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Dixon J, Field J, Gibson E, Martin N. Curriculum content for Environmental Sustainability in Dentistry. J Dent 2024; 147:105021. [PMID: 38679135 DOI: 10.1016/j.jdent.2024.105021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/20/2024] [Accepted: 04/23/2024] [Indexed: 05/01/2024] Open
Abstract
OBJECTIVES (i) To identify suitable strategies and opportunities to embed Environmental Sustainability (ES) within an existing Oral Health Professional (OHP) curriculum through a series of focus groups with students and academic staff and (ii) To create high-level evidence-based and subject-specific ES content through an approach grounded in evidence and collaboration with key stakeholders in OHP education. METHODS Focus groups were used to explore academic staff and student views on appropriate teaching and assessment methods for ES. Content statements were developed from an extensive literature search, mapped to curriculum subjects, and validated through consultation with students, discipline-experts and education-experts. RESULTS Five themes were identified from the focus groups: ES transcends all disciplines of dentistry and oral healthcare; baseline knowledge transmission with relevant practical application; viewing and modifying existing teaching and assessment events through a different lens; normalising the topic of ES to support attitude and behaviour change and safeguarding against misinformation and disinformation. Forty-four content statements were developed and mapped to nineteen curriculum subjects. CONCLUSIONS This study identifies for the first time a comprehensive strategy for the inclusion and delivery of ES (method and content) in the curriculum. A novel method to define and map curriculum content has been explored and validated using a range of complementary methodologies. A comprehensive and robust list of evidence-based and subject-specific educational content statements have been defined in the field of Environmental Sustainability in dentistry and oral healthcare. CLINICAL SIGNIFICANCE Oral healthcare has a significant environmental impact, the key to all mitigation strategies is educating the profession at all levels.
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Affiliation(s)
- Jonathan Dixon
- School of Clinical Dentistry, University of Sheffield, UK.
| | | | - Emma Gibson
- School of Clinical Dentistry, University of Sheffield, UK
| | - Nicolas Martin
- School of Clinical Dentistry, University of Sheffield, UK
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Yassaie R, Brooks L. Reassessing 'good' medical practice and the climate crisis. JOURNAL OF MEDICAL ETHICS 2024:jme-2023-109713. [PMID: 38871401 DOI: 10.1136/jme-2023-109713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 06/05/2024] [Indexed: 06/15/2024]
Abstract
In August 2023, the General Medical Council released the latest update of Good Medical Practice, which sets out the standards of patient care and professional behaviour to be expected of UK doctors. These updated guidelines offer some environmental considerations that previous standards did not include. This paper explores these latest additions to Good Medical Practice through the healthcare ethics lens of non-maleficence, beneficence, justice and autonomy, alongside trust and physician well-being, to make the case that the latest updates to Good Medical Practice do not go far enough in specifying the duties for doctors in responding to climate and ecological emergencies to be seen as ethically justifiable.The paper argues that given the health implications of the climate crisis and the harms associated with high-emission healthcare, as well as the co-benefits of climate action on health, there must be a stronger commitment from the medical regulator to ensure the groundwork is set for doctors to learn, understand and advocate for the importance and urgency of practicing sustainable healthcare. The case for this is strengthened by also examining the importance of maintaining public trust in the medical profession as advocates for public health, along with the notable societal and generational injustices that continue to deepen as the climate emergency escalates.The paper concludes by arguing that doctors can and should be a part of writing a new chapter for health in the climate era, but our standards for practice need to offer a strengthened starting point of consensus for what is expected of the medical profession for that to come to fruition and raise questions as to what doctors can and should do when they have questions over their own regulators' commitment to maintaining public health in relation to the climate and ecological crisis.
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Affiliation(s)
- Rammina Yassaie
- Sheffield Hallam University College of Health Wellbeing and Life Sciences, Sheffield, UK
| | - Lucy Brooks
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
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Whitehouse CL, Hall H, Shiju M, Webster J, Yazbek J, Parslow-Williams S. Exploring the sustainable impacts of a clinical healthcare research scholarship programme. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:515-521. [PMID: 38850139 DOI: 10.12968/bjon.2024.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2024]
Abstract
BACKGROUND The NHS is the first public body globally to commit to net zero. AIM This study aimed to explore the environmental sustainability impact of a hospital scholarship programme. METHOD A sustainable quality improvement value framework was used to measure the programme's environmental, social and financial effects. RESULTS The social impact through face-to-face contact was most valued by scholars; there were also savings in carbon emissions and costs. DISCUSSION Training in sustainability is essential for the workforce but little infrastructure and expertise are available within organisations to support staff to provide sustainable healthcare in day-to-day practice. CONCLUSION Sustainable healthcare should be supported by education and national guidance and implementation plans should be drawn up to this end. The social impact of the framework used is often seen as less important than its environmental and financial components; however, as its value to scholars illustrates, the components are intertwined and should be considered of equal importance.
