Inadequate learning facilities concern school of medicine administrators
By Jack Mazurak
Lack of space across the School of Medicine at the University of Mississippi Medical Center leaves the state’s future physicians learning, testing and training in cramped and out-dated labs, makeshift facilities and converted closets.
Larger class sizes the last few years pushed many of the school’s aged-out classrooms and laboratories beyond maximum capacity. Faculty members instruct many laboratory classes, including gross anatomy and pathology, in multiple sessions due to space constraints.
With no single building housing the school, faculty conduct classes, labs and test sessions in a hodgepodge of buildings on and off campus. There’s no computer lab even though digital testing for national board exams is on the horizon. The microbiology lab accommodates only one-third of the class at a time.
The clinical skills assessment center, built with an assortment of salvaged modular office panels, is housed in the Jackson Medical Mall, far removed from the main campus where students spend most of their time. At the simulation center, students, training mannequins and supplies get crammed into small classrooms ill-suited for the purpose, including a basement.
Charged with care of one of the state’s premier educational programs, medical school administrators and faculty are hopeful that a new medical education building is on the horizon. The state legislature appropriated $4.5 million for architectural and engineering planning for a new building, and school administrators have submitted the proposed project to the state officials for possible inclusion in a bond package.
School administrators expanded class sizes from 105 in 2005 to 135 in 2010 to produce more doctors for the most medically needy state. For the most part, they did it without additional funding. But progress hit a wall at 135.
Without specialized educational space, class sizes can’t reach the 165-to-170-student target. The school lacks the space – especially the kind of small-group and flexible-use space – needed to expand and maintain quality and accreditation.
Without substantial improvements, the state risks missing the goal of an additional 1,000 new doctors trained by 2025, atop those produced with current size classes. Without more doctors, Mississippi almost certainly will remain last in physicians per capita, which will drastically impact the population’s health.
“Alumni who were in the larger classes in the 1980s have asked why we need more space and new facilities when we previously had a larger class size in current facilities,” said Dr. LouAnn Woodward, associate vice chancellor for health affairs and vice dean of the School of Medicine.
“In short, it’s changing accreditation standards.”
The Liaison Committee on Medical Education, the national accrediting body for medical schools, is requiring more active-learning space, among other changes. As compared with passive learning space where students listen to a lecture and take notes, active-learning space fosters discussions, group work and hands-on participation.
“There is a standard that speaks to active learning. While it does not give a threshold, we know schools with most of their preclinical education experience being lecture-based have been put on probation for having too little active learning,” Woodward said.
“We are about 50 percent lecture based. Other methods, like small-group sessions, simulation and clinical skills labs, are important and require new and different space than our large amphitheater from 1982.”
Education space also must be flexible for multiple uses, such as large-discussion or small-group work, and tech-ready with wireless Internet, video monitoring where necessary, screens and projectors.
A single, purpose-built structure for the School of Medicine would provide a consolidated, specialized space for educating Mississippi’s next doctors to modern standards, she said.
Second-year medical students take medical microbiology in the second-floor pathology laboratory in the original Medical Center building. The room’s painted wood lab benches are relics of the 1950s building. High schools, universities and commercial labs long ago switched to the industry-standard laminated, resin-composite tabletops.
Pillars and electrical conduits running floor to ceiling obstruct views to the front of the room. Faculty members break each session into table groups because not everyone can see the one blackboard. They set up temporary dry-erase boards along the sides on counters and in a sink to compensate.
The lab holds 62 students maximum, so microbiology department faculty members run two sessions, one right after the other. That isn’t fair to the first group, said Dr. Richard O’Callaghan, professor and department chair of microbiology.
“They don’t get enough time on the microscopes if they feel they need it,” O’Callaghan said. “The second group is coming in and we’re scrambling to get set up for them.”
As the class expanded, even two lab sessions couldn’t fit the 135 students. O’Callaghan resorted to a histology lab on the seventh floor.
In a fifth-floor lab, faculty and techs prepare cultures and samples for the medical microbiology class, then they shuttle the supplies between the second, fifth and seventh floors to set up all of the sessions.
“As a facility, it’s the equivalent to what you’d find in third-world centers,” O’Callaghan said of UMMC’s original structure. “Fifty-eight years in this building is long enough.”
The seventh-floor histology lab, where students study cellular structures in different tissue types, holds 100 people.
Dozens of identical microscopes sprout from room-length lab benches. The benches, with cabinets underneath, form rows all facing a front blackboard. During histology classes, aisles quickly choke with students, chairs and backpacks.
Dr. James Lynch, professor of neurobiology and anatomical sciences, said faculty began teaching two sessions once medical school classes surpassed 100 students. Add in graduate students, and faculty and staff set up for as many as 142 students a day.
“This lab was renovated about a decade ago to great effect,” Lynch said. “But for 140 students, it’s too many and the cabinets are in the way. It’s difficult for students to do group work with the cabinets so close together.”
Renovations planned for the medical gross anatomy laboratory in the original building, where medical students dissect human cadavers, would relieve some space shortage.
But even after the renovations, Lynch said, faculty will still need to run A and B sessions of gross anatomy and, still, no single student will experience all the cadaver procedures.
