EP. 151: TO CREATE A MEDICAL SCHOOL

May 14

WITH SHARMILA MAKHIJA, MD

The Founding Dean of the new Alice L. Walton School of Medicine discusses her journey from gynecologic oncology to creating a medical school that focuses on empathy and prepares future physicians for the rapidly evolving healthcare landscape.

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If you were asked to build a medical school from scratch, how would you do it? It's not a chance most of us get — but that was exactly the task given to our guest on this episode, Sharmila Makhija, MD, MBA. Dr. Makhija is a gynecologic oncologist by training, a clinician who has spent her career working with patients through some of life's most vulnerable and uncertain moments. She has also served as chair of obstetrics and gynecology at Montefiore Health System in New York, and before that, at Emory University.

Most recently, and most notably, she is Founding Dean of the new Alice L. Walton School of Medicine in Bentonville, Arkansas. Here, she has taken on the ambitious and deeply human task of creating a medical school that doesn't just teach medicine, but reimagines its purpose. Over the course of our conversation, Dr. Makhija shares how her parents were instrumental to helping her find meaning in medicine, how she accompanies patients through serious illnesses, and the quiet but transformative power of presence. We then hear how she got the opportunity to create a new medical school — so new, in fact, that they are matriculating their first class in July 2025 — and her vision for preparing future doctors to face the technological, societal and professional uncertainties of medicine in the coming decades.

Sharmila Makhija, MD, MBA, is the Founding Dean and CEO of the Alice L. Walton School of Medicine, focusing on advancing medical education and preparing students for healthcare roles.
A gynecologic cancer expert, Dr. Makhija previously chaired the Department of Obstetrics & Gynecology at Albert Einstein College of Medicine and Montefiore Health System. She has also held faculty positions at the University of Pittsburgh, University of Alabama at Birmingham, Emory University, and the University of Louisville.
Dr. Makhija was a Women’s Reproductive Health Research Scholar at both the University of Pittsburgh and University of Alabama. At Emory, she served as Division Chief of gynecologic oncology. At the University of Louisville, she was Department Chair and Chief Medical Officer for the Center for Women and Infants.
She earned a BA in chemistry from Cornell, an MD from the University of Alabama at Birmingham, completed residency at the University of Louisville, and a fellowship at Memorial Sloan-Kettering. She also holds an executive MBA from Emory University.
In this episode, you will hear about:
• 2:45 - What drew Dr. Makhija to a career in medicine, and specifically to her clinical focus in gynecological oncology
• 11:10 - How Dr. Makhija learned how to support patients through some of the hardest moments of their lives, and her advice on guiding patients through a poor prognosis
• 25:22 - Dr. Makhija’s to becoming Founding Dean of the Alice Walton School of Medicine
• 32:00 - The school’s approach to creating a new medical curriculum
• 45:51 - Experiences that have surprised Dr. Makhija on her leadership journey
• 48:38 - How Dr. Makhija plans to equip her students to face the rapid changes that are transforming the medical field
Henry Bair: [00:00:01] Hi, I'm Henry Bair.
Tyler Johnson: [00:00:03] And I'm Tyler Johnson.
Henry Bair: [00:00:04] And you're listening to The Doctor's Art, a podcast that explores meaning in medicine. Throughout our medical training and career, we have pondered what makes medicine meaningful. Can a stronger understanding of this meaning create better doctors? How can we build healthcare institutions that nurture the doctor patient connection? What can we learn about the human condition from accompanying our patients in times of suffering?
Tyler Johnson: [00:00:27] In seeking answers to these questions, we meet with deep thinkers working across healthcare, from doctors and nurses to patients and healthcare executives. Those who have collected a career's worth of hard earned wisdom, probing the moral heart that beats at the core of medicine. We will hear stories that are by turns heartbreaking, amusing, inspiring, challenging, and enlightening. We welcome anyone curious about why doctors do what they do. Join us as we think out loud about what illness and healing can teach us about some of life's biggest questions.
Henry Bair: [00:01:02] If you are asked to build a medical school from scratch, how would you do it? It's not a chance that most of us get, but that was exactly the task given to our guest on this episode. Doctor Sharmila makhija. Doctor Makhija is a gynecologic oncologist by training a clinician who has spent her career working with patients through some of life's most vulnerable and uncertain moments. She has also served as chair of obstetrics and gynecology at Montefiore Health System in New York, and before that at Emory University. Most recently, and most notably, she is the founding dean of the new Alice Walton School of Medicine in Bentonville, Arkansas. Here, she has taken on the ambitious and deeply human task of creating a medical school that doesn't just teach medicine, but reimagines its purpose. Over the course of our conversation, Doctor Makhija shares how her parents were instrumental to helping her find meaning in medicine, how she accompanies patients through serious illnesses, and the quiet but transformative power of presence. We then hear how she got the chance to create a new medical school. So new, in fact, that they are matriculating their first class just this July. In her vision for preparing future doctors to face the technological, societal and professional uncertainties of medicine in the coming decades, Doctor Makhija brings a rare blend of clinical wisdom, cultural fluency and educational boldness. We hope you'll find her perspective both grounding and inspiring, especially for anyone wondering what the future of medicine could look like if we dare to dream a little bigger. Sharmila, thank you for taking the time to join us and welcome to the show.
Dr. Sharmila Makhija: [00:02:42] Well, thank you for having me. It's a pleasure to be with you today.
Henry Bair: [00:02:45] To start us off, can you tell us what first drew you to a medical career?
