Eva’s Excerpt May 2022

Last week, I had the pleasure of both participating in the planning of our upcoming commencement ceremonies and meeting with our outstanding alumni. For information about commencement, take a look at the University webpage. This is the first year that ALL faculty are invited to both the university-wide event and the School of Medicine MD events. Both will be held at Francis Field. OT, PT, DBBS, and the master’s programs have events leading into commencement and afterward as well. We have exciting speakers lined up and a wonderful series of events planned. I hope to see you there!

As for the alumni, we welcomed back several class years for the reunion, given the impact of COVID. I had the pleasure of speaking about the Gateway Curriculum, and the synergistic impact of the curriculum and scholarships on our student body. My slides are available here for anyone with an interest. I also had the pleasure of seeing several of our amazing faculty and alumni (some who are both) receive recognition for their outstanding contributions to medicine, the school and science. It was so wonderful to see the interest of our alumni in what we are doing educationally, clinically and scientifically—and there is so much to be proud of.

I had a dear friend who each year, as the students, residents and fellows moved to their next phase of training or professional development quoted one or more Irish toasts (she was Irish). I would love to continue this legacy (although will broaden across multiple cultures) and have chosen the following Irish toast this year for all our graduates and those transitioning to new roles in honor of my friend and mentor, Maureen Garrity: “May you get all your wishes but one, so you always have something to strive for.”

While some may hope for a lack of struggle in life, I am now fairly convinced that life is all about the struggle. It is in the struggle that we grow. It is in the struggle that we learn. It is in the struggle that we hope for more, and ultimately achieve more. Each of our students, residents, fellows, faculty and staff have struggled these last few years. We have grown, changed, developed, as people, as teams, and as an organization. We have been imperfect, and we have been glorious. Nevertheless, we have all grown- better, stronger, more capable. We have learned, developed, and changed. We have seen different ways of doing things and different ways of being. We have and continue to strive for more—for a better future for ourselves, our learners, our patients, our community, our Wash U.

While we do not know that the next struggle will be, I think we all know that there will be one. What I hope for our graduates and alumni, for our current trainees, and for our faculty and staff, is that we have provided you with the knowledge, attitudes, skills, resilience and support needed to face those struggles, overcome them, and yet always have something to strive for. In addition, while you continue in the struggle, I wish you the following:

“For every storm a rainbow, for every tear a smile, for every care a promise, and a blessing in each trial. For every problem life sends, a faithful friend to share, for every sigh a sweet song, and an answer for each prayer.” (Irish Prayer)

Thank You Dr. Deptola and Welcome Dr. Kummer

Dr. Amber Deptola is stepping down from her leadership role directing the Explore Program of the Gateway Curriculum. Dr. Deptola led the creation of the program from its inception, including supervising the development of the Explore Immersion, the Inquiry Curriculum, and providing oversight of the four Explore Pathways. Under her leadership, the Explore program was transformed from a concept to a highly successful and popular curriculum that has positively impacted our first cohort of Gateway students through Phase 1 and Phase 2. She will remain the director of the Medical Education pathway within the Explore program as she puts more focus on this and her clinical work. We are so grateful for her creative vision and organization that has laid a solid foundation for the Explore program.

We are pleased to announce that Dr. Terrance Kummer is taking over the reins as the new Director of the Explore Program. Dr. Kummer is an Associate Professor of Neurology, specializing in Neurocritical care. He received his MD and PhD degrees from Washington University School of Medicine before completing his Neurology residency and Critical Care Neurology fellowship training at Massachusetts General Hospital and Brigham and Women’s Hospital. He is the current director of the Neurotrauma ICU and was the Neurological and Neurosurgical ICU resident education director for five years, a role in which he lead their curriculum renewal efforts. Dr. Kummer is a highly successful researcher, whose laboratory focuses on understanding the cellular mechanisms underlying neuronal trauma and degeneration. In this new role, he brings enthusiasm and a strong record of research success, research and clinical team leadership, and experience as a medical educator.

