The Washington University School of Medicine plans to revamp its entire curriculum starting in the 2020-2021 academic year.

Photo by Curran Neenan

The new “gateway curriculum,” which is structured around the three core concepts of competency-based learning, integrated education and community engagement, has been in the drafting stage since the 2017-2018 academic year.

Due to logistical considerations caused by a shorted preclinical period, the school’s incoming class size was lowered from around 125 to 100 for the 2019-2020 and 2020-2021 academic years, but will return to 125 after that.

“When you’ve shortened the preclinical curriculum… there will be an overlap in the clinical space between the last class of the traditional curriculum and the new class,” WUSM’s Senior Associate Dean for Education Dr. Eva Aagaard said. “And so to address the ability to accommodate students in the clinical workspace, we needed to decrease the total number of students.”

According to Aagaard, the school’s curriculum was due for a major revamp after twenty-five years with only minor updates. Additionally, the University’s upcoming accreditation process prompted administrators to shift to a competency-based curriculum, which many other medical schools have adopted.

“In competency curriculum, you actually define: ‘What does society need from a graduate?’” Aagaard said. “So [at] our medical school, what do we think are important outcomes that all students should be able to achieve at the time of graduation? And defining those standards and then designing the curriculum backwards from those standards and goals.”

Due to the significance of the potential curricular shift, Aagaard, Dr. Thomas De Fer and other administrators employed a variety of methods to garner feedback from all groups who would be affected by the new curriculum. After a kickoff retreat involving faculty, students, residents and others, administrators created two committees to guide the process forward.

“[First we created] a working group called Blue Skies, which was charged with blowing up the whole thing and, and using evidence-based best practices as well as educational theory to design an ideal curriculum that would help us meet our goals,” Aagaard said. “And then we charged the second committee, called Greener Pastures, with doing quality improvement: taking the current curriculum, learning about what other schools have done and suggesting an improved or enhanced plan.”

In an effort to include current medical students in the curricular development process, a third advisory group called Golden Horizons was also formed.

“We were asked to take what we liked from the models we had seen, our own ideas, and our experience as students to create our ideal curriculum,” third-year medical student and Golden Horizons committee member Jason Morris wrote in a statement to Student Life. “We looked at mentorship, meaningful early clinical exposure, community engagement, academic individualization, professional identity formation.”

In order to address concerns that the University was not adequately engaging in the St Louis community, the working groups also came up with two programs to encourage this type of engagement.

“One is a social medicines thread, which is woven throughout the curriculum in all four years,” Aagaard said. “And then the second is through an intentional and required community engagement curriculum where we’re… providing [students] with structured opportunities within the community that will help them address some of these long standing social inequities in our city.”

The previous curriculum had employed a traditional learning structure, with students starting off by learning certain medical concepts and later applying those concepts in later clinical and research stages. The new gateway curriculum will break up this structure by adopting an integrative learning system.

“Integration means that you’re learning things simultaneously and in context,” Aagaard said. “And so this curriculum integrates basic science, clinical science and social science throughout the curriculum through all three phases. And that’s the first time we’ve done that in at this medical school.”

However despite these radical changes, students currently enrolled in WUSM will be allowed to continue their studies under the old curriculum, although they will be able to take advantage of the new opportunities offered by the gateway curriculum.

“[Students enrolled in WUSM before the curriculum change] will have the opportunity to participate in innovative pilot programs/courses/rotations including those involving basic, clinical, social and community sciences—especially in the fourth year,” WUSM’s website writes. “Any participation in new programming will be elective, and there will be no changes to the current graduation requirements for students entering in 2019.”

Reflecting on the impact of his work at the Golden Horizons committee, Morris emphasized how the process of seeking input from faculty, residents and especially students had added valuable new aspects to the gateway curriculum.

“These components help update the medical school experience to not only stay current with current educational literature, but also to produce future physicians who are equipped with the skills and knowledge to excel and be leaders in the changing landscape of modern medicine,” Morris wrote.