Ask David Peters what York University’s new medical school looks like, and he won’t describe a building. He describes a network where hospitals, primary care clinics, family health teams and non-profit organizations are brought together to improve the quality of life in the communities they serve.

“In Muskoka, the network might include primary care clinics in Gravenhurst, Bracebridge, Huntsville, and a hospital in two towns,” says Peters, founding dean of the York University School of Medicine. “In another community, there might be one leading organization, like Mackenzie Health, that brings together the clinical players.  What's unique about our model is that we are integrating the different clinical sites present in each area and creating a broader network that links teaching, service and research across the community. That is the beauty of it, rather than one-size-fits-all.”

That inversion, designing the school around its communities rather than asking communities to adapt to the school, is the organizing principle of everything Peters and his team are building. It is also the reason the story of the York University School of Medicine, which is set to welcome its first cohort in 2028 once accredited, is really a story about partnerships.

Peters’ conviction was shaped by four decades of work in Canada and abroad. Early general practice in Northern Manitoba, including outreach with Indigenous communities, taught him the force of social and structural determinants of health and the limits of simply treating problems that face you in the clinic, one patient at a time. Later, working to strengthen health systems in countries across Asia and Africa, supporting local, national, and international organizations, he saw again that durable change depends on systems built with the people they serve.

In Liberia during the Ebola outbreak, Peters saw the same lesson under crisis conditions. The international response had focused on rapidly building treatment centres, but the emergency required something broader: community leadership, public health, lab services, clinical care, and real-time communication and rapid response working together. “Many of the big temporary hospitals that were built were never used, because they were able to turn the epidemic around faster than the models predicted. The integrated community-led approach was what did that,” he says. The lesson he carried into building a medical school is not hard to spot: the buildings were never the point.

Afghanistan also shaped Peters' thinking about how efficient health systems can be organized. After the fall of the Taliban in 2001, his team, working with the country’s Ministry of Public Health, helped build the country's first national health-care scorecard, using data to measure performance and accountability and guide improvements. The lesson, Peters says, was the power of using data within an integrated system designed to serve patients and communities.

Another experience proved especially influential in shaping the school's educational philosophy: helping reorganize Uganda's Makerere College of Health Sciences. It raised a question that would eventually bring Peters to York: "How do you educate in the way you hope that your students will work?" He came, he says, for the opportunity to contribute to a school of medicine that does things differently.

Doing things differently starts with moving past the most obvious issues. “What’s in the news is: we need more family doctors and we need more family doctors,” says Peters. “Well, yes, and we need more nurses, and a lot more other health professionals. But we’re not going to close that gap based on the current way in which we provide services. We need to reorganize.” The school, he says, was not to just add more numbers. It really was to reimagine the academic model.

In practice, that means a school unlike the one its own faculty trained in. There are no lectures; the curriculum is case-based, built on simulation and teamwork, and compressed into three years. Gone, too, are traditional short hospital rotations where students may see a patient once and never learn what happens next. Instead, students spend their second year embedded in one of six core communities, following a small number of patients through the arc of their care with the same mentors coaching them throughout.  “You’re going to see them at home. You’re going to see them in the clinic. You’re going to see them in the emergency room, at their worst, under the most stress,” says Peters. “And you’re going to see them hopefully recovering over time.”

The goal is a different kind of physician altogether: a consummate diagnostician, a systems thinker, and a networker, equipped to lead in teams and manage whole panels of patients using population data. Some of this borrows from a growing evidence base; other parts are without precedent here. “What is different for us in Canada is this integrated learning health system,” says Peters. “We are building really the first learning health system at scale that goes beyond a single organization.”

None of it works without partners, and the partnerships came first. From the early days of COVID until Peters arrived in January 2023, municipalities, health organizations and community stakeholders across the region had been building the case for a medical school focused on primary care.

What York’s school did first upon approval reveals a great deal about its priorities: it formalized a relationship agreement with the Indigenous Primary Health Care Council and its member organizations. “The commitment to long-term relationships is important for communities,” he says, “and solidifying that this really is community-based.”