Eva’s Excerpt April 2022

I want to begin by recognizing our 3rd and 4th year students, Kathy Diemer, Angie MacBryde, Tom De Fer and our Clerkship Directors. Our 4th years just completed the match, in stellar fashion if I do say so! And our 3rd years are now 4th years, having completed the last of the large scale Legacy clerkships at the end of March! I could not be prouder of these two classes. While bearing the brunt of COVID-related changes to classroom and clinical learning, they have excelled in every way— academically, professionally, and as leaders, and it is they who helped us solidify our commitment to social justice in education and more broadly. I would also like to recognize Tom De Fer and the Clerkship Directors for spearheading relentless changes to the clinical curriculum in Legacy throughout COVID, paving the way for many of the changes possible in Gateway. Congratulations to all of you for successfully navigating “the bulge” – that difficult time in curriculum transformation when two classes are in the clinical clerkship environment at once!

In the last month, I have had the occasion to speak several times on the topic of addressing racism in medical education, both locally and nationally. It has caused me to reflect deeply on the last two years and I think it is time to revisit Our Commitment to Addressing Racism in Education to assess the progress we have made and what is still left incomplete. Here is what we said we would do and our progress to date:

  1. We will educate ourselves as we attempt to educate others: We have made significant progress in this domain. We have required bias and antiracism training of all admissions and curriculum faculty and staff. Our Gateway coaches have led the way with the most in-depth training. The School of Medicine Office of Diversity, Equity and Inclusion led by Sherree Wilson has launched the Understanding Systemic Racism Curriculum (modeled on the faculty development provided to our coaches and core curriculum faculty) led by Erin Stampp. They are currently training equity champions to be able to further disseminate this curriculum in a tailored way to each department and program. Our Executive Faculty voted to require this curriculum for all faculty, housestaff, and staff, so as the champion training continues, this will be rolled out broadly to all of us. If you are interested in becoming an equity champion, you can find more information here.
  2. We will investigate and address biases, discrimination, racism and white supremacy culture in all aspects of our educational work: Here we have also made significant progress. Our admissions team in the MD program has implemented holistic review and implemented other practices to reduce barriers to application to WUSM. As I previously commented, we have seen continued increases in applicants and an almost doubling of students traditionally identifying as under-represented in medicine within our classes over the last 2 years. We will have our largest ever Second Look event on the weekend of April 7 with a larger representation of diversity applicants than we have ever had before.

    We have fully implemented a longitudinal health equity and justice curriculum across Phase 1 and Phase 2 of the Gateway Curriculum grounded in structural competence and anti-racism. Recent AAMC Y2Q data (this is a national survey of all second year students across the country) shows that our first cohort of Gateway students rated the curriculum above the 90th percentile (the highest benchmark) in learning effective tools for recognizing their own biases and contributing to their ability to work in disadvantaged communities. Kaytlin Reedy-Rogier and Audrey Coolman have also developed individual curricula in structural competency and anti-racism for each of the Legacy years and our MSTP students, led by Mackenzie Lemieux created a social justice and anti-racism journal club curriculum. In addition, the Gateway clinical skills curriculum trains students a trauma-informed approach to history taking, physical examination and clinical care. Medical students have the opportunity to practice these skills and gain a deeper understanding of the social and structural determinants of health, as well as the importance of an interprofessional team in addressing these factors during the Ambulatory Immersion, through dedicated partnerships with Affinia and Care STL, 2 local Federally Qualified Health Centers and critical partners in our education mission. Our new Phase 2 students are receiving rave reviews in the clinical environment from faculty, residents and patients alike for the skills they have acquired.

    We have also implemented a truly thoughtful competency-based assessment system with an eye toward addressing the equity issues identified in grading in the Legacy Clerkships and incorporating the recommendations of the Committee on Equity in Clinical Grading led by Steve Lawrence and Sherree Wilson. Amanda Emke has worked tirelessly to bring this to fruition. It is still too early to determine if we will see an impact on equity in grading and assessment, but this remains a critical outcome that we are committed to measuring and addressing through this new system of assessment. Amanda, Steve and Kathy Diemer are also currently working with a cohort of highly dedicated program directors to help us design the new Medical Student Performance Evaluation (MSPE or Dean’s Letter) and a new standardized department letter to further support the differentiation of our students while attending to issues of bias and equity when applying to residency.

