1. Rabin, M. B; Laney, B. E., Philipsborn, P. R., The Unique Role of Medical Students in Catalyzing Climate Change Education. Journal of Medical Education and Curricular Development, 2020, vol. 7: 1-7.
Abstract
Climate change is a well-recognized threat to human health with impacts on every organ system and with implications for disease processes across subspecialties. Climate-driven environmental exposures influence the pathophysiologic underpinnings of disease emphasized in the pre-clinical years of medical school. While medical schools are beginning to offer climate change and health electives, medical education is lagging in providing fundamental climate-and-health content to adequately prepare the next generation of physicians for the challenges that they will face in the provision of healthcare and the prevention and treatment of disease. This perspective piece highlights the unique role of medical students in catalyzing the incorporation of climate content into the pre-clinical medical school curriculum and provides topics for disseminated curricular integration with the concepts emphasized in the pre-clinical years of medical education.
2. Philipsborn, P. R., Sheffield, P., White, A., Osta, A., Anderson, S,. M. Bernstein, A., Climate Change and the Practice of Medicine: Essentials for Resident Education Academic Medicine, 2021, vol. 96 (3)
Abstract
Despite calls for including content on climate change and its effect on health in curricula across the spectrum of medical education, no widely used resource exists to guide residency training programs in this effort. This lack of resources poses challenges for training program leaders seeking to incorporate evidence-based climate and health content into their curricula. Climate change increases risks of heat-related illness, infections, asthma, mental health disorders, poor perinatal outcomes, adverse experiences from trauma and displacement, and other harms. More numerous and increasingly dangerous natural disasters caused by climate change impair delivery of care by disrupting supply chains and compromising power supplies. Graduating trainees face a knowledge gap in understanding, managing, and mitigating these many-faceted consequences of climate change, which—expected to intensify in coming decades—will influence both the health of their patients and the health care they deliver. In this article, the authors propose a framework of climate change and health educational content for residents, including how climate change (1) harms health, (2) necessitates adaptation in clinical practice, and (3) undermines health care delivery. The authors propose not only learning objectives linked to the Accreditation Council for Graduate Medical Education core competencies for resident education but also learning formats and assessment strategies in each content area. They also present opportunities for implementation of climate and health education in residency training programs. Including this content in residency education will better prepare doctors to deliver anticipatory guidance to at-risk patients, manage those experiencing climate-related health effects, and reduce care disruptions during climate-driven extreme weather events.
3. Tun M. S., Fulfilling a new obligation: teaching and learning of sustainable healthcare in the medical education curriculum. Med Teach. 2019, 41:1168-1177.
Abstract
Aims: leading the growing international recognition of the need for sustainability in healthcare delivery, the UK medical regulator has mandated that newly qualified doctors must be able to apply the principles of sustainable healthcare to medical practice. This original research investigates how best to incorporate this new learning into the medical curriculum.
Methods: data from multiple sources were triangulated to generate themes through grounded theory. Meetings were held with representatives of key stakeholder organizations, relevant documents were reviewed and semi-structured interviews were conducted with diverse medical educators who teach sustainable healthcare.
Results: there is continual pressure on space in the curriculum, and faculty lack the knowledge to teach this emerging subject, which is also difficult to examine. Students increasingly demand that sustainability be addressed in their education and future careers. Many sources of support and learning resources are available.
Conclusions: practical recommendations for implementation in any medical school include: teaching sustainability as a cross-cutting theme rather than a topic, clinicians and students learning from each other in this developing field, and embedding into assessment the wider determinants of disease. Sustainable healthcare emphasizes prevention rather than late intervention, with benefits to the environment on which health depends, healthcare systems and patients.
4.Omrani, O. E., Dafallah, A., Paniello Castillo, B., Amaro, B., Taneja, S., Amzil, M., Sajib, M. R. U., Ezzine, T., Envisioning planetary health in every medical curriculum: An international medical student organization’s perspective. Med Teach. 2020, 42 (10):1107-11.
Abstract
Background: with deteriorating ecosystems, the health of mankind is at risk. Future health care professionals must be trained to recognize the interdependence of health and ecosystems to address the needs of their patients and communities. Health issues related to, e.g. climate change and air pollution, are not, however, generally included in medical education.
Objectives: to assess the inclusion of climate change and air pollution in medical curricula and to guide the International Federation of Medical Students’ Associations’ (IFMSA) Vision of Climate Change in the Medical Curriculum.
Methods: a study comprising three surveys (March 2019, August 2019, March 2020) explored medical students’ perceptions of the current status of formal and non-formal elements of climate change and air pollution and health in their medical programs.
Results: respondents originated from 2817 medical schools in 112 countries. Only 15% of medical schools have incorporated climate change and health into the curriculum. Students led climate-related activities in an additional 12% of medical schools. With regard to air pollution and health, only 11% of medical schools have formal education on the topic.
Conclusions: it is crucial to acknowledge the current omissions from medical curricula and the importance of meaningful student involvement in curriculum transformation.
