Flexible learning environments are the foundation of Duke University's mission to prepare students to be competent medical professionals in real-world health care settings. Duke's interprofessional learning environments are based on the premise that teaching students to work collaboratively with various medical disciplines will produce graduates who are capable of working in teams and communicating effectively. Improved communication can ultimately result in enhanced patient outcomes and less medical errors.
“The increased focus on patient safety is driving interprofessional education,” notes Colleen O’Connor Grochowski, associate dean for curricular affairs at the Duke University School of Medicine. “Many of the errors that are being reported involve miscommunication or a lack of communication. We believe interprofessional education can reduce medical errors because it offers team-based and case-based learning that gives students an opportunity to practice teamwork, collaboration, and shared decision making – the same skills they need when practicing in health care.”
Medical care is changing rapidly as a result of scientific advances and the proliferation of information. Today’s physicians must be able to access scientific information, analyze the data, and then apply it to solving clinical problems as part of a health care team.
Using an interprofessional model is one way in which medical education faculty can prepare tomorrow’s professionals for changes that are occurring in health care delivery. The subsequent changes in teaching and skills assessment occurring at Duke epitomize the World Health Organization’s definition of interprofessional education -- “having groups of learners come together and learn about, from, and with each other.”
Providing interprofessional education means medical schools must create flexible learning spaces to accommodate changes in their teaching pedagogy. The new teaching methods require more than the traditional lecture hall of yesterday.
New Teaching Methods
A transformation in health care delivery requires medical schools to alter their approach to teaching starting with the curriculum. It is essential to teach self-learning, critical thinking, and problem-solving skills where students can access, assess, and apply information.
In the past, medical students were taught courses in a silo format where anatomy and physiology were independent of biochemistry and cell biology. Content was not presented in a manner which enabled students to see how the topics were related.
Today, Duke offers an integrated basic science curriculum that clusters related courses together and helps students learn in context. For example, biochemistry, genetics, and cell biology are grouped together under the topic of molecules and cells; while immunology, microbiology, pathology, and pharmacology are included under the body and disease category. Clinical content is introduced in the basic science years of the curriculum and basic science principles are revisited in the clinical years.
Case-based learning, which is conducted in teams, represents an advance in education that requires students to apply the principles they learn in problem-solving situations. The team-based learning focuses on preparation, readiness assurance, and application of course concepts.
Students study the course content on their own before going to class and then must demonstrate how well they understand the concepts. Their understanding, or readiness assessment, is tested in class through an individual quiz. They take the same closed-book quiz again as part of a team.
“The energy in the room when this is going on is fabulous because students are teaching students,” says Grochowski. “They are working with what they recall from their self-teaching before class. The responses to the individual and team quizzes are recorded and the instructor is able to monitor in real time the questions the students or the teams have difficulty with.”
After the team quiz, the instructor briefly intervenes to explain any confusing concepts and then gives the teams a problem to solve using their textbook and their collective knowledge. Small groups work together in a large room with one or two faculty members present in each class.
Teaching spaces must be redefined to facilitate team-based learning. Traditional classrooms and university lecture halls are no longer sufficient to meet the evolving needs of the new educational paradigm. Spaces must be learning halls, rather than lecture halls, to facilitate interaction among students and between students and faculty.
Implications for Learning Spaces
Effective team-based learning requires an environment that can accommodate a large lecture format and the ability of many small groups to work under the supervision of one faculty member. Such spaces provide an ideal learning environment for students and also make the best use of the faculty members’ time since one professor can simultaneously oversee many small groups.
“We need a variety of spaces to address the new approaches to medical education,” says Grochowski. “We need spaces that run the spectrum from instructor-directed education to self-directed education, spaces that are flexible and accessible, and spaces that allow for interactive learning and small-group work.”
The Duke University horseshoe-shaped learning hall is designed to give instructors access to all of the groups and to ensure sight lines. In order for team-based learning and other interactive methods to work, the students need to be able to see each other at all times no matter where they are sitting in the room.
The hall also is equipped with the appropriate infrastructure to permit the use of a wide variety of instructional technology. It is part of Duke’s new $50 million School of Medicine Learning Center, which was designed by the S/L/A/M Collaborative in association with Duda Paine Architects. The center includes six interactive teaching laboratories with a cluster of four and a cluster of two. One or both of the interior walls in the cluster of four and the wall between the cluster of two can be removed, if necessary.
“We can grow the size of our learning spaces, depending on the number of learners and the number of faculty who are available,” says Grochowski. “Our lab rooms are located across the hall from a series of six small-group rooms. One of the walls between two of the small-group rooms can be removed so we have either a medium-sized room or the ability to upfit another laboratory if our class size grows. Flexibility is the key.”
Delivering interprofessional education can be daunting because it involves a large number of learners and many faculty members. Again, space becomes an issue. Therefore, Duke also created a large meeting room that can accommodate 400 students. Movable walls can easily change the configuration to create smaller spaces or to increase the seating capacity beyond 400.
Today’s advances in medical education provide students with opportunities to simulate caring for patients in a way that enables them to achieve a higher level of competence. The Duke University School of Medicine’s simulation suite features high- and low-fidelity simulation. Two operating rooms, an intensive care unit, and a surgical task trainer room are included. In addition, there are 12 clinical performance exam rooms staffed by actors trained to play the role of patients.
“Simulation is going to play a seminal role in reducing medical errors because students are able to practice what needs to be done, study their work, and learn from it,” says Grochowski. “The simulation suites also let us assess our students’ clinical competence both in the simulation lab and in the clinical setting. That’s important because competency-based assessment is another emerging national agenda item.”
Medical schools should be designed or renovated to include a variety of learning spaces which redefine the traditional lecture hall and accommodate interprofessional education. The spaces must enable students to practice their skills and give faculty an opportunity to assess their competency both at the individual and team levels. Building flexibility into the design of these spaces makes it easier to accommodate the needs of students and faculty members as teaching methods evolve.
“The ultimate outcome for interprofessional education is to produce a collaborative-ready workforce that delivers increased quality of care with greater patient safety and better health care outcomes,” says Grochowski. “We are linking our educational program to health care delivery.”
By Tracy Carbasho
This report is based on a presentation given by Grochowski at the Tradeline 2011 Academic Medical and Health Science Centers conference.