    We continue to work on our learning environment and there remains significant work to be done. Our students and residents experience offensive remarks regarding race, ethnicity and gender at unacceptable rates. To this end, the SAFE committee and the Academy of Educators, with dedicated work by Abby Spencer and our Instructional Design Studio, have implemented training for all faculty, housestaff and staff on microaggressions and upstanding. Jenny Duncan and Lisa Moscoso have presented at departments across WUSM on the new reporting and management process for mistreatment including issues of gender, racial and ethnic bias. Finally, it is critically important that we look at our entire educational program through an anti-racism lens- from pre-matriculation to graduation, programming and policies. The Health Equity and Anti-Racism Committee (a subcommittee of COMSE) chaired by Nichole Zehnder does just this and will be continually monitoring our progress.

  3. We will hold ourselves accountable, admit when we make mistakes, learn from it and continually improve. We also invite our community partners to hold us accountable: Our Program Evaluation and CQI unit is continually gathering data on the curriculum, on student opinion, on the outcomes of our initiatives, and our learner outcomes. We are still too early in the process to see whether we have truly made a difference, but I am hopeful. The curriculum has not gone perfectly, and our students have told us about it. We have relentlessly changed to address concerns and will continue to do so. The early Y2Q data and feedback from our faculty and residents shared above is a good sign that we are making a difference where it matters, but this will be a continual improvement process.
  4. We will disseminate what we learn so others can benefit from it: We are in the process of completing a mixed methods study of contributions to bias in grading led by Donna Jeffe, Jan Hanson, Eve Colson, Maria Perez and Yaheng Lu. I am participating in a national collaborative of medical education senior leaders to build an institutional self-assessment tool for anti-racism, and many of us are engaged nationally in initiatives at the AAMC, and ACGME to further this work. Our Office of Diversity Equity and Inclusion and our Health Equity and Justice team (Kaytlin and Audrey) have been presenting around the country on the work they have been doing.

This is a long article, but it seemed very important to update you all on the progress we are making and where work still needs to be done. I am pretty darn impressed by what we have accomplished to date (in spite of COVID). This will be a long journey and hard work and it is of such critical importance. It will take ALL OF US to ensure our ultimate success in creating a truly equitable and inclusive environment for all the learners, staff and faculty we serve.

Gateway’s Approach to IPE

What I love about sports is that for a team to succeed, each team member must know their role and responsibility even in individual sports like tennis – trainers, coaches, racquet stringers.

Just like athletes, future physicians must learn to work effectively on healthcare teams which are complex and require the cooperation of many different health professionals. In the Gateway curriculum, our approach to interprofessional education (IPE) began with a review of the 4 Competency Domains created by the Interprofessional Education Collaborative (IPEC), a collaboration of 21 national health professional associations (https://www.ipecollaborative.org/membership): Interprofessional Communication, Roles and Responsibilities, Values and Ethics and Interprofessional Teamwork. These competencies are meant to be achieved over a lifetime from training to practice.

With these IPEC competencies and our guiding light of finding “natural fits” where IPE could be highlighted in mind, we began in phase 1 by collaborating with Module leads to integrate the roles and responsibilities of our interprofessional colleagues within what they were already teaching. This ranged from having social workers on panels talking about organ transplant to having physical therapy senior students teaching musculoskeletal exams to Phase 1 Gateway students through clinical vignettes. In this way, phase 1 students saw the expertise our interprofessional colleagues possess and the vital role they play in patient care.

We also focused on integrating interprofessional communication and teamwork. The Center for Interprofessional Practice and Education (CIPE) already coordinated sessions with early learners from all schools on the Washington University Medical Campus (Audiology, Genetics, Medicine, Nursing, Occupational Therapy, Pharmacy, Physical Therapy) to learn about social and structural determinants of health, and interprofessional communication and teamwork. We deliberately integrated what was learned in the CIPE sessions into the Gateway curriculum around communication and health, equity and justice (HEJ) – often highlighting the interprofessional perspective. For example in the HEJ curriculum, we had occupational therapy (OT) faculty and an OT doctorate student teach about housing insecurity and the role OT plays in working with the unhoused here in St Louis.

