Teaching can learn from paediatric healthcare design

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So, what is Paediatrics, and what is Pedagogy, and how can one better inform the other? Paediatrics is essentially the branch of medicine dealing with the health and medical care of infants, children, and adolescents — from birth up to the age of 18. On the other hand, Pedagogy is simply defined as the method and practice of teaching, which incorporates teaching approaches, teaching theory, feedback, and ultimate assessment. Crucially, healthcare has much to offer multiple sectors in terms of knowledge, child-centric focus, ameliorating outcomes, health/safety guideline documents and wellbeing, best practice, products, insights, design interventions, and legislation. An insight into Paediatrics, physical and mental health development, the 7 ages of childhood, and cerebral and sensory maturation, can usefully help develop more refined education tools and new models of teaching.

Healthcare design tools

Healthcare design tools such as Sense-Sensitive Design, Design Prescription, Emotional Mapping, and the AEDET and ASPECT evaluation toolkits, underpinned by Evidence Based Research, can usefully benefit Pedagogy, as, for example, in the 2023 research paper by Rebecca McLaughlan — ‘Engaging young people in architectural research. Three visual methods for understanding the impact of the built environment on children’s wellbeing’.

Insights into post-COVID paediatric neurological symptoms and mental health conditions can be of considerable value, as can an intimate understanding of developing neural landscapes in the delivery of new models of teaching such as Neurodidactics and Neuroeducation. Where ‘Best to see Best Practice’ than in children’s hospital schools such as those at GOSH (Great Ormond Street Hospital), UCH (University College Hospital), and the best CAMHS (Child and Adolescent Mental Health Services) units, such as The Pears Maudsley Centre for Children and Young People in London, that assess and treat children and young people with emotional, behavioural /and mental health difficulties, which are so prevalent post-COVID?

Using significant paediatric knowledge and insights, predominantly from healthcare settings, Evidence Based Research through TH!NK (the research and development arm of IBI, with whom Arcadis merged in late 2022), and global insights including Snoezelen therapy and Synaesthesia, Neurodiversity will broaden our understanding of the child, and how those insights will inform the decisions we may make at all levels of pedagogy that can make material differences to the integration of all our children. This includes the key stages of inclusivity, ranging from the Macro to the Micro, from:

Macro: Health and wellbeing embedded at the centre of urban masterplanning, integrating children at all of the 7 ages of childhood at all levels.
Meso: School initiatives to be actively integrated with the community beyond the classroom.
Micro: New blueprint guidance for teachers and tutors to actively help curate and choreograph optimal education environments.
Neuro: Focus on state of Mind, Neural landscapes, and Nature v Nurture.

The seven ages of childhood

We can only respect the needs of the child if we understand who they are. Children are highly demanding of their immediate environment. Medically, there are seven ages of childhood — ranging from the child before birth, to the newly born child, the infant, the pre-school, elementary and high school child, and the adolescent undergoing that difficult transition to adulthood. An understanding of each group — in terms of their physiological, psychological, and sensory development — is essential if we are to design age-appropriate teaching, and indeed healthcare, environments that impact positively on the learning processes. In the past, some care and teaching regimes and environments have actually harmed the long-term health of children, with damage to the eyes, hearing, and respiratory systems of infants, and to the self-esteem and mental health of adolescents. We draw on our extensive knowledge of evidence-based design to create healing environments for children of all ages — from the ‘room like a womb’, delivering constant temperature, attenuated light and sound, and support for neonates, to dedicated chill-out spaces to suit the needs of teenagers.

Inspired by the desire to create optimal healthcare paediatric-focused healing environments, substantial investigative work by Arcadis, THiNK, and Arcadis’s specialist Healthcare group, have resulted in the development of a number of unique design tools with vital links between academic research and models of care. For over 20 years THiNK has funded, participated in, and reviewed, considerable supportive research in collaboration with many international universities. Paediatric design tools such as the well-known ‘Sense-Sensitive Design’, ‘Sensory Plans’, ‘Design Prescription’, Emotional Mapping, and Sensory Audits, can all usefully benefit Pedagogy in teaching methods, both theoretical and practical.

AEDET and ASPECT Toolkits

Both the AEDET (Achieving Excellence Design Evaluation Toolkit) and ASPECT (A Staff and Patient Environment Calibration Toolkit) toolkits are healthcare evaluation toolkits which may well translate and benefit the education sector. Healthcare building design frequently involves complex concepts which are difficult to measure and evaluate. The AEDET Evolution toolkit evaluates a design by posing a series of clear, non-technical statements, encompassing the three key areas of Impact, Building Quality, and Functionality. For its part, the ASPECT toolkit measures the way healthcare environments can impact the satisfaction levels of both patients (children) and staff.