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Affiliation(s)
- Claire L Whitehouse
- Senior Nurse for Nursing, Midwifery and Allied Health Professions Research, and Clinical Director for Research, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth; Honorary Fellow, University of East Anglia, Norwich; and Visiting Professor, Staffordshire University, Stoke-on-Trent
| | - Helen Hall
- Research Grants Advisor and Research Paramedic, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, and Honorary Fellow, University of East Anglia, Norwich
| | - Mehar Shiju
- Research and Evaluation Associate, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth
| | - Jonathan Webster
- Professor of Practice Development, Norfolk Initiative for Coastal and Rural Health Equalities, University of East Anglia, Norwich
| | - Jonathan Yazbek
- Head of Quality Improvement, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth
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Stevens M, Israel A, Nusselder A, Mattijsen JC, Chen F, Erasmus V, van Beeck E, Otto S. Drawing a line from CO 2 emissions to health-evaluation of medical students' knowledge and attitudes towards climate change and health following a novel serious game: a mixed-methods study. BMC MEDICAL EDUCATION 2024; 24:626. [PMID: 38840201 PMCID: PMC11155108 DOI: 10.1186/s12909-024-05619-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 05/29/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Education is urgently needed to equip medical students with knowledge, values and skills to promote planetary health. However, the current literature offers little insight into evidence-based approaches and best practices. In response to this pressing need, a novel serious game was introduced into the medical curriculum at Erasmus Medical Center in 2023. The aim of this study was to evaluate the knowledge and attitudes of medical students after they had played a serious game that addresses climate change and health. METHODS In accordance with a mixed-methods design, quantitative data were collected using pre- and post-intervention surveys. Differences were assessed using the Wilcoxon signed rank test. Focus group discussions were held after the game and thematically analysed. RESULTS One hundred forty-five students (38.6% of the entire cohort) played the game, of which 59 students completed the pre- and post-intervention surveys. After the game, self-reported knowledge increased. Regarding objective knowledge, an increase in the proportion of students who answered one of the two questions correctly was observed, while the proportion of correct responses decreased for the other question. Student's responses to two out of five attitude questions were significantly more positive. The proportion of students who recognized the importance of climate change education, to inform patients and society about the health impacts of climate change, increased. Moreover, survey results indicated a significant increase in climate worry subsequent to the game. Eleven students participated in the focus group discussions. Thematic analysis highlighted participants' reflections on the roles and responsibilities in climate change and health, along with their realisation of the tools for action that climate and health co-benefits provide. Another significant aspect was the importance participants placed on learning alongside peers with diverse attitudes. Additionally, participants appreciated the tangible overview of climate change and health provided by the serious game. CONCLUSIONS Our novel serious game addressed an important gap in the medical curriculum. The game can enable medical students to cultivate the necessary knowledge and attitudes to promote health in times of a climate crisis. The accompanying climate worry needs attention through the empowerment of students' agency to foster change.
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Affiliation(s)
- Merel Stevens
- Department of Public Health, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
| | - Adriana Israel
- Department of Public Health, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Anouk Nusselder
- Department of Public Health, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
- IFMSA, Joan Muyskenweg 38, P.O. Box 8628, The Netherlands, 1114 AN, Amsterdam
| | - Juliette C Mattijsen
- Department of Public Health, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
- Dutch Green Health Alliance (GZA), Botersloot 177, 3011 HE, Rotterdam, the Netherlands
| | - Feng Chen
- Department of Public Health, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Vicki Erasmus
- Department of Public Health, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Ed van Beeck
- Department of Public Health, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Suzie Otto
- Department of Public Health, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
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Dalapati T, Alway EJ, Mantri S, Mitchell P, George IA, Kaplan S, Andolsek KM, Velkey JM, Lawson J, Muzyk AJ. Development of a curricular thread to foster medical students' critical reflection and promote action on climate change, health, and equity. PLoS One 2024; 19:e0303615. [PMID: 38814920 PMCID: PMC11139332 DOI: 10.1371/journal.pone.0303615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 04/26/2024] [Indexed: 06/01/2024] Open
Abstract
INTRODUCTION Due to the health consequences arising from climate change, medical students will inevitably interact with affected patients during their training and careers. Accordingly, medical schools must incorporate education on the impacts of climate change on health and equity into their curricula. We created a curricular thread called "Climate Change, Health, and Equity" in the first-year preclinical medical program to teach foundational concepts and foster self-reflection and critical consciousness. METHODS The authors developed a continuum of practice including administrators, educators and faculty members, students, and community partners to plan and design curricular activities. First-year medical students at Duke University School of Medicine participated in seven mandatory foundational lectures and two experiential learning opportunities in the local community. Following completion of activities, students wrote a critical reflection essay and completed a self-directed learning exercise. Essays were evaluated using the REFLECT rubric to assess if students achieved critical reflection and for thematic analysis by Bloom's Taxonomy. RESULTS All students (118) submitted essays. A random sample of 30 (25%) essays underwent analysis. Evaluation by the REFLECT rubric underscored that all students were reflecting or critically reflecting on thread content. Thematic analysis highlighted that all students (30/30, 100%) were adept at identifying new areas of medical knowledge and connecting concepts to individual experiences, institutional practices, and public health and policy. Most students (27/30; 90%) used emotionally laden words, expressing negative feelings like frustration and fear but also positive sentiments of solidarity and hope regarding climate change and effects on health. Many students (24/30; 80%) expressed actionable items at every level including continuing self-directed learning and conversing with patients, minimizing healthcare waste, and advocating for climate-friendly policies. CONCLUSION After participating in the curricular thread, most medical students reflected on cognitive, affective, and actionable aspects relating to climate change, health, and equity.