5. Lemery, J., Balbus, J. Sorensen, C., Rublee, C., Dresser, C., Balsari, S., Hynes, E. C., Training Clinical And Public Health Leaders In Climate And Health, Health Affairs vol.39 (12)
Abstract
The effects of climate change are accelerating and undermining human health and well-being in many different ways. There is no doubt that the health care sector will need to adapt, and although it has begun to develop more targeted strategies to address climate-related challenges, a broad knowledge gap persists. There is a critical need to develop and cultivate new knowledge and skill sets among health professionals, including those in public health, environmental science, policy, and communication roles. This article describes specific initiatives to train future leaders to be proficient in understanding the linkages between climate change and health. We present an agenda for expanding education on climate and health through health professional schools and graduate and postgraduate curricula, as well as in professional and continuing education settings. Our agenda also identifies ways to promote sustainability in clinical practice and health care management and policy. Throughout, we cite metrics by which to measure progress and highlight potential barriers to achieving these educational objectives on a larger scale.
6. Brand, G., Collins, J., Bedi, G., Bonnamy, J. Barbour, L., Ilangakoon, C., Wotherspoon, R., Simmons, M., Kim, M., Schwerdtle, N. P., “I teach it because it is the biggest threat to health”: Integrating sustainable healthcare into health professions education Med. Teach., 2021, vol. 43 (3):325-333.
Abstract
Background: steering planetary and human health towards a more sustainable future demands educated and prepared health professionals.
Aim: this research aimed: to explore health professions educators’ sustainable healthcare education (SHE) knowledge, attitudes, self-efficacy and teaching practices across 13 health professions courses in one Australian university.
Methods: utilising a sequential mixed-methods design: Phase one (understanding) involved an online survey to ascertain educators’ SHE knowledge, attitudes, self-efficacy and teaching practices to inform phase two (solution generation), ‘Teach Green’ Hackathon. Survey data was descriptively analysed and a gap analysis performed to promote generation of solutions during phase two. Results from the hackathon were thematically analysed to produce five recommendations.
Results: regarding SHE, survey data across 13 health professions disciplines (n = 163) identified strong content knowledge (90.8%); however, only (36.9%) reported confidence to ‘explain’ and (44.2%) to ‘inspire’ students. Two thirds of participants (67.5%) reported not knowing how best to teach SHE. Hackathon data revealed three main influencing factors: regulatory, policy and socio-cultural drivers.
Conclusions: The five actionable recommendations to strengthen interdisciplinary capacity to integrate SHE include: inspire multi-level leadership and collaboration; privilege student voice; develop a SHE curriculum and resources repository; and integrate SHE into course accreditation standards.
7. Hansen, M., Rohn, S., Moglan, E., Sutton, W., Olagunju, T. A. Promoting climate change issues in medical education: Lessons from a student-driven advocacy project in a Canadian Medical school, Jour Clima Chang and Health, 2021, (3)
Abstract
Health advocacy is an essential competency prescribed by many professional medical bodies tasked with fostering the development of medical trainees into well-rounded physicians. With increasing recognition of the ramifications of the negative impacts of climate change on population health, mitigation intervention is gaining traction as an important area in public health and physician’s advocacy work. However, several lines of evidence show that Canadian medical training provides limited curricular activities to understand the impacts of climate change on health. This report highlights an advocacy effort by a group of medical students at McMaster University, Canada to promote better awareness and formal educational activities on climate change and health among medical learners. The project involves educational activities, didactic lectures, and an engagement with the medical school administration to promote curricular activities and resources on cli-mate change and health. The lessons from this advocacy work include the need for better integration of cli-mate change issues and health education into medical training, celebrating climate advocacy work, and creating a formalized portfolio within medical school administration to support climate change and health issues.
8. Kotcher, J., Maibach, E., Miller, J., Campbell,.E., Alqodmani, L., Maiero, M., Wyns, A., Views of health professionals on climate change and health: a multinational survey study. The Lancet Planetary health, 2021, 5 (5):e316-e23.
Abstract
Climate change arguably represents one of the greatest global health threats of our time. Health professionals can advocate for global efforts to reduce emissions and protect people from climate change; however, evidence of their willingness to do so remains scarce. In this Viewpoint, we report findings from a large, multinational survey of health professionals (n=4654) that examined their views of climate change as a human health issue. Consistent with previous research, participants in this survey largely understood that climate change is happening and is caused by humans, viewed climate change as an important and growing cause of health harm in their country, and felt a responsibility to educate the public and policymakers about the problem. Despite their high levels of commitment to engaging in education and advocacy on the issue, many survey participants indicated that a range of personal, professional, and societal barriers impede them from doing so, with time constraints being the most widely reported barrier. However, participants say various resources – continuing professional education, communication training, patient education materials, policy statements, action alerts, and guidance on how to make health-care workplaces sustainable – can help to address those barriers. We offer recommendations on how to strengthen and support health professional education and advocacy activities to address the human health challenges of climate change.