Dr. Sharmila Makhija: [00:02:50] Yes. You know, it's interesting, I, I knew when I was nine that I wanted to be a doctor. And, you know, my grandfather was a doctor. My mom's dad in India, but I just always was around other physicians that were family friends. So one summer I said to my mom and dad, you know, I'd really like to a spend time with my grandparents in India because everybody gets to go see their grandparents. But I'd really like to, more importantly, spend time with my grandfather to see what he does in action. So I spent the summer I flew by myself to India. I was able to spend the entire summer between my ninth and 10th birthday, and spent time with my grandfather in the clinics. And, you know, a lot of the patients were lined up outside waiting to see him. And their grandkids were my age, most of them, which was unusual, and they spoke English. So I felt like I could go and talk to the grandkids and find out what was wrong with their grandparent. And then I would go back and report it to my grandfather and then be in the clinical room and observe what he was doing and how he assessed. And I carried his little doctor's bag around and and so I decided at the end of that summer I was going to be a doctor. And I remember coming back and telling my parents that, and they said, well, okay, well, that sounds like it was fun for you, but what do you really think about it? You know, what is it that really makes you want to be a doctor? And I said, you know, I just saw the look on the face of both the patient and their family of being so grateful and relieved at being taken care of. And I want to be a part of that for other people's lives. So that's that's when I first decided and haven't changed my mind since.
Henry Bair: [00:04:37] It's pretty remarkable that your parents actually asked you specifically. Okay, so what is it about this? And I say that coming from a place where so I grew up in Taiwan, I also had multiple physicians in the family. Okay. And it was a little bit different because for me, in my case, I think there was always the expectation that, like everyone around me is a physician, and the way, at least the unwritten curriculum in my culture is if you have the grades for it. If you're doing well in school, then the default path is becoming a physician. And there wasn't so much introspection about why it is you really want to do this. Like, what is it about it for yourself? I think it's remarkable your parents pushed you a little bit on that.
Dr. Sharmila Makhija: [00:05:18] They did. And, you know, I think both of my parents were educators. So my dad was a college chemistry professor, and my mom was a high school biology teacher. And even though they grew up in families that had doctors and, you know, in the Indian culture, too, it's, you know, sometimes it's just assumed you're going to be a doctor and engineer. My parents told me, you know, I think it's a hard life. So you really have to know this is what you want, because there are going to be days where it's difficult. And I think they just wanted me to be prepared and think about things. But yeah, I have to say, my parents were pretty special to spend the time. And I think it's just the way we were raised. We always talked about things. Um, and it's really helped me going further in life to not make assumptions and really ask more questions, be curious about things.
Henry Bair: [00:06:04] So where did you grow up? Like what was the setting and what was the setting of your grandfather's practice?
Dr. Sharmila Makhija: [00:06:10] So I grew up in I was born and raised in Montgomery, Alabama, and, um, the eldest of three. And, you know, as I mentioned, both my parents were in education and we grew up, you know, in a very wholesome type of atmosphere, so to speak. We always had dinner together as a family. And in the evenings during the weekday, you know, we either were a family night at the YMCA, so either it was swimming or tennis, and that's how we grew up doing one of the two every night. And then we'd come home and have dinner. And what I thought was really fascinating about the insight for my parents at dinner time, we, you know, the typical things were what did you do today? What you know, but they would go a step further and ask, what did you do to make someone else's life better for today? And that quickly evolved into just a natural conversation. And I feel like I try to carry that wherever I go to work of what are we doing to make someone else's life better? Because we do tend to be, you know, naturally you focus on yourself and you should have a lot of self-care. But I've been very service oriented, I think, from an early age of, of how can we serve others and how does that impact look?
Henry Bair: [00:07:27] Okay, so this experience early on convinced you that medicine was right for you. But I mean, medicine is so broad, right? For example, like, you know, my co-host is a medical oncologist focusing on GI tumors. I'm a resident in ophthalmology, which is a surgical subspecialty. And those two could not be further apart in terms of what the day to day looks like. Right. So okay, so you know, you want to do medicine. But then what was the journey to practicing the kind of medicine you currently do.
Dr. Sharmila Makhija: [00:07:55] So you asked me about my grandfather and he was a general surgeon. It also did, you know general surgeons? There were really general practitioners in India. So they did everything from basic medicine care to, you know, he'd come home at dinner and have a, an appendix in a, in a jar at dinner, which my grandmother's like, what are you doing? You know, what are you doing? But I just grew up being fascinated with the fact that he could do everything. I did start off in med school thinking I would do internal medicine, because I felt like that I would have the knowledge of a wide spectrum of diseases and being able to care for patients for whatever their needs are. And back when I was in med school, you had to, you know, literally type out your applications and send them in. In my last rotation was ob gyn. And I thought, you know, I'm not sure I can stay up all night delivering babies. So I'm going to go ahead and turn in internal medicine with the thought I might do cardiology or GI because again, my parents friends that were in those areas were really nice. You know, I just thought, I really like how they are and they seem to be enjoying their lives. So I turned everything in and I'm doing the ob gyn in the rotation in med school, and I enjoyed OB, but I said, you know, it's not enough to change anything. Did gyn. It was nice. And then one of my classmates fell ill and he had signed up to do GI and oncology for a two week rotation. And so the school asked me if I would cover his rotation and I said no problem.
Dr. Sharmila Makhija: [00:09:27] And immediately on that day, when I am rounding with the doctors, with the patients, I thought, I have to change my applications because it just connected. It just clicked and I thought, I'm going to have to do it, but let me give another day and see if tomorrow is a different day. And it just didn't change. And I think what what really resonated with me was the fact that you are taking care of women that are in the worst situation, they could be right there, diagnosed with cancer. They have families. They are the core part of their family unit. And yet they were incredibly grateful. The families were incredibly grateful. And and really, you worked with the entire family. And I like the persona of the doctors that were taking care of those patients because they were still positive, helpful, caring, and I liked I know this sounds a little odd. I liked being with that patient throughout her entire journey, which often meant they did pass away, but I wanted to be a part of the entire picture. And in oncology, we're a little bit different. We do both the surgery and we give chemotherapy, so we do both. We still work with a lot of other colleagues like radiation oncologists and even medical oncologists that if a patient lives too far away and can't come to us for the chemo, we work collaboratively. So I liked that atmosphere of collaboration, working with teams and being a part of that family in a different way. So that's how I chose that particular specialty. It just happened. It just happened that I was covering for someone.