“Gross anatomy is the very foundation of a medical education, and our ability to do a really good job in educating our Mississippi physicians is compromised by our current space crunch,” Lynch said.
Group work is difficult in the R153 amphitheater, where faculty members instruct seven medical neurobiology small-group learning sessions. Steeply graded seating and narrow aisles make space unfit for anything other than lectures. Each seat offers a swing-out desk barely big enough for a notebook, much less a laptop and textbook.
The department moved one part of medical neurobiology online, but that means students needing extra help must voluntarily seek it.
“Students still have the opportunity for interaction with faculty members, but it’s just that some don’t avail themselves of the opportunity,” Lynch said.
“Because of our space crunch, I feel like there’s potential for short-changing students who are struggling.”
Medical School students crowd into narrow rows that make group work difficult during a histology lab session.
More than a dozen first-year anesthesiology residents crowded elbow-to-elbow into a small 15-by-30-foot Classroom Wing room on a recent morning to practice spinals and epidurals.
“This room isn’t even technically a part of the simulation center,” said Dr. Anna Lerant, director of the Medical Advanced Skill and Simulation Education Center.
Another student group had booked the room the prior hour, so the anesthesiology group trained on computers in a room next door. Then the simulation center staff scurried to set up the spinal and epidural simulation.
Beyond medical students and residents, the center trains dental, nursing and pharmacy students. It also offers courses and individual assessment for outside health-care workers and trainees, like Jackson paramedics and physicians-assistant students. Those sessions help bring in revenue.
Begun in a basement storage room in 2005, the center grew to 1,600 square feet. Its rooms, still including a converted storage space in the basement, are patch-worked throughout the Classroom Wing building’s three floors.
Shuttling mannequins, parts and supplies between floors and setting up, tearing down and setting up again are routine for Lerant and her staff, still handicapped by lack of space.
The excess activity wastes time, effort and sometimes requires students to wait, Lerant said. It crimps students’ training opportunities and puts trainees in less-than-realistic settings.
“We use a lot of curtains for walls, a lot of duct tape, a lot of bubble gum and staplers, and we make it work,” she said. “It’s really all about creativity.”
With the epidural training over, Lerant and her staff rushed to set up an IV-placement session for 10 students in another borrowed room. The room normally used for IV training holds only five.
Three major parts of a simulated operating room are wedged into one space, a control room, the simulator, and a space set off by white fabric dividers where groups get critiques and instruction.
Clinical Skills Assessment Center
A similar space shortage besieges the Clinical Skills Assessment Center, where students build their patient-examination, interaction and recordkeeping skills.
Housed at the Jackson Medical Mall Thad Cochran Center, the center's every square foot gets purposed and repurposed.
A set of eight mock exam rooms, much like actual clinical offices except made of 10-foot-tall cubicle walls, occupies much of the room. In these, third-year medical students interview and examine volunteers acting as standardized patients.
Without enough exam rooms, the conference room - where standardized patient groups get briefed - doubles as an exam room. The equipment storage room serves as another exam room, furnished with a portable exam table, small medical supplies, desk, phone and extra chair.
A kitchen and break room doubles as storage for office supplies. It triples as an area for standardized patients to use during exams. And all three staff offices also double as exam rooms.
"We are the queens of frugality," said Dr. Judith Gearhart, professor of family medicine and the center's director. "It's frustrating to see so much unused space in the medical mall, but we do everything we can to make sure they get a quality educational experience.
"We have state-of-the-art medicine at UMMC. In our Clinical Skills Assessment Center, our technology is state of the art, with video monitoring, recording and web-based data collection. But logistically, spacially, our center isn't up to that same standard."
The facility tests medical students seven times throughout the year, one for each of seven specialty rotations students complete. Students come through in 12-15-person groups.
"But as class sizes grow, we have to schedule groups more frequently. We can do it, but that's disruptive to pull them out of their clinical rotations," Gearhart said. "We're always in a time crunch."
In addition to third-year medical students, the center also tests other groups including graduate medical, nursing, dentistry, pharmacy and second-year medical students.
Woodward said both the simulation center and the clinical skills center need similar space.
"Both need so many of the same things, small rooms, a waiting room, check-in station, video and monitoring," Woodward said. "You put these together in a flexible area and we'll get much better use out of the space."
Faculty also could teach continuing medical education classes in the same space, providing a way to make revenue.
The Medical School's list of issues goes on: No space for test proctoring or admission interviews. The medical student lounge, recently refurbished as required for accreditation, sits in the basement near the morgue and is still far too small to accommodate the expanded class sizes. Without facilities in the same league as other medical schools, recruitment of top Mississippi students to UMMC suffers.
The impact of inadequate facilities on the school's educational effectiveness remains a serious concern for administrators.
According to Woodward, without a School of Medicine building at UMMC and the expanded class sizes it would permit, the state's health is at greater risk, the school itself risks accreditation violations and isn't in the same league with most Southeastern medical schools in terms of facilities.
With the need clear for more modern, specialized education space, and a proposal completed for a new building, School of Medicine administrators remain hopeful their shrinking facilities will be addressed soon.
Third-year medical students train in cramped quarters in the Clinical Skills Assessment Center, housed on the second floor of the Jackson Medical Mall Thad Cochran Center.