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Affiliation(s)
- Trisha Dalapati
- Duke University School of Medicine, Durham, NC, United States of America
| | - Emily J. Alway
- Duke University School of Medicine, Durham, NC, United States of America
| | - Sneha Mantri
- Program in Medical Humanities, Trent Center for Bioethics, Humanities & History of Medicine, Duke University School of Medicine, Durham, NC, United States of America
| | - Phillip Mitchell
- Interprofessional Education Program, Western University of Health Sciences, Lebanon, OR, United States of America
| | - Ian A. George
- Duke University School of Medicine, Durham, NC, United States of America
| | - Samantha Kaplan
- Duke University Medical Center Library & Archives, Duke University School of Medicine, Durham, NC, United States of America
| | - Kathryn M. Andolsek
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, United States of America
| | - J. Matthew Velkey
- Practice of Medical Education, Department of Cell Biology, Duke University School of Medicine, Durham, NC, United States of America
| | - Jennifer Lawson
- Trent Center for Bioethics, Humanities & History of Medicine, Duke University School of Medicine, Durham, NC, United States of America
| | - Andrew J. Muzyk
- Practice of Medical Education, Duke University School of Medicine, Durham, NC, United States of America
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Chambers J, Alberti H, Harrison M, Mulgrew N. Sustainable quality improvement: An essential ingredient for sustainability in modern medical curricula? CLINICAL TEACHER 2024:e13776. [PMID: 38711395 DOI: 10.1111/tct.13776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 04/07/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Health care delivery contributes a significant carbon footprint in the United Kingdom, and paradoxically climate change is linked to poorer human health outcomes. New General Medical Council (GMC) requirements mandate medical graduates must be able to apply sustainable care to their practice. Implementation of sustainable health care (SHC) teaching is a new challenge for medical schools, and there are several identified barriers including an overcrowded curriculum, lack of expertise within faculties, lack of institutional support and inadequate assessment techniques. APPROACH We established a new SHC curriculum spiralling throughout the overall medical curriculum, and as part of this introduced a sustainable quality improvement (susQI) project to our final year cohort. SusQI considers the environmental, social and financial impacts as well as patient and population outcomes. Our students undertook this in their final year GP assistantships. EVALUATION We sought multi-sourced data through focus groups, formal end of placement feedback, informal feedback and external feedback. We applied thematic analysis to focus group transcriptions and triangulated with the other data sources. We identified some common themes: First, susQI was enjoyed and valuable; second, it allowed meaningful participation; third, it created a co-learning environment; and fourth, timing and curriculum placement are important when integrating susQI. IMPLICATIONS SusQI can implement SHC into the overcrowded medical curriculum in a low cost, low resource manner without the need for experienced faculty. SusQI is empowering for students and grants them an active team role. Expansion into secondary and tertiary care is feasible, and we contend that susQI can be placed in other health care curricula.
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Affiliation(s)
- Jenna Chambers
- Newcastle University Medical School, Newcastle upon Tyne, UK
| | - Hugh Alberti
- Newcastle University Medical School, Newcastle upon Tyne, UK
| | | | - Nicola Mulgrew
- Newcastle University Medical School, Newcastle upon Tyne, UK
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Nassar M, Shalan W, Al-Janaby U, Elnagar H, Alawadhi M, Jaser S, Joury E. Exploring environmental sustainability in dentistry among students and educators in the United Arab Emirates: a cross-sectional survey. BMC MEDICAL EDUCATION 2024; 24:489. [PMID: 38698346 PMCID: PMC11067139 DOI: 10.1186/s12909-024-05488-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 04/29/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVES Creating environmentally sustainable healthcare culture within the dental field requires embedding the content in the dental curriculum at the undergraduate level. This study aimed to explore the current awareness and drivers among dental students and educators regarding environmentally sustainable dentistry (ESD) in the United Arab Emirates (UAE) and identify barriers and enablers to embrace it. METHODS A cross-sectional survey using online questionnaires was carried out in six undergraduate dental education institutes within the UAE. Data analysis included descriptive statistics. RESULTS In total 153 students and 53 educators participated in the survey. Most students and educators were not aware of any ESD content in their curricula. However, the majority of educators were familiar with the concept of ESD, while students were mostly unfamiliar or slightly familiar. Nonetheless, students largely agreed on its importance and their interest in learning it, as they viewed it relevant to their future practice. Educators agreed that the dental profession has a responsibility to be environmentally friendly and expressed their desire in introducing ESD content into the curricula. Several barriers were reported such as lack of knowledge, curricula space, educational resources, and time. Meanwhile, enablers included providing ESD capacity building, training and resources. CONCLUSIONS There was no explicit presence of ESD content in the dental curricula in the UAE. Despite the lack of adequate awareness on this topic among educators and more so among students, they both had positive views towards incorporating ESD into dental curricula. Overall, this study highlighted the importance of promoting ESD in dental programs. CLINICAL SIGNIFICANCE ESD is gradually becoming a critical aspect of modern oral healthcare system. It has been mandated in the dental curricula in several regions globally. Embedding ESD in the UAE dental curricula would have several benefits for the environment as well as the future of the dental profession in the region. The clinical significance includes, but not limited to, improved treatment outcomes; patients, students and staff health and well-being; reduced health risks, and cost savings.
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Affiliation(s)
- Mohannad Nassar
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates.
