Medical Education for the Future by Alan Bleakley John Bligh & Julie Browne

Author:Alan Bleakley, John Bligh & Julie Browne
Language: eng
Format: epub
Publisher: Springer Netherlands, Dordrecht

Hospital Architectures and Cognitive Architectures

The kinds of learning and identity constructions in medical education that have traditionally occurred in hospital settings can be seen to reflect the architecture of the hospital. In turn, architectural forms embody and reflect the kinds of power structures that we discussed in the previous chapter. The classic nineteenth-century hospital style reflected strict divisions between specialties: a circle of buildings, each devoted to a medical specialty, is arranged around a common green space (Keating and Cambrosio 2003). The message is to maintain strict silos within hospital care, but to offer a communal space for relaxation. The learning model is one of students rotating around specialties with little sense of connectedness to the whole—the traditional ‘firm’ system. The smaller cottage hospitals also reflect craft forms of work and production, where the autonomy of the medical profession is paramount and patients, as customers, have no say in how such work shall proceed.

The twentieth-century hospital, under the sway of the ‘efficiency’ model, developed the ‘tower and platform’ design. This is the modern, industrial complex, hospital that is a familiar landmark in most cities, where laboratories (tests and research) and the mortuary constitute the platform and wards constitute the towers. The towers maintain the specialty divisions but multiply numbers of patients (upwards). Within the hospital, clinical spaces are built on the ‘white cube’ model. In modernist medicine, medical education and hospital care, horizontal platforms feed the activities of the vertical building. In the horizontal space, both ‘support’ and ‘development’ occur. These provide stability for the vertical activities, but hierarchies are still the rule in the vertical domain (wards, direct patient care), where networks characterize the base or platform (scientific research, laboratories, testing, product development, educational support).

The ‘tower-on-a-podium’ or ‘matchbox-on-a-muffin’—Modernist, Internationalist and Brutalist styles of architecture using concrete, steel and glass—have come to dominate hospital architecture. As Jencks (2007, p. 39) notes: ‘The most appropriate and successful application of the International Style was on hospitals,’ where a ‘machine aesthetic’ is evident. Again, the rhetoric of such a building program has been efficiency and rationality, promoting a flow of patients within an industrial model. Organization of work follows the same structure, shifting from craft production to mass production. Mass production becomes inefficient and lean production process enhancement (quality assurance) models of work in health care become popular. These still do not involve the customer (patient) as such involvement remains hard to enact in faceless spaces such as large hospitals. Where patients start to get involved with provision of care, mass customization models are developed, attempting to modularize hospital spaces and to return some sense of face or identity to portions of buildings whose brutal overall presence remains.

In Verghese’s (2009, p. 385) novel Cutting for Stone, a young doctor arrives from Ethiopia to work in a poor section of New York in a hybrid hospital that is:

L-shaped, the long limb seven stories high, overlooking the street, a wall separating it from the sidewalk. The short limb was newer and just four stories high with a helicopter parked on top.

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