We further took advantage of the clinical immersions in Phase 1 of the Gateway Curriculum, where phase 1 students are placed on healthcare teams for 3 weeks at a time with no classroom responsibilities. This was a unique opportunity for the students to see and meet first hand our interprofessional colleagues that they had learned about in the Modules. Immersion students were required to interview and shadow at least 1 non-MD health professional working with their clinical team whether that was a nurse, physical therapist, coder, biller or social worker. Through this activity, Gateway students gained a better understanding of the challenges and responsibilities each member of the healthcare team faces. They are then required to incorporate this into their end of immersion analysis on healthcare teams.

Now in Phase 2, the Gateway students are immersed in their clerkships and we are pushing them to further incorporate interprofessional roles and responsibilities, teamwork and communication into their emerging role as a physician. Students on the Neurology clerkship are placed in physician clinics that have interprofessional practitioners integrated into the work flow and also placed them in non-physician centered clinics such as a stroke occupational therapy clinic or the Stephen A. Orthwein Center at Paraquad which is a fully accessible gym for people with disabilities staffed solely by occupational and physical therapy practitioners.

Phase 2 students are also asked to incorporate their interprofessional skills into their decision making. In one of our standardized patient team scenarios, students create a discharge plan for a stroke patient alongside other interprofessional students and receive feedback on their teamwork and communication skills. Moreover, students are required to turn in physician notes that focus on interprofessional team members that should be included in a patient’s care based on the specific needs of the patient and healthcare team and, importantly, how interprofessional teams caring for patients support high value patient care.

As we finalize our phase 3 curriculum, we hope to continue to find “natural fits” for our students to further their skills around Interprofessional Communication, Roles and Responsibilities, and Interprofessional Teamwork. And since phase 3 Gateway students will have spent significant time in clinical areas, we will have phase 3 students begin to explore the Values and Ethics around interprofessional collaboration.

Hopefully at graduation, our Gateway students will have a great base of skills and habits that will help them succeed on interprofessional health care teams as trainees and as physicians and continue their life long journey of interprofessional education and collaboration.

Eva and Steve’s Excerpt March 2022

First, let me send my thoughts and prayers to all of you who have family, friends and loved ones in the Ukraine. There is nothing I can say or do to reduce the fear and sadness many of you are feeling. I simply hope you know that I care and am thinking of you.

In addition to the devastation of war, we are navigating a particularly tumultuous phase of the COVID-19 pandemic. First, let us all recognize that there is good news to celebrate on the COVID front. Our community has seen dramatic drops in the numbers of COVID-19 cases since the Omicron variant caused record levels of transmission over the holidays. We are now at levels lower than at the start of the Omicron surge and still trending downward. We also have continued to get reassuring data throughout the Omicron surge that severe illness is very rare for most people who are up to date with their COVID-19 vaccinations. Very recently, there is also evidence that vaccination significantly reduces the risk of developing long-COVID.

Despite the emerging optimism, there are still important reasons to remain cautious. While the transmission rates are coming down, there is still a moderate level of spread and a measurable risk that we can come into contact with COVID-19 in our daily interactions. Importantly, there are many people who remain vulnerable to the possibility of more serious COVID-19, including those with severely compromised immune systems, those over age 65, and children under age 5 who are not yet eligible to be vaccinated. There are also many more people who, even if they are not at elevated risk for severe illness, may live with or care for someone who is, or may have other reasons for a high level of concern about getting COVID.

Before vaccines were available, universal masking requirements were necessary to prevent serious illness and deaths. Once vaccines became widely available but transmission rates remained high, universal masking served as an important public health tool to reduce the risk of large-scale disruptions to daily operations in our core missions of research and education, and reduced the risk that our healthcare system would be overwhelmed. Masks are still an important tool for personal safety.