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.
| | - Wed Shalan
- College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Uesser Al-Janaby
- College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Hagar Elnagar
- College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Maryam Alawadhi
- College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Sara Jaser
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Easter Joury
- Centre for Dental Public Health and Primary Care, Institute of Dentistry, Queen Mary University of London, London, UK
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Balay-Odao EM, Colet PC, Almazan JU, Kuntuganova A, Syzdykova A, Kavashev Z, Smagulova M, Dauletkaliyeva Z, Seidakhmetova A, Cruz JP. Environmental sustainability in healthcare: A qualitative study of the perspectives of nursing, medical and public health students in Kazakhstan. Nurse Educ Pract 2024; 76:103917. [PMID: 38402830 DOI: 10.1016/j.nepr.2024.103917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/19/2024] [Accepted: 02/06/2024] [Indexed: 02/27/2024]
Abstract
THE AIM WAS This study explored the perspectives of nursing, medical and public health students on environmental sustainability in healthcare. BACKGROUND The healthcare sector has increasingly recognized the importance of adopting environmental sustainability over the past few years. This growing awareness emphasizes the need to thoroughly assess the connection between health care and environmental responsibility. DESIGN Qualitative descriptive-exploratory design. METHODS This study explored the views on environmental sustainability in health care of 29 nursing, medical and public health students at three universities in Kazakhstan through focus group discussions. Thematic analysis was used in the data analysis. Data collection was carried out from June to August 2023. RESULTS Using semantic thematic analysis, 209 initial codes were extracted, and then similar codes and meanings were grouped, leading to 21 categories until the development of the five significant themes. The five main themes are 'the impact of the environment on health', 'environmental sustainability practices in healthcare care', 'the importance of interdisciplinary collaboration in environmental sustainability in healthcare', 'intrinsic motivation to engage in environmental sustainability practices in healthcare' and 'challenges and barriers to practicing environmental sustainability in healthcare'. CONCLUSIONS The study findings suggest the critical aspect of addressing environmental sustainability through interprofessional collaboration and working on intrinsic motivation among health professionals. Furthermore, our study contributes in several ways to our understanding of environmental sustainability in healthcare. Provides a basis for clinicians, educators and policy makers to consider adding sustainability to their agenda to prepare future health professionals.
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Affiliation(s)
| | - Paolo C Colet
- Department of Medicine, School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | - Joseph U Almazan
- Department of Medicine, School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | - Anargul Kuntuganova
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | - Alma Syzdykova
- Education Department, "University Medical Center" Corporate Fund, Astana, Kazakhstan
| | - Zulyar Kavashev
- Graduate School of Education, Nazarbayev University, Astana, Kazakhstan
| | - Meruyert Smagulova
- Central Asian Research Centre for Educational Innovation and Transformation, Graduate School of Education, Nazarbayev University, Astana, Kazakhstan
| | | | - Aizat Seidakhmetova
- Department of Emergency Medicine and Nursing, South Kazakhstan Medical Academy, Shymkent, Kazakhstan
| | - Jonas Preposi Cruz
- Department of Medicine, School of Medicine, Nazarbayev University, Astana, Kazakhstan.
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Swärdh E, Brodin N, Pettersson A, Palstam A. Time to Rethink Intended Learning Outcomes for Sustainable Development? A Qualitative Exploration and Reflection of Course Syllabuses in Swedish Undergraduate Physiotherapy Education. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241260599. [PMID: 39092289 PMCID: PMC11292048 DOI: 10.1177/23821205241260599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 05/17/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVE Several calls to action for the implementation of education for sustainable development in health profession education have been put forth during the last few years. The aim was therefore to explore and describe sustainability-focused intended learning outcomes (SD-ILOs) in curricula of undergraduate physiotherapy education in Sweden. METHODS Using a deductive, descriptive, and qualitative approach, SD-ILOs in programs (n = 8) and course syllabuses (n = 143) from eight higher education institutions providing physiotherapy undergraduate education in Sweden were analyzed. SD-ILOs were described based on the subject content or condition, level of cognitive processes, sustainability learning dimensions, and key sustainability competencies. RESULTS Six of the eight physiotherapy programs provided course syllabuses with SD-ILOs. However, only 3% (n = 36) of all ILOs were sustainability-focused. A larger part of the SD-ILOs, 78% (n = 28) was described within the cognitive dimension of learning, and 80% (n = 27) were linked to either the cognitive process 'understanding' or 'analyzing'. The most frequently identified key competency in the SD-ILOs was 'systems-thinking' n = 10 (28%), and 30% (n = 11) lacked key competency. CONCLUSION There is an urgent need for rapid initiatives to enhance sustainable development education in Swedish undergraduate physiotherapy education. Pedagogical approaches that cover not only cognitive dimensions of learning for sustainable development but also socio-emotional and behavioral dimensions, as well as more complex cognitive learning processes must also be developed. The current lack of key sustainability competencies further emphasizes the necessity to enrich physiotherapy curricula with action-oriented learning to develop powerful future sustainability agency within healthcare and the public health arena.
