Though we’re all masked and distanced, though you know that’s changing over time, we have still remained masked in spite of California opening up on June 15. But we learned that we really enjoy being in-person more than virtual. We were able to get instruction done. We were able to do it without skipping a beat. Even the students endorsed preferring to be in-person. So we have a wonderful team. We have a wonderful group who are behind us, constantly keeping the spaces sanitized.
Our students have been quite wonderful in terms of keeping their masks on, remaining distanced in the classrooms. Because we only have 50 students this year, we were able to utilize just about every room in the school. We do have enough space because we’re in fact built out to house about 200 students. All in all, it’s been good. It’s been as challenging as you can imagine, building the plane and flying it all at the same time in the midst of a global pandemic, but it’s been an amazing, amazing year. Our students will be finished on July 2, and we will have M2s in mid July. So we’re getting ready for that.
Are there any adaptations to COVID that you think you’re going to keep around? [42:52]
I do believe that we’re still in flux with this whole thing. We’re still wondering. I think we’re going to be able to do away with distancing, I suspect, we’re going to have to remain masked for a little bit longer. One of the areas we’re critically looking at is who’s vaccinated. It’s really a choice and for that reason, I think we’ll remain masked. That’s one of the areas that we are currently having conversations about.
One of the things I remember from last year is that there’s significant and early clinical exposure. Were your students able to maintain that clinical exposure after being vaccinated? [43:31]
They were and they had to be vaccinated. So again, we did have a little bit of a break from the students going out to their longitudinal integrated clerkships after the holiday; they were able to engage in March. That was definitely cut for a little bit. The other area that we did have a few challenges with in light of a pandemic were the service learning opportunities. Our service learning leads are exploring options there. But even that has gone quite well.
Great. Dr. Willies-Jacobo, thank you so much for joining me today. I really enjoyed learning about Kaiser Permanente School of Medicine. I’m sure that you’ve piqued listeners’ interest as well. Where can they learn more about the Kaiser Permanente Tyson Medical School? [44:28]
Great, thank you so much also for having me, Linda. Students can learn more about us at medschool.kp.org. Our website is organized in ways that you can navigate any number of pillars and departments so we definitely welcome that level of engagement. It was wonderful being with you again, Linda. Thank you so much for having me.
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