UB Medical School is designed for a new way of training doctors

Saturday, January 6, 2018

Source: The Buffalo News

With its terra cotta skin, dramatic seven-story atrium and more than 19,000 feet of glass, the new University at Buffalo Jacobs School of Medicine and Biomedical Sciences offers a sleek addition to the downtown cityscape.

The eye-catching building on the Buffalo Niagara Medical Campus opens with students on Monday, but it aims for more than a visual wow factor. It reflects big changes in medical education, helping UB keep pace with a movement to reorganize the training of doctors of the future.

The new school is more than twice as large as the old one on the South Campus. First-year enrollment is 180 students this year, up from 144 in the recent past. The number of faculty members is growing, too – now 812 with a goal of 860 by 2020.

UB is not alone. First-year enrollment at U.S. medical schools increased by 28 percent to 21,030 students from 2002 to 2017, as schools responded to concerns about projected physician shortages, according to the Association of American Medical Colleges, which represents accredited medical schools.

When students arrive Monday for the start of the spring semester, they will find "flipped" classsrooms that can quickly transition from lectures to small groupings of desktops and back again to lecture formats. The flipped aspect involves students studying lecture material on their own, and then using the classroom for problem-solving exercises and discussion with each other and the professor.

Traditional lecture halls still exist, but they are augmented by rooms with digital displays for breaking into smaller groups, with an emphasis on team-based learning with students in other health professions, such as nursing and pharmacy.

The building boasts bigger and better simulation spaces wired for audio and video debriefings afterward. They offer more realistic conditions for working with sophisticated medical mannequins and actors to train in surgery, medical diagnosis and bedside manner.

Scattered throughout the building are lounges, study areas to work alone or in groups, and congregation zones to hang out and that encourage chance interactions among students, doctors and researchers.

And it's all technology-rich, chock full of digital screens and ports for smartphones, tablets and laptop computers. Among other features, lectures can be video-recorded, converted from voice to text, and searched by keyword. Students can also respond digitally to professors in real time during class, letting teachers know instantaneously if the audience understands the material.

The school's flexible design acknowledges that different people learn in different ways.

"We can take advantage of the building. We can look at courses taught in the traditional lecture format and change that to teach in an interactive learning manner, small groups or simulation," said Dr. Michael E. Cain, dean of the medical school and UB's vice president for health sciences.

The new building coincides with UB's plan to introduce a new curriculum in the fall, a trend sweeping through medical schools across the country and advocated by the American Medical Association and other major medical organizations.

Since 1910, when a report by educator Abraham Flexner led medical schools to adopt standards, the structure of medical education has remained largely the same. Students spent the first two years devoted to learning basic science and the last two years to clinical experience. Advances in health care, society and technology have pushed schools in recent years to adopt a new approach.

Among other revisions, the focus increasingly centers on teamwork, earlier clinical experience, problem-solving, communication skills, and training in new technology. Students must be prepared to work in a health care landscape that, in addition to hospitals and doctors' offices, includes urgent care centers, specialty clinics, retail clinics, robot surgery, and outpatient surgery centers.

One of the fundamental transitions is a move away from the accumulation of facts and toward mastering core competencies. It is impossible today to memorize all you need to know to be a doctor. There is too much. It isn't necessary either when computers offer instant access to the facts.

Similarly, schools have replaced the traditional system of learning individual subjects – such as biochemistry, histology and anatomy – with a more integrated organ-based approach that attempts to connect those subjects and show how each relates to larger systems in the body.

"Part of the the changing medical curriculum across the country is driven by how readily available knowledge is in the 21st century. A cellphone will tell you the side effects of a drug or drug interactions, whereas when I went to medical school that had to be hammered into your head," said Cain. "Now, you can spend more time in medical school on how you are going to use that information."

How care is delivered and paid for has also changed. That's why curriculum reforms place a growing emphasis on learning about disease prevention, interpersonal skills, health care policy and economics, evidence-based care, and such important social determinants of health as poverty and housing.

Moreover, the solo practitioner working alone is an iconic figure largely of the past. Today's doctor is more likely working in a group as a leader of a team of people with expertise in certain areas of care, including nurses, dietitians, therapists, pharmacists, and social workers. Medical schools need to reflect that new reality.

"A medical school has to serve the community, as well as the students. Students have to realize how the health care system is put together, and how payment works. They need to learn with, from and about other specialties because that is how care is delivered today," said Dr. Alan Lesse, senior associate dean for medical curriculum at UB and an associate professor in the department of medicine.

One of the most striking features of the new building is its cavernous central atrium dotted on multiple floors with areas to congregate. The designers wanted to encourage people to come into contact with each other, whether for organized meetings or chance encounters. It's a response to the fractured layout of UB's old medical school facilities, and the designs of many others, that gave little thought to fostering collegiality and collaboration as part of the educational process.

"It's very student-centered and communal, but it's also for clinicians and researchers. There's an attempt to create a sense of community," said Kelly Hayes McAlonie, director of campus planning at UB.

The transition to a new curriculum isn't like flipping a switch. It's a complicated change, especially at the start. Among other challenges, the educators must be educated. Faculty members need to adapt to new teaching methods that integrate discussion, problem-solving, test question reviews, and quick feedback from students in real time.

"Medical school is no longer about standing in front of a few hundred students and lecturing for an hour," said Lesse.

Connor Arquette, a third-year medical student at UB and member of the steering committee that oversaw the reorganization of the curriculum, praises the new school's design but stresses that its significance goes beyond the looks.

To him, the new curriculum and interesting design elements of the building, fit in with the growth of the downtown medical campus. Together, they have created a better recruiting tool for students, doctors and researchers.

"The building is more like a symbol of bigger changes in the clinical experience. It's an exciting time to be a student here," he said.

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