Curriculum Related

The Class Resource Development Group (CRDG) is a group of students who compile notes, Anki decks, and other resources from our classmates into one centralized location so that present and future students can utilize them while studying. We’ve been updating previous years’ content to match the new Gateway Curriculum, as well as assembling a spreadsheet of USMLE Step exam resources corresponding to the sequence of lectures at WashU School of Medicine.

Out of all the immersions, I was the most nervous for the procedural immersion, but it turned out to be a pleasant and engaging learning experience! I was on colorectal surgery, and I appreciated being able to see how the surgical team worked together in different settings ranging from the operating room to the floor to clinic. There were also plenty of opportunities to scrub in to assist with procedures, which is a great way to solidify my understanding of anatomy. Even if we hadn’t covered the content yet, there were residents, fellows, and other team members who were happy to teach and answer questions.  

My biggest pieces of advice are to be as helpful as possible, take learning opportunities as they come, and not take things personally. Communication can sometimes be direct in a procedural setting, but it’s also really interesting to see how tactful and respectful communication can facilitate a seamless flow in the operating room. Beyond seeing fascinating procedures, the most enjoyable part of the immersion was interacting with all the team members, learning about patients, witnessing how form enables function, and understanding how procedures can address pathologic states. 

The clinical mentoring program here pairs two M1 students with an M4, who serves as their clinical mentor. Together, we interview patients, take histories, and may perform a quick physical in a low-stress, non-evaluated environment. Everyone has a different schedule, but most teams begin about a month or so into medical school. For many students, clinical mentoring is the earliest opportunity for M1s to integrate and directly apply what they have learned in a clinical setting. My M4 mentor has been so instrumental in building my confidence by guiding me through taking histories from patients and expanding my clinical knowledge. I consistently leave our sessions feeling more informed and very supported by his mentorship. Clinical mentoring is also a great way to get to know one of your classmates early on and build that relationship throughout Phase 1, which has been so enjoyable for my partner and me! It is definitely one of my favorite elements of our curriculum! 

The Gateway Curriculum approaches clinical skills in an integrated, trauma-informed, and patient-centered manner. These sessions are woven continually through each module, allowing us to develop relevant clinical reasoning skills while simultaneously learning about each organ system. There are also plenty of opportunities to practice interacting with patients in a low-stakes environment through standardized patient simulations. Students can even book patient suites in the simulation center to practice physical exam skills together on their own time and can meet one-on-one with their coach to discuss their progress. Dr. Mullin and Dr. Yau — the Clinical Skills thread co-leads — are also available and willing to work with students one-on-one.

From the special bond that I’ve formed with my faculty coach and group members to the honest discussions we’ve had on current events and medical school struggles, the coaching experience has been one of my favorite parts of the new Gateway Curriculum! In our one-on-one coaching meetings — where we touch base and reflect on our medical school experience — I have found my coach to be completely supportive, genuine, and helpful. Our group sessions have also been a consistently safe and fun space where I can freely share my thoughts and hear the honest perspectives of my classmates. Overall, the coaching system provides a unique and extremely valuable opportunity for personal growth and mentorship in medical school.  

Coaching is where a small group of med students meet with a faculty coach to talk through many topics, including professional identity formation. The groups are small enough that coaches have time dedicated to our specific needs rather than being spread thin among the entire class. The structure also lets us discuss topics in greater depth than we can in a class setting. Our coaches also meet with us individually to provide personalized advice on how to improve our performance in academics and clinical skills. It is great to have someone regularly checking in with us throughout all four years of medical school.  

It is easy to get involved in the WashU School of Medicine community almost immediately. Many of our student groups have teams dedicated to community engagement, so there is a plethora of volunteering opportunities. For example, I was able to participate in a service project with the sustainability group removing invasive bush honeysuckle from a park. I had never done something like that before and found it fun and cathartic. I would definitely do it again. I was also able to go into one of the all-girl schools in St. Louis and teach eighth grade students how to take basic vital signs. These experiences were very rewarding, and I had no trouble getting involved early on in medical school. Although community engagement is a requirement as part of the Health Equity and Justice curriculum, the requirement is low stakes and only requires four experiences throughout all of Phase I. Community engagement is what you make of it; you can do as much or as little as you want, but if you want to help with a project or start one of your own, there is definitely someone at WashU School of Medicine who can help.

