Duke University School of Medicine - Aesculapian Yearbook (Durham, NC)

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bility Analysis of Duke Hospital. Seven altematives, ranging from staying in the existing hospital with minimal bed expan- sion, minimal new spaoe, and maximum ren- ovation, to total replacement of the existing hospital by a new hospital, were presented by AHF. Studies were done which indicated that it was functionally inappropriate and financially unfeasible to relocate the entire inpatient and ambulatory functions of Duke Hospital, includ- ing support facilities, in a new structure. No use for the vacated structure could be found and the price was not acceptable to the trustees. The altemative specifying renovation of the ex- isting hospital with minimal new construction was also rejected onthe basis that the renova- tion would be drawn out over 15 years. inflation would elevate the cost to that of a new hospi- tal. ln addition the final product would be less efficient than a new construction and would not allow for appropriate expansion. On January 19, 1973, the Hospital Advisory Committee approved as the target for fiscal evaluation the altemative called G-94 North. This altemative provided for 615 new beds and all support services, with Psychiatric and Ob! lo .VT gf li j.. ,.,- 3. i ' la' Luv- rf L3 1'-5 Ar'

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year. The real difficulty arose in trying to decide what to include and where. Each department had to justify the number of hours it was allo- cated. To appreciate The dimensions of this burden, a comparison of the number of hours assigned tothe departments in The respective curricula is helpful: DEPARTMENT OLD NEW CURRICULUM CURRICULUM Anatomy igross, micro. and neuroj 531 252 Biochemistry 208 117 Physiology 358 150 Microbiology and immunology 164 160 Pharmacology 110 121 Pathology 348 214 Introduction to Clinical Medicine 364 96 The most conspicuous cutbacks were in The time allotted to Gross Anatomy and to Physical Diagnosis. Despite The obvious shortcomings ot The system, however, iT has been The consensus of most students over The past 18 years that The sacrifices and constraints of years one and two are well-compensated by The immense free- dom of The elective curriculum of years Three and four. Although The new curriculum weathered almost 15 years without major revi- sions, The 1980s brought a few major changes. By original design, the second year was composed of five required clinical rotations each of Two months duration: lntemal Medi- cine, Surgery, Pediatrics, Ob-Gyn, and Psychi- atry. However, tothe surprise land constema- tion of somel of The class of 1984, a sixth re- quired rotation - Family Medicine - was added effective September of 1981. Although the rotation has generally been a popular one, the12-month duration ofthe second year has been a source of dissatisfaction to many stu- dents. The most recent chapter in the evolution of the curriculum was written in January of 1984 when MEDSAC lthe Medical School Advisory Committeej, after months of deliberation by various committees, announced major curric- ulum changes to take effect with the entering class of 1984. The changes included: 111 mov- ing Introduction to Clinical Medicine to the early part ofthe second year, 121 utilizing the six weeks thus vacated to decompress the first year - not by increasing the number of lec- tures, but by setting aside Tuesday and Thurs- day afternoons throughout the first year for study, and 131 allowing second year students the choice of five ofthe currently required six rotations, with the option of taking the omitted rotation as an elective during the fourth year. Thus, the second year was restored to its origi- nal 10 months in duration. There were no changes made in the elective curriculum. lf the unfolding of the new curriculum dominated the middle and late 1960s, the de- velopment of Duke North was foremost in the decade ofthe 1970s. The history of the development of Duke Hos- pital North TDHNJ began on November 22, 1970 with a decision made by the Medical Center Administration and supproted by its clin- ical departments to proceed with the plan- ning of new hospital facilities. The decision re- sulted in the authorization of a hospital plan- ning staff, the Hospital Planning Studies Office, To coordinate all planning activities associ- ated with new hospital facilities. The members ofthe HPSO were Dr. Jane Elchlepp, Associate Vice President of Health Affairs who, in The words ofthe Vice President of Health Affairs, Dr. William Anlyan, orchestrated the develop- ment of Duke North, Wallace E. Jarboe. Larry D. Nelson, and Robert G. Winfree. This office established liaison with planning agencies and area hospitals, collected patient statisti- cal data, and involved clinical faculty and staff and administration in developing other plan- ning data. Inpatient and outpatient data was gathered from as far back as 1964 and was analyzed with respect to patient loads, origins, etc., in order to obsenfe trends in the patient population. One of the more important observations, noted Dr. Elchlepp, was that pa- tients were coming from farther and farther away - Duke was becoming a tertiary care hospital. The data generated also showed that inpatient services were grossly overloaded. For example, occupancy studies showed that surgery frequently ran in excess of 100070 ca- pacity. a feat made possible bythe existency of a recovery room. When the inpatient func- tional unit analyses were compared with Unit- ed States Public Health data, Duke Hospital was found to be severely lacking in both pa- tient space and support space. The HPSO data documented the need for expansion. The HPSO went on to identify consultants necessary to develop programs for hospital modemization. On January 14, 1972, the Execu- tive Committee ofthe Board of Trustees autho- rized acceptance of a proposal submitted in November, 1971, by American Health Facilities TAHFJ, lnc., To Develop the Conceptual Mas- ter Plan, Project Budget and Economic Feasi- Dr. Roy T. Parker X 1 15

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'X G-yn inpatient services and all ambulatory ser- vices remaining in existing buildings. The esti- mated total project cost was 899.6 million of which 862.1 million was directly related to new hospital construction and 36.8 million to a Per- sonalized Rapid Transit System. The balance of the costs were for financing charges of 515.4 million, movable-equipment costs of 310.7 mil- lion, and remodeling-of-existing-buildings costs of 341.6 million. The actual cost was 5941.5 million. Progress during the 1973-19711 period con- tinued with furlher planning for space alloca- tion, financial feasibility study, architectural selection, and construction management firm selection. Approximately 50 Task Force Committees composed of physicians, nurses, adminis- trators, and appropriate hospital departmen- tal staff were set up to work with the architects. The idea behind the Task Forces was that the people who used the hospital would con- tribute best to its design. While schematic draw- ings were developed by the architects with the help of the Task Forces, mechanical and elec- trical studies, structural studies, energy use analyses, traffic studies, and environmental im- 17