9. Madden, D.L., McLean, M., Brennan, M., Moore, A., Why use indicators to measure and monitor the inclusion of climate change and environmental sustainability in health professions’ education? Med Teach. 2020, 42 (10):1119–22.
Abstract
Currently, health professionals are inadequately prepared to meet the challenges that climate change and environmental degradation pose to health systems. Health professions’ education (HPE) has an ethical responsibility to address this and must include the health effects of climate change and environmental sustainability across all curricula. As there is a narrow, closing window in which to take action to avoid the worst health outcomes from climate change, urgent, systematic, system-level change is required by the education sector. Measuring, monitoring, and reporting activity using indicators have been demonstrated to support change by providing a focus for action. A review of the literature on the use of indicators in medical education for climate change and health, however, yielded no publications. The framework of targets and indicators developed for implementation of the Sustainable Development Goals (SDGs) by 2030 and the UNESCO initiative of the Education for Sustainable Development provide a guide for the development of indicators for HPE. Engaging stakeholders and achieving consensus on an approach to indicator development is essential and, where they exist, accreditation standards may have a supporting role. Creating capacity for environmentally sustainable health care at scale and pace should be our collective goal as health professions’ educators.
10. Nikendei C, Cranz A, Bugaj TJ. Medical education and the COVID-19 pandemic - a dress rehearsal for the "climate pandemic"? GMS J Med Educ. 2021; 38 (1)
Abstract
In the present commentary, we raise the question whether the COVID-19 pandemic should be seen as just the dress rehearsal for what awaits us in the impending climate crisis. Many factors have helped us navigate the challenge of this coronavirus pandemic and continue to do so. These include recognizing scientific expertise, medical education, and digitalization as important driving forces, providing us with key information about the SARS-CoV-2 virus, as well as integrating it into our curricula and promoting action-oriented research. However, the "premiere of the climate pandemic" will, in all likelihood, confront us with even greater challenges, difficulties, and threats. Adhering to scientific findings, promoting medical education about the effects of global warming and using the power of digitalization, as well as consciously engaging in our role as medical caregivers and leaders will make a decisive contribution to providing impetus for climate action.
11. Shea B, Knowlton K, Shaman J. Assessment of Climate-Health Curricula at International Health Professions Schools. JAMA Netw Open. 2020; 3 (5):e206609.
Abstract
Importance: Researchers have published surveys on health professionals' perceptions of the possible association between climate change and health (climate-health) and assessed climate-health or planetary health curricula in medical schools. However, curricula on climate-health are still lacking and gaps in knowledge persist.
Objective: To understand the state of climate-health curricula among health professions institutions internationally.
Design, Setting, and Participants: A survey of 160 institutional members of the Global Consortium on Climate and Health Education, which includes international health professions schools and programs, was conducted from August 3, 2017, to March 1, 2018. The survey, hosted by Columbia University Mailman School of Public Health, used an online survey tool for data collection.
Main Outcomes and Measures: The survey assessed climate-health curricular offerings across health professions institutions internationally, including existing climate-health educational offerings, method of teaching climate-health education, whether institutions are considering adding climate-health education, whether institutions received a positive response to adding climate-health curricula and/or encountered challenges in adding curricula, and opportunities to advance climate-health education.
Results: Overall response rate to the survey was 53%, with 84 of 160 institutional responses collected; 59 of the responses (70%) were from schools/programs of public health, health sciences, or health professions; 15 (18%) were from medicine; 9 (11%) were from nursing; and 1 (1%) was from another type of health profession institution. Among respondents, 53 (63%) institutions offer climate-health education, most commonly as part of a required core course (41 [76%]). Sixty-one of 82 respondents (74%) reported that climate-health offerings are under discussion to add, 42 of 59 respondents (71%) encountered some challenges trying to institute the curriculum, and most respondents have received a positive response to adding content, mainly from students (39 of 58 [67%]), faculty (35 of 58 [60%]), and administration (23 of 58 [40%]).
Conclusions and Relevance: Current climate-health educational offerings appear to vary considerably among health professions institutions. Students, faculty, and administration are important groups to engage when instituting curricula, and awareness, support, and resources may be able to assist in this effort.
12. Fadadu, P. R., Erny, C. B., Necessity and implementation of climate and health education for medical students and physicians J Clim Change Health (1) (2021), 10.1016/j.joclim.2021.100004
Abstract
As the climate crisis intensifies, it is necessary for medical students to be trained to recognize, address, and mitigate the resulting health harms on individual patients and their communities via climate and health education. The World Health Organization and Lancet declared that climate change is the greatest threat to human health in the 21st century. Several professional societies, including the American Medical Association, have released statements in support of climate health education for pre-clinical, clinical, and continuing medical education. To advocate for climate health education, medical students in the United States have recently formed a national alliance: Medical Students for a Sustainable Future. Despite these calls for action, current medical education in the U.S. and globally does not sufficiently include climate and health topics. Since medical education aims to teach learners how to diagnose, treat, and prevent diseases as well as promote public health, the effects of climate change on human health and health systems are appropriate and essential content.