Sense-Sensitive Design is a well-established and well-known design tool first established over 20 years ago. Essentially it harnesses robust international research to create optimal healing environments for paediatric departments for patients ranging from pre-term babies in neonatal units with jaundice and retinopathy, to self-harming adolescents with eating disorders. The data is recorded and tabulated on an X,Y axis, addressing the individual senses on the Y axis, and the three key diagnostic body systems — i.e. autonomic, motor, and state systems — on the X axis. This component of design decision making enables designers to create optimal therapeutic environments. Research from a variety of disciplines shows that a range of environmental characteristics can have powerful healing and therapeutic benefits for their users (Ulrich, 1991; Scher, 1996; Lewy et al, 1980, Murgia & San Martin, 2002). These characteristics include natural and artificial light, colour, views, artwork, aroma, modulation of space and form, arrangement of furniture, manipulation of scale and proportion, sound, texture and materials, movement through space and time, and indoor and outdoor plantscapes.

Within the education field, interest is fast growing in the relationship between the learning environment and its potential impact on learning, achievement, engagement, motivation, behaviour, and sense of well-being for both the student/pupil and the teacher/lecturers. Research projects such as ‘Clever Classrooms’ and the ‘Head’ research project, undertaken by Salford University in collaboration with Nightingale Associates, are supportive of this concept. This is especially evident in Special Education Needs and Disability schools, and in new studies in Neurodidactics — a term coined in Germany in 1988 from the fusion of various fields of study, such as education, psychology, and neuroscience. The ‘fusion’ was built from an attempt to understand the aspects of neural development that influence learning, and to use this knowledge to create new methodologies in a classroom, and to optimise the teaching / learning process.

Sensory plans

Sensory plans are an offshoot of Sense-Sensitive Design, and offer unusual yet insightful levels of information. For example, seemingly unusual olfactory plans, as first generated for Gainsborough Primary School in Hackney, will identify predominant smells in teaching spaces — such as polyurethane from adjacent gym floors, wet cloakrooms, cabbage from the school kitchen, gym kits, adjacent WCs/changing rooms, chemistry lab toxins, baking smells from home economics, and indeed the ingress of outside smells, VOCs, traffic pollution, spring/summer pollen, bone glue from carpentry workshops, and general off-gassing from interior materials. There is compelling evidence in the form of research to prove that olfaction profiles alone can impair learning.

Sensory audits

Sensory audits are a tool developed by Arcadis — THINK, evolved from Rush Copley Medical Centre in Chicago, and indeed the US hospitality sector, to ensure optimal comfort for their guests. They have at times been known as the ‘5 Sense Tour’. Proven to be truly impactful in school settings, in essence sensory audits apply rigour to ensuring that optimal environments are achieved within individual rooms and spaces, and need to be undertaken regularly to achieve results. Essentially the five cardinal senses and more are audited, to ensure that optimal learning environments are achieved over the seven ages of childhood and their respective sensory maturation. Such audits have already been undertaken successfully in Oxfordshire primary schools across Key Stage 1-4 and indeed 5. In these audits, it was clearly evident that some pupils were ‘super-sensitive’, and were thus able to hear, see, and smell things that other pupils, siblings, or teachers, were unaware of. The factors impacted on their learning, and were subsequently addressed to good effect.

‘Do you see what I see?’

Visual neuroscientist, Jenny Boston, states that ‘it all depends on age, individual eye structure, to how our brain processes images, to what language we speak’. Clearly damage and disease such as retinopathy, astigmatism, myopia, muscular degeneration, and impaired vision, will critically impact the learning process. According to research, vision is the key sense for successful learning, and — the Vision Council says — 80% of the brain’s input and data are relayed through the optic nerve.

It is estimated that over 60% of problem learners have undiagnosed vision problems. The majority of these vision problems that interfere with reading and learning are very treatable — reference ‘seeing clearly; seeing clearly 20/20’. Interestingly, in terms of colour, we can identify specific hues by measuring what happens to the brain structure, as distinct patterns are revealed under MRI procedures, only to reveal very different neural landscapes.

This tool, developed with paediatricians at the Royal London Hospital, represents a crucial level of information which enables paediatricians and designers to navigate through the emotions, feelings, sentiments, and anxieties of children more skilfully and sensitively within core settings. It essentially makes the invisible visible on a set of colour-rendered plans, identifying the predominant emotions that normally inhabit individual spaces, e.g. Polytrauma may be coloured tones of red to represent fear, terror, and anxiety, while a children’s play area may be colour rendered yellow to reflect euphoria. In turn, a chapel space may be coloured mauve to reflect a meditative state. This design tool has been used to good effect in multiple scenarios in recent years, at facilities ranging from the Coventry Children’s Hospital, to CASA Edmonton — in Canada’s design development of a new children’s/adolescent and family mental health unit. In addition, an adolescent Assessment Unit in Belfast, and a Personality Disorder Unit in East London, adopted this tool to good effect in their early days of design development.

