Duke University's new School of Medicine Learning Center is being built with a focus on space effectiveness rather than simply greater space efficiencies. The $50 million facility, slated for completion in November 2012, includes spaces for collaborative teaching models that are proving to be more cost effective to incorporate than building spaces that support only traditional teaching models.

“We want to ensure that our students have an opportunity to participate in self-directed learning, are responsible for making decisions, are able to draw on their life experiences, and are able to practice what they are learning,” notes Colleen O’Connor Grochowski, associate dean for curricular affairs at Duke University. “We want to be very intentional in providing learning processes that include these principles and then design spaces that allow us to be innovative in our delivery.”

Studies by the National Training Laboratories (NTL) in Arlington, Va., demonstrate how learning environments affect retention. The old-fashioned lecture format produces a 5 percent retention rate, while giving students an opportunity to practice by doing results in a 75 percent retention rate. Using a team-based, experiential approach however, can result in a 90 percent retention rate. This latter format, teams of students are required to demonstrate their understanding of core concepts and their ability to apply the concepts in problem solving situations while simultaneously learning from and teaching other students.

**Aligning Design with Learning Principles**

“We’ve been exploring the cost-effectiveness of the best ways of teaching when you look at learning retention not just the instructional hours or the cost of the space,” says Robert Pulito, president of The S/L/A/M Collaborative (SLAM), which, in association with Duda Paine Architects, is designing the learning center for Duke.

Three key instructional models are being used in medical education. Each produces specific behavior among students and has particular desired outcomes. Although problem- and team-based approaches can produce more meaningful results than the lecture method, only problem-based learning has been widely adopted in health science education up to this point.

**Lecture-based format**

Students must be motivated to attend class and to study lecture notes in order to perform well on examinations. A lecture hall is typically used to accommodate large groups of students. The desired outcome is content acquisition and conceptual understanding of the material.

**Problem-based format**

As part of this approach, students work in small groups of six to eight people with one or two faculty members. The faculty member introduces a problem to be reviewed by the students. In small groups, students then study the relevant issues and identify additional information that may be needed to solve the challenge. Students assume responsibility for studying certain aspects of the problem and commit to doing independent research.

The students meet again in their small groups to discuss what they have learned about the issue, develop a solution, make a presentation, and receive feedback from the faculty. They also evaluate their peers and the overall learning experience. The desired outcome is to facilitate students’ active inquiry and encourage them to work both independently and collaboratively to resolve a problem.

**Team-Based format**

In this format, students prepare for class both as individuals and team members. The faculty member assigns students material to read, research to conduct, or some other project to complete independently prior to attending class. Upon arriving in the classroom, students are expected to demonstrate their understanding of core concepts studied independently by passing an individual quiz. The same quiz is then taken by teams broken into groups of five to seven students. Once the faculty member confirms students have an understanding of core concepts, the teams are given a case to solve that requires them to apply the core concepts.

The team-based format utilizes lecture halls and learning studios to the small student teams. The team-based learning (TBL) lecture hall differs from a standard lecture hall in that breakout space is provided within the room. By placing two rows of seats on each tier with tables in between, students can quickly move from lecture to small-group mode yet benefit from the dynamics of multiple groups working together. The anticipated outcomes of team-based learning are content mastery along with an improved ability to solve problems, communicate effectively, and work collaboratively.

“Team-based learning is relatively new in medical education, but the emerging literature is showing there are positive outcomes,” Grochowski says. “Students are scoring higher than those who used the standard lecture-based instruction and have enhanced critical analysis skills.”

**Assessing the Effectiveness of Learning Environments **

Five learning environments being used at academic institutions include the traditional lecture hall, the TBL lecture hall, the studio classroom, the teaching lab, and the problem-based learning (PBL) classroom/small group room. The studio classroom is similar to the TBL lecture hall, but it has a flat floor and students are always in small groups. The small group room, where problem-based learning occurs, is usually a conference room equipped with technology. The new facility at Duke will feature a TBL lecture hall, teaching labs, and small group rooms to support team-based learning and interprofessional education.