From there, the network has grown outward from three founding hospital partners – Mackenzie Health, Southlake Health, and Oak Valley Health – to developing partnerships with Muskoka Algonquin Healthcare, Collingwood General and Marine Hospital, and five community hubs stretching from South Georgian Bay to Muskoka. Where institutions have long-standing ties elsewhere, the posture is deliberate:  building on existing relationships and structures rather than replacing them. The same spirit extends to Ontario’s other medical schools, including collaboration with the Northern Ontario School of Medicine on a “whole-of-Ontario approach” to avoid competing for the same physicians and patients.

And the partners are not just hosting the school; they are designing it through what the school calls its Integrated Community-based Learning Network, or ICLN. “The whole ICLN is a co-design proposition,” says Peters. “The five interprofessional primary care clinics at the heart of the network were proposed by the communities themselves, through the province’s Primary Care Action Team program. They are hub-and-spoke arrangements that look different in every location, all different and designed according to local input. The collaboration reaches all the way into the classroom: as the curriculum is being built out, we have people from the community who have been recruited and are designing the curriculum to ensure that it matches local need.”

If Peters drew the blueprint, Mira Backo-Shannon is wiring it into the region’s health system. The school’s vice-dean is a family physician with 24 years of practice across hospitals, primary care and long-term care, and a leadership résumé that maps closely onto the system the school needs to bring together. She oversaw teaching units tied to the University of Toronto’s satellite medical school in Mississauga, helped launch Ontario’s first Ontario Health Team, and created CarePoint Health, a hub connecting family doctors working alone or in small groups to team-based care and shared infrastructure. By the time Peters recruited her, she was Ontario Health’s vice-president of clinical and innovation for the Central Region, covering much of the geography York is now stepping into. Or, as Peters puts it: “She knew them all before she started with us. She’s been working with them for years.”

Her design philosophy borrows from another discipline entirely. “Successful engineers always think about the end that you’re trying to get to, and then design backwards to get there,” says Backo-Shannon. “What the school must teach is fixed — prescribed by the colleges and audited by accreditors. The ‘how we do it’ part is where we’ve got the flexibility of design and the art of the possible.”

In each community, organized along Ontario Health Team boundaries, the school is establishing a primary care teaching centre: the engine behind the primary care teaching that happens throughout that community. Family health teams and physician groups plug into the hub as satellite teaching sites. The partnership pays in both directions: practices that take on students also gain access, through the hub, to pharmacists, dietitians and occupational therapists for their own patients, along with professional development for themselves. “We are only as good as our people,” says Backo-Shannon. “And so, we have to invest in our people.”

She notes that team-based care must start with learning together. From their first year, York’s medical students will learn in small, case-based groups alongside nursing, kinesiology and nutrition students from across the university’s health programs. And when they disperse to their communities in second year, they will follow patients wherever care leads.

“Take a family-practice patient headed for gallbladder surgery,” she says. “The student would go with that patient to their surgical pre-op consultation. They would go into the OR to see that gallbladder removal. They would go to the post-op clinic. They would see the entire cycle, including the fear and confusion the patient carries through it.”

She is also designing for a profession in the middle of a technological upheaval. “The reason we need specialists is because we needed people who had deep access to information and knowledge in a particular area. What AI does is narrow the field between generalists and specialists, because that knowledge is readily available to all clinicians now.”

What the physician of the future needs, she argues, is critical appraisal. “They need to ask, ‘Is this real? Is this true? Is this applicable to this patient?’ and have the skill to translate it to a person’s values and social context. The need for generalists — a doctor who has broad knowledge, rather than deep specialization in one specific issue — will actually be much larger than it is today.”

Backo-Shannon describes the work not as building a school so much as changing a system. She sees incredible synergies waiting across the university, between the School of Medicine and engineering, business, social work, even music as medicine, noting that the intersections with other faculties are endless. For her, the case for doing all of it in partnership is simple. “Health can’t solve its own problems alone anymore. It’s become too complicated,” she says. “We need the engineers and the business minds and the others in the conversation to solve this and really make our communities as healthy as possible.”

Ask the partners, and they will tell you the relationship already runs both ways.

Dr. Loredana DiSanto, a family physician leading the build of the primary care network in Vaughan, Richmond Hill and King, the school’s own backyard, has sat on its committees since the early inception days. What strikes her most is exactly the experience Peters and Backo-Shannon describe: an education that follows the patient.