13. Kligler, B., Pinto Zipp, G., Rocchetti, C. et al. The impact of integrating environmental health into medical school curricula: a survey-based study. BMC Med Educ, 2021, 21, 40 (2021). https://doi.org/10.1186/s12909-020-02458-x
Abstract
Background: Inclusion of environmental health (EH) in medical education serves as a catalyst for preparing future physicians to address issues as complex as climate change and health, water pollution and lead contamination. However, previous research has found EH education to be largely lacking in U.S. medical education, putting future physicians at risk of not having the expertise to address patients’ environmental illnesses, nor speak to prevention.
Methods: Environmental health (EH) knowledge and skills were incorporated into the first-year medical school curriculum at Hackensack Meridian School of Medicine (Nutley, New Jersey), via a two-hour interactive large group learning module with follow up activities. Students completed the Environmental Health in Med School (EHMS) survey before and after the year 1 EH module. This survey evaluates medical students’ attitudes, awareness and professionalism regarding environmental health. In year 2, students completed the Environmental Health Survey II, which measured students’ perceptions of preparedness to discuss EH with future patients. The research team created both surveys based upon learning objectives that broadly aligned with the Institute of Medicine six competency-based environmental health learning objectives.
Results: 36 year 1 students completed both the pre and post EHMS surveys. McNemar’s test was used for paired comparisons. Results identified no statistically significant changes from pre to post surveys, identifying a dramatic ceiling. When comparing year 2, EHS II pre-survey (n = 84) and post-survey (n = 79) responses, a statistically significant positive change in students’ self-reported sense of preparedness to discuss environmental health with their patients following the curriculum intervention was noted.
Conclusions: our conclusion for the EHMS in Year 1 was that the current generation of medical students at this school is already extremely aware of and concerned about the impact of environmental issues on health. Through the EHS II in Year 2, we found that the six-week environmental health module combining didactic and experiential elements significantly increased medical students’ self-reported sense of preparedness to discuss environmental health issues, including climate change, with their patients.
14. Goshua A, Gomez J, Erny B, Burke M, Luby S, Sokolow S, et al. Addressing climate change and its effects on human health: a call to action for medical schools. Acad Med 2020, 96, (3)
Human health is increasingly threatened by rapid and widespread changes in the environment and climate, including rising temperatures, air and water pollution, disease vector migration, floods, and droughts. In the United States, many medical schools, the American Medical Association, and the National Academy of Sciences have published calls for physicians and physicians-in-training to develop a basic knowledge of the science of climate change and an awareness of the associated health risks. The authors—all medical students and educators—argue for the expeditious redesign of medical school curricula to teach students to recognize, diagnose, and treat the many health conditions exacerbated by climate change as well as understand public health issues. In this Invited Commentary, the authors briefly review the health impacts of climate change, examine current climate change course offerings and proposals, and describe the rationale for promptly and comprehensively including climate science education in medical school curricula. Efforts in training physicians now will benefit those physicians’ communities whose health will be impacted by a period of remarkable climate change. The bottom line is that the health effects of climate reality cannot be ignored, and people everywhere must adapt as quickly as possible.
15. Sullivan, J. K.; Lowe, K. E.; Ilyssa, O. G., Colleen, Y. C.; Renee, N. S.; Aaron, B.; Jon, U.; Marvin, R. N.; Neil, M.; Isaacson, J. H. Climate Change and Medical Education an Integrative Model, academic medicine, 2021, ahead-of-print
Abstract
Medical schools face a challenge when trying to include new topics, such as climate change and health (CCH), in their curricula because of competing demands from more traditional biomedical content. At the same time, an understanding of CCH topics is crucial for physicians as they have clear implications for clinical practice and health care delivery. Although some medical schools have begun to incorporate CCH into curricula, the inclusion usually lacks a comprehensive framework for content and implementation. The authors propose a model for integrating CCH into medical school curricula using a practical, multi-stakeholder approach designed to mitigate competition for time with existing content by weaving meaningful CCH examples into current curricular activities. After the authors identified stakeholders to include in their curricular development working group, this working group determined the goals and desired outcomes of the curriculum; aligned those outcomes with the school’s framework of educational objectives, competencies, and milestones; and strove to integrate CCH goals into as many existing curricular settings as possible. This article includes an illustration of the proposed model for one of the curricular goals (understanding the impacts of climate change on communities), with examples from the CCH curriculum integration that began in the fall of 2020 at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. The authors have found that this approach does minimize competition for time with existing content and allows mapping of content to existing curricular competencies and milestones, while encouraging a broad understanding of CCH in the context of individual patients, populations, and communities. This model for curricular integration can be applied to other topics such as social determinants of health, health equity, disability studies, and structural racism.
