The exacting demands of medical education are always evolving, driven by relentless advancements in medical knowledge, technology, and patient care. Thus, medical school architecture must also evolve and be flexible, to house new curriculums informed by state-of-the-art medical treatment.

Broadly speaking, interdisciplinary team-based care for patients has become the gold standard in medicine in many hospital settings. Consequently, today’s medical schools are demanding buildings and layouts to facilitate multidisciplinary instruction of small groups.

Medical schools now also require architecture to improve not only the academic, but also the social experience, in part to boost student retention rates. This requirement translates into spaces for spontaneous, informal social and academic interaction.

Some medical school requirements are enduring. School administrators, staff, and students want architecture that reflects the pride and prestige of the institution. In addition, today’s new structures need to adhere to emerging green standards of resource conservation.

Interdisciplinary teams
That being the new reality, medical school architecture and design must accommodate a circular loop of information and feedback, rather than a linear curriculum of sequential stages.

Spaces designed for interdisciplinary approaches, much like collaborative research facilities, must encourage human interaction. Medical schools today are reviewing their facilities to determine how, perhaps unintentionally, they work against informal collegiality. Simple factors, such as circulation patterns and proximity of spaces, can encourage or discourage interaction among groups of students, professors, and guests.

Photo courtesy of CO Architects

Designing the facility to put people into places where they come into contact with others—social spaces, public study areas, gyms, cafés, enlarged stairway landings, and open corridors—encourages chance meetings as well as organized interactions. This begins to shift the education culture informally, easing the transition to a more collaborative pedagogical structure.

Mirroring real-world clinical environments is another means to encouraging interaction, by placing students into clinical treatment scenarios where they are required to develop a team-based approach to care. Spaces that mimic an emergency or operating room setting impart a sense of place and complement the sophisticated full-body simulation mannequins that are central to the hands-on training conducted in such facilities.

Not only emergency and operating rooms are changing, but patients rooms as well. Acuity-adaptable approaches to treatment, now seen in more hospitals, require teams of specialists, accompanying technology, and changing levels of care to come to the patient’s own environment, that of the patient room. The old model—shuttling the patient around the hospital—is becoming outmoded, thus dictating changes in medical school architecture and instruction as well.

These complex spaces require a variety of support spaces, such as control rooms, debriefing areas, observation suites, part-task rooms, and storage and equipment. Placing these new spaces near more-traditional lecture halls, labs, and classrooms plays a key role in encouraging interaction among students and faculty, while creating efficient learning environments attuned to the changing realities of modern hospitals.

Changing student body, flexibility
Today’s student more-easily works in small-group settings, can focus well in distracting surroundings, and is adept at using technology. This means that traditional pedagogies, such as gross anatomy labs, can be augmented with new technologies, such as computer and internet access at every station.

The technology-rich, smaller-scale classrooms of today are a constant reminder that architectural flexibility is the key element in programming and design to extend the life and usefulness of a new facility. Large open spaces, sturdy floor loads, and high ceilings allow floor layouts and technology to be altered as needed.

Recent case studies

Photo courtesy of CO Architects

At the University of Virginia, CO Architects is designing a facility for an education program that is itself under revision. The programming of learning spaces is being developed to accommodate the integration of clinical education early in the curriculum, alongside basic sciences. Spaces are designed to adapt to improving simulation and visualization technologies, and classrooms are a mix of traditional and small-group, activity-oriented spaces.

CO Architects has developed a number of benchmarks based on its recent medical projects. This evidence-based design method helps assure medical school administrators that spaces are configured adequately for their needs and that buildings will function as intended.

From our work on behalf of many other universities and medical schools, we recommended that the new Virginia facility have one 560-square-foot exam room for every 10 students to optimize the learning environment.

Each new project in which CO Architects participates informs benchmarks, such as these, allowing the program models to mature alongside curricular changes.

Similarly, the new medical education building at Texas Tech University-El Paso School of Medicine also reflects a modern curriculum that emphasizes small-group and problem-based learning. Accordingly, lecture halls are supplemented with case rooms and flexible classrooms designed to accommodate small groups. Multiple “human simulator” teaching rooms are wired so that audio-visual signals can be sent to briefing and debriefing areas.

The concept of interdisciplinary training is also becoming prevalent at the professional level. The Methodist Institute for Technology, Innovation, and Education (MITIE) at Houston-based Methodist Hospital, is a national center for research and education in minimally invasive surgical training techniques, and a resident training center for the Cornell School of Medicine.

MITIE was designed as a group of adjacent multifunctional sites with technologies that include virtual environments, simulators, technical trainers, robotics, image-guidance devices, and conferencing and debriefing capabilities. The carefully designed training environment will foster innovation while allowing physicians to acquire new procedural and patient-care skills in an interdisciplinary, participatory small-group environment.

At CO Architects, we are fortunate to design not only medical schools, but also hospitals, giving us deep insights into the nexus between the two institutions. This is put into practice in the design of the School of Nursing at California State University in San Marcos, California. We applied in-house expertise in the design of patient rooms, gained in part from our work on the nearby under-construction 740,000-square-foot Palomar Medical Center West (PMCW) hospital. Both facilities are funded by Palomar Pomerado Health District—a district, like many others, struggling to fill nursing slots.

The futuristic acuity-adaptable patient rooms of PMCW feature greater infrastructure and technology than earlier patient rooms, and thus militate for updated skill sets for nurses. In direct response, the new nursing school features general and specific skills training areas, computer lab for video-based training, lecture room, and technology-equipped classrooms—all designed to transition students into service at PMCW, or other advanced hospitals.

Sustainability, community

Photo courtesy of Robert Canfield

Beyond programmatic needs, modern medical school buildings are expected to reflect and instill institutional pride, attract faculty and students, and meet sustainable building goals.

In the main, of course, buildings must be beautiful, inviting, and infused with sufficient gravitas for the serious business at hand—but, in some cases, even smaller flourishes can be very useful. For example, at the Texas Tech University-El Paso School of Medicine, CO Architects designed courtyard spaces that recall the traditional outdoor learning spaces of medical schools in Mexico, a recognition of the regional heritage of the school. Additionally, medicinal herbs are featured in the school’s landscaping to build a connection to traditional values and to the healing powers of nature.

Indeed, an overarching CO Architects’ design principle is to reinforce natural healing connections wherever possible, especially in the use of daylighting, plant-life, and views. In healthcare facilities, as well as in medical education buildings, the connection to nature is of prime importance. Sustainable and healthful design is part of the process of designing buildings that both embrace technology and accommodate it in humanizing, inspiring environments.

Moreover, buildings must create a sense of place and repair fragmented contexts to enhance a sense of community and institutional pride. Buildings are the physical symbols of the educational and pedagogical work of schools and thus powerful assets in forging a strong program that attracts world-class faculty and quality students.

As programs, curricula, and technology evolve, and students’ expectations change, the buildings that house them must also evolve and reflect the advances of science while supporting fundamental and constant human needs.

It is a balance between art and science that achieves the best outcomes and maximizes the investment in medical school design and construction.

Scott Kelsey, AIA, is managing principal at the Los Angeles-based CO Architects, a firm that specializes in healthcare, academic, and science and technology architecture, planning, programming, and design.