You’re going to hear the term “competency” a lot at WashU School of Medicine, so we thought it would be helpful to break it down a bit from a student’s perspective. As in undergrad, we have regular exams (though we call them assessments), typically every three weeks or so. Each assessment question belongs to a content category, such as “basic science,” “histology,” or “ethics.” At the end of Phase 1 — the preclinical portion of the curriculum — each student’s cumulative point total in each category is tallied to ensure that they have achieved the set competency threshold before progressing to clerkships.

It’s sort of like having a bucket corresponding to each area of knowledge, which you fill slowly throughout Phase 1 through various assessments. As long as you have enough water in each of the buckets at the end of Phase 1, you can proceed to Phase 2, where there will be more buckets to fill! The competency-based framework is like a pass/fail system but stretched over a longer time and across multiple knowledge areas.

Now, you may be wondering, “What if I don’t have enough water in my buckets? Then what happens?!” Don’t worry; the faculty pays close attention to how each student is doing and will provide plenty of advance notice and extra support if a student begins to fall behind in a competency. As it was explained to me by an upperclassman, “The worst that can happen is that you get some extra help until you are on track again.”

The Health, Equity, and Justice (HEJ) thread is undoubtedly one of the most unique and meaningful components of the Gateway Curriculum here at WashU. It highlights the social and structural determinants of health from both a theoretical perspective and through the lived experiences of patients, providers, and community workers facing those barriers in St. Louis. As a longitudinal element, HEJ content builds continually throughout the curriculum and integrates meaningfully with other subject areas. Even when there isn’t a concrete solution to complex issues, HEJ provides frameworks for us to think critically about those problems, so we can improve outcomes and avoid perpetuating harm in vulnerable populations. I feel immensely privileged to be a student of the HEJ curriculum and am confident that I will be a better doctor because of this foundational exposure.

The MD/PhD curriculum offers a class, called MSTP Thread, which meets once a week during the preclinical years of medical school. Thread is a one-hour class that alternates between a lecture by a WashU School of Medicine professor and a journal club, where a group of students presents a paper chosen by the lecturing faculty member. The most exciting part is that the topics and papers we discuss relate to the medical school block we are currently studying! I feel like we get to put on the critical thinking hat of a physician-scientist while absorbing all the new material.

As a result of the Gateway Curriculum beginning in September, which is later than most schools, the MSTP timeline is adjusted so that we now participate in a research rotation prior to starting our first year. This was honestly an amazing four-to-eight-week period (longer for students who decided to do multiple rotations) where we settled into St. Louis, explored the city with our cohort, and began working in a lab. The MSTP group truly bonded during this time, and I feel like I can speak for all of us when I say that I feel supported no matter what happens in the next seven to eight years.

In May of our first year, we will get a chance to do our second lab rotation. Finally, after completing Phase 1 (midway through M2), we can choose to take the Step 1 exam, do a third lab rotation, and/or do one or two clinical clerkships before joining a lab to start our PhD. Although there is a lot of flexibility based on what we think will work best for us, the MSTP and MD faculty also provide recommendations to help guide our decisions. After completing and defending our PhD, we will return to complete the clinical phases (Phase 2 and 3) of our med school curriculum.

WashU School of Medicine’s entering class of 2021 is just the second class ever to experience the newly revamped Gateway Curriculum. Our first 16 months are spent in Phase 1 (the pre-clinical phase), which is divided into seven modules covering each organ system, three clinical immersions, and a one-month Explore course. Woven throughout each module are longitudinal “threads,” which feature recurring topics like epidemiology; clinical skills; professional development; health, equity, and justice (HEJ); and bioethics. Students are also given the opportunity to rotate through three one-month-long clinical immersions in inpatient, outpatient, and procedural settings, where we can contribute to a real health-care team while previewing the later clinical phases of our curriculum. Finally, our Explore course provides an unscheduled block to explore (no pun intended) a project of our choosing in either global health, research, education, or health-care innovation.