The Gateway Curriculum

I chose the Education pathway not only for my interest in MedEd but also because every Education Pathway student in the year above me rated it 5/5 in the Course Evaluation (as did everyone in my year). Of course, you’ll learn how to properly design Course Evaluation, in addition to the sciences of curricular design, assessment (yes, it’s different from evaluation), presenting skills (yes, you have much more to learn, I didn’t think I did), and qualitative and quantitative analyses. Part of the reason I chose WashU was to be part of a brand new curriculum with passionate educators, and as part of the formal MedEd training in this pathway, I was taught each pillar of medical education from the faculty member that brought that specific expertise to the design of the Gateway Curriculum. I came in passionate about climate change, and with the Education pathway mentorship and training, I designed a Lecture+ (you’ll learn about this too) on the health impacts of climate change that is now an integrated and required part of the curriculum, am currently in the process of designing longitudinal modules to teach students more advanced topics at the interface of climate and disease (“spiral learning”), and in a few years am hoping to have 3+ publications related to making these resources freely available and implementing curriculum changes as a first-year medical student.

If you are at all interested in a career in global/public health work, public policy, or health equity, I would highly encourage you to pursue the EXPLORE pathway in Global Health/Advocacy! The faculty involved in the pathway display such passion in the subjects they teach. There are very informal opportunities during EXPLORE to network and get to know these leaders better – many students who have gone through the pathway have met physicians to shadow or even research PIs through these sessions!

During the pathway-specific sessions, you get the opportunity to learn about topics you would not get to hear about anywhere else in your medical school curriculum, such as HIV advocacy, climate change, and neo-colonialism in global health. You also get to apply your knowledge in hands-on experiences such as participating in a World Health Organization simulation and writing policy briefs and op-eds. If you are particularly passionate about these subjects, the faculty are happy to work with you to get some of this work published on a greater scale as well! It’s a fantastic opportunity to explore (pun intended) and develop your interest in these fields alongside phenomenal, supportive faculty.

The EXPLORE Innovation pathway is unique because it teaches you topics and skills that are difficult to find in other areas of medical education, namely business. From the first week, it ramps up with quite a lot of work as you start learning about and conducting stakeholder interviews. You then “create” a prototype (which is already given to you) and explore the financial aspects of your project (how big the potential markets are, how your competition affects your market, etc.). You do weekly presentations as you go through your project, and you get direct feedback from the pathway leads. At the end of the three weeks, you’ll get even more direct feedback from actual investors who look at your presentation as if you’re actually pitching them your product, which is an experience you won’t find elsewhere!

With WashU being well-known as a research powerhouse, I couldn’t imagine missing out on the chance to engage with the school’s incredible research faculty members and clinician-scientists. For students eager to pursue research — whether it’s basic science, clinical, epidemiologic, or translational — the Research EXPLORE pathway is a fantastic opportunity to acquire foundational statistical skills including coding in the Statistical Package for Social Sciences (SPSS) software, hearing from premier physician-scientists at WashU, and even developing a research proposal and poster presentation for the end-of-the-year EXPLORE symposium.

For the ambulatory part of this immersion, I rotated with Endocrinology and saw patients in an outpatient clinic. I got ample practice doing the History of Present Illness (HPI) portions of the history and physical exam (H&P), presenting patients to attendings, and writing student notes. I also had the opportunity to practice clinical reasoning and come up with an assessment and plan for patients, using the knowledge I had learned in Phase 1 (preclinical). For the emergency department (ED) part of the immersion, I did shifts in the Trauma/Critical Care Unit (TCC) and ED pods 1-3, but also spent time with the social work office and bedside nurses. It was a great way to see what different members of the care team did and how they all came together to help the ED run smoothly.

For the inpatient immersion, I was placed at my top choice — nephrology consults. This was a wonderful opportunity to understand the day-to-day activities of a consult team, the flow of patients in the hospital, and the general layout of Barnes-Jewish Hospital. The typical schedule for nephrology was 7:00 a.m.-4:00 p.m., although schedules varied by service. This was my first chance to be a part of the health care team with real patients, and I was even able to perform actual procedures like inserting a foley catheter. As a person who is 100% interested in inpatient medicine, I’m so grateful to have had this immersion before clerkships. I feel more prepared to perform history and physical exams (H&Ps), check up on patients longitudinally, and interact with consultants. Furthermore, I connected with a mentor in the nephrology department and came up with a research project to carry forward over the next year. You definitely get out of immersions what you put in!

I spent three weeks with the Department of Orthopedic Surgery for my procedural immersion and absolutely loved it. I rotated with the Shoulder & Elbow, Trauma, and Physical Medicine & Rehabilitation (PM&R) services and saw a variety of procedures including reverse shoulder arthroplasties, intramedullary nailing, and ultrasound-guided steroid injections. I learned to scrub in, do simple running and interrupted sutures, and perform physical exams for musculoskeletal injuries. The attendings and residents were all very happy to teach and I loved seeing how happy they were, doing what they loved doing.