The CDC on Friday altered their guidance to say that universal masking requirements are not necessary to prevent a public health crisis in places where hospital systems are not overwhelmed and case rates are less than 200/ 100,000 people- St Louis fits within this group. Individual jurisdictions or institutions may still decide requirements are necessary depending on local conditions. While mask requirements are being relaxed in the County and soon City, we need to recognize the different perspectives of individuals on this campus as we move forward. WashU is a community that cares for each other and the community we work in. As we progressively pull back COVID mitigation on campus in coming weeks and individuals make personal decisions about masking, we must also focus on how we care for each other, even if our own risk perceptions and tolerances are different from our colleagues. To do this, the following things need to be adhered to:

  1. STAY HOME IF SICK;
  2. Even after universal indoor masking requirements are relaxed, it will still be recommended until transmission drops to low levels and remains an excellent tool for personal protection;
  3. Never shame someone or make assumptions about them because they choose to wear a mask or say no to a social engagement;
  4. If you know a colleague or co-worker is at higher risk or cares for others at higher risk, support them, and wear a mask even if the rules don’t require it.

We are in yet another time of change- this one for better overall, but it will not be without angst and fear. Please care for each other and yourself in the process. And begin to prepare personally for policy changes in coming days and weeks to our COVID mitigation requirements.

Eva’s Excerpt January 2022

Happy New Year?

I mean it as a rhetorical question. Without a doubt, we are starting this year in a tough spot. COVID cases are surging with the widespread introduction of the Omicron variant across the US. Unlike prior surges, we are hit hard with not just hospitalizations, but also large numbers of faculty and staff testing positive and unable to work. The COVID Call Center has been overwhelmed with calls and testing sites are packed, so much so that we are unable to perform post-exposure testing on employees through Occupational Health. Even if you have not thus far been impacted by COVID in your home or amongst your family members, you may be struggling with back to school woes, the strains COVID has placed on travel, or the sheer weight of emotion that this wave has brought down on us and the country.

While it may feel like we are reliving the winter of 2021, we are decidedly not. We are blessed with vaccines that are remarkably effective at reducing death, hospitalization and severe illness. That is HUGE! We know so much more about how to prevent the spread of COVID through simple measures like wearing a mask when we are inside or in close proximity to others and washing your hands regularly and before eating, drinking or touching your face. We have adequate personal protective equipment in the hospital and clinics. We know how to run our hospital, clinics, labs and classrooms safely. That is all a LOT different. This is not a happy time, but it is a much more hopeful time than last year, and for that I am very grateful.

Because of the volume of people out—students, residents, fellows, faculty, staff, we will need to be nimble to get through this time. Again, fortunately for us, we know something about how to do that. Some classes may need to move to virtual, regardless of size. We will need to help each other out, in whatever ways we can. We will need to be patient and kind, despite frustrations. And we will need to remember that everyone is doing the best they can given their situation. Finally, and importantly, we need to keep steadfast in ensuring we stay focused on decisions that maintain the success of our critical vision and mission. A special thank you to our clerkship directors and clerkship staff and our OMSE team who are remarkably juggling the launch of Gateway Phase 2, the ongoing Year 3 clerkships, and the moving target that is the clinical environment in a COVID surge. There are no words to express my gratitude.

So, while we may not be starting the new year “happy,” there remains much to be thankful for and, at least I, have a lot of hope for a better 2022.

Announcing – Supporting a Fair Environment (SAFE) Initiative Launch

The SAFE initiative aims to improve our learning environment by promoting positive behaviors and managing concerns about mistreatment and unprofessional behaviors. The new Supporting a Fair Environment (SAFE) committee, led by Dr. Lisa Moscoso, Associate Dean for Student Affairs and Dr. Jenny Duncan, Director of Wellness for GME has been working over the past few months to launch this new initiative, which includes a new website , required education modules, and a new process for reporting positive experiences and concerns. This work includes all learners at WUSM, including our graduate and professional degree programs, post-doctoral fellowships and trainees in the WUSM/BJH/SLCH GME Consortium. We encourage all learners, faculty and staff to check out the new website, many of you will find a new shortcut to the website on your WU computers. The icon is the same as the image above.

This month all clinical residents and fellows will receive an email to register for the SAFE education modules in WashU Extended Learning, so they can complete 3 educational modules about mistreatment and the new reporting process. In early January, all students, faculty and staff that interact with our learners will also receive an invitation for these modules. The 3 modules will take approximately 30 minutes or less to complete in total. The education is required because we want to be sure that all of us recognize what mistreatment looks like, understand the consequences of mistreatment, and are able to report when such events occur. We also want everyone to understand what happens when a report is filed. Importantly, the SAFE committee will ensure consistency in our approach across all of our Departments and programs.