Henry Bair: [00:11:10] It's a lot to I mean, internal medicine, you can deal with very sick individuals. But I would say like day to day, you're not generally speaking, unless you go into oncology or palliative care. You're not really dealing with, you know, like people who are seriously ill.
Dr. Sharmila Makhija: [00:11:25] Right?
Henry Bair: [00:11:25] But it sounds like I am not familiar with as a subspecialty, but it sounds like what you're describing is that is sort of a big part of your practice. And I'm just wondering, how did you learn to confront some of the worst moments in people's lives, some of the most serious conditions someone can have, right. Like, is that did that come naturally to you? Did you feel like there was a learning curve to it. Can you tell us more about that?
Dr. Sharmila Makhija: [00:11:48] Yes. So I you know, I think that's a great, you know, insight as to how do you really prepare, in essence, to tell people that they're not doing well and they're not going to make it? I can't say it's natural, but I think that my background of communication, of with my parents and how we just talked about things, I learned to not hide from it, but just to really be open with the lines of communication. And I will say, my training in fellowship when I was at Sloan Kettering to do my fellowship, you know, I watched an incredible medical oncologist give bad news, and I started to watch and listen to how she spoke to the patient and the family and then their responses. And so I, I, I learned through really great mentors on how they were delivering the messages. And then, I believe it or not, became the person in my group when I did go into practice that when there was a bad situation, they'd ask me to go in, even though it wasn't my patient, to go and deliver the bad news. And I, I can't say I enjoy it, but I think what I do is I take some time to learn about that person and learn about the family and what resonates with them and try to start the conversation. So even with my patients, when they are diagnosed, we talk about the hopeful things and what we're going to do to treat.
Dr. Sharmila Makhija: [00:13:13] But I also start the conversation sooner than later and say, look, we all are going to face death. You happen to maybe be closer to that conversation than we are, but you have the opportunity to tell us how you want this to look for you and start having the conversations with your families. It's a little counterintuitive to talk that way, but and I tell them, you don't have to make any decisions or say anything to me now, but I just want you to know I'm ready when you're ready. But you need to be able to start thinking about it. And so that did open the door of bringing them back in to talk about it when they were ready to talk about it, instead of when it's very dire. That's not the time to talk about your thoughts and your needs, and sometimes they're not even able to understand, to talk about it. And then the burden is on the family to make this decision. So I, I saw all the different impacts on a family. And I thought, how do we lessen and make it better? I mean, it's not a great situation, but how do we make it a little better for them?
Henry Bair: [00:14:16] Even though I'm currently an ophthalmology resident, my first year after graduating from medical school was spent doing internal medicine internship. Okay, so I was basically my very first year as a resident was I was rotating through all the internal medicine units in a large academic urban hospital. And what you just described, the approach to dealing with the dire prognosis, dealing with serious illnesses. It definitely does not come easy easily to a lot of people, and a lot of people shy away from it. A lot of people, a lot of residents, I hear this, or fellows or even attendings say that this is one of their least favorite parts. I mean, not that I'm not saying that's your favorite part, but they aren't particularly motivated to engage with this kind of conversation for for whatever reason and understandably. And I think it's just it's not a part of standard medical training. No one really teaches it and sits down with us to tell us some of the advice and insights, just like you're sharing with me right now. Yes. And I'm wondering, are there stories you can share? Are there patient encounters? You can you can think of that really illustrate why this is meaningful and valuable.
Dr. Sharmila Makhija: [00:15:22] I feel that when you see it done poorly, sometimes that makes you want to do it better, right? So I wasn't great at it at the beginning. You know, I think I was really nervous and scared because you don't you don't want to give bad news. I mean, nobody wants to give bad news, But I think that when I saw a patient being given bad news and then the doctor just walks out, there's no follow up. There's nothing to help them process that family and the patient. And so I think some of the experiences that I had as a resident and then even as an attending, you know, fast forward in different places that I've worked at, when I didn't see it done well, I always stayed behind. And I said, what can I do for you now? Like, I just always felt like at least that is what they teach us is to be empathetic and to be caring. I feel like even when we experience being a patient and when someone isn't telling us things authentically, it's just a different feeling, right? So we're no different than a patient and how we take in how our care is given. So there's so many that I don't know if I can be super specific, but I do recall one instance where it was a young patient of mine that that I was a resident. I'm sorry, a fellow at Sloan Kettering, and we didn't expect her to get sick so fast, and she had to go into the ICU. And it was it was a complication from the chemotherapy. And she it was looking like she was going to die. I just remember the attending saying, I have to go, and nobody was going to tell the family.
Dr. Sharmila Makhija: [00:17:10] They were just going to wait and just say, we're working on things. We'll be back later. And I, I could just see the pain and the family's eyes, like they knew. They knew something was really terrible. And so I just sat with them and I listened and I, I just thought if I were ever in this situation, I would want someone to just tell me. Tell me the truth. And so I just said, we don't know what's happened. We really don't know. But I think it's the chemo and I don't know I don't know if she's going to make it. So spend time with her. With her. Talk to her. We really don't know. And I think just being okay with being in that space of not having all the answers and having the ability to be authentic and real, I think that just helped them be a little bit more peaceful and accepting that this something may happen. So when when she did pass away, it wasn't. It's still difficult, but it just made it a little easier. And I just felt like instead of running away from it, we should really run towards it. Most things that I, I when I face a conflict or an issue, I now tend to just run towards it to see how much can we manage and and help alleviate the pain or the suffering or the conflict. You know, you brought up a good point. We don't teach this in med school. We're not so open about talking about this. And that is something that we are addressing in our med school is the empathetic piece. The communication piece is so important with the patient and their family.