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Affiliation(s)
- Emma Swärdh
- Division of Physiotherapy, Department of Neurobiology, Health Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Nina Brodin
- Division of Physiotherapy, Department of Neurobiology, Health Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Division of Physiotherapy, Department of Orthopaedics, Danderyd Hospital, Stockholm, Sweden
| | - Anna Pettersson
- Division of Physiotherapy, Department of Neurobiology, Health Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Annie Palstam
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Pettinger C, Tripathi S, Shoker B, Hodge G. Collaborative leadership to support sustainability in practice for dietitians as allied health professionals. J Hum Nutr Diet 2023; 36:2323-2335. [PMID: 37489277 DOI: 10.1111/jhn.13211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 07/06/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Allied health professionals (AHPs) have an important role to support the Greener National Health Service (NHS) agenda. Dietitians are AHPs who are already demonstrating strong influence on food sustainability advocacy. There is call for more collaboration across the health professions to optimise "green" leadership in the pursuit of planetary health. The present study aimed to investigate the perceived role of AHP leaders and future leaders around more sustainable healthcare practices. METHODS A mixed methods approach using audio-recorded semi-structured interviews with strategic AHP leaders (n = 11) and focus groups with student AHPs (n = 2). Standardised open-ended questions considered concepts of (i) leadership, (ii) green agenda, (iii) collaboration and (iv) sustainability. Purposive sampling used already established AHP networks. Thematic analysis systematically generated codes and themes with dietetic narratives drawn out specifically as exemplars. RESULTS The findings represent diverse AHP voices, with six of 14 AHPs analysed, including dietetic (future) leaders. Three key themes emerged: (1) collective vision of sustainable practice; (2) empowering, enabling and embedding; and (3) embracing collaborative change. Dietetic specific narratives included food waste, NHS food supply chain issues, and tensions between health and sustainability advice. CONCLUSIONS The present study shows that collaborative leadership is a core aspiration across AHP leaders and future leaders to inform the green agenda. Despite inherent challenges, participant perceptions illustrate how "change leadership" might be realised to support the net zero agenda within health and social care. Dietitians possess the relevant skills and competencies, and therefore have a fundamental role in evolving collaborative leadership and directing transformational change towards greener healthcare practices. Recommendations are made for future leaders to embrace this agenda to meet the ambitious net zero targets.
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Affiliation(s)
- Clare Pettinger
- School of Health Professions, Peninsula Allied Health Centre (PAHC), Faculty of Health, University of Plymouth, Plymouth, UK
| | - Smita Tripathi
- Plymouth Business School, Faculty of Arts, Humanities and Business, University of Plymouth, Plymouth, UK
| | - Benji Shoker
- Plymouth Business School, Faculty of Arts, Humanities and Business, University of Plymouth, Plymouth, UK
| | - Gary Hodge
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK
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Zubair AS, Sivakolundu DK, DeVito M, Dewey JJ. Financial Literacy Among Medical Trainees and Faculty: A Pilot Study. Cureus 2023; 15:e44829. [PMID: 37809136 PMCID: PMC10559332 DOI: 10.7759/cureus.44829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 10/10/2023] Open
Abstract
INTRODUCTION Medical education systems are trained to produce efficient, thorough clinicians. These programs provide limited training on personal finances. The current socioeconomic climate for medical trainees includes increasing education debt and stagnating reimbursement. We conducted a survey-based cross-sectional pilot study at an academic institution targeted at residents, fellows, and attendings of all medical specialties. Our aim was to understand baseline levels of financial literacy at different training and career stages, which can inform targeted interventions to improve this crucial aspect of physician well-being. METHODS A survey was devised with the assistance of a certified financial planner. This survey was distributed at an academic institution targeting residents, fellows, and attendings. The survey was anonymous, and no identifying data were collected. Two reminders were sent to subjects to complete the survey. RESULTS A total of 50 physicians completed the survey in 2021. There were eight responses from interns, 14 responses from residents (post-graduate year 2 or later), 14 responses from fellows, and nine responses from attendings. The majority of our respondents reported not having any particular financial education, and over 70% of respondents reported that their graduate education had not provided them with the tools needed for personal financial success. CONCLUSION Financial education and financial literacy are important topics that need to be further incorporated into the medical education pathway. Physicians are not well equipped in this realm, and further training is necessary. This study provides pilot data that highlight important aspects of physician knowledge and practices in regard to finances.
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Affiliation(s)
| | | | | | - Jeffrey J Dewey
- Neurology, Yale New Haven Hospital, New Haven, USA
- Neurology, Yale School of Medicine, New Haven, USA
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Tan E, Ng WM, Soh PC, Tan D, Cleland J. 'But what if you miss something …?': factors that influence medical student consideration of cost in decision making. BMC MEDICAL EDUCATION 2023; 23:437. [PMID: 37316844 DOI: 10.1186/s12909-023-04349-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/11/2023] [Indexed: 06/16/2023]
Abstract
CONTEXT Cost-conscious care is critical for healthcare sustainability but evidence suggests that most doctors do not consider cost in their clinical decision making. A critical step in changing this is understanding the barriers to encouraging behaviours and attitudes related to cost-conscious care. We therefore conducted a qualitative study to address the research question: what factors influence consideration of cost in emergency medicine (ED) clinical decision making? METHODS This was a qualitative focus group study using patient vignettes to explore attitudes towards cost-conscious clinical decision making. Participants were Year 4 and Year 5 medical students from Singapore, a country with a fee-for-service healthcare system. After a data-driven initial data analysis, and to make sense of a multitude of factors impacting on cost conscious care, we selected Fishbein's integrative model of behavioural prediction to underpin secondary data analysis. RESULTS Via four focus groups with 21 participants, we identified five main themes relevant to the integrative model of behavioural prediction. These were: attitudes towards considering cost when managing a patient (e.g., "better safe than sorry"); normative beliefs (e.g., doing what others do, perceptions of patient wishes); efficacy beliefs (e.g., no authority to take decisions or challenge); skills and knowledge (e.g., little knowledge of costs), and environmental constraints (e.g., the nature of the healthcare system). DISCUSSION Medical students do not consider cost in their clinical decision making due to numerous factors, of which lack of knowledge of costs is but one. While some of the factors identified reflect those found in previous studies with residents and fully-trained staff, and in other contexts, theory driven analysis added value in that it facilitated a richer exploration of why students do not consider cost in clinical decision making. Our findings provide insight to inform how best to engage and empower educators and learners in teaching and learning about cost-conscious care.
