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Washington University School of Medicine began a curriculum renewal process in 2017 with a goal of implementing the Gateway Curriculum in 2020. In this article, we describe the vision of this curriculum and the infrastructure that was built to support it. We also describe the impact of COVID‐19 on the legacy curriculum and the Gateway Curriculum as well as the lessons learned to date.

Interprofessional education is becoming a requirement for accreditation of most health profession programs, therefore it is necessary to share innovative experiences so all can learn from the successes and barriers of implementation. Faculty members from five health profession programs (medicine, nursing, occupational therapy, pharmacy, and physical therapy) were tasked with developing a pilot interprofessional education experience focused on transitions of care. The result was a three-phase experience in which students individually completed online virtual cases, then came together for small- and large-group discussions, and concluded by working through a simulated patient discharge. Objectives centered on recognizing the individual's professional role during transitions of care, identifying barriers to transitions of care, and evaluating strategies to improve safety during a transition. Outcomes were measured using an anonymous pre and post-experience survey. Twenty-three students completed the experience and identified key themes related to their profession's role in, and barriers to a transition of care. The majority of students strongly agreed that this experience has made them more aware of the importance of interprofessional communication, and that they would recommend this pilot experience to a colleague.

In the medical profession, teaching has always been a routine expectation for practicing physicians. While this remains true today, in recent years, we have seen the emergence of a well-defined career pathway for those practicing physicians who want to focus on education: the clinician educator. This is a physician who is highly active in the practice of teaching, science of learning, service as a role model for young physicians, and leading educational programs. In nephrology, one can have a fruitful and fulfilling career as a lifelong clinician educator. As career interest in our specialty wanes, the clinician educator is the professional well suited to reverse this trend. In this article, we will further define the clinician educator and map out a pathway of skills needed to thrive in this rewarding career. We also provide recommendations to both educators and leaders to ensure the clinician educator pathway continues to grow.

Real-time heuristic search methods are used by situated agents in applications that require the amount of planning per move to be independent of the problem size. Such agents plan only a few actions at a time in a local search space and avoid getting trapped in local minima by improving their heuristic function over time. We extend a wide class of real-time search algorithms with automatically-built state abstraction and prove completeness and convergence of the resulting family of algorithms. We then analyze the impact of abstraction in an extensive empirical study in real-time pathfinding. Abstraction is found to improve efficiency by providing better trading offs between planning time, learning speed and other negatively correlated performance measures.

Background/Aims: The Oxford classification of IgA nephropathy (IgAN) assesses the presence of mesangial hypercellularity ≧50% (M1 vs. 0), endocapillary proliferation (E1 vs. 0), segmental glomerulosclerosis (S1 vs. 0), tubular atrophy/interstitial fibrosis >25 or 50% (T1 or 2 vs. 0), and has been reported as having prognostic value. We studied the clinical significance of the classification in our adult patients with IgAN. Methods: Retrospective study of 54 patients with biopsy-proven IgAN seen from 1983 to 2009. The correlation between the Oxford classification and baseline renal function was assessed. The primary endpoint was a 50% reduction in eGFR or end-stage renal disease. Predictors for progression to the endpoint were determined by multivariate analyses. Results: Patients were 41 ± 15 years of age with a serum creatinine of 1.5 ± 0.8 mg/dl, eGFR of 61 ± 24 ml/min/1.73 m2, and proteinuria of 2.0 ± 1.6 g/day. Oxford classifications were as follows: M1 = 72%, E1 = 20%, S1 = 81%, and T1 = 13%/T2 = 22%. During the follow-up of 5.8 ± 4.8 years, 19% of patients reached the primary endpoint. While the Oxford classification was associated with progressive renal disease, only the T score (T0, T1, T2) was predictive of outcome with 6, 29, and 50% of patients (p = 0.002) reaching the primary endpoint. The 10-year renal survival for T0, T1, and T2 was 100, 50, and 17%, respectively (p < 0.001). By multivariate analysis, the hazard ratio for reaching the primary endpoint was 32 for patients with T ≧1 versus T0 (p = 0.01). Conclusions: In our experience, the Oxford classification predicts progressive renal disease, but the degree of tubulointerstitial fibrosis was the only feature independently predictive of outcome.

Electric utilities are employing large fossil and nuclear generating plants which are difficult to cycle to follow load. Additionally, it is very expensive to provide regulation with large fossil plants and government regulations prohibit the use of nuclear plants for regulation. The inability to cycle large plants produces a need for energy storage devices. Currently, several projects are underway to develop batteries to provide energy storage for peak shaving and load leveling. The batteries have a fast rate of response and therefore can potentially be used to provide regulation, thus improving the area control error (ACE)