Henry Bair: [00:18:41] Yeah, we're definitely going to explore your current work in a bit. Yes. Just to tug on a few other threads here. To your point about how you approach these kinds of conversations and why you do it. You know, hearing your story brings to mind one of the earliest, I think, my first or second week in internship, which is to say, my first or second week officially with an MD after my name. I knew no medicine, really. Just clinical medicine was still so, so foreign to me. And I started my intern year in in the intensive care unit. Wow. Which is not a great place to start when you don't feel like you know what's going on. Yes, yes. And I had this patient who was severe complications from liver failure. So they were bleeding out in a lot of places. And we knew he was going to pass away soon. I remember going into the patient room. The patient was intubated at this point so they could not talk.
Dr. Sharmila Makhija: [00:19:36] Oh, gosh.
Henry Bair: [00:19:37] Yeah, but the wife was there, and I remember thinking, what can I offer? I have no medical knowledge. I cannot manage the ventilator settings. I don't know how to titrate, you know, the blood pressure medications, anything like that. Like how can I possibly contribute meaningfully to this person's care? And all I could really do was just be there and listen to the patient's wife and ask questions to help them, to help her sort of think about to help her remember, remember his life, to help her reflect on what you know, what their time together has been like and what it means to her. And I remember at the end of it, after he died, the wife was obviously devastated, but she actually made the point to come back to the unit and pull me aside and thank me for it. Wow. And in that moment, I didn't really understand. Like I didn't do anything. I just I was just there and I asked questions, but I didn't really give. I didn't feel like I offered any medically meaningful or useful things. But to your point, I think it helps to remember that even when you don't know what's going on, or when you don't know what to do next, or you feel like medically, there's nothing else to give to treat the patient with. I think just being there actually means a lot to patients, and they can be very grateful for that. What I've learned is you haven't failed a patient or a family just because you feel like there's medically nothing else to do. There's a lot of other things you can do, like the whole presence aspect, the listening aspect. That's sort of one of my biggest takeaways from hearing what you share and my personal experiences.
Dr. Sharmila Makhija: [00:21:05] Yes. Now, how did you know to do that?
Henry Bair: [00:21:08] It helped that I had mentors in medical school who made that a pretty big part of their career.
Dr. Sharmila Makhija: [00:21:17] That's great.
Henry Bair: [00:21:18] My co-host Tyler, for example, he's a medical oncologist. He's not formally trained as a palliative care physician, but I've seen him in clinic and he brings a lot of those palliative approaches. Right. Palliative as in focusing less so much on fixing the problem, but more so on how do we make sure that whatever we're doing aligns with what actually matters to the patient? Maybe what matters to the patient isn't necessarily breathing for as long as possible. Maybe it's spending more quality time, maybe spending time away from the hospital, all those kinds of conversations. So I think I was not entirely foreign to the idea of listening. Again, this the story I just shared with you with my first week of medicine that was still very, very foreign territory for me because it was the first time I was having those kinds of conversations in the position of an MD. So the expectation that comes with that MD after my name is that I'm supposed to know what to do. And I felt like that conflicted with the sense of just not knowing what to do. That's right. So there was still a lot of there was still very unfamiliar and uncomfortable territory for me at that time. Yeah, yeah.
Dr. Sharmila Makhija: [00:22:27] Well, thank you for sharing that because that's that is what we want to make easier for a student that becomes a doctor to know this is just part of the care, right? Learning how to be comfortable with not knowing the answers and communicating.
Henry Bair: [00:22:44] Before we go into your current work, I just want to go back to one thing that has stood out to me. You said that your parents, since you were young, would ask you, what is something you did to help someone that day? Is that correct?
Dr. Sharmila Makhija: [00:22:58] Yes.
Henry Bair: [00:22:59] I think that's really striking, and I can imagine that must have early on been like a very a value, a driving value in the work that you do. Yes, either subconsciously or consciously. And I'm just wondering where did that come from? I mean, I don't know if you have that answer.
Dr. Sharmila Makhija: [00:23:14] How did they.
Henry Bair: [00:23:14] Come? Like, is this what where did this.
Dr. Sharmila Makhija: [00:23:16] I.
Henry Bair: [00:23:17] In hindsight or I don't know if you've had this conversation with them, but why did they think to raise you and your siblings in that way?
Dr. Sharmila Makhija: [00:23:24] Yeah, we've had conversations about this. And, you know, I think they were raised in a similar way, but maybe different. And I think coming to the US, you know, after they got married and becoming citizens and just knowing that the people around them helped them with coming and acclimating to a new country, they've always been very giving and wanting to give back. And so I think that it was kind of innately in them, but then brought out and amplified when they immigrated here. And I think being very grateful people, they're, you know, they're just very giving and grateful folks. So I don't know what led them to that exact question, except I felt like they really wanted us to see us beyond ourselves and to really be in that mode of being grateful and giving. And I. And it did shape, frankly, every job that I've taken has been a very service oriented type of position where, you know, my last position, I was, you know, working in the Bronx and where you are truly working for the underserved, incredible community. But I've always gravitated to those type of positions, and I think it's I always feel those that are underserved probably deserve the best doctors and the best care, because they have so many other issues that they have to deal with. But I don't know, I just feel like I'm pretty lucky. And I, you know, these are parents that when I was away in college, they would send me care packages and say, well, what? You know, what is your roommate like? And then she would get her own care package because I would recognize her handwriting. So they've always been that those kind of parents that always cared about everybody.
