AAMC Reporter, November 2000: Not Your Father's Classroom: Schools Shape Learning Spaces Around New Curricula

VOLUME 10, NUMBER 2

JORDAN J. COHEN, M.D., PRESIDENT

NOVEMBER 2000

Not Your Father's Classroom: Schools Shape Learning Spaces Around New Curricula

By Barbara Gabriel

The University of Iowa College of Medicine's state-of-the-art Medical Education and Biomedical Research Facility is set to open its doors to students in time for next year's fall semester.

In a large amphitheater lecture hall with rows of seats sloping up to the ceiling, hundreds of first- and second-year medical students listen with varying degrees of attention to a lecture delivered from a professor behind a podium in the center of the floor. Taking notes on material they will soon be expected to reiterate in tests and exams, some students attempt to keep up with every word that falls from the professor's mouth, while others struggle to stay awake in their hard-backed chairs.

At least that's how it used to be. "Today's classroom bears little resemblance to the huge lecture halls we had when I was in college, where students would either sleep or read the paper in the back rows," says Lindsey C. Henson, M.D., Ph.D., senior associate dean for medical education and associate professor of anesthesiology at the University of Rochester School of Medicine and Dentistry. "Today we try to do as little large group lectures as possible - we want to reserve the majority of our students' time for active learning."

Also gone is the predictability of those seemingly endless lectures. "Up until the early 1990s, our medical students had the traditional dawn-to-dusk class schedule that was structured so that they knew what they were doing every hour of their medical school career from day one," says Stephen Slogoff, M.D., professor of anesthesiology and dean of the Loyola University of Chicago Stritch School of Medicine. "Now our students have almost 50 percent of their time for individual study, and we've essentially reduced our didactic curriculum to less than 25 percent."

This change in the philosophy of medical education from passive to active learning, from structured to self-designed study, is hardly fitting in colossal lecture halls and oversized classrooms. Educators began to realize that if they wanted to actively engage students, students would need to be engaged by their environment.

Engaging the Student

Dr. Slogoff says that as Loyola University's new undergraduate medical curriculum began to take shape in the early 1990s, so did plans for the new medical education building that would house it. "But as the curriculum evolved, we realized that the physical plan for the new medical school was just a new set of lecture halls and classrooms; it clearly didn't fit the needs of the new curriculum. So we started to design a building to meet those needs."

While the new building does retain a technologically enhanced large auditorium, most learning in the $46 million facility that opened in 1997 takes place in small, conference-like rooms that accommodate between nine and 12 students. "The emphasis is on students sitting around a table talking to one another in order to problem solve on their own," Dr. Slogoff explains.

Similarly, the University of Rochester School of Medicine and Dentistry's plan to revamp its curriculum to emphasize small-group learning and the early acquisition of clinical skills coincided with its strategic plan to build a new medical research building with extra lab space. Plans for the new building were expanded to include teaching space designed to accommodate the new undergraduate medical school curriculum.

The recently completed Arthur Kornberg Medical Research Building incorporates 12 problem-based learning (PBL) classrooms - small, conference-like rooms designed to facilitate small-group learning. Technologically enhanced to enable students to access the Internet and perform literature searches as they work together on cases, the rooms also adjoin miniature, fully equipped doctors' offices.

"The idea is to make knowledge less abstract by immediately putting into clinical practice the skills students are learning," Dr. Henson says. Like the 14 "clinical skills centers" in the new Loyola building, the mock physicians' offices at Rochester incorporate all the equipment a student needs for the basic examination of a patient. These rooms are used to teach and test physical examination and interviewing skills at both colleges starting in the first year of medical school.

Loyola and Rochester have also equipped these exam rooms with unobtrusive video cameras, which "allow students to interact with simulated patients on their own," Dr. Slogoff says. "The instructor and the student's peers can then use the videotape to critique the student's performance, permitting the student to develop clinical skills in an authentic environment without having someone stand over his or her shoulder."

The University of Iowa College of Medicine is in the construction phase of new educational facilities for its medical students and hopes to open its Medical Education and Biomedical Research Facility in time for next year's fall semester. Its new facilities will also utilize small, case-based learning classrooms and mock examination rooms equipped with video cameras for evaluation.