16. Philipsborn, R. P.; Sheffield, P.; White, A.; Osta, A.; Anderson, M. S.; Bernstein, A. Climate Change and the Practice of Medicine: Essentials for Resident Education Academic medicine, 2021, 96 (3)
Abstract
Despite calls for including content on climate change and its effect on health in curricula across the spectrum of medical education, no widely used resource exists to guide residency training programs in this effort. This lack of resources poses challenges for training program leaders seeking to incorporate evidence-based climate and health content into their curricula. Climate change increases risks of heat-related illness, infections, asthma, mental health disorders, poor perinatal outcomes, adverse experiences from trauma and displacement, and other harms. More numerous and increasingly dangerous natural disasters caused by climate change impair delivery of care by disrupting supply chains and compromising power supplies. Graduating trainees face a knowledge gap in understanding, managing, and mitigating these many-faceted consequences of climate change, which—expected to intensify in coming decades—will influence both the health of their patients and the health care they deliver. In this article, the authors propose a framework of climate change and health educational content for residents, including how climate change (1) harms health, (2) necessitates adaptation in clinical practice, and (3) undermines health care delivery. The authors propose not only learning objectives linked to the Accreditation Council for Graduate Medical Education core competencies for resident education but also learning formats and assessment strategies in each content area. They also present opportunities for implementation of climate and health education in residency training programs. Including this content in residency education will better prepare doctors to deliver anticipatory guidance to at-risk patients, manage those experiencing climate-related health effects, and reduce care disruptions during climate-driven extreme weather events.
17. McElroy, G.K.; Gilden, R.; Sattler, B. Environmental health nursing education: One school’s journey, Public Health Nurs, 2021, 38:258-265
Abstract
Nurse educators have long recognized the need for an increased focus on environmental health education in nursing. For decades, schools of nursing have answered the call to action put forth by the Institute of Medicine and the American Nurses Association to incorporate environmental health content into nursing curricula. This article details the experiences of faculty and staff at the University of Maryland School of Nursing as they launched a national environmental health nursing organization, developed individual undergraduate elective courses on environmental health and climate change, and created a post-baccalaureate certificate program. We also report student registration and evaluation data from five environmental health courses over 10 years. Five hundred five undergraduate and 291 graduate nursing students from a variety of programs received formal environmental health education. Relevance of content was consistently highly rated, ranging from 4.17 to 4.61 out of 5, and students completed projects on a wide range of environmental health topics. Graduates of the certificate program have greatly impacted their communities in the areas of nursing practice, education, and policy.
18. Guide to Climate and Health Curriculum Reform in Medical Schools. Medical Students for a Sustainable Future. (2020, April 19) https://drive.google.com/file/d/1L07y0o5CiYJH4mTyuEo3QGfQQSYrnHjC/view
Climate change is the greatest public health and medical crisis of the 21st century, as it is a defining modifier of the global burden of disease (1). We propose introducing a “Climate Change & Health” longitudinal thread into the Phase I, II, and II curriculums to provide medical students with education on the environmental determinants of health. This longitudinal thread will provide an overview of the wide- ranging health impacts of climate change and the impact of the health system on the environment.
Over the last 30 years various health associations, international organizations, and physicians have described climate change as a health crisis that health professionals must prepare to face (1). In 2008 and again in 2019, the American Medical Association (AMA) released a policy on “Global Climate Change and Human Health” advocating for research on the health impacts of climate change and inclusion of climate education in medical school curricula (1,2). Numerous other medical organizations including the American College of Physicians, the United Nations, and the World Health Organization have followed suit (3–8). While climate change is undoubtedly a global health challenge, it also presents an opportunity for us as the rising generation of clinicians to protect the health of our future patients. Penn State College of Medicine, in line with our institution’s mission to create holistic, innovative leaders, should take a leading role to incorporate this discipline into medical training. This integrative “Climate Change & Health” curriculum will significantly benefit the student body and the patients we serve.
19. Schwerdtle PN, Maxwell J, Horton G, Bonnamy J. 2020. 12 tips for teaching environmental sustainability to health professionals. MedTeach. 42(2):150–155.
Abstract
Background: As recognition of the health impacts of climate change and other environmental challenges increases, so too does the need for health care professionals to practice healthcare sustainably. Environmental sustainability in healthcare extends beyond our traditional understanding of environmental health, which is often limited to environmental hazards and disease. Health services, professional organizations, and training institutions are increasingly forming climate and sustainability position statements and policies accordingly. To prepare future health professionals for global environmental change, environmental sustainability must be meaningfully integrated into health curricula.
Aim: To provide educators with 12 tips for integrating environmental sustainability into health professional education.
Methods: The authors reviewed the literature relating to climate change, environmental sustainability and health, and health professional education. By combining findings from this search with reflections on their own experience in clinical and public health teaching across nursing and midwifery, paramedicine, medicine, and public health, the authors developed recommendations for integrating environmental sustainability into health professional education.
Results: These 12 tips can be used to teach students and qualified health professionals in nursing, allied health, and medicine to practice healthcare in an environmentally sustainable manner.