Henry Bair: [00:25:09] I mean, that's that's wonderful. And you know that question, what is one thing that you've done today to help someone? I definitely something that's worth everyone to be thinking about, regardless of whatever job you do. I love that.
Dr. Sharmila Makhija: [00:25:21] That's right.
Henry Bair: [00:25:22] Okay. So you are the founding dean of a brand new medical school, and that's incredible. We've never spoken to anyone who is the creator or who has played such a large part in creating a new medical school from scratch?
Dr. Sharmila Makhija: [00:25:34] Yes.
Henry Bair: [00:25:35] How did that come about? Like, how did you go from a practicing clinician to now leading a new medical school?
Dr. Sharmila Makhija: [00:25:42] You know, it's interesting. You know, I know I keep going back to my parents, but my dad would often say to me, you know, you're going to be a dean someday. And I'm like, no, dad, what are you talking about? Like, I am great. At first I was, you know, a clinical researcher and then division chief. I was a little bit of a reluctant leader, so to speak. I mean, I, I enjoy being around teams, but I don't need to be the lead. And so when I was a department chair, I, you know, fast forward, I became a department chair at Montefiore in the Bronx. And I was, you know, chair for eight years. I really enjoyed it. But I was also not doing I was doing my core work of Jin-ok, but I was also looking at all of my specialties. Right. And wherever the dire need was, which was maternal health at the time, and it still is, we focused on that area. So I, you know, worked there during the pandemic and really had the department doing quite well. And then this this opportunity came actually even two years before I actually interviewed for the job. And I knew a lot of the recruiters because they were part of the same leadership academy for women, but it was they wanted to get my thoughts on it.
Dr. Sharmila Makhija: [00:26:51] And I said, you know, I really love this concept, but I don't understand it fully. Like, can you explain it? So I actually helped them try to form a better plan without realizing that I would ever be working here. So I said, you know, this is what it should look like ideally. And if you're going to talk about a whole person approach, get more deep about it and look at it more holistically. So then, you know, they worked on things. They came back to me two years later and said, hey, you know, we really want you to look at this position. And I said, well, let me send you some of my friends because they might be the ones because I'm really good here. And they said, well, just that's fine. We'll talk to your friends. But why don't you just come and just explore this, right? So I did come down and, you know, and I'm born and raised in Alabama, so I'm not, you know, I'm fine going to the South or Midwest. I had a zoom call with Alice and some of the board members.
Henry Bair: [00:27:44] So just for our listeners who don't have the context, who is them and who's been organizing, who's who's been leading this effort?
Dr. Sharmila Makhija: [00:27:51] Yeah. So this is Alice Walton, who is our amazing founder, who has this incredible vision of based on her own experiences of health care, wanting to bring better health to the state of Arkansas. And she has a vision of how do you incorporate whole health, whole person care, because it's kind of been lost out there. And that's, you know, as a practicing oncologist, how I've described how my work has been. It just connected because it was very similar to how we've been practicing in oncology, or even how I practiced my own clinical practice. And so just listening to her on our zoom interview and with the board members that include, you know, Lloyd Minor, who's the dean of Stanford, who's our board chair, and, you know, this incredible group of board members we got, you know, I could name all of them. We can. Each one is a pistol in their own right. You know, they're just amazing folks. But listening to Alice is really where it just clicked with talking to her and the passion that she has. She could be doing anything she wants, and she's going to tackle one of the more complex areas in our world of healthcare. And I thought, what an opportunity to work beside her and try to implement this vision. I will tell you, part of my background is I think like an operations person. I can think strategically, but I like to figure out how to get things working effectively, efficiently organized that help everybody. So my the wheels were turning in my head and I thought, this is an interesting challenge, but let's let's see.
Dr. Sharmila Makhija: [00:29:42] So because I was one of many that they were interviewing, and then I came down for an in-person interview. And, you know, it's a smaller city than I've ever lived in. But immediately the people are incredible warm, inviting, and they were all passionate about fulfilling this dream. And so I met the team that's part of our we call them awesome, right? Because it's Alice Walton School of Medicine. So we call ourselves awesome. And we're not trying to be, you know, cheeky about it, but that is the only way she agreed to have her name on the building is that we would call it awesome and not her name, but that that connection with the teams here with Alice. That really got me very excited and interested. And as I started to delve in deeper, I thought, this is how I practice medicine and it isn't how everybody else practices medicine. Wouldn't it be nice to be able to produce and support medical students, to produce doctors that are addressing things on a whole person level, and kind of bring it back to the core of how we communicate, how we empathize, how we work together with each other on healthcare teams, but for the patient and with the patient, instead of just speaking at patients. But how do you work with patients? And so that's what brought me here. And it's been an incredible I've only been here two years, and it's been a whirlwind. And it's been really, really exciting and fun.
Henry Bair: [00:31:14] Is this the first academic year where you have students?
Dr. Sharmila Makhija: [00:31:17] July 14th is our first day of class. So we have we we are finalizing we've made offers. We I think the final list goes in this week. And so we just had our first admitted students day last Friday. So we welcomed a large group of students that, you know, are accepting with their families. And so for us, it was, you know, when you've had your head down getting all the pieces together and you look up and you see these students and their families, it really made it very real for us on Friday. And it was exciting.
Henry Bair: [00:31:49] Yeah, it's amazing times.
Dr. Sharmila Makhija: [00:31:51] Yes.
