The Gateway Curriculum

Congrats — you made it to medical school! Now what? It’s completely normal to feel nervous, excited, or somewhere in between. There’s no doubt that the start of this journey can feel overwhelming: you’ll be hit with a ton of information, experience new things, and meet an incredible variety of people. So, what’s the best way to deal with this big change?

For many of us, the key to adjusting has been building strong friendships early on. Your classmates will be your closest allies during Phase 1 and beyond. Having a solid support network can make all the difference when things get tough, so take the time to connect and invest in those relationships.

Another piece of advice? Take it slow. Everyone here has done incredible things to get to WashU Med, and it’s tempting to dive headfirst into extracurriculars, research, or volunteering right away. If that’s your style, go for it! But remember, med school is a huge change. It’s okay to focus on finding your footing before you take on too much.

And here’s perhaps the most important advice: Don’t compare yourself to others. Seriously—don’t. You’ll see classmates joining clubs, pursuing research, or using study methods that seem completely different from yours. You might even feel like you’re not the smartest person in the room. But guess what? Everyone here is brilliant, including you. Each of us has a unique journey and a different way of thriving. Keep reminding yourself: you made it to WashU Med for a reason. You deserve to be here. 

So, to sum it up: be kind to yourself, avoid comparisons, prioritize friendships, and take things at your own pace. Be open to new experiences and perspectives—you might find something unexpected that works for you or expands your horizons. Most importantly, welcome to WashU Med—we’re so glad you’re here!

Welcome to WashU Med Anatomy! We hope you will enjoy your Anatomy experience as much as we love teaching it. Human anatomical dissection is a rare and privileged experience, and you will learn more from the process than from any textbook. Our body donors have given you an incredible gift from which to learn the geography of the human body and the variation therein. Take this gift seriously and honor their wishes, but enjoy the experience.

The Anatomy lab is a vibrant place where you will spend much of your time engaging with faculty and peers as you work through the structures assigned for that week. You will dissect as a team with three of your peers, exploring the material through tactile discovery. Although there is a huge amount of material in the anatomical sciences, try not to let this overwhelm you. We are training you to be doctors, not anatomists. You will not retain every detail of the subject, but you will become familiar with the language and concepts of anatomy with more immediacy than you may have thought possible. Work closely with your team, and take advantage of the presence of the faculty and teaching assistants.

Remember that having fun is not incompatible with learning! We look forward to working with you in your exploration of the structure of the human body.

Amy L. Bauernfeind, PhD
Associate Professor of Anatomy in Neuroscience
Vice Chair of Education

Kari L. Allen, PhD
Assistant Professor of Anatomy in Neuroscience

The grading system at WashU Med is probably the most confusing topic for prospective (and current!) students. WashU Med 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 Med 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 Med 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 EXPLORE program in the Gateway Curriculum is a formalized approach to career development that helps WashU Med students find their niche in academic medicine. It allows students to explore and define their individual career interests and aspirations, then to pursue those interests and gain exposure to academic careers.

EXPLORE is a longitudinal, immersive experience that begins during Phase 1 and continues throughout medical school. It connects students to physician role models and mentors, creates opportunity for scholarship in key academic pathways, and provides core training in the respective career pathway.

Students select one of four EXPLORE pathways, catered to their career aspirations: Advocacy/Global Health, Education, Innovation, and Research. During Phase 1, the pre-clerkship phase of the curriculum, there is a four-week period dedicated to the EXPLORE Immersion. Students develop their knowledge and skills in their chosen pathway by working closely with a faculty mentor on a scholarly project.

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.

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 Med 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 at least three publications related to making these resources freely available and implementing curriculum changes as a first-year medical student.

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 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 Med 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 Med, and even developing a research proposal and poster presentation for the end-of-the-year EXPLORE symposium.

The Health, Equity, and Justice (HEJ) curriculum stands out as a cornerstone of WashU Med’s Gateway Program. By exploring how social and structural factors influence health outcomes, it illuminates the real challenges encountered by patients, healthcare providers, and community advocates in St. Louis. The curriculum’s longitudinal structure demonstrates how these factors intersect with various medical disciplines, providing a comprehensive understanding of healthcare disparities. Through HEJ, students develop essential skills to address complex challenges when serving diverse patient populations, and it prepares them to become compassionate providers committed to protecting vulnerable patients.

Clinical immersions are an exceptionally unique aspect of the Gateway Curriculum. Phase 1 students have three total immersions (one each in a procedural, inpatient, and outpatient/ED setting) that each last for three weeks, during which you are placed on a clinical team. Through this experience, pre-clinical students gain valuable experience with rounding, taking histories, performing physical exams, and presenting cases to the healthcare team. We all enter medical school with varying levels of clinical experiences, so immersions are a great way to even the playing field and expose students to a variety of specialties. It also serves as an opportunity to develop foundational clinical skills prior to Phase 2 clerkships, where your performance is evaluated.

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 portions of the history and physical exam, 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  part of the immersion, I did shifts in the Trauma/Critical Care Unit and ED pods one through three, 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.

Immersions are the most unique part of WashU Medicine’s preclinical curriculum. This summer, after emerging from a haze of M1 classes and exams, I joined the cardiology firm team for three weeks as part of my inpatient immersion. Seeing the clinical knowledge I had just amassed over the past year of medical school now being applied to patients was really helpful; it helped me synthesize each of our organ-based modules together and really understand how a disease impacted the lives of real people. Despite being in the middle of preclinicals and not yet knowing all of the systems, the healthcare team I was with really treated me as part of the team. Moreover, I got familiar with some of the language used for body systems that we hadn’t yet covered, but that we would learn after the immersion finished. Being able to practice my history taking, assessment and plan, and clinical workflow in a low stakes environment has given me confidence as I now enter my clerkships.

I spent three weeks within the Orthopedic Surgery Department, rotating through pediatric surgery, physical medicine & rehabilitation, and trauma. The unique structure of my immersion provided me with exposure to a diverse range of specialties and clinical settings, helping me clarify my vision for my future career. Along with attending physicians, I also worked alongside fourth year medical students, residents, and fellows, who all provided me with helpful career advice and insight into their specialties. Everyone I met was kind, welcoming, and willing to teach, even though I (frequently) broke the sterile field.

The Medical Scientist Training Program here at WashU Med is a collaborative space where students are able to participate in cutting-edge research while learning new medicine in the context of the 21st century. The community here is really big which provides a great resource for students to connect with upperclassmen and MD/PhD faculty members and gain supportive mentorship for this long journey ahead. Throughout Phase 1, the Gateway Curriculum is well-integrated with weekly journal club and Thursday seminars to further engage with the topics outside of the classroom. These journal clubs and seminars allow us to meet researchers and is also a great opportunity for us to engage with the food scene here in St. Louis! The Medical Scientist Training Program administration does a great job at supporting our journeys and making sure we feel at home here.

Phase 1 of the curriculum is WashU Med’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 1 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.