Learning by doing:  Midterm reviews are conducted in a collaborative program between an architecture firm and university that is termed the “Chicago Studio.”

Photo by William Worn, AIA, EDAC, LEED

Since the early 1900s, when the Flexner Report radically revised thinking regarding medical education, medical students have experienced a combination of academic (didactic) education and hands-on rotations through hospital clinical services as part of their degree requirements.

This mix of learning experiences prepares them for their transition into direct patient care during their residencies.

Health care design requires a unique set of knowledge skills and experiences. Young professionals are confronted with complex technical and functional requirements, a barrage of building codes and regulations, and clients that frequently use complex medical terminology.

Alternatives to the traditional academic educational model have emerged to respond to these demands. These include high-quality focused master’s degree programs at Clemson University, Texas A&M University, Texas Tech University and a dozen others. Additionally, new learning model experiences bridge the gap between classroom learning and practice.

Learning models

A look at these three models and how they’re changing provides an overview of the learning environment for new health care architects:

1. The internship model. The internship — or apprenticeship — model of architectural education was the primary method by which architects gained entry into the profession prior to the early years of the 20th century, and a minimum period of practical training under the supervision of a registered architect is still required by all the licensing jurisdictions in the U.S.

Until recently, the divisions between the academic programs of architectural education and professional internships have been stark, with most architectural graduates initiating their professional training after receiving their degrees. As the number of health care-related design programs have increased, however, architectural educators are recognizing that students can benefit from being introduced to complex technical, social and economic medical facility trends in practice settings.

In 2009, the Health + Wellness Design program at the University of Kansas (KU) established a master of architecture (M.Arch.) program that featured a seven-month internship experience in the summer and fall semester of the student’s last year of the degree program. Approximately 40 architectural firms have been recruited to support paid internships for these students to provide real-world exposure to the issues that were introduced in previous graduate seminars in health care systems, evidence-based design (EBD) methods and medical-planning design exercises. Upon the completion of the health care internship, each student returns to campus to complete a capstone design and research project before receiving his or her professional degree.

The firms participating in the internship program have agreed to match the work schedules of the interns with specific design or research issues that they feel would benefit the educational needs of the students and expand the knowledge base of both the firm and the students. Because the students bring with them the latest knowledge of EBD processes and digital techniques, most of the sponsoring firms take full advantage of these skills to explore critical issues in their current health care projects. Some recent examples of this collaboration include post-occupancy studies of inpatient and ambulatory facilities and nurse-station configurations, explorations of virtual reality techniques with health care clients, and annotated bibliographies of behavioral health environments.

Each student is assigned a professional mentor and an academic adviser to monitor his or her work experience and research focus throughout the internship. The students establish their National Council of Architectural Registration Boards (NCARB) work experience file at the start of their internships and they are assigned a minimum number of hours in a subset of the Architectural Experience Program (AXP) categories that deal directly with issues in health care design.

In addition to the knowledge gained working on real projects during their internships, the students are much more effective and open to working in teams. They have experienced how complex health care projects require collaboration and communication skills.

2. The embedded studio. For the past three years, the University of Illinois at Urbana/Champaign (UIUC) and the Chicago office of Stantec have collaborated to provide a base for the UIUC Health and Wellness program, termed the “Chicago Studio.” Professor Bill Worn, AIA, EDAC, LEED, visiting lecturers Douglas King, AIA, and Sheila Cahnman, FAIA, along with other health care and architecture professionals in the region provide support for the spring studio and seminar courses.

Mentors from the Stantec staff are assigned to each student, assisting in orientation, technical support, firm engagement and participation in the program events, including local American Institute of Architects health care-related activities. Depending upon the studio assignment, architects from other Chicago firms, such as HDR and Perkins+Will, actively support the studio experience. Most assignments are not directly related to Stantec projects, but students are encouraged to observe internal project reviews and other office activities.

The rich regional health care resources provide multiple opportunities for case study site visits and interaction with health care professionals through office visits and tours. 

The typical enrollment in the UIUC program ranges from eight to 12 students. King, principal at Stantec, reported that Stantec typically offers full-time employment opportunities to one or two students each year. The firm also maintains traditional internship experiences for students at the Illinois Institute of Technology, the University of Cincinnati and other institutions.

As with the KU intern program, the logistics of moving from, and back to, the university community for one semester presents challenges to the students. The University of Illinois is recruiting to expand its health and wellness initiative at the Champaign campus, presenting potential complexity to the Chicago initiative. Future models for the studio may integrate both the University of Illinois’ Chicago and Champaign campuses during the spring semester.

3. Evidence-based research studies. A unique demand in health care is for the development of sound evidence for planning and design decisions. Exposing students to applied research methods is essential in helping them to interpret research findings and to contribute new knowledge to the field.

For the HKS Healthcare Fellowship, it hires yearlong interns with 40 percent of their time dedicated to a research topic of their choice. This allows them to delve deeply into a topic as they get their first taste of working on projects. Architectural interns also have the opportunity to work directly with the HKS research team, engage with the HKS Laboratory for INtensive Exploration (HKS LINE) or volunteer with the nonprofit research arm — the Center for Advanced Design Research & Evaluation.