Henry Bair: [00:31:52] I have no idea what it takes to run a medical school or to create a medical school.
Dr. Sharmila Makhija: [00:31:56] Takes a team, a big team.
Henry Bair: [00:32:00] I assume you've been instrumental to creating the curriculum itself. Like how do you think about designing the curriculum? Like obviously there is the the science part, the clinical science part of it. There's not a whole lot of wiggle room like you just you have to cover the things that you have to cover. And that's right. When I talk to pre-medical students and they always asking me like, oh, where are you going to get the best training, you know what? What are some medical schools that I should look out for. I generally reassure them that there are no bad medical schools in. That's correct. The standards for being accredited as medical school is so high in the United States that you're going to get pretty decent medical training, you're going to get good clinical knowledge wherever you go. And of course, plus you have to study hard. That's right. Um, so there's there's that aspect. You don't have a whole lot of wiggle room. You need to cover whatever. You need to get accredited. And, you know, and train your students to do well on board exams and whatnot. But then there's this whole other aspect, as you've talked to us about the clinical, not the clinical science part of it, but the clinical skills, if you will, or the interpersonal dynamic stuff that's really difficult to teach. How do you think about creating a curriculum around that?
Dr. Sharmila Makhija: [00:33:07] So I will say we have a great we have great teams and we have a great curriculum team. I can influence there are standard ways of how you develop the curriculum. Ours is called arches. And as you said, you know, you have to have the core clinical foundational basic sciences that are at the core. We joke internally, you still have to know how to take care of the kidney, right? You still, no matter what, you have to know how to pass the test, take care of. So the the the C and the S are the clinical and the foundational sciences we have in the arches, the R for research. We have not built our own wet labs, but we are collaborating with those in the community that have the state of the art facilities to have joint faculty, but have opportunities for our students to work not only with the local teams, but also with Stanford. We have a collaboration so you can be here in Bentonville, but working with world class faculty, either here locally or with Stanford. So we have a lot of great collaborations. So the A in arches is the art of healing, and that's where we start to weave in different aspects. We're sitting on the campus of a world famous, you know, world class museum Crystal bridges, which is also Alice's museum that she started. And we are utilizing their curators to help us develop the curriculum that incorporates art. They already have programs for the K through 12 students in the communities. So we're taking that and pulling it into the curriculum because looking at art, learning how to vocalize and verbalize what you're seeing, we want to create a different level of empathy and acceptance and how we communicate. So with the H of arches, we are doing health system sciences because, you know, I ended up getting my MBA at some point because, you know, the financial crisis happened and I didn't know how to communicate with the financial teams.
Dr. Sharmila Makhija: [00:35:10] So I knew I needed to learn that vocabulary. So Health System Sciences is incorporating a different aspect of vocabulary where you learn about system sciences. You learn about finances. You learn about policymaking. You know the practicalities of when you're out in the real world. How do you actually do this right? So we are working with our sister institution, the Heartland Whole Health Institute, that's also on our campus, where that team are actually working on policy and payers and lobbying and trying to work on that health system piece. They're going to be teaching all of that in real time. That gives us a little flexibility to incorporate AI. Whatever's coming out new, we can incorporate and have real time learning from the experts in the community, in the health systems. And then we have E for embracing whole health. So the philosophy of that is instead of saying, what's the matter with you? It's what matters to you. And how do you incorporate that patient interaction, not only the physical but the mental, emotional, spiritual well-being of a patient. Calling it out and talking about it and learning how to communicate about it and incorporating that on the assessments. That is how we have modified the curriculum to a certain extent. And we've also, like many schools do, but not all do. We are doing a flipped classroom, so it's not just sitting and listening to lectures. You have small group sessions. And I think that's it's more on the adult learning type of learning that we feel will be helpful in developing more critical skills, critical thinking.
Henry Bair: [00:36:51] That's really wonderful. And I there are some elements there that I see in other medical schools, some I haven't heard so much about, you know, the whole health science part of it. So I got the MBA at Stanford alongside my MD, and I remember thinking that all these things I was only getting from the MBA, negotiation skills, conflict resolution, organizational management operations. How do you manage people? It made me think that all physicians are leaders in a sense, right? You might not be leading a hospital, but you're probably leading a team of nurses or leading a team of other doctors, or you're leading the patient. Right. That's I think that's kind of leadership skill, too. And why is it that we don't learn all these skills? Why aren't these skills baked into medical training? So I'm really glad to hear that. That's something that you're trying to bring to fruition in your medical school.
Dr. Sharmila Makhija: [00:37:43] And I love that you did that. And you you know, one of my favorite pieces in MBA school, I thought I was taking it for the finance and accounting. But organizational behavior is what I really gravitated to. And I think that's the piece that I use the most in my job is just how are you, the organization, the team dynamics, how you work together. It's so important.
Henry Bair: [00:38:08] Yeah. So I have been interested in medical education since medical school. Um, I like thinking about how we can train future doctors in a better way. And it is a fantasy of mine to often just brainstorm. Just if I were to create a medical school from scratch, blank slate, what would I do here? You're actually doing it. And I think that's that's why I'm fascinated just hearing how you're approaching this.
Dr. Sharmila Makhija: [00:38:30] Well, please share how you would want things done, because we would totally take it in. And, uh, we'll talk later.
Henry Bair: [00:38:37] We'll talk later. But I want to hear a little bit more. So obviously you would not be trying to create a new medical school if you didn't feel like you could offer something to the school that maybe students might not be able to get at another school. You must feel like you have the ability to create something, to contribute something great here. If you were to sort of in a few words. I know you mentioned that Alice Walton's vision of focusing on whole body or whole person care. I get that, but in more concrete terms, are there some things you can list out? Just what are the things that you feel like students can get from your school that you feel like you can really uniquely, or you're trying through this new curriculum to try to uniquely bring to them.
