As climate change accelerates, education becomes critical in medical schools

Key takeaways:

• Only 40% of medical schools that were surveyed have some integration of climate change education.
• The effects of climate change can apply to almost every specialty and their respective curriculum.

The impacts of climate change on the environment and society are rapidly progressing, and as a result, physicians will see more climate-related health effects in clinical settings, several experts and organizations have warned.

Last year, the AMA declared climate change a public health crisis threatening the well-being of all people. According to AMA Board Member Ilse R. Levin, DO, MPH, patients already face adverse health effects due to climate change, such as heat-related injuries, vector-borne diseases, air pollution from wildfires, worsening seasonal allergies and storm-related illness and injuries.

The Pan American Health Organization and WHO estimate that an additional 250,000 deaths per year will occur over the next decades as a result from climate change.

Arianne Teherani, PhD, a professor of medicine and founding codirector of the Center for Climate, Health and Equity at the University of California, San Francisco School of Medicine, told Healio that climate change education “needs to be mandatory, and it’s pretty clear that things are going from bad to worse.”

“Many physicians have not been trained about the impact of climate change on health, how it impacts health disparities among patients or how to identify that or be aware of it in the clinical setting,” Teherani said.

There have been talks of climate change becoming an area that medical professionals can specialize in, but Teherani said this “has to be something every physician knows how to address.”

“We already hit the world's record hot temperature, and this is not going to change,” she said. “Every human is going to be impacted by it. You can't escape from it. The health workforce must be ready to recognize and address overall health and inequitable health impacts.”

Metrics show schools’ climate change curriculums are middling

The current state of climate change education in the United States is captured in the 2022-2023 Planetary Health Report Card (PHRC) Summary Report, according to Taylor Diedrich, an MD candidate at the Indiana University School of Medicine and co-director of PHRC.

Created in 2019, PHRC is a metrics-based tool for measuring and grading planetary health content within medical schools. According to the PHRC website, schools are graded on metrics in five categories, including planetary health curriculum, campus sustainability, interdisciplinary research on health, support for student-led initiatives and the environment and community outreach and advocacy.

Overall, 96 medical schools worldwide participated in the 2022-2023 report card, including 44 schools in the U.S.

Diedrich told Healio that of the 44 schools:

• two reported that climate change was already well integrated into their core curriculum;
• 40% reported there is some integration into core curriculum;
• 43% reported that it is addressed in occasional standalone lectures; and
• 14% reported that they do not cover climate change.

Among the schools, 48% said they offered a course on climate change as an elective.

Although the average grade of all schools was a C, Diedrich said that 36% and 60% of institutions are in the process of making major and minor changes to curriculums, respectively. Only 5% of schools said they were not making any changes.

“That tells us that hopefully over the next few years, report card scores will significantly increase,” she said. “On average, schools participating in the PHRC have been getting better every year and making improvements to their curriculum. But we’re expecting to see a bigger change over the next few years.”

Content of climate change education

In climate change education, the specific content of a course or talk can be just as important — and varied — as what curriculum is offered.

Some schools “will have at least one lecture on the impact of climate change on health,” Teherani said.

“Some may not ... but most medical schools in the first or second year will have a course that focuses on the pulmonary system and that particular course may cover something in the way of wildfires,” she said.

Because climate change can affect every organ system and health outcome, Teherani said “it is possibly imaginable that a discussion of any sort of health outcome has to include what the impacts of climate change are.”

“It’s like the focus on health disparities,” she said. “Many communities are impacted by health disparities, and we have to proactively address those inequities when we talk about any aspect of health.”

Diedrich added that it may be more effective to incorporate climate health education within current classes as an overarching theme rather than having the topic taught in a single class.

“It should be in cardiology, it should be in psychiatry,” she said. “We know that there's a link between heat and suicide. We’re not asking for it to be its own class, but rather to include this content in existing lectures and case studies.”

Ultimately, “by integrating it into what you’re already learning about all the organ systems, it’s showing that a changing climate affects all of these areas,” Diedrich said. “We're not expecting students to leave school being an expert, but rather by seeing this information over and over, they're going to leave thinking, ‘okay, whatever field of medicine I go into, there is going to be a link there.’”

In addition to understanding the health effects of climate change, it will be important for medical students to engage in discussions about beliefs about climate change because this will likely come up in practice, Teherani said. A 2021 Yale Program on Climate Change Communication opinion map found that among respondents:

• 14% did not believe climate change is occurring;
• 34% were not worried about global warming; and
• 45% were a little or not at all worried that climate change would hurt them personally.