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Affiliation(s)
- Emmanuel Tan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
| | - Wei Ming Ng
- Department of Emergency Medicine, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Poh Choong Soh
- Department of Emergency Medicine, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Daniel Tan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Jennifer Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Rybol L, Nieder J, Amelung D, Hachad H, Sauerborn R, Depoux A, Herrmann A. Integrating climate change and health topics into the medical curriculum - a quantitative needs assessment of medical students at Heidelberg University in Germany. GMS JOURNAL FOR MEDICAL EDUCATION 2023; 40:Doc36. [PMID: 37377571 PMCID: PMC10291352 DOI: 10.3205/zma001618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/23/2022] [Accepted: 03/02/2023] [Indexed: 06/29/2023]
Abstract
Objectives Climate change (CC) is of major importance for physicians as they are directly confronted with changing disease patterns, work in a greenhouse gas intensive sector and can be potential advocates for healthy people on a healthy planet. Methods We assessed third to fifth year medical students' needs to support the integration of CC topics into medical curricula. A questionnaire with 54 single choice-based items was newly designed with the following sections: role perception, knowledge test, learning needs, preference of educational strategies and demographic characteristics. It was administered online to students at Heidelberg medical faculty. Data sets were used for descriptive statistics and regression modelling. Results 72.4% of students (N=170, 56.2% female, 76% aged 20-24 years) (strongly) agreed that physicians carry a responsibility to address CC in their work setting while only 4.7% (strongly) agreed that their current medical training had given them enough skills to do so. Knowledge was high in the area of CC, health impacts of CC, vulnerabilities and adaptation (70.1% correct answers). Knowledge gaps were greatest for health co-benefits and climate-friendly healthcare (55.5% and 16.7% of correct answers, respectively). 79.4% wanted to see CC and health included in the medical curriculum with a preference for integration into existing mandatory courses. A multilinear regression model with factors age, gender, semester, aspired work setting, political leaning, role perception and knowledge explained 45.9% of variance for learning needs. Conclusion The presented results encourage the integration of CC and health topics including health co-benefits and climate-friendly healthcare, as well as respective professional role development into existing mandatory courses of the medical curriculum.
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Affiliation(s)
- Leonie Rybol
- University Hospital Heidelberg, Heidelberg Institute of Global Health, Heidelberg, Germany
| | - Jessica Nieder
- University Hospital Heidelberg, Heidelberg Institute of Global Health, Heidelberg, Germany
| | | | | | - Rainer Sauerborn
- University Hospital Heidelberg, Heidelberg Institute of Global Health, Heidelberg, Germany
| | - Anneliese Depoux
- University of Paris Cité, Centre Virchow-Villermé, Paris, France
| | - Alina Herrmann
- University Hospital Heidelberg, Heidelberg Institute of Global Health, Heidelberg, Germany
- University Hospital Cologne, Medical Faculty Cologne University, Institute for General Medicine, Cologne, Germany
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14
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Boekels R, Nikendei C, Roether E, Friederich HC, Bugaj TJ. Climate change and health in international medical education - a narrative review. GMS JOURNAL FOR MEDICAL EDUCATION 2023; 40:Doc37. [PMID: 37377569 PMCID: PMC10291340 DOI: 10.3205/zma001619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 11/03/2022] [Accepted: 11/23/2022] [Indexed: 06/29/2023]
Abstract
Objective Climate change is a key threat to human health worldwide. Accordingly, medical education should prepare future physicians for climate-associated hazards and corresponding professional challenges. Currently, this is not yet implemented across the board. The aim of this review is to present (I) the knowledge and (II) the attitudes of medical students and physicians towards climate change and (III) the expectations of medical education as formulated by medical students. In addition, the available literature will be used to look at (IV) global teaching activities, (V) international learning goals and learning goal catalogues, and (VI) applied teaching methods and formats. This review should simplify and, considering the urgency of the topic, accelerate the design of future teaching activities. Methodology The paper is based on a selective literature search supplemented by a topic-guided internet search. Results Knowledge about the causes and concrete health consequences of climate change seems to be incomplete. The majority of medical students consider human health to be at risk from climate change and the health sector to be inadequately prepared. A majority of surveyed medical students would like to see teaching about climate change. It is evident that internationally, teaching projects on climate change and climate health, as well as topic-specific learning objectives and learning goal catalogues, have been developed and integrated into medical education. Conclusion There is a need for and acceptance of teaching climate change in the medical curriculum. This literature review can assist in the development and implementation of new teaching formats.
