Health equity is an elusive and still urgent goal in the modern practice of medicine. Health is determined by where we live, work, learn, and recreate. Effective healthcare requires an active understanding of these determinants of health and the ability to navigate the complexity of healthcare systems to deliver that care. The new Gateway curriculum seeks to provide students with opportunities to gain those skills of navigation, or structural competency in medicine, through an integrated approach which includes social, clinical and basic sciences. This competency requires an understanding of both the internal and external communities which drive healthcare, including professionals from many different disciplines and people with a diverse range of identities and experiences.
Community engagement within the Gateway curriculum is being structured to allow students deep understanding and lived experience in social and structural determinants of health. This work will cut across all modules in Phase 1, broken into three sections. In the first three months students will cover the pre-requisites of community engagement including history, equity, trauma informed care, narrative and health needs, not unlike learning how to take a history. Then students will be systematically introduced to “The Anatomy of Health”, an exploration of the structural determinants of health lead by faculty champions with expertise in areas such as housing, education and justice. Similar to the components of a physical exam or dissection, they will deconstruct the structures which create the health. For the final portion of Phase 1 students will be able to select a health determinant within an area of their own personal interest. Lead by faculty champions within that interest, small groups of students will progress through stages of community engagement in partnership with organizations to address one of the key community health needs as determined by the ThinkHealth St. Louis City and County Community Health Improvement Plan (CHIP). Community partnerships in research will be another featured element of the experience.
Through aligned and longitudinal work, the student body will be positioned to impact health outcomes in the St. Louis region where there is greatest need. This content will be largely housed within one afternoon per week and will likely include support from coaches in the first six months. While this content represents a challenging body of knowledge, students will be given time and space to deconstruct these concepts over time to better understand the St. Louis region that they will serve throughout their medical education while interacting consistently with the community on topics that are of interest to them. Continued collaboration with campus partners and community members will help to develop a robust community engagement curriculum that will help to serve the identified needs of the St. Louis region throughout all three phases of medical education at Washington University School of Medicine, in St. Louis, for St. Louis.