“A lot of where we struggle as clinicians is that we’re referring people to services, but we’ve maybe never actually seen what that means for the patient,” she says. “I know what it means to go to physiotherapy, but I was never trained alongside a physiotherapist. Getting to see that perspective through the patient experience is pretty unique.”

The clearest evidence of the two-way relationship may be a clinic that does not exist yet. Mackenzie Health recently received provincial funding to help establish a new community academic family health team in the region, and DiSanto’s team designed it with the future York University School of Medicine in mind: a space configured for learners, an interdisciplinary team assembled with teaching in view, and recruitment conversations with community physicians that put York front and centre as an important partner in the academic family health team.

The reception in the community reinforces why this matters. “It’s not like teaching doesn’t exist in our community, but it’s never existed with a medical school that is situated in our community,” she says. “That’s a very different feel to it. It creates a different kind of investment than if you’re kind of far removed, not in the centre of it. This has been front and centre for people, and that’s really exciting to people.”

It is doing something for the doctors already there, too. “A lot of the doctors in our community are in that twenty-plus-years range of practice,” DiSanto says. “From their perspective, it’s ‘How do I now start to be able to give back? How do I refresh my practice, and refresh my joy in practice?’ The School of Medicine has really helped with that.”

At Southlake Health, one of the school’s three lead hospital partners, Dr. David Makary, has seen the co-design from both sides of the table. A family physician and graduate of Southlake’s own family medicine residency program, he is now the hospital’s vice-president of academics and community health and sits on the executive committee guiding the school’s development. Ask him what will set York’s graduates apart, and he starts with what will not. “Medicine is medicine,” he says, noting that York’s students and residents will write the same licensing exams as every other graduate in the province. “What’s really going to be different, I believe, is how that is taught, and their experience.”

That experience begins immediately — even first-year students will spend a half day a week in a family medicine clinic — and it plays out in hospitals that are not, as Makary puts it, saturated with learners. “The learners that come to Southlake will have the opportunity to work right alongside their staff physician,” he says. “They won’t have to get in line.”

Southlake and its fellow affiliates helped define what every teaching site will need — call rooms, classrooms, simulation labs — and then pushed the school to aim beyond the minimum. “Let’s not just call this a minimum spec to pass accreditation,” Makary says. “We want this to be an incredible residency program and clerkship program.” For him, that includes the case for simulation labs at each partner hospital rather than a single lab at the medical school.

Southlake also brings proof of the school’s core bet. Its family medicine residency has been training doctors since 2009, and about forty of its graduates have stayed to practise in the region, in everything from emergency medicine to palliative care to comprehensive primary care — Makary among them. “You’re not just hiring anyone,” he says. “When you are graduating these residents, you are graduating a high-quality staff physician that you then get to keep in your community.”

The anticipation is measurable too. On his rounds through the hospital, Makary is stopped by colleagues – doctors, nurses, physiotherapists, occupational therapists, and more – asking what the school means for them. An academic newsletter launched this spring draws an average sixty-per-cent read rate, the highest of any all-staff newsletter in years, and for the first time he can remember, academics is on the hospital’s strategic plan. “There’s an appetite and an excitement for this,” he says.

None of this is finished — and no one involved pretends otherwise. “Because we haven’t become accredited yet, we’re not officially a school,” Backo-Shannon says. The main milestone now is accreditation: first for the undergraduate program, then for each of six residency programs, family medicine foremost among them, alongside the generalist specialties. The process is standardized and exacting. That, DiSanto suggests, is the point.

“The ideal state is that we’re all really working together in partnership — a bi-directional working relationship where we’re both saying: ‘here’s what we’ve got, and how can we make it better?’” And this, she adds, is just the start. “Right now, what we’re seeing is maybe the tip of the iceberg. I really think we’re going to see a whole lot more of how partner involvement can shape the outcome of how new doctors are educated at the School.”

Ask Peters what success looks like fifteen years from now, coming back to see what the school has become, and he starts by correcting the premise of the question. Not “I did it” but instead “we did it.” He hopes to find physicians who are working in teams and using data to improve outcomes for individuals and communities, and, around them, the network that made them possible. “Ultimately, if they are demonstrating that community health outcomes are improving, that we are providing value to our communities, that’s what I’d like to see.”

It would be the final proof of how this school was made: not for its communities, but with them, for them, and out of them.