In the new reporting system individuals will be able to report anonymously, if they choose, and can still have bidirectional communication in the system by using a password. The link for follow-up is also on the new SAFE website. Learners also have the option to delay action in many cases, in the event they want to wait until rotations are complete or grades are filed. At the new SAFE website, you will also find a link for reporting accolades, so that we can highlight the positive behaviors in our learning spaces. Deidentified, aggregate data regarding accolades and concerns will be reported back to Department chairs, educational leaders and learners throughout the year.

We are optimistic this new leadership supported initiative will begin to make important, positive changes in the culture of our learning environment. We hope that everyone will commit to this important work in promoting an environment of inclusive excellence for all.

Eva’s Excerpt December 2021

“What’s your why?” It’s a question I suspect a lot of people are asking themselves these days and it’s a question I think most of us don’t ask ourselves enough. Your why is the reason for your life’s work, your calling, convictions, and career mission. It is where and how you spend your time and the things you are willing to make sacrifices for to achieve. We spend more than a third of our lives working, 30 plus years, so “why” is an important question worthy of deep consideration. It’s also a question not everyone has the privilege to ask, so for those of us who do, like me, it is a blessing for which I am consistently thankful.

As most of you know, I am a general internist, and I found my clinical calling in medical school. I remain convinced that I could have been happy in any number of specialties, but what drew me to internal medicine was the complexity of the problem solving around multiple medical issues combined with the deep connection I was able to make with my patients in good times and bad. During COVID, I have had to sacrifice some of this time in order to help lead our occupational health and campus safety response, which has been very rewarding in its own right, but I do miss the unique grounding I feel when working with patients and learners at the bedside and in the clinic. Reflecting on that feeling of loss over the last year has confirmed that patient care is an important part of my why.

Early in the formation of my identity as a physician, I also became curious about what makes a good doctor and that eventually evolved into asking how we can train really great doctors. Answering this question and developing systems, programs, and people to do this has been my life’s work and is my career mission. In the last few years, I have been able to expand that mission to think broadly about health and scientific professions and contribute more broadly to the quest to determine how we equitably improve health through science, systems, education, and advocacy. These are hugely complex problems and I have no illusions that I will be the one to solve any of them. But, I feel blessed every day to lead some people, work with many people, participate in the training and mentoring of many more, and engage across our missions to contribute to this work. I feel very proud to work at an institution and with people who live and breathe pieces and parts of these things as their why. It is what I truly love about Washington University School of Medicine- it is SUCH a mission-driven place. Research, clinical care, and educating the future of medicine and science is what we do and who we are, and nothing we do could be done without each and every person here contributing towards that why each day.

I have another why that provides a different kind of grounding, my family and the networks of individuals I am lucky to call my friends. During these last two years they have perhaps been impacted by the demands of my career and life’s work more than I have fully observed. These individuals are my foundation and support, a source of recovery, and often the reason why I am able to accomplish the things that challenge and reward my professional capacities and curiosities.

During this holiday season and as we likely face another challenging winter, I want to remind you all of the importance of finding meaning in how you spend your time, and to seek a balance between the things that are difficult and those that are rewarding and fulfill on a broader purpose. My request to you is that you consider your individual why and ground yourself in it. Ask yourself: Is there a problem or challenge that emotionally moves you to take action? What kind of work gives you a sense of satisfaction and fulfillment? What aspect of your career have you enjoyed across all your past work experiences? What kind of work feels effortless to you, but drives your curiosity to learn more? Then think about what you can do to increase the time spent doing those things. All of us do things we don’t enjoy or at least enjoy less, but the trick is to try to do more of what you love, root your work in an important why, and take time to recharge to be able to get through the harder times.

I wish you and your families a happy holiday season, and a life filled with your why.

