Past its prime
While Berryhill Hall was a new medical education building in the 1970s, the building’s limitations – both in size and design – are impediments to overcome for today's medical students.
When Joe Jenkins entered UNC School of Medicine in the 1970s, Berryhill Hall was a new medical education building that fit the times. But more than 40 years later, the building’s limitations – both in size and design – are impediments to overcome for medical students like Krishan Sivaraj.
Krishan Sivaraj of Cary considered a few professions before realizing that medicine would give him the best opportunity to help reduce social and health disparities on both a global and local scale.
When he entered the UNC School of Medicine, the amount of support he received from faculty and other students exceeded his expectations.
“I always imagined the solitary medical student studying alone for nights on end, trying to learn all the information,” said Sivaraj, a first-year medical student who graduated from William G. Enloe High School in Raleigh and Duke University. “But that’s not how it is. It’s so much better to study and work with other people. You want that collaborative experience before you’re caring for patients in real life.”
Joe Jenkins said he experienced that same kind of support as a Carolina medical student shortly after Berryhill Hall opened as the new medical education building in 1970.
“The camaraderie that existed at that time, from both faculty members and students, was special,” recalled Jenkins, a urologist who worked in private practice in Washington, North Carolina. “We were the biggest class of students the School of Medicine had seen. It had just grown from 60 students per class to 100, and yet it was a close-knit community.”
Yet, much has changed in the more than 40 years that separate their experiences as medical students at Carolina.
The state’s population has climbed to 10 million. More people are older, and more have access to health care – factors that are further driving the demand for more doctors. Another factor is that roughly a third of doctors are baby boomers who are expected to retire by 2020.
In anticipation of this impending doctor shortage, the UNC Board of Governors has approved the expansion of incoming classes to 230 students. But Berryhill, which was designed to accommodate a class cohort of 100, now accepts 180 first-year students and lacks the capacity to add more.
What has also changed even more dramatically is medicine itself – both the way it is practiced and the styles for teaching it.
When Jenkins was a student at Berryhill, the large, windowless lecture halls were well suited to the classic didactic lectures of the 1970s.
Today’s curriculum, which was updated in 2014, calls upon students to learn from each other through small-group interactions that lecture halls with fixed seating are ill suited to foster.
Both Sivaraj and Jenkins support the proposed new medical school building included in the Connect NC bond referendum that voters will decide on March 15. They believe it would help the medical school offer a modern, state-of-the-art educational experience to an expanded number of students to help meet the state’s growing need for doctors, including the need for more doctors in rural areas. Part of the $2 billion bond would include $68 million to partially fund a new medical education building.
‘Promoting active learning’
A 21st century medical school curriculum calls for students to teach and learn from each other.
For Sivaraj, the best small-group experiences focus on clinical cases – when faculty present hypothetical patients exhibiting symptoms of a disease recently covered in a lecture. Then students work together in small groups to figure out a diagnosis and course of treatment.
“That’s where the real learning occurs,” said Sivaraj. “I imagine that’s what it’s like on the wards. It’s a team-based approach to patient care.”
These moments balance out the large-group learning that is still common to medical school, said Kurt Gilliland, assistant professor of cell biology and physiology and assistant dean of curriculum and evaluation.
“We try to engage students beyond simply relying on a lecture from a podium,” Gilliland said. “Large-group lectures can sometimes be unnecessarily boring. We want an environment where you don’t just turn the lights down and say, ‘I’m going to show you slides now.’ We’re promoting active learning – situations where small groups of people interact with each other and not just with the instructor.”
Similarly, professors have embraced team-based learning, in which students read material the night before class; then during class they break into small groups, debate cases, and even get quizzed on the material. The idea is that collaboration will help students learn the material while they simultaneously develop communication and teamwork skills.
In large group lectures, where there may be up to 180 medical students, professors promote “Think, Pair, Share” – groups where students are asked to think about a question and share their ideas with students next to them, Gilliland said. If they disagree on the answer, they work it out together until they come to a consensus. Then one of them may share the answer with the larger group.
“Five times in 50 minutes you have a two-minute activity and students interact with each other,” said Gilliland. “It gives them a formative opportunity in which they take a step back and realize, ‘I didn’t really know this,’ which may spark the student to correct a misconception during or after class.”
In small-group situations, today’s professors incorporate active learning software such as Kahoot and Plickers. Kahoot involves a handheld device-based and speed-based quiz, in which students answer questions. It has become popular in labs.
“The medical school has been making education more fun with experiences like Kahoot,” said Sivaraj. “Any time you can improve the learning process by bringing in creative, active learning techniques, it’s a good thing.”
Gilliland doesn’t see such technologies as drivers of the educational experience but rather as enhancers of it.
“Our hope is that these different modes of learning break up the student experience and allow an exchange of information that otherwise wouldn’t happen,” he said.
Matching quality with quality
Sivaraj said the quality of the medical education building should match the expertise of the faculty and the talents of the students. He points to the School of Dentistry’s new building as an example.
Gilliland agreed.
“Berryhill is not conducive for people physically leaning in and working in groups of four or five,” Gilliland said. “Look at the business school or the pharmacy school. Chairs pivot so that students can work with a group while remaining seated. There’s plenty of room for their laptops or tablets. The students have the ability to hit a button and speak to the auditorium rather than having to project their voices across the room. Rows are wide enough so that students can get to the restroom, if necessary.”
Jenkins sees this sort of small group approach in medical education as a reflection of the nature of collaborative healthcare today.
“It’s driving medical education, and it didn’t so much in our day,” Jenkins said. “None of us knows if the model will sustain itself in 25 years – if it will be a team effort, a collaborative effort – but if it does, then medical students need to know how to be at the center of that team.”
That is why a new medical education building is needed, Sivaraj said.
“I think we do an incredible job with what we have, but if we could work in better space, it would make a difference,” Sivaraj said. “You hear about other medical schools where a professor is at the front of the room teaching pathology and each small group of students has a monitor showing exactly what’s going on at the front; they can see every tiny cell. If you have such content right in front of you, it’s going to get you zoned in and paying attention to everything.”
Building the future
Carolina now attracts some of the top medical student candidates in the country to its top-ranked medical school. Those students deserve a building worthy of their potential, said Gov. Pat McCrory when he toured Berryhill Hall last week.
During his tour, McCrory passed by classrooms being held in cramped hallways next to drinking fountains, peeling paint on ceilings and other inadequacies. “We need to rectify that,” McCrory said after the tour.
A new facility will allow for the increase in students, which will in turn prepare more doctors to serve the people of North Carolina.