Neuroeducation

It is useful to understand the maturation and development of the brain over the 7 ages of childhood, particularly between the age of 5-18. MRI scans have identified radical brain changes over these years that can correct and significantly inform new models of teaching. Within this arena now enter confusing terms such as ‘Neuropedagogy’, ‘Neurodidactics’, ‘Educational Neurosciences’, and ‘Brain focused learning’ — all of which fit broadly under the category of Neuroeducation. It is said that Neuroeducation is the science that will ultimately change education. Walden University in the US usefully identifies three examples of implementing Neuroeducation in the classroom:

1 Research has revealed that pupils absorb data more effectively in short bursts known as ‘micro learning’.

2 Neuroscientists have also discovered how important sleep patterns are over the 7 ages of childhood in cognitive functioning, e.g. adolescents have a bio-predisposition to sleeping longer in the mornings. At Monkseaton High School, North Tyneside, timetable changes were implemented to match body clocks, which subsequently boosted concentration levels, and consequently grades.

3 Researchers have discovered how important it is to teach in multi-sensory environments. This is where the Sense-Sensitive Design tool could assist in choreographing optimal learning environments.

Hospital schools

Insights into the running of hospital schools are truly revealing. These special schools are seldom recognised for the unique specialist services they offer. The Great Ormond Street Hospital School and The Evelina Hospital School in London are great exemplars. The GOSH enjoys approx. 30 staff and a headmistress, offering an ‘enriched national curriculum’ for all inpatient children aged from 5-19 years old — Key stage 1 and 2 to stage 3 and 4. Teaching occurs by the bedside and on the wards throughout the day. However, children who are well enough to leave the ward can attend the well-staffed and equipped school rooms. By arrangement, teachers will also teach the siblings of long-stay patients. Apart from classrooms, the hospital offers other supportive spaces, such as Snoezelen, Sensory Rooms, Dens, Chill out Spaces, and Radio Lollipop, etc. There are also ‘Child Centres’ that serve inpatients, outpatients, and siblings of all ages (0-19 years old). They offer resources, art, activities, toys, games, and interactive consoles. Evening activities are generated by Youth Clubs, Scout and Guides groups, interactive games, and Radio Lollipop interaction.

The Evelina London Children’s Hospital, located opposite the Houses of Parliament, also has a Children’s School. Effectively a Department of Education Hospital Community Special School, it provides personalised education for both children and young people. The curriculum is tailored to address individual pupils around their age, illness, and disabilities. The teachers work flexibly in small groups, one to one, by the bedside, or in the atrium for those well enough to leave the wards. The school celebrates the fact that it is best placed to help children develop Social, Moral, Spiritual, and Cultural awareness, known as ‘SMSC’, as well as encouraging self-expression and engagement in debate. Many children’s hospitals in the UK and Europe are often open during half-term and school holidays, welcoming children from the immediate community.

Alder Hey facility

The well-known Alder Hey Children’s Hospital in Liverpool also has a dedicated and well-established Children’s School. The hospital enjoys an international reputation for treating everything from common illnesses to highly complex and specialist conditions. It is also a leader in paediatric research, with a wonderful 1000 m2 innovation centre centrally located within the Children’s Health Campus. Its activities are supported by international industry and academia, and range from UX and Wow factor, HealthTech Wearables, AI and Data Science, Digital Platforms, Virtual Engineering Rooms, ‘Walk in’ VR organs, UX Rooms, Data AI and Automation (AIHQ), to Rapid prototyping, 3D printing, and immersives. The Centre actively appeals for ideas and concepts on its ‘Invite Challenge’ site, to further develop — a real opportunity for paediatricians and Educationals to fast forward a much needed new style of teaching and learning. Perhaps Neurodidactics may be the science that could change education?

Conclusion

In the past, the healthcare sector has learnt and embraced much from other sectors — from Formula 1 ‘pit stop’ tactics for the resuscitation of newborns, to surgeons adopting aviation ‘flight cockpit’ scenarios in operating theatres, to 3D human-tissue/bone printing, to cardiothoracic surgeons physically entering VR damaged heart chambers, and orthopaedic surgeons wearing infection control NASA-type astronaut suits. Today healthcare can offer much to multiple sectors, and especially to education. Paediatric knowledge can have a profound and considerable impact in helping to define new models of Pedagogy such as Neurodidactics, Neuroeducation, and beyond.

Paediatric insights, guidelines, design tools, innovation, AI/VR, neurodiversity, and new models of care underpinned by research, in collaboration with emerging educational neurosciences, will truly prove to be transformational tools for the new generations of teachers and pupils. There is much talk of ‘Education in crisis and conflict’. Pre- and post-COVID the issues have been many, and have included mental health, autism, self-harm, Dyspraxia, poverty, absenteeism, LGBTQ and fear of discrimination, attitudes, behaviour, eating disorders, cyber bullying, peer pressures, self-image, drugs, alcohol, vaping, and much more. “We cannot continue teaching each generation of children like the previous one,” says Scottish historian and education expert, Niall Ferguson. So, let us embrace today’s challenges, deconstructing, reconstructing, and rebooting them into forward-looking Pedagogy. We must harness the multiple aspects of paediatrics, together with the emerging neurosciences, to ultimately change the trajectory of teaching and learning as we know it today.