The Gateway Curriculum

Several years ago, members of WUSM leadership decided that WashU should pursue a revamped curriculum to meet the evolving education needs that are inherent in a rapidly-changing medical landscape. Formal renewal efforts began in 2017, when outlines for the project scope, goals, and timeline were developed. Additional work was dedicated to determining the core competencies that define the success of WashU graduates, and the underlying principles that would guide curriculum design.

In 2018, two faculty teams were commissioned to design two novel curricula based on a study of other institutions’ curricula and an understanding of educational best practices. Over the course of six months, these teams presented elements of their curriculum proposals to an advisory board. Recognizing that input from current students was vital to fully understanding the impact of the proposed changes, this advisory board contained 10 student representatives representing both MDs and MSTPs at various stages in their training. This advisory board provided feedback on the proposed architecture and the smaller structural elements contained within each idea. In November 2018, a team comprised entirely of students was tasked with putting together a third proposal with elements that had been discussed at advisory board meetings. These three proposals were presented at the curriculum retreat attended by students, faculty, and staff. Qualitative and quantitative feedback from over 150 faculty, 25 staff and 50 student attendees was collected and used to guide future decisions.

In January 2019, the Curriculum Architecture Consensus team comprising deans, faculty, and students began meeting weekly to integrate the existing proposals and retreat feedback. It was this team that decided on the final overall architecture of the new curriculum by incorporating elements of the three proposals presented at the retreat. The result was an exciting modern curriculum based on educational best practices that could be flexible enough to accommodate individual student interests and robust enough to evolve alongside the field of medicine. The end product was also designed to maximally leverage the clinical and research strengths that WashU has long had as an institution.

The resulting structure will have three phases, outlined briefly below:

(1) Phase I begins when students matriculate in July of the first academic year. Included in the 16 months of Phase 1 content are 12 months of foundational sciences instruction, three one-month clinical immersions, and one month of total break time. It is during phase one that the students will experience the majority of their didactic learning, which will take the form of lectures, small group activities, and other educational techniques. The three month-long clinical immersions will also give students the opportunity to apply their foundational knowledge, develop basic clinical stills, and gain familiarity with different clinical environments.

(2)  Phase II begins in November of the second academic year, and lasts 12 months. Phase II is broken into six 8-week clinical modules covering the traditional clerkship disciplines (Internal Medicine, Surgery, OB/Gyn, Pediatrics, Neurology, and Psychiatry.) Each 8-week module contains between 4-6 weeks of clinical clerkship experience and 1-3 weeks of additional foundational science content. Each module concludes with one week for assessment, reflection, and passions development (see information about the “EXPLORE” curriculum, below).

(3)   Phase III begins in November of the third academic year, and will include a variety of curricular elements including clinical electives and sub-internships. There is also additional elective time for students to explore passions in teaching, research, advocacy, and global health. Students will also be able to choose from a menu of Keystone Integrated Science courses that will represent transdisciplinary ‘deeper dives’ into important topics in medicine. These month-long courses will be assembled by a group of faculty with a shared interest in a particular topic. 

For example, a Keystone course centered around the opioid epidemic might include:

– A discussion of opioid pharmacology

– Instruction on the neurological basis of addiction

– Case studies examine psychiatric effect of addiction on patients and families

– Exposure to a naloxone clinic or opioid treatment program

– Journal Club discussions on emerging therapeutics 

Relative to the traditional two years preclinical plus two years clinical curriculum structure, this new curriculum has a variety of exciting advantages:

–       Approximately 30% of foundational science content and boards-style assessment instruments are distributed throughout the clerkships, decreasing the latency between foundational learning and clinical application.

–       Most topics are revisited multiple times in a helical learning model to ensure that students can continue to grow their knowledge base and comfort with material.

–       Flexible clinical time for electives and sub-internships beginning early in students’ third year allows students to explore clinical interest in greater detail before having to select sub-internships and begin the residency application process.

–       Throughout the curriculum, there is built-in time for students to develop their professional identity and explore passions that will help guide their choice of career upon graduation. 

Of course, the curriculum renewal work is far from over. Curriculum development teams are currently designing the foundational science modules and clinical immersions that will occur during Phase I, and will soon begin work on the Phase II clerkship blocks. These teams will continue to incorporate student input as part of their fundamental design process. Just as importantly, a dedicated team of faculty will remain focused on ongoing program evaluation and continuous quality improvement to ensure that student feedback continues to be taken into account and acted upon appropriately. WashU students have an extensive history of innovation and influence in curriculum decision-making, and that will continue under the Gateway Curriculum. The curriculum renewal process has been a busy but rewarding experience for the students that have been involved in the efforts. Although the new curriculum will certainly not be perfect (no curricular are), we are enthusiastic about the direction the curriculum is taking. We are excited for the future generations of WashU students who will be able to experience the Gateway Curriculum, and for the opportunity they will have to shape the direction of the curriculum moving forward.