Dr. Sharmila Makhija: [00:39:23] You know, I think there's a couple things. And one of the other pieces that we've added in that I know 1 or 2 other med schools are, you know, they've got to retrofit and to change things. What I feel strongly about that, you also alluded to that I think part of your experience, you know, being exposed early on gives you an idea of what you want to do. Maybe you don't want to do. And I felt very lucky that I was exposed to things. And then it it clicked for me. And I do think some of the burnout and the stressors are that people are, you know, students are pressured into picking a, you know, a high paying specialty or something that they just assume they're going to know what it's going to be like to practice. So we've incorporated something called early clinical experience. So within the first two months of being in medical school, they are in the clinic and we're doing it a couple ways. We have teamed up with Mercy Hospital System, which is our educational partner. There are 55 hospital system in the heartland. They have two sites in Arkansas and one is just seven miles away from us. We have picked one of their primary care specialists. That's incredible. She has a whole group of primary care docs. They practice value based care. So whole health, whole person care, if you really look at it, is the premise of value based care. Looking at outcomes, not just fee for service or how you're, you know, treating X, but the total outcome of care. Because in the end, if you can't impact health outcome, are you really helping? Are you really changing things? So she practices that.
Dr. Sharmila Makhija: [00:41:11] Her whole team practices that Mercy's system is based on value based care. So we're bringing it into real life, where they will go and practice in that clinic. So they will be in the classroom. In our simulation downstairs and then into a clinic experience with another doctor, putting these things into practice to get exposed to it very early on. And we do feel that that will impact even the areas that they specialize in later, but really understand how it is to fine tune and practice some of these skills in real time. So I think that while it might not be fully unique to just us, we're incorporating the whole health and whole person practice in conjunction with real time exposure and practice in a clinical arena. And on our first floor we have 12 clinical rooms, half of which are the simulation rooms. So they're working in a real clinic room. And the other half, we will be putting in our own clinic and seeing patients. Probably not right when we start in July because we, you know, we got to get started with the classes, but we will be seeing patients in our in our building. And we want to reinforce that, that the faculty that are teaching are also practicing. And so I think that concretely we're practicing what we're preaching literally and trying to reinforce that practice. If I were going back to med school, this is the way I would want it to be.
Henry Bair: [00:42:51] That's wonderful. As you over the past year assembled your first class, what were some of the things that you looked for?
Dr. Sharmila Makhija: [00:42:58] So we were again, very intentional, uh, working closely with Alice Walton in our board. You know, if you look at the poor health outcomes for the state, we hit very close to rock bottom on many markers, maternal health were 50 out of 50. So that's that resonates with me quite a bit. But the other health outcomes are looking at 4748. We are located in northwest Arkansas, so we we do pretty well in this area, but we are very focused on how do we improve the health of the entire state. And it's a very rural part of the country. We know that there's a lack of primary care physicians in rural America. When you look at the models of med schools that give free tuition and then ask them to go into primary care, but you don't have another way of supporting them, they don't go into primary care, and they're not going into rural America. So we know that we aren't going to necessarily take someone and say, go work here. What we're starting with is very intentionally, even the students that we're recruiting, we are looking to see, are they from a rural background? Because if you are from that background, it's going to resonate with you a little differently about going back into the rural areas. And if you look across the country, less than 5% of all medical students are from a rural background.
Dr. Sharmila Makhija: [00:44:19] So we're trying to intentionally increase that. That's a long term. We are also working closely with mercy. So Alice doesn't just stop with a medical school. She in addition to everything she does, she's very intentional and mindful with how we work. With Mercy Health System. There is something called NewCo. We haven't come up with the final name yet, but she as co-invested with Mercy Hospitals $700 million to build out a campus that looks at. How are we approaching whole person care value based care. What's interesting is mercy is is what was one of the top leaders in is still a leading contender with virtual care networks. They did this pre-pandemic. And what we want to do is create this virtual care network that will help support those docs and these rural communities that maybe they're the solo practitioner, or they maybe there's not even a doctor there, but the doctors that are on their own will have access to the specialists, to other support teams that can help them in managing patients in rural communities. So we want to be able to provide a support system to not only placing doctors more in rural communities, but amplifying that with this virtual care network. So we're really looking at it holistically as to how we develop this pathway for our students to be able to practice.
Henry Bair: [00:45:51] Wow. As you reflect on, I mean, it's an ongoing journey, but as you reflect on what you've done so far, what are some of the surprising challenges you've encountered?
Dr. Sharmila Makhija: [00:46:02] You know, I could say that nothing surprises me, but everything surprises me. So I have to say, you know, sometimes if you overthink it, it can be daunting. But our teams are really, you know, when there's an issue or we have a problem or we see the next step because we're always looking at how do we look at each piece? Long term, I have to say, our teams just jump right in and try to start looking at the short term solutions, long term solutions. I think that like many places across the country, you have our medical students, but you have to have a place to train them. So residency programs are really the next area that we're hyper focused on and creating more residency spots. And as you know, it's not easy to do across the country. We feel pretty strongly that we want to be able to create more residencies in the state, to be able to have our students land there, as well as our colleagues at University of Arkansas. Right. They are losing their classes to other cities and These in states and then they're not coming back to work. So we we are looking at that as a challenge and challenging the current philosophy of of how those are designed and how they how they support a community. So we are we're continuing to tackle these problems that maybe, you know, it's daunting for others. But we you know, with the backing of Alice, you know, I sit on the GME board for the state by the governor. We're bringing some other thoughts to light that we want to try to address that will help the other medical school and the other, you know, there's two Doe schools in the state. We want to work together with everyone to see how do we improve the situation for the entire state.
