Rethinking Medical Education
Delivering Quality Healthcare Through An Interdisciplinary Team Model
If trends illustrate that the most effective way to deliver quality healthcare is through an interdisciplinary team model, then doesn’t it make sense to rethink medical education? They think so at Thomas Jefferson University. Jefferson has created an environment in which students from diverse health specialties work together, not as future individual practitioners, but as members of multidisciplinary teams in the best interest of the patient.
The new education building at Thomas Jefferson University, the Dorrance H. Hamilton Building, was specifically designed for team-based training. Medical students will learn in an environment that fosters clinical education. Students have an extensive virtual realm in which to learn: occupational therapy students learn by teaching their patients to negotiate an apartment; nurses and medical students will interact with standardized patients in a simulated hospital ward, an intensive care unit, or a dedicated virtual operating room. This training can take place at any time best suited for the learning experience rather than in an ad hoc and often off hours when the “live” spaces can be accessed in the hospital. Students can be recorded in the simulation rooms, so they can review their work with instructors. They will be prepared for real-time medicine before they face the challenges of a busy hospital environment.
CONNECTING TO THE COMMUNITY
On the outside, a 60,000-square-foot college green was created that transformed the look and feel of the campus. The new plaza provides space for informal learning and interaction between students, faculty, and staff. As downtown Philadelphia’s largest infusion of green space in half a century, the 1.4 acres of open green space in front of the building is a welcome addition to the neighborhood. All who visit the Jefferson campus can now enjoy tree-lined sidewalks, improved lighting and enhanced landscaping.
The urban plaza exemplifies sustainable, multifunction urban design. The grassy open space defines a center for the campus with character, quality, and flexibility of function; creates a space that encourages interaction not only among the TJU community, but the Philadelphia community as well; and provides a safe, welcoming, and versatile space.
The plaza’s design focuses on elliptical forms in granite that provide changing perspectives as people move through the space. This pattern makes the space feel larger by leading the eye toward the long views across the plaza. The open views also make the space more defensible and safe. Minor changes in elevation divide the space into a structured gathering area with planted beds near the building and a more casual greensward to the south and east, with both areas shaded by canopy trees. The planted beds include flowering native ground covers and medicinal plants, however, for enhanced security, none obscure views across the site. Irrigation is supplied from rainwater and air conditioner condensate collected in cisterns beneath the plaza’s lawn space.
Prior to the construction of this complex, the parking garages that served the university consumed half of a city block and distracted from the identity of the campus. The new 252-car parking facility is located underground, which allowed the campus (and the city) to reclaim over an acre of street-level open space.
CREATING CAMPUS IDENTITY
During initial discussions, the school strongly emphasized their need for campus identity. For years, the urban Philadelphia grounds had been scattered throughout several city blocks which made it difficult to unite the campus. The lack of campus identity also made it hard to establish a relationship with the neighboring community. It was clear that the new space would need to be aesthetically pleasing, as well as functional. “We are committed to creating open spaces and to constructing buildings that are human in scale, outward looking, and express our university’s openness toward our Philadelphia neighbors,” said Robert L. Barchi, M.D., Ph.D., President of Thomas Jefferson University.
The building enriches campus image by welcoming its role as part of the community. Instead of filling every inch of space with concrete and steel, it works as part of THE open space.
BUILDING DESIGN
The design of the seven-story, 135,000-square-foot, state-of-the-art academic medical building supports TJU’s desire to reshape a new paradigm for education in the health sciences. The new curriculum will educate students to work and succeed as part of the integrated, multidisciplinary healthcare delivery team that is the future of healthcare. The team-learning approach was a driving force behind the building’s design.
INTERDISCIPLINARY ROLE OF EDUCATION
The building is organized around the education model of the building. The first floor houses a 300-seat auditorium designed for large group lectures for both students and faculty. The second floor features meeting rooms for smaller group discussions and application of lessons from the auditorium lectures. The upper levels contain more specialized teaching spaces including the clinical skills assessment center on the third and fourth floors, specialty simulation automation classrooms on the third floor, fourth-floor simulation medical surgical setting and mock operating room, and simulation trauma and intensive care unit settings on the fifth floor. The fifth floor is also home to an occupational therapy mock apartment and splint lab, as well as specialized nursing program classrooms.
