Karly Hampshire had just started medical school when historic wildfires tore through Northern California in the fall of 2018.
Hampshire, now a fourth-year medical student at the University of California, San Francisco (UCSF), was struck by the dystopian bright orange skies on her commute to class, wearing an N95 mask to protect herself from the smog.
The environmental stresses of everyday life became even more apparent in places where they weren’t discussed – in the classroom.
“Even though we went to school every day in this horrible hellscape…our lung block didn’t cover the health effects of air pollution,” Hampshire said. MedPage today. “The reality of what was happening in our daily lives was so disconnected from what we were learning in the classroom.”
Although there has been growing pressure to introduce climate and health studies curricula in medical schools, courses on climate change are still not widespread. A recent survey by the International Federation of Medical Students Associations found that only 15% of medical schools worldwide teach a climate and health curriculum.
However, while some believe that adding a climate component to medical education could make the curriculum too crowded, alienating other clinical topics, climate and health advocates have pushed for an integrated approach. , asserting that climate change is a necessary core topic for physicians practicing in the 21st century.
“It’s fundamental to the mission of medicine,” said Renee Salas, MD, MPH, MS, an emergency physician at Massachusetts General Hospital in Boston who studies climate change and health. MedPage today. “It is an obligation of medical schools and continuing education to ensure that we can optimally prepare individuals to practice in today’s environment.”
Slow adoption, growing momentum
Hampshire’s freshman year in medical school inspired her to get involved in efforts to create a climate and health curriculum at UCSF. She also wanted to find a way to encourage other schools to participate and provide resources for incoming students to evaluate climate change initiatives at different institutions.
Hampshire and colleagues created the Planetary Health Report Card in 2019, a tool that compiles data on medical school climate-related offerings. The database includes information on 74 member institutions in seven countries, rating schools based on their planetary health agenda, interdisciplinary research, institutional support for climate projects, advocacy efforts, and campus sustainability.
It is difficult to assess exactly how many medical schools in the United States offer a climate change and health curriculum because the curricula are not publicly available. Hampshire noted that while uptake of climate and health studies curricula in medical schools across the country is currently slow, there is “tremendous momentum” to integrate this material into existing courses.
Over the next 5 or 10 years, Hampshire said, most schools will likely offer climate and health content.
“We are already seeing the health effects of climate change in our immediate environment and our immediate communities,” Hampshire said. “I think medical schools will start to feel like they’re lagging behind if they don’t address it in the curriculum.”
Added “One More Thing”
The movement to include climate change and health education in medical school curricula has gained momentum through many grassroots movements led by medical students and interns. However, medical schools often do not have the resources to deliver courses on climate.
According to Cecilia Sorensen, MD, director of Columbia University’s Global Consortium on Climate and Health Education, “There are tons of medical student groups who want this, but one of the big problems is that professors don’t have the expertise to teach it.”
“There are just knowledge capacity gaps everywhere that we are trying to fill,” Sorensen said. MedPage today. The consortium has nearly 300 members in more than 50 countries, including programs that train doctors, nurses, public health professionals and others, and offer resources to help schools develop climate curriculum, as well as continuing medical education courses for teachers who are interested. .
But aside from a lack of expertise, another hurdle is simply a lack of resources, Sorensen said. “For a faculty member to be able to do this work, to fit this into a very long-standing curriculum, that faculty has to be funded.”
In addition to concerns about the availability of resources to develop and teach a climate and health studies curriculum, there is also the busy schedule of the modern medical student to consider.
“I think a lot of people are worried because medical programs are already full of valuable information,” Salas said. “There are concerns about how they can add one more thing.”
An integrated approach
Medical schools have taken different approaches to providing climate and health education. Some schools offer semester-long courses on climate and health. Others choose a longitudinal approach, integrating climate change into their existing program. Climate and health advocates have advocated for an integrated approach to climate change education in medical schools to address concerns about taking time away from other necessary clinical topics.
James Sullivan, a medical student at the Cleveland Clinic Lerner College of Medicine in Ohio, and colleagues have proposed a model for integrating climate and health content into the current curriculum, adding planetary health components to clubs. reading, didactic sessions, learning problems and clinical rotations.
For example, Sullivan’s group recommended modified problem-based learning, adding questions about environmental triggers for asthma cases. Additionally, they proposed updating content around clinical and communication skills, and modifying learning objectives to incorporate conversations about the history and risks of climate change during patient examinations.
“This integrated approach, spanning all years of medical school and touching on multiple aspects of existing curricula, can enhance – rather than compete with – other content and better represent the real issues that clinicians will face in practice,” wrote Sullivan’s group.
While these integrated efforts are underway, there is significant room for improvement in how medical schools teach students about climate. In institutions where climate and health education exists, for example, there is wide variation in content, Sorensen said. Since climate-related content is not included in medical board exams, the material taught by schools is inconsistent.
“It’s not something that’s recognized as a universal skill for medical students,” Sorensen noted. “Because of this, we see a great variation in terms of what is actually taught.”
Along with efforts to add climate questions to board exams and increase the number of faculty members trained to teach, Hampshire said it would like to see more training in climate communication to patients. Physicians are in a unique position to engage with patients on a one-to-one basis, allowing them to communicate information not only about health, but also about climate advocacy efforts.
“A lot of times people think climate change is happening to someone else, somewhere else,” Hampshire said. “But when they realize that their health issues are directly linked to climate change, perhaps it can inspire broader change in our lives.”
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