‘A journey of a lifetime’

By itself, beginning medical school is a major milestone. But the entering class of 2024 also experienced several significant firsts upon their arrival earlier this month at Washington University School of Medicine in St. Louis.

The 105 aspiring physicians are beginning medical school in the midst of a global pandemic.

The students’ entrance into medical education also marks the official debut of the Gateway Curriculum, the first overhaul of the School of Medicine’s program of studies in more than two decades.

“This is a class that will be remembered as special because it is the first in the new curriculum and the challenge of COVID-19,” said David H. Perlmutter, MD, executive vice chancellor for medical affairs, the George and Carol Bauer Dean of the School of Medicine, and the Spencer T. and Ann W. Olin Distinguished Professor. “Every student has demonstrated drive, intelligence and a desire to change the world, and they will now engage in the profession of medicine, a profession that requires elements of art and science. At this moment in history, health care and biomedical sciences are on the minds of people all over the world. There could not be a better time for future physicians and scientists to enter the field of medicine, and Washington University intends to be at the forefront of innovations in medical education and physician training.”

As COVID-19 continues to ravage the world — sickening more than 30 million people and killing nearly 1 million — first-year students started their medical journeys with urgent commitments to improving human health and advancing scientific discovery. Excitement mingled with nervousness as students attended orientation and classes that were a mix of online via Zoom, and in-person while masked and socially distant.

Driving students on their journey is a modern, high-tech new curriculum that emphasizes community outreach, diversity and inclusion, wellness and professional identity. Additionally, the curriculum enhances career development with dual-degree, certificate and mentoring programs for physicians-to-be who also aspire to lead innovations in medical education and scientific research. The students will get earlier clinical experiences to accelerate the maturation of clinical skills, and the new curriculum is designed to foster development of physicians and physician-scientists to best adapt to society’s evolving future.

At its foundation, the curriculum highlights an integration of basic science, research and clinical experiences throughout all four years. Straightaway, for instance, students become immersed in clinical experiences, from conducting patient exams, to monitoring vital signs, to studying research on psychological trauma and its effects on patients’ health. Learning how to interview patients for their medical histories — a tool that accounts for some 75% of diagnoses by physicians — will include sessions on explaining science in lay language to patients and listening with compassion. This will dovetail with simulated experiences with standardized patients and early immersive clinical experiences.

In welcoming students on campus, Eva Aagaard, MD, the School of Medicine’s senior associate dean for education and the Carol B. and Jerome T. Loeb Professor of Medical Education, lauded the Class of 2024’s talents and tenacity, and their big brains and big hearts. “You chose to say yes to medical school in the middle of a pandemic, where the only certainty is uncertainty,” she said. “That makes you brave. You also chose to come to here at a time when we are launching a new curriculum. That makes you remarkable.

“The first day of medical school is momentous,” Aagaard continued on Zoom, during the kickoff to orientation week. “Over the next four years, you are going to have a huge number of experiences. Some of those will be amazing and some scary. Some will be terribly sad and some, frankly, bad. And there’s nothing we can do as your faculty, or that we want to do, to stop those experiences because they will shape you into the physicians you will become. This journey you are on, the one you are starting right now, is a journey of a lifetime.”

Pondering experiences while on the journey is important in forming professional identity — another hallmark of the new curriculum.

A time to reflect and connect with peers and mentors is built into the students’ schedules on Wednesday afternoons. During this time, faculty coaches and a team of eight to nine students will meet for mentorship, camaraderie and an exchanging of resources, said Nichole Zehnder, MD, the newly appointed, inaugural associate dean for educational strategy. Coaches also will review students’ academic work and provide one-on-one counseling to help optimize performance. The coaching groups will be weaved into all four years.

The aim is for individuals to share honest, sometimes confidential and often emotional conversations about communal experiences encountered in medical school and, more broadly, in medicine. Topics may include ethics involving organ donation and transplantation, dignified dying among the terminally ill, and each student’s relationship with his or her first patient, a human cadaver.

Before breaking into coaching groups for the first time on orientation day, Zehnder reassured students, via Zoom, that new beginnings are both exciting and nerve-racking. She acknowledged feeling the same way, even after more than a dozen years in academic medicine.

In the accompanying Zoom chat board, Zehnder, an associate professor of medicine, asked students to offer a one-word description of how they felt at that moment.

“Pumped.”

“Caffeinated.”

“Thankful.”

“Eager.”

“Nervous,” the students wrote.

But the most frequently expressed feeling, by far, was “excited.”

Excited describes Carly Duncan, a first-year who is from Modesto, Calif., and is in Zehnder’s coaching group. “I came to Washington University because, from the beginning, the faculty have made me feel valued,” she said. “There’s a unique emphasis on people and relationships that made St. Louis feel like home and the university’s faculty, staff and students feel like family. I’ve already made a group of friends ridiculously quickly, and I’m so excited to change the world with them.”

Overwhelmingly, students agreed that the new curriculum’s emphasis on social justice and health-care equality lured them to the university. Training will direct students to look beyond singularly treating an ailment or disease. Instead, the doctors-to-be will learn to evaluate circumstances of the whole person, including race, gender, sexual orientation, income, neighborhood, among other social and economic factors that may influence health.

Incoming students also will join the medical school’s efforts to build on existing community and university partnerships, and develop new ones — all with the goal of improving the health of the St. Louis region and beyond.

“As an East African immigrant, I understand some of the differences that minority populations face in health care,” said Ian Marigi, a first-year from Brooklyn Park, Minn. “I’m excited to be at a medical school that acknowledges this reality and is active in addressing health disparities that come with different identities. The Gateway Curriculum drew me here because it speaks to my values by integrating social advocacy with medicine and science.”

At the end of orientation week, students reaffirmed their dedication to medicine and helping humanity during an annual rite of passage known as the White Coat ceremony, which occurs when new medical students receive their white coats.

Pre-COVID, many family and friends would attend these large celebrations in auditorium settings. This year, however, faculty presented white coats to small groups of mask-wearing students in myriad classrooms. Loved ones watched via Facebook livestreams and Zoom gatherings.

“The White Coat celebration in our coaching groups was amazing,” said Dennis Chang, MD, an associate professor of medicine. “Advisers coated students individually, and, although different this year, it was still meaningful. If anything, it was more so.”

A White Coat celebration including the entire class is scheduled tentatively for late October, provided the number of COVID-19 cases recedes and health protocols can ensure safety. As is tradition, students will don white coats and reflect on the garment’s significance.

“My white coat symbolizes my commitment to serve my community with empathy, respect and action,” said Emma Landes, of Cape Elizabeth, Maine.

“My white coat symbolizes my lifelong promise to advocate for the community that I serve,” said Larissa Lushniak of Rockville, Md. “It represents my commitment to eliminating barriers to health care so that all of my patients can receive the care that they deserve.”

Said Andrew Benckendorf, of St. Louis: “My white coat symbolizes a promise and commitment to my community. Doctors have a duty to use their expertise to advise officials and advocate for those silenced in society. The white coat is a solemn pledge of service and stewardship to future patients and society as a whole.”

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