Updated COVID Activity Guidance

WUSM Specific Updated Activity Guidance (effective November 5, 2021):

Updated Guidelines:

Masking:

  • Masking is required in all indoor spaces, including cubicles, regardless of vaccination status.
    • Masks may be removed while alone in non-clinical private spaces (offices, private meeting spaces, break rooms, labs, classrooms, meeting rooms).
    • Masks may be removed while eating or drinking with appropriate six foot distancing from others.
  • Masking is recommended in outdoor spaces when crowded or when distancing is difficult to maintain

Events and Meetings:

  • We strongly recommend utilizing large spaces or meeting outside when possible
  • For outdoor events, masking is encouraged for large events and in crowded settings
  • Indoor events should be planned to allow sufficient space to avoid crowding and to provide for 6-foot distancing if food and beverage are being served. Masking is required for all regardless of vaccination status when not actively eating or drinking.
  • Off-campus events: When planning or attending WashU-sponsored events that take place away from campus, you may adhere to the rules of the venue, but we strongly encourage following best practices to reduce risk of spread of COVID and other cold and flu viruses amongst members of our community. These include:
    • Not having, or limiting the time spent participating in, stand-up cocktail-style mingling events while indoors
    • Masking when not actively eating or seated at a dining table
    • Maximizing physical spacing
    • Using spaces with enhanced ventilation (outdoors, open doors/windows, or using filtration devices if available)
    • Limiting the total number of guests to avoid crowding and to minimize exposure opportunities
  • All participants should screen for COVID-19 symptoms no more than two hours prior to the event. WUSM personnel should use the daily symptom screening that is required for entering campus. Visitors should use visitorscreening.wustl.edu/symptom-screener. Evidence of a successfully passed screening should be given to the activity organizer on site. Active temperature monitoring is not necessary. Mild symptoms, such as runny nose and headache, may be associated with mild COVID-19 infections. People having either of these symptoms should not attend events and meetings while symptomatic.

Food and Drink:

  • Food and drink may be consumed in the following locations:
    • At outdoor events
    • In campus restaurants/cafes and dining areas where seats are pre-positioned for appropriate physical distancing
    • In conference rooms, classrooms and auditoriums if six-foot distancing can be maintained
    • In any private indoor space when alone

Travel:

  • Work related domestic travel is permitted
  • Work-related international travel requires approval and should consider conditions in the country and whether the travel is essential. Travelers should consult with the International Travel Oversight Committee (ITOC), and approval from both the ITOC and the department/unit is required.

Visitors:

  • Visitors may be on campus in non-clinical spaces including research labs and clinical research spaces where their presence for the research is required
  • Visitors may not return to clinical spaces unless they are part of a formal program (i.e. PEMRAP, training contract for devices, physicians or allied professionals) or there is a pre-existing relationship with a Memorandum of Understanding/ Program Level Agreement. High school and undergraduate shadowing experiences are not allowed outside of these circumstances. Health professional students and graduate students at Washington University School of Medicine and other Washington University Clinically Oriented Graduate Programs (i.e. graduate engineering students or social work students working in the clinical environment as part of their core training rotations) are not considered visitors. Health professional students and residents/ fellows from affiliates with a formal MOU/ PLA are allowed for either formal rotations or shadowing if incorporated in the MOU/ PLA. Medical students from outside of Washington University are allowed for formal rotations for credit but must apply and be approved for a visiting rotation through VSAS to manage total clinical volumes. Faculty may not take shadowers outside of these parameters at this time because of density within the clinical space.

Approval:

  • Approval for events and meetings is not required as long as requests fall within these guidelines
  • Advice regarding events/ visitors, etc. may be sent to aagaarde@wustl.edu
  • Failure to adhere to guidelines will likely result in changes to guidelines and process. These guidelines rely on the understanding and honor of our community.

Note: These rules may change as disease activity changes and CDC guidelines and science advance including potential return to more restricted guidance based on local conditions.