How well we acclimate to being a medical student makes a lasting impact on our academic experience and I think that the way WashU facilitates this transition is *chef’s kiss* perfection. Becoming a medical student requires significant adjustment. Many students are living in an unfamiliar town with no friends or family nearby, navigating a new school system, figuring out finances, making new friends, realizing go-to study methods may not work as well as they used to, choosing from an overwhelming abundance of clubs and extracurricular activities, having first experiences with unique pedagogies like team-based learning (TBL) and standardized patients, and the list goes on. I was intimidated to face all of these changes at once, especially considering all of the well-intentioned warnings I had received about how difficult medical school will be. So, I was pleasantly surprised by how manageable it all felt. Sure, it was a faster pace and unfamiliar, but I did not feel the sense of panic that my friends at other schools were experiencing in their first few months.

The Gateway Curriculum was intentionally structured to make the adjustment to medical school not only manageable but enjoyable. The more challenging aspects of medical education are layered in over time, so it doesn’t hit you like a ton of bricks while you are still making it through the many personal adjustments mentioned above. Standardized patient interactions are introduced early on and while we are given feedback for improvement, they are not graded. This gives us time to build our clinical skills well before our first Objective Structured Clinical Exam (OSCE) rolls around in the late spring. New learning environments like TBLs are introduced in a low-stakes manner and gently increase in difficulty as we progress through the curriculum. Anatomy lab is also held off until the third module. All of this allows us time in the early months of our education to focus on finding our groove and building foundational skills, so we are set up for success when things ramp up in subsequent modules. We have time to make friends, explore academic interests, and get comfortable in our new environment before bearing the full weight of medical school. Having a smooth transition into the life of a medical student is one of the many underrated privileges of being a student here. Stay excited, enjoy the ride, and welcome to the WashU family!

The grading system at WashU is probably the most confusing topic for prospective (and current!) students. WashU uses a “competency/no-competency” based grading system, which yes, sounds like just a fancy way of saying pass/fail, but there are important differences.

What’s the same is that there is a “threshold” students have to meet to attain competency, just like getting a 70% to ‘pass’. What’s different is that you cannot “fail out” due to a single test or module. If you don’t meet an overall threshold of 70% at the end of a module or exam, you will not be asked to retake that module. Instead, WashU measures our points attained longitudinally across multiple courses and various types of assessment, and we receive our designation of competency/no-competency at the end of each Phase before passing on to the next (there are three phases: pre-clerkship, core clerkships, and specialization).

It is probably best explained using an example. Let’s say over four modules we will have taken eight exams and had several other assignments that contribute to competency. All of these assess our knowledge in different areas (i.e. biochemistry, health equity, health systems sciences, anatomy, genetics, etc.). WashU keeps track of our progress in each of those areas over time. If a student is lagging in any given area, we discuss those areas for improvement with our coach or the Student Success Team well in advance of the competency determination. That way, we can improve before we would reach the point of earning a “no-competency” designation. It makes preparing for exams feel less like a make-or-break situation and keeps you in the focus of aiming to be the best learner you can be.

Students that are completing their core clerkships in Phase 2 are able to gain “competency with distinction” in foundational knowledge, clinical reasoning, and interpersonal communication. This is similar to ‘honors’ but it is not competitive in nature. It is awarded to any number of students at the end of the phase, and it is truly a merit-based recognition for outstanding performance in a particular area of clinical performance and is also based on how we have done over the entire phase.

The final phase, the specialization one, also measures our performance across multiple courses using many types of assessments. Students in this phase are able to apply for “competency with distinction” in systems-based practice (how we help improve the patient experience or health care system) and practice-based learning and improvement (demonstrating how we have worked to improve an area of weakness or use literature to improve patient care).

In terms of competition, WashU does not keep internal rankings of students and does not participate in Alpha Omega Alpha (AOA). Exam grade distributions are not available to the class and that helps facilitate a collaborative learning environment. Classmates are always working together to compile resources in shared google drives to learn the material (Anki decks, notes, useful guidelines, etc.). Each class makes a class-wide chat, and the students keep each other in the loop about upcoming deadlines, where to find resources, ask questions, and so on.

Amanda R. Emke, MD, MHPE

Assistant Dean for Student Assessment

Associate Fellowship Program Director Critical Care Management

St. Louis Children’s Hospital

The Health, Equity, and Justice (HEJ) thread is undoubtably one of the most meaningful, unique, and constantly improving components of the Gateway Curriculum. This thread highlights the social and structural components of health, not only from a theoretical standpoint, but also from the testimonies of patients, providers, and community workers who live in St. Louis. Throughout the curriculum, HEJ weaves together social determinants of health with the module it is presented in to give a zoomed out perspective of the patient model. Often times there is not a concrete solution to many of the complex issues discussed, but HEJ provides a useful framework to approach these issues and provides exposure to conversations surrounding the urgent medical issues physicians face today. Beyond giving much needed context to health and disease, HEJ seeks to prepare us to think critically about these complex issues to improve outcomes and prevent harming vulnerable communities. I am proud to be at an institution that is prioritizing the human condition and one that is receptive to feedback in an effort to continuously improve the HEJ curriculum.