Henry Bair: [00:47:52] Yeah. As I hear the challenges that you're tackling, I think this is an incredible opportunity to see how this living, breathing, evolving thing entity organization can really make some real impact in this area of the country, and I for one, I'm eager to sort of just keep a close eye on, you know, what happens, you know?
Dr. Sharmila Makhija: [00:48:11] Well, we'd love to host you to come down anytime you'd like to come visit.
Henry Bair: [00:48:14] And thank you.
Dr. Sharmila Makhija: [00:48:15] You know, especially, you know, with your background and and your passion for medical education, that would be a treat for us. So please, you know, that's an open invitation any time.
Henry Bair: [00:48:26] I appreciate that very much. And definitely I'll be on the lookout for the opportunity. You know, the desire is there. It's more so just I'm in a part of my training where timing can be challenging.
Dr. Sharmila Makhija: [00:48:35] I know, I know it is.
Henry Bair: [00:48:38] So I want to spend the last few minutes we have. So looking into the future, when I think hard to find a clinician who would disagree with the sentiment that we are living in a time of rapid, rapid change, technological change, organizational change, the whole landscape of how hospitals are run and how clinicians work is changing so quickly with the advent of AI. With changing demographic trends every way you want to cut it, it feels like we're accelerating at a pace that we've never seen before. We're often asking each other, what is the role of the doctor in ten years and 30 years? And I think even more, um, I don't know if concerning is the right word, but the thing that even gives us greater pause than just how often these conversations are is how little people seem to agree on on what the answers are, right. How uncertain it is.
Dr. Sharmila Makhija: [00:49:36] Yes.
Henry Bair: [00:49:37] As you think about not just the changing nature of what medicine looks like, but also the uncertainty of that. How do you plan to equip your your students with facing that uncertain future?
Dr. Sharmila Makhija: [00:49:51] It's definitely a challenge. And I think, you know, you mentioned AI, and I feel it's very important to expose our students to the newest technologies to get them comfortable with understanding it. I saw some stat that more than half of students are overwhelmed by constant changes in technology and how to apply it. We've actually even held an AI conference earlier this year jointly with Stanford, and we're holding another one this year because we're trying to talk about what does I mean for health. You know, we talk about the clinical aspects. What does it look like for education and the future of doctors? What I feel pretty strongly is I don't think there's any doubt that it will complement and make our diagnostic abilities stronger and maybe more consistent and reliable. But you can't replace the human piece. And I think even more so, how we're trying to approach how we train our students and attract the faculty that embrace this, how we are with each other, how we communicate, how we are able to support a patient, the teams. How we collaborate is going to be even more important to have those skills that are really just so valuable. And, you know, we've even taken it to the degree that how we recruit our medical students, we're looking at things like resiliency and adaptability and flexibility, because those are skills that we don't really talk about as being necessary in medicine.
Dr. Sharmila Makhija: [00:51:29] It tends to be very technical focused, getting the right diagnosis, making sure you don't get sued, you know, like things that are very technical, but that probably has not done us well with managing burnout and managing retention of doctors in the field. So the more I think we can bring the humane aspect of it back, the joy of it back, while technology continues to develop, that maybe offloads some of that intense burden of being technically correct all the time. I think we're just going to evolve in a different way. I'm very hopeful for it. I think it's probably bringing us back to the core of what we need to be. But it you know, it depends on your outlook. I think it it is a little scary and unnerving because we haven't prepared our teams for that. So I, I think it's look, change is always going to happen. So I think the more we can embrace it and understand how to utilize it to our benefit, the better.
Henry Bair: [00:52:33] I think you you reveal a mindset and an approach that I think is very enlightening of, of this whole endeavor, and I think it does bring us full circle back to what initially drew you to medicine, but also to gynecology. Oncology. Yeah. Right. Where? Yes, of course. Like, I think there are many cases where AI does diagnostics probably better than humans, definitely faster than humans, and in many cases more accurately. And I think there are certainly many settings where you can imagine a patient probably prefers just something really quick, really simple that an AI can offer. But then there are also other circumstances, you know, when you're sitting down with a patient who's just been diagnosed with a, you know, a very, very terrible cancer, or in my neck of the woods, when you sit down with a patient who's irreversibly losing their eyesight due to glaucoma, and it's not a matter of medical knowledge. We know what's going on. You know, we know the available options. But then beyond that, what else can you do? The human presence, the listening that we talked to, we talked about 45 minutes ago. That's the part that I don't think I can replace. Right. And that's also the part that isn't so much emphasized right now in medical education. And I think those two combined mean that that is the part that offers the most opportunity for us. That's right. And I'm so glad to hear that. That is something that your medical school is focusing on expanding more of. So, you know, with that, we want to thank you so much for taking the time to join us. It's a busy time for you, for your medical school, so we really appreciate you taking the moment to speak with us.
Dr. Sharmila Makhija: [00:54:06] Well thank you. It was a pleasure to be with you today.
Henry Bair: [00:54:12] Thank you for joining our conversation on this week's episode of The Doctor's Art. You can find program notes and transcripts of all episodes at the Doctor's Art.com. If you enjoyed the episode, please subscribe, rate, and review our show available for free on Spotify, Apple Podcasts, or wherever you get your podcasts.
Tyler Johnson: [00:54:31] We also encourage you to share the podcast with any friends or colleagues who you think might enjoy the program. And if you know of a doctor or patient, or anyone working in healthcare who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments.
Henry Bair: [00:54:45] I'm Henry Bair.
Tyler Johnson: [00:54:46] And I'm Tyler Johnson. We hope you can join us next time. Until then, be well.