Background & Principles:

  • Fully vaccinated individuals are highly protected against severe illness, are at lower risk of contracting, and may be at reduced risk of spreading COVID-19. These risks are further reduced after receipt of a booster dose of vaccine.
  • Individuals are considered fully vaccinated 2 weeks after they have received the 2nd dose in a 2-dose series (e.g. Pfizer-BioNTech or Moderna vaccine, or 2 weeks after they have received the single dose of the Johnson & Johnson/Janssen vaccine. At this time, receipt of a booster dose is not required to be considered fully vaccinated.
  • Over 97% of WUSM faculty, staff and trainees are fully vaccinated
  • There are many in our patient population and work environment who are immune- compromised and may not be able to develop a fully protective immune response to the vaccines or who are otherwise at risk of severe COVID-19 infection.
  • The vaccination rate in St Louis is well below “herd immunity”
  • Despite substantial reductions from the peak activity in September, transmission rates in the St. Louis region remain elevated at categories considered by the CDC to be Substantial or High
  • St Louis City and County currently have indoor mask mandates

Eva’s Excerpt November 2021

 

But what’s your ultimate goal, you’ll say. That goal will become clearer, will take shape slowly and surely, as the croquis becomes a sketch and the sketch a painting…

– Vincent van Gogh to Theo van Gogh, June 1880.

On Friday, October 29th, we celebrated the White Coat Ceremony with our new first year students and their family members, both in person and afar. This is my favorite event of the year. The White Coat Ceremony originated in the 1990s spurred by the Arnold P Gold Foundation to highlight the importance of humanism in medicine. It has since become an iconic ritual that places important emphasis on compassionate, collaborative and scientifically excellent care. Lisa Moscoso, our Associate Dean for Student Affairs, serves as MC. Dean Perlmutter provides opening remarks- telling an important story about attending to details, the importance of getting the basics right, and the critical role of practicing your craft with the goal of progressively achieving excellence. This is followed by a keynote speech, this year given by Dr. Jennifer Gould, describing what the white coat means to her and what she hopes it will mean to our students as they don it for the first time, and in the many years to come. The students then are brought forward one by one to be gowned in their short white coats, symbolizing their entrance into our hallowed profession. A special part of this ceremony here at Wash U is that our students work together to write their own oath. This process is repeated each year, led by Dr. Colleen Wallace, now leader of our Professional Identity Formation thread. Proclaiming it aloud as a group is the culmination of the ceremony. I get to lead that recitation and each year, I find it more and more meaningful and inspirational. If you are in need of something to remind you of your purpose as an educator, I encourage you to read the oath our students have crafted this year.

This year marked the first time we have been able to have this ceremony in person since the launch of Gateway and it included some important new changes. First, the Gateway Coaches are now the faculty who have the honor of helping the students to don their white coats. The coaches will be with their groups of 8-9 students throughout the four years of medical school. They are not just sources of personal support for the students, but serve as guides in our students’ journey through their own professional identity as physicians, discussing often challenging events and topics, as well as helping students to understand their own strengths and weaknesses, passions and pitfalls as they traverse their training here. Second, the oath writing and White Coat Ceremony now occur at the end of the first module of the curriculum, Molecules to Society. This timing is important. In years past, the ceremony occurred at the completion of orientation, before students had any ability to explore what this professional journey will even really be about. Molecules to Society provides a high level overview and foundation for what is to come, and so it seems fitting to move the first oath to this timing in their journey.

Yes, I said first oath. The students and coaches, under the thoughtful leadership of Dr. Wallace will revisit and revise this oath at critical transitions in their medical school training- our second year Gateway students will be coming back to their oath during the Phase 1 Capstone in December. Students will again revisit it at the completion of Phase 2 and in preparation for Match and Graduation. Each time, they will reflect on their experiences and how they either resonate with or change what they believed and pledged at their entry into their training as a physician. I suppose this is why I find the White Coat Ceremony to be the most wonderful event of the year- it is my opportunity to do the same and to be reminded how fortunate I am to work in such a wonderful profession, with all its challenges, and in academic medicine, with the ability to guide these gifted young people to change the world for the better.

In closing, I bring you this excerpt from a letter from Vincent van Gogh to his brother: “But what’s your ultimate goal, you’ll say. That goal will become clearer, will take shape slowly and surely, as the croquis becomes a sketch and the sketch a painting…”

I was fortunate to read it at the Beyond Van Gogh Exhibit this weekend and it struck me as so relevant to us as role models, coaches, teachers, and mentors, as we support and guide our students, residents and fellows through their own journey to becoming the final painting they are destined to be. And if you haven’t visited the exhibit, it is now open until January 2, 2022!