Conclusions: Empowering health professionals to practice environmentally sustainable healthcare has economic, social, health, and environmental benefits. Teaching environmental sustainability to health professionals enhances existing learning by updating curricula with the latest evidence of how environmental determinants of health are rapidly changing and enables both educators and students to make an important contribution to safeguarding human health, the environment, and healthcare for future generations.
20. McLean, M., Madden, D. L., Maxwell, J., Schwerdtle, P. N., Richardson, J., Singleton, J., MacKenzie, K., Behrens, G., Cooling, N., Matthews, R. S., & Hortibn, G. Planetary Health: Educating the current and future health workforce. Clinical Education for the Health Professions, 2020, pp.1-30
Abstarct
Human health and well-being are inextricably linked to the environment, but human development in Western countries has been at the expense of the natural environment, largely through our reliance on fossil fuels. As we may have already reached “tipping points” in terms of some global environmental changes (e.g., climate change, biodiversity loss, air pollution), threatening human health and well-being, health professionals must respond urgently through mitigation, adaptation, and advocacy. Many are, however, not sufficiently informed to feel confident to do so. There is thus an imperative to upskill and educate practicing health professionals and current health professional students to practice environmentally sustainable health care and to take action to protect the environment to ensure human health. This chapter sets the scene in terms of the importance of the environmental determinants of health for individuals and for populations. It also provides health professionals and health professions educators with a resource list and case studies to guide the integration of planetary health and sustainable health care into the curriculum.
21. Bandyopadhyay, S., Thomas, H. S., Gurung, B., Trout, I., Wadanamby, S. W., Akhbari, M., Sharma, K., Fitzgerald, J. E., Harrison, E. M., Smith, A. D., Shortland, T., Patel, R., Khundkar, R., Patel, R., Clark, D., Dunn, M., Johnson, O., Hussain, N., Nepogodiev, D.,. Global health education in medical schools (GHEMS): A national, collaborative study of medical curricula. BMC Medical Education, 2020, 20(1), 389
Abstract
Background: Global health is the study, research, and practice of medicine focused on improving health and achieving health equity for all persons worldwide. International and national bodies stipulate that global health be integrated into medical school curricula. However, there is a global paucity of data evaluating the state of global health teaching in medical schools. This study aimed to evaluate the extent of global health teaching activities at United Kingdom (UK) medical schools.
Methods: a national, cross-sectional study assessing all timetabled teachings sessions within UK medical courses for global health content during the academic year 2018/19. Global health content was evaluated against a comprehensive list of global health learning outcomes for medical students.
Results: data from 39 medical courses representing 86% (30/36) of eligible medical schools was collected. Typically, medical courses reported timetabled teaching covering over three-quarters of all global health learning outcomes. However, a wide degree of variation existed among granular global health learning objectives covered within the different medical courses. On average, each learning outcome had a 79% [95% CI: 73, 83%] probability of being included in course curricula. There were a number of learning outcomes that had a lower probability, such as ‘access to surgeons with the necessary skills and equipment in different countries’ (36%) [95% CI: 21, 53%], ‘future impact of climate change on health and healthcare systems’ (67%) [95% CI: 50, 81%], and ‘role of the WHO’ (54%) [95% CI: 28, 60%].
Conclusions: this study served as the first national assessment of global health education and curricula within UK medical schools. Through a formalised assessment of teaching events produced by medical schools around the country, we were able to capture a national picture of global health education, including the strengths of global health prioritisation in the UK, as well as areas for improvement. Overall, it appears broad-level global health themes are widely discussed; however, the granularities of key, emerging areas of concern are omitted by curricula. In particular, gaps persist relating to international healthcare systems, multilateral global health agencies such as the WHO, global surgery, climate change and more.
22. Schwerdtle N, Horton G, Kent F, Walker L, McLean M. 2020. Education for sustainable healthcare: a transdisciplinary approach to transversal environmental threats. Med Teach. 42(10):1102–1105.
Abstract
Global Environmental Changes are dynamic and complex, crossing disciplines, sectors, regions, and populations and shaping the health of current and future generations. GECs present an unprecedented challenge demanding a response of equal scale and complexity involving unfettered collaboration beyond disciplines with implications for global health. At this critical point, health professions’ education should have moved on from building consensus about the relevance of education for sustainable healthcare (ESH) to active implementation. In this commentary, we discuss why transdisciplinary problem-solving and interprofessional education should be considered in education for sustainable healthcare. We review types of collaborative educational practices, outline opportunities, challenges, and resources to enable implementation.
23. Matthews NR, Davies B, Ward H. Global health education in UK medical schools: a review of undergraduate university curricula. BMJ Global Health 2020; 5: e002801.
Abstract
Introduction: In recognition of our increasingly globalised world, global health is now a required component of the medical school curriculum in the UK. We review the current provision of global health education (GHE) in UK medical schools to identify gaps in compulsory teaching.
Methods: We conducted a review of the literature to inform a two- part electronic survey of global health compulsory teaching, optional teaching and pre- elective training. Surveys were sent to all 33 UK medical schools for completion by the faculty lead on global health and the nominated final year student representative.