For example, a recent KU intern, while working on a design project, also served as a liaison between KU and HKS to get imagery for a virtual reality library that KU was putting together. Additionally, he helped the research team by conducting literature reviews, and interviewing experts within the firm on a select research topic. In the Washington, D.C., office, another intern worked with the HKS research team to conduct a post-occupancy performance evaluation, in collaboration with KU, for the Virginia Commonwealth University Health system’s Children’s Hospital of Richmond at VCU Children’s Pavilion. Through the evaluation process, the intern learned several research methodologies, including parametric plan analysis, behavior mapping, interviewing and survey development.

The Idea Fellowship is another internal HKS initiative where emerging professionals are given 800 hours of time to dedicate to a research topic of interest. In this fellowship, a kickoff research boot camp is conducted so that teams can be introduced to the basic tenets of research — the “why, how, what and so what” of their projects.

Firmwide, project teams are also trained to develop “intent documents” that record the vision, goals, design strategies and supporting evidence during the design process, which can then be used to measure meaningful impact post-occupancy. A research in practice for health serves as a mentor body and subject matter resource throughout the company.

Students during their KU internships have participated with faculty and in post-occupancy studies of nursing units with the Lawrence Group and other firms, leading to significant findings reported at conferences and in publications. They also have been able to experience cutting-edge virtual reality applications.

The graduate program in Architecture + Health at Clemson has executed a number of research initiatives with hospital systems and architectural firms. They are currently engaged in a major Agency for Healthcare Research and Quality study on the operating room (OR) environment in conjunction with the Medical University of South Carolina (MUSC).

As part of that research, graduate design students took on the challenge of designing the initial OR prototype in collaboration with a team of health care design researchers, industrial engineers, operations researchers, clinicians and architects. Building off a year of literature review, best-practice case-study research, site visits and observations, they developed a set of key evidence-based design guidelines with the overall goal of improving safety and quality in the OR.

The guidelines then served as the basis for design decisions and as the framework for evaluating different iterations of this OR design via physical mock-ups. The design progressed through iterative physical mock-ups, including a “tape-on-the-floor” and cardboard mock-up. Scenario-based mock-up evaluations were then conducted with surgical teams from MUSC to understand how different features impacted flow, efficiency and safety. The final design concept has been built as a high-fidelity mock-up at the Clemson Design Center in Charleston and will be further refined through additional mock-up evaluations.

These intensive research-based prototyping projects provide students with a deep exposure into the evidence-based design process, along with evidence and best practices from a broad cross section of sources. These experiences also give students an opportunity to learn how to translate research knowledge into useful formats for design decision-making.

Envisioning the future

It is difficult to envision an undergraduate education model that does not center around the traditional design studio. A strong case for specialization into building types and technology can be made at the graduate level as the unique information needs increase. The diversity of career opportunities in health care could change the traditional format to build on the industry knowledge and the academic research skills. A closer linkage is beneficial to both segments.

With the proliferation of computer software and the ability to access from remote locations, the learning dynamics of the university studio have changed. The exposure to close collaboration in the business setting can augment the loss of the studio camaraderie experienced prior to our current level of computerization. It can reinforce the significance of the team.

Many universities are struggling financially as states cut back on support and costs increase. The potential for collaboration among schools has not occurred at a significant level, but would be a logical option for offering health care education in the future, particularly with the availability of distance learning and high-speed internet.

It’s also possible to envision modifications to the licensure process to reflect the need for updating knowledge and recertification. Returning to the medical education analogy referenced at the beginning of this article, the requirement for recertification is intense continuing education. This could provide an opportunity for the universities and the American College of Healthcare Architects to play a more significant role in postgraduate education.

A recent change in the way NCARB encourages collaboration between the academy and practice is the Integrated Path to Architectural Licensure program. Currently, 21 accredited university programs of architecture are certified by NCARB to fully integrate aspects of their curricula with professional internships in an attempt to reduce the time to obtain an architectural license. This program provides incentives to students, firms and educators to devise learning opportunities that leverage the strengths of academic programs with firms doing significant design and research in complex health care projects.

A recent American Institute of Architects analysis projected a need for 25,000 new architects during the upcoming decade to replace retiring baby boomers and to meet economic growth. The same analysis pointed out the projected graduation of 60,000 students during the same period, with approximately 50,000 remaining in the U.S.

By building bridges with the practice community, health care architectural students will be positioned for success.

Frank Zilm, D.Arch., FAIA, FACHA (ret.) is Chester Dean Director of the Institute for Health + Wellness Design at the University of Kansas, Lawrence, and Kent Spreckelmeyer, D.Arch., FAIA, is professor of architecture at the School of Architecture & Design at the University of Kansas, Lawrence. They can be reached at frankzilm@ku.edu and kents@ku.edu, respectively.

About this article

This feature is one of a series of articles published by Health Facilities Management() in partnership with the American College of Healthcare Architects