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Affiliation(s)
- Rebecca Boekels
- Heidelberg University Hospital, Department of General Internal Medicine and Psychosomatics, Heidelberg, Germany
| | - Christoph Nikendei
- Heidelberg University Hospital, Department of General Internal Medicine and Psychosomatics, Heidelberg, Germany
| | - Emma Roether
- Heidelberg University Hospital, Department of General Internal Medicine and Psychosomatics, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Heidelberg University Hospital, Department of General Internal Medicine and Psychosomatics, Heidelberg, Germany
| | - Till Johannes Bugaj
- Heidelberg University Hospital, Department of General Internal Medicine and Psychosomatics, Heidelberg, Germany
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15
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Abuzied Y, Alshammary SA, Alhalahlah T, Somduth S. Using FOCUS-PDSA Quality Improvement Methodology Model in Healthcare: Process and Outcomes. GLOBAL JOURNAL ON QUALITY AND SAFETY IN HEALTHCARE 2023; 6:70-72. [PMID: 37333757 PMCID: PMC10275632 DOI: 10.36401/jqsh-22-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 02/11/2023] [Accepted: 03/07/2023] [Indexed: 06/20/2023]
Affiliation(s)
- Yacoub Abuzied
- Nursing Department, Rehabilitation Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Sami Ayed Alshammary
- Palliative Care Department, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Trad Alhalahlah
- Anesthesia Department, Jordanian Royal Medical Services, Amman, Jordan
| | - Shreemathie Somduth
- Nursing Department, Rehabilitation Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
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Howard C, MacNeill AJ, Hughes F, Alqodmani L, Charlesworth K, de Almeida R, Harris R, Jochum B, Maibach E, Maki L, McGain F, Miller J, Nirmala M, Pencheon D, Robertson S, Sherman JD, Vipond J, Yin H, Montgomery H. Learning to treat the climate emergency together: social tipping interventions by the health community. Lancet Planet Health 2023; 7:e251-e264. [PMID: 36889866 DOI: 10.1016/s2542-5196(23)00022-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 12/06/2022] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
Accelerating the decarbonisation of local and national economies is a profound public health imperative. As trusted voices within communities around the world, health professionals and health organisations have enormous potential to influence the social and policy landscape in support of decarbonisation. We assembled a multidisciplinary, gender-balanced group of experts from six continents to develop a framework for maximising the social and policy influence of the health community on decarbonisation at the micro levels, meso levels, and macro levels of society. We identify practical, learning-by-doing approaches and networks to implement this strategic framework. Collectively, the actions of health-care workers can shift practice, finance, and power in ways that can transform the public narrative and influence investment, activate socioeconomic tipping points, and catalyse the rapid decarbonisation needed to protect health and health systems.
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Affiliation(s)
- Courtney Howard
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Dahdaleh Institute for Global Health Research, York University, Toronto, Canada; Blavatnik School of Government, University of Oxford, Oxford, UK.
| | - Andrea J MacNeill
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | | | | | - Kate Charlesworth
- Climate Risk and Net Zero Unit, New South Wales Health, Sydney, NSW, Australia
| | - Roberto de Almeida
- Instituto Ideia Ambiental, Foz do Iguaçu, Brazil; Federal University of Latin American Integration, Foz do Iguaçu, Brazil
| | - Roger Harris
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; CODA Change, Sydney, NSW, Australia
| | | | - Edward Maibach
- Center for Climate Change Communication, George Mason University, Fairfax, VA, USA
| | - Lwando Maki
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Forbes McGain
- Western Health, Melbourne, VIC, Australia; Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia
| | - Jeni Miller
- Global Climate and Health Alliance, San Francisco, CA, USA
| | | | - David Pencheon
- Health and Sustainable Development, Medical and Health School, University of Exeter, Exeter, UK
| | | | - Jodi D Sherman
- Yale School of Medicine, Yale University, New Haven, CT, USA; Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Joe Vipond
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Hao Yin
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; Yale School of Public Health, Yale University, New Haven, CT, USA; Department of Economics, University of Southern California, Los Angeles, CA, USA
| | - Hugh Montgomery
- CODA Change, Sydney, NSW, Australia; Intensive Care Medicine, University College London, London, UK
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Parikh N, Gardner A, Myers AL, Halpin R, Holland JN, van der Hoeven D. The impact of coronavirus disease 2019 pandemic on dental school assessments - Current status and future perspectives. J Dent Educ 2023. [PMID: 36852938 DOI: 10.1002/jdd.13190] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 01/23/2023] [Accepted: 02/10/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE To evaluate course directors' feedback on the assessment methods used during the coronavirus disease 2019 (COVID-19) pandemic and identify effective approaches for future assessments in dental education. METHODS Course directors at the US dental schools were surveyed for changes in assessments implemented during the early stages of the pandemic (March-July 2020) using the Qualtrics platform. The survey questions addressed assessment methods utilized in didactic, preclinical, and clinical arenas pre-COVID-19 (before March 2020) and during the early phase of the pandemic (between March and July 2020) and identified any sustained changes in assessments post-COVID-19. Of the 295 responses for the type of courses directed, 48%, 22%, and 30% responses were for didactic, pre-clinical, and clinical assessments, respectively. Chi-square tests and 95% confidence intervals were used to assess quantitative differences. RESULTS Computer-based un-proctored and remote- proctored assessments increased whereas paper-based in-person proctored assessments decreased during an early pandemic. For pre-clinical and clinical courses, objective-structured clinical exams and case-based assessments increased whereas, for didactic courses, the number of presentations, short-answer, and multiple-choice questions-based assessments increased. Specimen-based assessments and patient-based encounters decreased significantly in didactic and clinical courses, respectively. Manikin-based exams increased in clinical but not in pre-clinical courses. Survey respondents disagreed that alternative assessments helped students learn better, resulted in better course evaluations, or were an equivalent replacement for pre-COVID-19 assessments. Interestingly, 49% of respondents indicated a likelihood of continuing alternative assessments whereas 36% were unlikely and 15% were neutral. CONCLUSIONS A combination of effective pre-pandemic and innovative alternative assessments developed during the pandemic may be the new normal in the dental education curriculum.
