Gateway Curriculum at School of Medicine marks first renewal in 20 years, focuses on integration and community engagement

Grace Kennard | Staff Reporter

A three-year-long process of building, planning and implementing has culminated in the release of the new Gateway Curriculum at Washington University’s School of Medicine. It has been twenty years since the last renewal, and this milestone marks several timely changes and additions to the traditional curriculum.

One of the curriculum’s major stated goals is to “empower future academic physicians to lead the advancement of human health.”

Among the biggest changes, Senior Associate Dean of Education Dr. Eva Aagaard said, is the switch to a competency-based curriculum.

“We ask the question at the completion of this entire training: What outcomes do we expect our students to be able to achieve? And then you build the curriculum backwards from those outcomes,” she said.

Aagaard added that this approach to education also informs a very formative framework that features assessments for learning, not of learning. The website states this as “Development of an assessment system that is transparent and continuously incorporating both regular feedback and routine self-reflection on strengths, direction and opportunities for growth.”

Matt Miller

Jess Pittman, MD, puts a coat on Michael Rosario. First-year medical students took part in a “White Coat Reflection.” Because of restrictions due to covid-19 coronavirus, they received their white coats and started their medical journey with a small group of students, their coach, and family and friends watching remotely on September 11, 2020.

Integration is another key aspect of the Gateway Curriculum that will help budding physicians be able to better understand the context of the heavy foundational scientific learning that medical students traditionally engage in. The new curriculum will prepare students to better realize how social science concepts and ethics directly relate to taking care of patients.

“The Gateway Curriculum is trying very hard to integrate those things so that you’re learning why something is important and how it’s relevant in real time,” Aagaard said.

Community engagement is also a crucial component of the new curriculum, which notably has a heavy anti-racism lens. Questions students will focus on include uncovering what structural racism means, how it has developed, how it results in disparities in health and how social and structural determinants of health impact the care that they deliver and the patients they care for.

“As part of that, they learn what it means to be a partner with our community colleagues who are caring for patients in a variety of different ways, people in a variety of different ways, in all different forms of social and structural determinants of health,” Aagaard noted.

As part of the community engagement portion of the Gateway Curriculum, students will also have required service learning components.

The community engagement component was a particular draw for first-year medical student Kevin Yin.

“My main reason for choosing WUSM was to be a part of the Wash. U. and St. Louis community, and the new curriculum has a very heavy emphasis on community engagement in St. Louis, which was a big draw for me,” Yin wrote in a statement to Student Life.

Yin also expressed his enthusiasm about being able to engage with the St. Louis community as part of his academic work.

“I think the importance of embracing our role in the community as advocates and understanding social and structural determinants of health that affect our patient populations is often overlooked, and I am very grateful that it is front and center in the Gateway Curriculum,” Yin wrote.

In terms of the actual renewal process, Executive Vice Chancellor for Medical Affairs Dr. David H. Perlmutter spoke to some of the reasons for updating the traditional curriculum.

“Part of the decision for us to go to renew and reformat [the] curriculum was really initiated in response to being ever more attractive to the best students in the country,” Perlmutter said. “So up until 2016 [or] 2017, we had a trend where our yield of the top students was going down progressively, and the two things that we could really do something about were scholarships and curriculum modernization.”

Perlmutter mentioned the $100 million commitment made by the School of Medicine over the next ten years. This funding does not include any donation, and primarily comes from the School of Medicine. Specific sources include new funding from Barnes-Jewish Hospital and St. Louis Children’s Hospital, the University’s affiliated training hospitals, as well as departments within the school. This commitment is dedicated to providing more MD scholarships, and has also considerably affected the Gateway renewal process.

“[The commitment] really is for us about continuing to be a place that attracts the best students, that allows us to attract students that couldn’t otherwise afford a medical education and to be a part of reducing the cost of healthcare,” Perlmutter said.

Instead of adopting a top-down approach to curriculum renewal, the School of Medicine decided to involve over 200 people from the WUSM community in a shared planning process for the gateway curriculum.

“Our students in our legacy curriculum have been critical partners all along in the Gateway design and really we could not have done it without them,” Aagaard said. “Their level of engagement, their ideas…them [and] the faculty are what made the Gateway Curriculum what it is.”

The COVID-19 pandemic has created a national and international public health crisis that has highlighted disparities in care, Aagaard said. Together with the realization of the racial injustices in our communities, this presented a historic time to commit oneself to the medical profession.

“In some ways, I’m envious of our students that they are going through their medical education at a time when everybody in society realizes the value of physicians and other healthcare providers,” Perlmutter said. “I continue to be amazed at the way that they have responded to their purpose, sometimes at great risk to themselves and their families. I can’t imagine an environment that would be more inspiring for students.”

“Medicine is, in my opinion, a vocation,” Aagaard said. “It’s a calling. It’s not really a job.

It becomes a part of who we are, and of course it would because of the things that we’re called to do for our patients, with our patients, with their families.”

Both Aagard and Perlmutter have high hopes for the impact the Gateway Curriculum will have on medical students and the subsequent impact the students will have on the industry of healthcare and their communities.

“I think [the curriculum] has the potential to create a different breed of physician, a person who is really thinking about the experiences of the person that they’re trying to care for,” Aagard said. “I hope that [some of these changes] raise the bar on what excellence in physicianship looks like and that someday, people will look at our students and be able to know them based on the way that they interact with their patients and the quality of the care that they deliver. They’ll say, ‘Oh, you must have [gone] to Wash. U.’”

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