“The kind of venues included in a facility need to be driven by the curriculum,” says Mary Jo Olenick, a principal and chief of strategic planning for SLAM. “There is also a lot of learning that goes on outside the classroom. So there is a need for space where students can study and work in groups.”

The learning pyramid developed by NTL illustrates the average retention rate for various teaching methods, including lectures at 5 percent; reading, 10 percent; audio/visual, 20 percent; demonstration, 30 percent; practice by doing, 75 percent; and immediate use of learning or team-based method, 90 percent. SLAM used this information to determine its implications with regard to space effectiveness and consequently, value.

In order to provide a basis for this analysis, SLAM developed the retention unit formula. A retention unit equates to one student with 100 percent retention according to the SLAM system. Here’s the math: Multiply the number of seats in a teaching venue by the retention percentage from the pyramid to determine the total retention units (RU) that each space type yields. For example, lecture halls typically have a 5 percent retention rate. Therefore, a 300-seat lecture hall would have 15 retention units or 15 students who are fully grasping the concepts. On the other hand, a 160-seat TBL lecture hall, which is in the 90 percent range on the pyramid, would have 144 retention units.

SLAM took the mathematical formula one step further to understand the correlation between what is being taught in each environment and the effectiveness of that space on a square foot basis. A 300-seat lecture hall with 18 nsf/seat would require 5,400 nsf. If there are 15 retention units among the 300 people, that means the retention unit per nsf is 0.003.

Meanwhile, a 160-seat TBL lecture hall with a nsf per seat of 24 would require 3,840 nsf. If there are 144 retention units divided by the 3,840 nsf, the value of the space would be greater than the lecture hall with 0.038 retention units per nsf.

The formula looks beyond space efficiency (NSF/student) to space effectiveness (RU/NSF) to determine that the TBL lecture hall has the highest level of effectiveness, followed by the problem-based group room and the learning studio, both at 0.030 retention units per nsf; teaching lab, 0.011 units per nsf; and lecture hall, 0.003 units per nsf.

**Determining the Value of Learning Venues**

The size of a room is an obvious cost factor, especially in new construction where larger rooms represent more dollars per square foot. The technology incorporated into each learning environment must also be considered, as rooms that require connectivity for groups are more expensive. Both types of lecture halls are costly because of the room size and the amount of technology required, yet they are cost-effective in terms of the number of students they can serve. The small group rooms have a significant technology cost, and the teaching lab is the most expensive because it is driven by the largest nsf per student in order to accommodate lab functions. The studio classroom is not as expensive because it does not feature tiers and is not as large as a lecture hall.

After doing the math, the TBL lecture hall cost per retention unit is just $10,292. Meanwhile, the lecture hall cost per retention unit is $128,750. The cost per seat of a TBL lecture hall versus that of a standard lecture hall is only slightly more: $8,763 for the former and $6,688 for the latter. These number illustrate that student learning does not have to cost a premium. In fact, it can be a downright bargain. Clearly, learning spaces should be designed and built with an eye on how effective those environments are for student learning rather than only zeroing in on the cost of space. And that's the prime focus for the design of the School of Medicine Learning Center at Duke.

Clearly, learning spaces need to be designed and built with an eye on how effective those learning environments are rather than just considerations of cost per square foot.

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“It’s important that we look at learning spaces in a broad context rather than focus exclusively on area per student or cost per square foot. When you factor in space effectiveness, you get a more comprehensive understanding of its true value,” Olenick says. “If we can design environments to produce specific results, we can achieve a lot.”

**By Tracy Carbasho**

This report is based on a presentation given by Colleen O’Connor Grochowski, Mary Jo Olenick, and Robert Pulito at Tradeline’s Academic Medical and Health Science Centers 2010 conference.

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