CONTINUED LEARNING IN AND OUT OF THE CLASSROOM
Every floor includes a breakout and gathering space. These spaces allows students and faculty a place to convene and engage in discussion and study sessions outside of the classroom. On the second through fourth floors, the gathering spaces are situated along the curved glass façade affording a connection to the plaza and a view of the Samuel Gross statue used as part of the medical college’s white coat ceremony. On the fifth floor, a 75-person classroom and additional meeting room move to the curved perimeter opening up the center of the floor for the gathering and breakout space.
Small group study spaces are located throughout the building. Every classroom has full audio/visual capabilities including internet access. A specialty digital system can display anything that is being filmed in the specialty labs or exam rooms via the internet in the building’s small group spaces on a 10-second delay. Classrooms hold groups of 15, 30, and 75.
THE EXTERIOR ACCENTS THE INTERIOR
The building’s exterior design accents the hierarchy of the interior space / usage by stepping inward as it rises – initially at the third floor separating the large group spaces from the specialized teaching spaces, then again at the fourth floor separating the clinical training spaces from the larger specialized classrooms. The building makes one final step on all sides at the mechanical level to separate the occupied portions from the mechanical spaces at the top. The building exterior also changes from brick and glass to aluminum panel at this level to lighten this element from the rest of the building.
The facility’s curved glass façade highlights views looking out onto the plaza, as well as views of the activity within. This transparency is an important feature, providing an engaging link between institution and community. The building’s entry is designed for ingress and egress through the plaza, with high ceiling heights and large expanses of glass that allow a direct view through the building from the street to the lobby and through to the plaza.
The height and mass of the building are broken down in a number of ways. The design utilizes stepping, which also serves to accent the floor use. A trellis on the roof deck caps the columns on the fourth floor. Recesses in the brick help to segment the building by column line and along floor lines to interrupt the repetition of glass and brick. In addition, projected metal shelves at the glazing create strong horizontal elements that interrupt large expanses of glass and brick.
To enliven the 11th Street façade, which primarily houses the entrances for loading and the parking garage, canopies were added over a series of niches that will house interpretive historical data about the university and the entrance to a retail space on the corner of 11th and Locust streets. Each column is accented with a sconce lighting fixture to bathe the niches in light in order to brighten the tree-lined street at night.
ROOFTOP TERRACE AND TRELLIS
The fourth floor of the building boasts a rooftop terrace overlooking the landscaped plaza. A trellis on the terrace is an element in the modern adaptation of the classical column form. The columns along the curved façade begin wide at the ground level, taper / step in at the second floor, and then are capped at the top not only with metal coping, but also by the extension of the trellis that serves as an exterior cornice for the façade. The trellis also acts as a shading device for the deck. As a site for student, faculty, and community events, it is essential that the terrace be shaded from the sun in order to maximize the times when it can be used. The trellis breaks up the light to maintain shade on portions of the deck throughout the day.
THE CONNELLY AUDITORIUM
The technologically advanced Connelly Auditorium is located off the main floor lobby. It seats 296 and was designed to hold an entire medical college class; it will be used for continuing education as well. The auditorium has full audio-visual capabilities, including internet access, and teleconferencing capabilities to enable a lecture to be broadcast to an off-site audience.
THE CLINICAL SKILLS CENTER
As a training ground for medical, nursing, physical therapy, and occupational therapy students, the building is home to the Dr. Robert and Dorothy Rector Clinical Skills Center, a two-floor clinical skills center featuring virtual diagnostic and surgical suites. The center is an expansion of the university’s existing clinical skills center that includes clinical training areas, classroom space, and an audio-video studio for taping student interactions. Every simulated lab space has lecture rooms with full range of audio-visual capabilities. The labs include surgical suites, exam rooms, critical care areas, a med-surg ward, mock apartments, and an acute care ward. Teleconferencing capabilities allow for classes to be projected to Jefferson’s affiliates and clinical sites as well as into the auditorium for student debriefing. The building’s teleconferencing and recordable simulation capabilities make interactive distance learning possible.
As Dr. Robert L. Barchi, President, Thomas Jefferson University said, “In our vision of tomorrow, quality and compassionate healthcare will be provided by coordinated teams that include all elements of health services. The Dorrance H. Hamilton Building was designed from the ground up to educate the leaders of tomorrow’s healthcare delivery teams, training nurses and physicians, occupational therapists and pharmacists side by side in simulated clinical environments This facility sets a new standard for healthcare education in the nation. Having trained in the Hamilton Building, our graduates will bring to their subsequent workplace and to their patients a new and powerful model of patient-centered, team-based healthcare.”