Results: Surveys were returned by 29 (88%) medical school faculty and 15 (45%) medical student representatives; 24 (83%) faculty and 10 (67%) students reported including GHE in the core curriculum; however, there was wide variation in the learning outcomes covered. On average 75% of faculty and 82% of students reported covering recommended global health themes ‘global burden of disease’, ‘socioeconomic and environmental determinants of health’, ‘human rights and ethics’, and ‘cultural diversity and health’, while only 48% of faculty and 33% of students reported teaching on ‘health systems’ and ‘global health governance’. Almost all institutions offered optional global health programmes and most offered some form of pre- elective training, although content and delivery were variable.
Conclusion: Over the last decade, the inclusion of global health in the core curriculum of UK medical schools has increased dramatically. Yet, despite interest among students, significant gaps are apparent in current GHE. Governing bodies in medical education should establish a comprehensive national strategy to help improve access to fundamental GHE for all medical students.
24. Fehlner, W. (2019) Educating for Sustainability: The Crucial Role of the Tertiary Sector. Journal of Sustainable Development, 12 (2), 18-28.
Abstract
The Sustainable Development Goals of the United Nations represent a universal response to current global challenges that include climate change, poverty, political instability and the massive displacement of people worldwide. The central role of education in achieving sustainable development has been internationally acknowledged and successfully promoted: Global enrolment rates are now 90 percent for primary education and over 70 percent for secondary education. Building on these achievements, this paper focuses the role of tertiary education in contributing to sustainable development. This study reviewed recent theoretical and empirical research relating to the field. Conclusions from theoretical studies confirm that building on human capital is crucial for achieving the sustainable development goals. The majority of empirical studies also confirm a positive correlation between tertiary education and sustainable development. This study highlighted, however, that the full benefits of tertiary education to society may have been underestimated and that there are significant research gaps in the field. Furthermore, current challenges including funding, equity and market relevancy in tertiary education need to be addressed. Given the pressing global issues and the mounting evidence of positive impacts, this paper calls for more research and attention to be devoted to tertiary education in the sustainable development debate.
25. Findler, F., Schönherr, N., Lozano, R., Reider, D. and Martinuzzi, A. (2019) The impacts of higher education institutions on sustainable development. A review and conceptualization. International Journal of Sustainability in Higher Education, 20 (1), 23-38.
Abstract
Purpose: this paper aims to conceptualize impacts of higher education institutions (HEIs) on sustainable development (SD), complementing previous literature reviews by broadening the perspective from what HEIs do in pursuit of SD to how these activities impact society, the environment and the economy.
Design/methodology/approach: the paper provides a systematic literature review of peer-reviewed journal articles published between 2005 and 2017. Inductive content analysis was applied to identify major themes and impact areas addressed in the literature to develop a conceptual framework detailing the relationship between HEIs’ activities and their impacts on SD.
Findings: the paper identifies six impact areas where direct and indirect impacts of HEIs on SD may occur. The findings indicate a strong focus on case studies dealing with specific projects and a lack of studies analyzing impacts from a more holistic perspective.
Practical implications: this systematic literature review enables decision-makers in HEIs, researchers and educators to better understand how their activities may affect society, the environment and the economy, and it provides a solid foundation to tackle these impacts.
Social implications: the review highlights that HEIs have an inherent responsibility to make societies more sustainable. HEIs must embed SD into their systems while considering their impacts on society.
Originality/value: this paper provides a holistic conceptualization of HEIs’ impacts on SD. The conceptual framework can be useful for future research that attempts to analyze HEIs’ impacts on SD from a holistic perspective.
26. Molthan-Hill, P.; Worsfold, N.; Nagy J.G; Filho, L.W. Mifsud, M. (2019) Climate change education for universities: A conceptual framework from an international study Journal of Cleaner Production 226, 1092e1101
Abstract
The role of universities in climate change education (CCE) is of great importance if the scientific, social, environmental and political challenges the world faces are to be met. Future leaders must make decisions from an informed position and the public will need to embed climate change mitigation tools into their work and private life. It is therefore essential to understand the range of CCE strategies being taken globally by Higher Education Institutions (HEIs) and to explore and analyse the ways that HEIs could better address this challenge. Consistent with this research need, this paper offers an analysis of the extent to which HEIs in 45 countries approach CCE and provides a conceptual framework for exploring how HEIs are embedding CCE into their curricula. In addition to the specialist approach (where students choose to study a degree to become experts in climate change adaptation and mitigation tools), the CCE framework developed identifies and highlights three other approaches HEIs can deploy to embed CCE: Piggybacking, mainstreaming and connecting (transdisciplinary). Using data gathered in an explorative international survey involving participants working across academic and senior management, this paper illustrates the different approaches taken and analyses practical examples of current CCE practice from across the world. Responses from 212 university staff from 45 countries indicated that CCE was highly variable e no clear pattern was identified at the country level, with CCE approaches varying significantly, even within individual HEIs. This plurality highlights the wide range of ideas and examples being shared and used by institutions in very different countries and contexts, and underlines the importance of the independence and autonomy of HEIs so that they can choose the right CCE approaches for them. To highlight the breadth and variety of approaches that were uncovered by our survey, the paper offers a range of examples illustrating how climate change education may be embedded in a higher education context, some of which could be replicated in HEIs across the world. The conceptualisation of CCE and the examples given in this paper are valuable for anyone who is thinking about strategies for embedding more climate education in the higher education curriculum.