"We will have four examination modules, each of which will consist of either five or six mock exam rooms around a central demonstration room," explains Peter Densen, M.D., associate dean for student affairs and curriculum at the University of Iowa College of Medicine. "Students can go from the central room to the exam rooms to put their learning into practice."

Dr. Henson adds that by videotaping mock medical exams, students gain a new perspective on their relationships with patients. "With this new space, students are able to evaluate, in a meaningful way, how they interact with patients," she explains. "For example, how do students deliver bad news? How do they counsel patients for smoking cessation? Being able to videotape a student in action and then critique him or her allows an objective analysis that reinforces Rochester's traditional emphasis on history taking, interviewing, and interpersonal skills."

Is the Lecture Hall Obsolete?

"I don't see lectures totally disappearing, but we want them to be a supplement to students' own learning initiatives," Dr. Henson says. "It's a completely different construct than lecture, memorize, and attempt to understand; it's more try to understand, and use the lecture as a supplement to that understanding."

Loyola's Stritch School of Medicine incorporates two new auditoriums that use modern technology - such as wiring for computer use for both students and faculty - to better engage students. Case-method rooms, which can hold up to 80 people, arrange students in a U-shape to facilitate more interaction. Rochester's new case-method room likewise incorporates the U-shape to enhance the interactivity of the traditional faculty lecture.

The University of Colorado Health Sciences Center (UCHSC), which is in the midst of a phased relocation of its entire campus from downtown Denver to a new 217-acre site in Aurora, Colo., will incorporate two auditoriums in its new school of medicine, scheduled for completion in 2003.

Denise Brown, UCHSC's chief planning officer, says that although these auditoriums will be traditionally sloped lecture-type facilities, they will be technology intensive, giving students the ability to hook up laptops at each seat and incorporating state-of-the-art audiovisuals, including flat-screen TVs with high resolution for viewing slides. "We're putting far more investment into the technical support of instructional spaces than we ever have before," Brown says.

The opportunity to create completely new instructional facilities that reflect changes in the philosophy of medical education has allowed schools like Loyola, Rochester, Iowa, and UCHSC to incorporate the latest in modern technology into their design of educational space.

A learning laboratory equipped with 50 computers and computer hookups around the building encourage student-initiated learning at Loyola. "By putting almost the entire pre- clinical and clinical curricula on our Intranet with interactive videos and graphics, we've pretty much gotten away from books," Dr. Slogoff says. "Students are encouraged to initiate their own learning and take it back to small groups for discussion."

Creating Communities of Learning

Schools are responding to recent calls for an increased emphasis on team dynamics in the health care setting by encouraging students to mentor and work with one another before they begin practicing medicine. In a shift from the traditional horizontal groupings of medical students by year, Iowa, Loyola, and UCHSC have constructed "student communities," in which students from each of the four years of medical school are randomly grouped into physical spaces that encourage group learning and peer-to-peer counseling.

Brown of UCHSC explains that many of the small-room facilities that will be scattered throughout the new medical school will be organized around student community environments, in which 30 to 35 students will be assigned to areas that will house a lounge, kitchen, and their mailboxes. "Adjacent to those areas will be small learning rooms that can be used as informal group study areas," she explains.

UCHSC is taking the concept of student communities to a new level in the design of its teaching facilities. Although the different schools at UCHSC - medicine, dentistry, pharmacy, and nursing - will have specialized rooms and resources that are unique to each of their curricula, unlike the old campus, they will not have separate buildings.

For the most part, instructional facilities will be shared across the disciplines. "The changes in our curriculum toward interdisciplinary models of learning have led us to pursue a wholesale integration across the health sciences disciplines," Brown says. "The success of that model depends upon the physical integration of the students. So, for example, a classroom may be used one hour by medical students, another hour by nursing students, and later in the day be shared by both medical and nursing students for a class on ethics or communication."

The new educational facilities at Loyola and Rochester and those in the works at UCHSC and Iowa reflect a fundamental shift in medical education that underlies the need for a new set of skills for a changing health care environment.

"Physicians will soon be able to access all the content they need pretty quickly from a computer," explains Iowa's Dr. Densen, "so the question of mastery of content is perhaps becoming less important than being able to work together and ask the right questions to uncover information from a patient. Being able to teach those skills changes the dynamics of educational space."