AAMC Reporter: May 2007

Medical School Facilities Have Education Built In

Architect's rendering of the Stanford University School of Medicine Learning and Knowledge Center

A dreary place consisting of little more than two big lecture halls is how Gregory Gruener, M.D., M.B.A., associate dean of educational affairs at Loyola University Chicago Stritch School of Medicine, described the medical school's original building. Undoubtedly, it was a far cry from the gleaming, state-of-the-art building that replaced it. But it did not happen overnight. Stritch's initiative to build an updated medical school—with the idea of designing it specifically to maximize student learning—started back in the mid-1980s, when faculty members began seriously considering replacing their aging medical school facility.

"We tried to guess what was going to be the new environment for delivering education, as well as how students could use medical school as a home away from home," Gruener said.

In 1997, Loyola University Chicago Stritch School of Medicine opened the doors of its new medical school building. Nationwide, it was hailed as a model for other medical schools seeking to develop innovative spaces in which today's medical students can best prepare to be tomorrow's doctors.

Here's why: Stritch's new teaching facilities physically enable students to work more collaboratively with faculty and each other. It also offered new ways of practicing clinical skills that do not require students to practice on, and potentially harm, real patients. Further, it provided the latest in communications technology, like wireless Internet access throughout its facilities and the capability to administer online examinations. And as construction of new medical schools flourishes around the country, those involved in the projects report goals similar to those achieved through Stritch's new building.

"There's a lot more research available on how students learn. Results show they learn more when they're engaged, and less passive," said Maggie Saunders, education programmer and project planner for Stanford University, whose medical school recently broke ground on the Learning and Knowledge Center, a project budgeted at about $138 million.

Moreover, a recent explosion of knowledge in the medical field makes memorization impractical.

"The amount of medical information is growing exponentially. You can't download it fast enough to teach all the new skills," Saunders said.

Consequently, said Saunders, medical education will require students to rely more heavily on critical thinking and problem solving and less on memorization. Stanford Medical Center's new teaching facilities will reflect what educators now know about how students learn. Students will spend less time attending lengthy lectures. In many instances, the traditional long lecture format will be replaced by a short didactic lecture, followed by small-group work guided by a roving instructor.

This new teaching format may take place in one of a few flat-floored lecture studios, described by Saunders as "large-group settings designed for small-group teaching."

Another option will be for students to go from a lecture studio, where they may learn how to conduct a medical procedure, to one of two simulation suites in the school's forthcoming Center for Immersive and Simulation-based Learning. The suites can be set up as operating rooms, emergency rooms, or intensive care units. There, students will practice medical procedures on mannequins. This structure not only encourages brainstorming among students, but also enhances interaction between students and instructors.

That's one reason why the University of Nebraska Medical Center's (UNMC) Michael F. Sorrell Center for Health Science Education, soon to be the new $52.7 million home of UNMC's College of Medicine, will incorporate small-group instruction rooms.

"Face-to-face interaction between instructor and student is important.We want to maintain that," said Gerald Moore, M.D., UNMC senior associate dean for academic affairs.

To facilitate this type of interaction, UNMC's new medical education facility will contain 22 small-group instruction rooms. All but two will seat 15 people in a circular pattern. Two of the slightly larger rooms will be used primarily for distance-learning opportunities. According to Moore, in the early 1980s UNMC's medical school made major curricular changes to incorporate more problem-based learning, a practice the school will be better able to promote with physical features like the new small-group instruction rooms.

Taking the concept of teamwork to a new level, many medical school redesigns are using simulation centers, whereby students practice clinical decision making on mannequins and actors, rather than real patients, often within a multidisciplinary group setting.

Consider Stanford's forthcoming Center for Immersive and Simulation-based Learning. Much of the 30,000- square-foot facility will consist of a virtual hospital.

"Here, you suspend disbelief. You get into character," said Mark Whitely, lead architect for the Stanford project and director of higher education and research facility design at NBBJ, a global architect and design firm specializing in health care, education, and research. The virtual hospital will contain 10 exam rooms where students will interact with actors trained as patients.

"It's getting back to the human aspect of medicine," Whitely said, referring to the doctor–patient communication skills that students will be expected to glean from dialogue with the actors.

The center will also contain two 750-square-foot rooms that can be set up as operating rooms, emergency rooms, or intensive care units. Here, students will work on adult and infant mannequins as well as clinical and procedural trainers—pieces of the human body that will provide students the opportunity to practice both specific clinical skills as well as particular procedures.

"Nursing students, medical students, and those from other allied health professions are getting together in the same environment in simulation rooms," said Scott Latimer, past president of the American Institute of Architects' Academy of Architecture for Health. "It's very much about enabling teams to work on problems together. No longer is it about a solo person with a cadaver."

That same scenario exists in a new facility at Stritch.

"We've done anatomical models, now we'll be moving into simulation of a higher level of fidelity," Gruener said.

But he is careful to add that the curriculum, not the technology, will remain at the forefront of education. "We don't want simulation to drive the curriculum; rather, it needs to be the other way around," he said.

As Gruener sees it, the benefits of the simulation center are twofold: "It allows you to make mistakes, and allows teams to work together."

At UNMC, student progress in the classroom will be tracked via video throughout their four years. "We will be certifying that students are capable of certain techniques," Moore said, citing IV preparation as one example. "Each simulation room will contain two cameras—one focused on the interview area, the other on the exam table."

That same monitoring technique will take place at Stanford's simulation center. "There will be a central monitoring room where faculty can watch what's going on; they'll have full video monitoring capabilities. After information is recorded, students can have a debriefing with their instructors," Whitely said.

When students do need to get out of their practice mode and delve into medical literature, they may no longer retrieve that information by copying articles from stacks of heavy books.

"Stanford's biomedical laboratory library is over 90 percent digital," Saunders said. The information is organized into discipline-specific portals, including topics like the history of medicine and multicultural health. Students can access the portals via computers in most areas of campus and not just in the library.

"The library, then, becomes the real powerhouse of knowledge, sort of a knowledge management center," said Whitely. Despite having gone largely digital, the library remains, Whitely said, "home to an amazing historical collection of books."

This is just one way medical students will be accessing information. At UNMC, virtual microscopy will replace the traditional microscope.

"With the old microscopes, no one else could view things at the same time," Moore said. Virtual microscopy allows instructors to pre-label slides, ensuring that all students know precisely what they are viewing.

"It's a tremendous change from student guessing," he said.

At many new medical schools, students will be able to plug into information anywhere, as most buildings will offer wireless Internet access. Many students will also be taking exams online, with real-time feedback from instructors. In student surveys, respondents expressed a desire for a seamless space for education and socialization, according to Saunders. And it is highly probable that students learn best in an environment that offers some of the comforts of being at home—particularly when they are spending such vast amounts of time away from home.

"If a person is spending upwards of 18 hours a day here, they need the opportunity to de-stress," Saunders said.

That is why Stanford built a student center complete with a kitchen, entertainment areas, a fitness center, and computer clusters. Stritch also added a fitness center, with racquetball courts and a pool, a mere 100 feet away from the main medical school building, which boasts a grand central foyer with glass dome.

"We want to make people feel good when they're here," Gruener said.

—By Elizabeth Heubeck, special to the Reporter

Contact Us    © 1995-2008 AAMC    Terms and Conditions    Privacy Statement