27. Purcell, W., Henriksen, H. and Spengler, J. (2019) Universities as the engine of transformational sustainability toward delivering the sustainable development goals. “Living labs” for sustainability. International Journal of Sustainability in Higher Education, 20 (8), 1343-1357.
Abstract
Purpose – Universities can do more to deliver against the sustainable development goals (SDGs), working with faculty, staff and students, as well as their wider stakeholder community and alumni body. They play a critical role in helping shape new ways for the world, educating global citizens and delivering knowledge and innovation into society. Universities can be engines of societal transformation. Using a multiple case study approach, this study aims to explore different ways of strategizing sustainability toward delivering the SDGs are explored in a university setting with an example from the UK, Bulgaria (Europe) and USA.
Design/methodology/approach – The first case is a public UK university that adopted enterprise and sustainability as its academic mission to secure differentiation in a disrupted and increasingly marketized global higher education sector; this became a source of inspiration for change in regional businesses and the local community. The second case is a business sector-led sustainability-driven transformation working with a private university in Bulgaria to catalyze economic regeneration and social innovation. Finally, a case from the office for sustainability in a major US research university is given to show how its engagement program connected faculty and students in sustainability projects within the institution and with external partners.
Findings – Each case is in effect a “living lab,” positioning sustainability as an intentional and aspirational strategy with sustainable development and the SDG framework a means to that end. Leadership at all levels, and by students, was key to success in acting with a shared purpose. Partnerships within and with universities can help accelerate delivery of the SDGs, enabling higher education to make a fuller contribution to sustaining the economic, environmental, cultural and intellectual well-being of our global communities.
Originality/value – The role of universities as the engine of transformational sustainability toward delivering the SDGs has been explored by way of three case studies that highlight different means toward that end. The collegiate nature of the higher education sector, with its shared governance models and different constituencies and performance drivers, means that sustainability at a strategic level must be led with leaders at all levels acting with purpose. The “living lab” model can become a part of transformative institutional change that draws on both top-down and bottom-up strategies in pursuit of sustainable development
28. Shields, R. (2019) The sustainability of international higher education: Student mobility and global climate change. Journal of Cleaner Production, 217, 594-602.
Abstract
Much literature discusses higher education as an agent for sustainable development, but the extent to which higher education contributes to unsustainable economic and social systems receives less attention. This paper examines the environmental impacts of international student mobility in higher education. Combining several datasets, the paper presents a model of greenhouse gas emission associated with international student mobility. Estimates suggest that these emissions are substantial and are rising faster than overall global emissions, but the emissions per student are slowly decreasing, largely due to changes in the patterns of mobility. The paper concludes that although international exchange is increasingly important, a meaningful consideration of higher education for sustainable development should take account of environmental costs of international mobility alongside its benefits.
29. Demaidi, M. N.; Al-Sahili, K. (2021) Integrating SDGs in Higher Education—Case of Climate Change Awareness and Gender Equality in a Developing Country According to RMEI-TARGET Strategy. Sustainability 2021, 13, 3101.
Abstract
Universities play an essential role in spreading climate change awareness. However, slight information on climate change and environmental issues had been integrated into the curricula. Moreover, minimal research had been carried out to understand university role in spreading awareness, and students level of awareness and daily behaviour towards climate change, especially in developing countries. This paper aims to investigate the aforementioned issues. An experimental study was carried out on 448 undergraduate students enrolled at An-Najah National University Palestine. The study aimed to examine students’ knowledge and daily behaviour towards climate change, and the important role the university and students’ societies play in terms of spreading and enhancing awareness. The results revealed that female and male students had a non satisfactory interest level in environmental topics and activities, and gender equality did not seem to be an issue. Moreover, female students tend to have a significantly lower level of awareness on climate change compared to male students. On the other hand, being an engineering students or a member in students’ societies had a positive impact on students’ level of awareness and especially females. The results revealed that female students who are enrolled in the engineering faculty or members of students’ societies had a significantly higher level of awareness compared to female students who are enrolled in other faculties or not members of students’ societies. In general, students had a low level of awareness regardless of gender or faculty and universities should offer undergraduate students and especially female students’ opportunities to learn more about climate change by integrating climate change topics into higher education. Moreover, universities should support extracurricular activities held by student societies, and some of these activities should be directed towards environmental and climate change issues. This study entails the activities of the Mediterranean Gender Equality Community of Practice co-created by the Mediterranean Network of Engineering Schools (RMEI), where An-Najah University is an active member, with the support of the EU TARGET project entitled ’Taking a reflexive approach to gender equality at Institutional transformation’.
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