“It can be in some areas a contentious topic,” Teherani said. “As a physician, you can be in an awkward position when you’re trying to help a patient who has had some sort of respiratory problems as a result of wildfire smoke, and you want to guide them to protect themselves from future wildfires, but the patient doesn’t really believe that the wildfire smoke was due to climate change and could happen again.”

She added that education on climate communication and miscommunication is something that needs to be taught “sooner rather than later, even though we don’t have a full curriculum on all the health outcomes.”

“That should also be an important component of preparing the primary care provider,” she said.

Students’ voices play a critical role in advocacy

Although progress has been made in integrating health-related climate education, the PHRC data show that institutions are still far apart regarding consistent and well-implemented offerings. However, experts agreed that change can start with students.

“The voice of the students is very, very important,” Teherani said. “If anybody’s going to listen to anybody, it’s the voice of the students. Faculty, providers, leaders are going to listen to that. Advocacy on part of the students to institutional leaders is definitely an important place to start.”

However, those pushing for greater climate education may often face resistance.

“Sometimes the biggest roadblock is getting buy-in from faculty,” Diedrich said. “A valid concern is that schools already have to fit an overwhelming amount of information into the curriculum, which is why it’s helpful to integrate planetary health content into existing lectures. Another concern is the time and expertise needed to create this content; this is why the open-source materials provided by Climate Resources for Health Education is so helpful.”

It can also go a long way to provide faculty with examples of integration efforts of other schools.

“Some of the best schools in the country have integrated planetary health into their curriculum” she said. “Harvard just did it. George Washington University just did it. Emory does this. I think other medical schools take lead from the top-ranked institutions.”

For students who are interested in advocating for climate change curriculum, Diedrich recommended that they conduct a needs assessment and find a figure at the school who is willing to champion integration of climate health and could connect students to the curriculum committee.

CME can provide training, confidence in climate change knowledge

For physicians and other health care professionals who did not receive climate-related health education during medical school, there are still several training options available to them.

“There are tons of training fellowships. For example, the climate medicine and climate advocacy fellowship at the University of Colorado,” Teheran said. “That is a way to really become involved in that work.”

Other organizations have also engaged in efforts to help support and strengthen climate change education and action in medicine. Among these are Climate for Health, an initiative by ecoAmerica that offers various tools and resources.

“One of the big things we do is provide education and training to get clinicians, students and residents comfortable talking about climate change and health,” Ben Fulgencio-Turner, MPP, director of Climate for Health, told Healio.

Fulgencio-Turner said the initiative offers an ambassador program, “which is three units of continuing education that’s coaccredited for doctors, nurses, physician assistants, social workers, pharmacists, dentists and dieticians.”

“We offer that for free and it covers the impacts and solutions from both the big picture and things you can do as an individual health care provider, and then communications and engagement training,” he said.

Fulgencio-Turner has found that health care professionals may be “more hesitant to talk about something that seems outside of that range of their specialization.”

“You get a lot of, ‘I'm not an expert here. Climate is too political or too big. Or I just don't have any control of it,’” he said. “One of the greatest benefits of the training is to build confidence that, as a health professional, you do know enough about climate and health, that you’re already on the front lines of climate change work and that there are actions you can take right away that protect patient health.”

Participate in Climate Change activities at Healio CME

References:

• About Climate for Health. https://climateforhealth.org/about-climate-for-health/. Accessed July 27, 2023.
• About us. https://phreportcard.org/about/. Accessed July 12, 2023.
• Air pollution. https://www.who.int/health-topics/air-pollution#tab=tab_2. Accessed July 12, 2023.
• AMA adopts new policy declaring climate change a public health crisis. https://www.ama-assn.org/press-center/press-releases/ama-adopts-new-policy-declaring-climate-change-public-health-crisis. Published June 13, 2022. Accessed July 12, 2023.
• Ambassador training. https://climateforhealth.org/ambassadors-training/. Accessed Aug. 9, 2023.
• Climate change and health. https://www.paho.org/en/topics/climate-change-and-health. Accessed July 12, 2023.
• Metrics. https://phreportcard.org/metrics/. Accessed July 27, 2023.
• Planetary health report card. https://phreportcard.org/wp-content/uploads/2023/04/PHRC-2023-Med-Summary-Report-FINAL.pdf. Accessed July 12, 2023.
• Yale climate opinion maps 2021. https://climatecommunication.yale.edu/visualizations-data/ycom-us/. Accessed July 17, 2023.
• University of California Center for Climate Health and Equity. https://climatehealth.ucsf.edu/. Accessed Aug. 9, 2023.
• University of California Center for Climate Health and Equity Wildfires and Health Education Hub. https://climatehealth.ucsf.edu/wildfires-health-education-hub. Accessed Aug. 9, 2023.