-By Jennifer Busch

"Taking care of patients requires good teamwork," says Dr. Alison Whelan, M.D., FACP, associate dean of medical student education and a professor of medicine at Washington University School of Medicine in St. Louis. She explains that the old model of one doctor taking care of complex illnesses no longer applies. "There is more and more interaction among different disciplines, and more complex teams can offer various opinions to inform the problem." Today the healthcare providers for a single patient might include a team of doctors, nurses, pharmacologists, respiratory therapists, and more.

"As the practice of medicine has changed," she continues, "what is the best way to repeat that experience to physicians-in-training? How should we approach medical education differently?" The questions are not exactly new; in fact, in 2004, HOK designed Farrell Learning and Teaching Center, a new medical school facility for Washington University (Wash. U.), around these very principles of integrated medical education. In the five years that have ensued, Whelan and her colleagues have been able to observe these concepts in action.

A more integrative approach to medical education, according to Whelan, has been heavily influenced by the growing association in medical practice between research and healthcare delivery. Translational medicine, the term by which this concept is known, describes the intersection of science with clinical application, and focuses on maximizing interactions between the medical and research communities with the hope that breakthroughs in medical science and better treatments can occur via interactivity between clinicians and researchers. The model has also found its way into medical schools. "We are educating physicians but we always expect that a certain number of them will become leaders in biomedical research," says Whelan. Thus the Wash. U. School of Medicine program creates multidisciplinary work groups that include students destined for research and those destined for practice.

And as new theories emerge from mainstream research on teaching and learning behaviors, Wash. U. also has responded with a heavier emphasis on interactive teaching. Despite the fact that a good amount of teaching still happens in the classroom, "active learning, problem-solving, and discussion are more powerful ways to do the high learning," insists Whelan. As a result, the teaching program has shifted away from large lecture groups (though these are still used, particularly in the early years of medical school) toward smaller discussion groups, collaborative learning, and informal social interaction. "The best patient outcomes involve active listening and actively sharing the information you have," says Whelan, noting that these skills are best learned in small group environments.

Wash. U. School of Medicine's teaching goals eventually intersected with its facilities requirements, and HOK was called in to design a new building around a more collaborative and interactive model of medical education. "We spent a lot of time thinking about the design of this facility," says Whelan. "There are a number of spaces that are purposefully designed to support the way students are learning today. The bottom line is that you need to have the infrastructure for a model that makes collaboration possible."

Technology has had a significant impact, and since all Wash. U. School of Medicine curricula is posted online, learning has essentially become a 24-hour, anytime/anywhere exercise. A lot of collaboration happens through the virtual sharing of notes and review sheets, admits Whelan, but the building also encourages face-to-face interaction, from the formal to the informal. The library is primarily a quiet space for individual study, but its use means students are together in a public place, not sitting at home in isolation hitting the books. Small rooms used for group study support a moderate amount of interaction, and mock operating room, intensive care unit, and emergency room for upper class students and residents simulate the teamwork that will be necessary to master clinical practice.

"We also devoted a large amount of floor space and dollars to social space, which is incredibly important to the culture of the school," says Whelan. "We created spaces to enhance chance interaction. It was a huge aspect of what we needed for this building. It breaks down barriers." A second floor lounge frequented by upper-class students for downtime is also used for receptions, while third and fourth floor lounges serve the social needs of first and second year students. "I like the idea of a graduated sense of privacy, and the balance of lecture halls and small group space is really appropriate," says Whelan.

At a time when healthcare and its associated costs are at the center of our political and ethical discussions, it's clear that Washington University—and other institutions like it—have a responsibility to respond to new models of medical practice. The focus on building a collaborative and social attitude among future physicians may be the first step in fixing what many believe to be a broken and inefficient system, which is nevertheless bursting with talent and potential.