If I were to boil down my “Why WashU” into a single word, it would be community. That is especially the case in the Medical Scientist Training (MSTP) program. Our cohort has been incredibly supportive to each other in our transition into medical school, and I’ve become super close friends with my MSTP classmates. Beyond this community feel of the MSTP, I chose WashU because of the amount of institutional experience and support here when it comes to MD/PhD training. It’s really nice knowing that there’s almost nothing that could come up in the course of my training that the MSTP administration hasn’t dealt with before.

Since training is kind of variable from school to school, here’s the breakdown of our MSTP timeline:

The MSTP at WashU kind of structed like a lasagna, where the PhD is the noodle and the MD is the sauce. We started with a four-week lab rotation (noodle) which is literally just to vibe check the lab. That first month was super fun because it was before medical school starts, and it let our MSTP group bond as a cohort during a relatively stress-free time. After that, we transitioned into M1 of med school (sauce layer) where we don’t have much MSTP responsibilities other than Wednesday lunch seminar. Those seminars are actually one of my favorite parts of the MSTP here, we get lunch from local restaurants catered and a physician-scientist gives a talk about their field of research/medicine which coincides with what we’re learning in our med school classes. For example, we’re currently learning about cancer in our med classes, and just had a lecture from a surgeon/scientist about the history of head and neck cancer treatment and his research into how HPV infection can affect the outcomes of cancer patients. These sessions aren’t tested or anything, they’re solely for enrichment of our med school learning and for connecting us with possible mentors.

Our next lab rotation (noodle layer) will be during the Explore month while our MD counterparts do their Explore stuff. Following that, we’ll finish out our preclinical courses and take Step 1 (back to sauce). After Step 1, we move into our PhD (noodle) and do an optional 3rd rotation or if one of the first two labs were a good match, just start on PhD research. After finishing the PhD, we come back to MD training to do clerkships and clinical electives (sauce layer).

What’s really nice about this timeline is that there’s no time that we really need to juggle lab work and medical school. When you’re in lab you’re completely focused on research, and when you’re in classes, you’re completely focused on being a medical student.

Phase 1 of the curriculum is WashU’s preclinical education and is split into seven modules. Each module lasts about seven weeks and exams are typically twice per module. The first module is an introduction to medicine, called Molecules to Society. The subsequent six modules are typically organ-system-based such as “Circulation and Breathing” (Cardiovascular, Pulmonary), “Ins and Outs” (GI), and more! Each day, we can expect the morning to be dedicated to lectures relating to this content, which are typically a mix of in-person and online, small group vs lecture-based, as well as required or recorded for later viewing. Three afternoons per week also include Clinical Skills; Coaching; or Health, Equity, and Justice (HEJ). There are also plenty of early patient interactions built into the curriculum, such as clinical mentoring with a fourth-year student or Standardized Patient sessions. Outside of the seven modules, students have one month in May-June to explore their interests through the EXPLORE program. Students can pursue a project in Global Health/Advocacy, Education, Innovation, or Research through EXPLORE. Overall, Phase I of the curriculum does a great job of teaching us the clinical and scientific fundamentals to enter the wards, while still allowing flexibility and encouraging students to pursue their interests.

If you’re reading this, I am fairly confident you’ve been looking forward to the day you will receive your very first white coat. The White Coat Ceremony marks a huge milestone on your road to becoming a physician. It is the culmination of all your hard work and success. Your family will be there, more proud of you than ever. Your friends will be cheering you on from afar. It is the moment you can feel your dreams are coming true. I was looking forward to it for years and years, so when I learned that WashU not only begins the academic year later than most schools, but also holds the ceremony off until after completion of the first module, I was a little bummed. Many of my friends had their ceremony in July or early August, but here we were in anticipation of this milestone until late October.

As time went on, I had a newfound appreciation for how this scheduling of the ceremony would make the experience even more special. Not only will your family be in the audience, but the classmates you’ve spent the past two months forming tight bonds with will be in the audience, too. Not only will you have successfully made it into medical school, but you will also have successfully completed the first module of medical school. I truly believe we had a unique experience at our White Coat Ceremony, because we had a sense of belonging, a genuine sense of community. I was teary-eyed and overjoyed watching my classmates receive their coats. So, thank you WashU, for knowing what I wanted better than I did. I hope this helps you find a little more patience than I had for this unforgettable, extraordinary experience.