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Affiliation(s)
- Neha Parikh
- Department of Diagnostic and Biomedical Sciences, School of Dentistry, The University of Texas Health Science Center at Houston, Houston, USA
| | - Amity Gardner
- Department of General Practice and Dental Public Health, School of Dentistry, The University of Texas Health Science Center at Houston, Houston, USA
| | - Alan L Myers
- Department of Diagnostic and Biomedical Sciences, School of Dentistry, The University of Texas Health Science Center at Houston, Houston, USA
| | - Richard Halpin
- School of Dentistry, The University of Texas Health Science Center at Houston, Houston, USA
| | - Julian N Holland
- School of Dentistry, The University of Texas Health Science Center at Houston, Houston, USA
| | - Dharini van der Hoeven
- Department of Diagnostic and Biomedical Sciences, School of Dentistry, The University of Texas Health Science Center at Houston, Houston, USA
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Irlam JH, Scheerens C, Mash B. Planetary health and environmental sustainability in African health professions education. Afr J Prim Health Care Fam Med 2023; 15:e1-e3. [PMID: 36861923 PMCID: PMC9982498 DOI: 10.4102/phcfm.v15i1.3925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 11/24/2022] [Indexed: 02/15/2023] Open
Abstract
CliMigHealth and the Education for Sustainable Healthcare (ESH) Special Interest Group of the Southern African Association of Health Educationalists (SAAHE) call for the urgent integration of planetary health (PH) and environmental sustainability into health professions curricula in Africa. Education on PH and sustainable healthcare develops much-needed health worker agency to address the connections between healthcare and PH. Faculties are urged to develop their own 'net zero' plans and to advocate for national and sub-national policies and practices that promote the Sustainable Development Goals (SDGs) and PH. National education bodies and health professional societies are urged to incentivise innovation in ESH and to provide discussion forums and resources to support the integration of PH into curricula.Contribution: This article provides a position statement for integrating planetary health and environmental sustainability into African health professions education curricula.
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Affiliation(s)
- James H. Irlam
- Department of Family, Community and Emergency Care, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Charlotte Scheerens
- Department of Public Health and Primary Care, Faculty of Medicine, University of Ghent, Ghent, Belgium,Department of Economics, Faculty of Medicine, University of Ghent, Ghent, Belgium
| | - Bob Mash
- Department of Family and Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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19
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Moro C, McLean M, Phelps C. Embedding planetary health concepts in a pre-medical physiology subject. MEDICAL TEACHER 2023; 45:179-186. [PMID: 36070483 DOI: 10.1080/0142159x.2022.2118041] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE There are increasing calls for planetary health (which includes sustainable healthcare) to be included in tertiary health professions education. With already busy curricula, particularly in medicine, educators need to find innovative ways of integrating these important concepts without adding to learners' workload. This study investigated whether planetary health concepts could be integrated into a Physiology subject as a stop-gap approach while longitudinal planning for longitudinal curriculum integration was underway. MATERIALS AND METHODS Each week, a planetary health fact (Did you know?) with a corresponding link were embedded at the bottom of a relevant PowerPoint lecture slide to match the topic of the week in a health science and medicine Physiology subject. The embedded facts were a mix of effects on health and the environmental impacts of healthcare activities, such as medical imaging. No other formal planetary health teaching was conducted in the subject. At the end of the semester, 44% of 100 students completed a survey regarding their perceptions of the planetary health inclusions. RESULTS Participants reported an appreciation of the facts, found them helpful for their overall learning, and were interested in learning about healthcare's large environmental footprint. Seventy-one percent were able to provide a reasonable definition of planetary health. Half of the participants reported their actions, behaviours, and thoughts had changed as a result of the planetary health inclusions. CONCLUSIONS This study provides a relatively simple approach for individual educators to include planetary health concepts into existing health professions subjects until more longitudinal curriculum revisions can be undertaken. Based on our findings, we would, however, recommend providing students with a brief introduction in terms of why planetary health has been included either at the start of the first lecture or as a 10-min video.
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Affiliation(s)
- Christian Moro
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Michelle McLean
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Charlotte Phelps
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
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20
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Brady Bates O, Walsh A, Stanistreet D. Factors influencing the integration of planetary health topics into undergraduate medical education in Ireland: a qualitative study of medical educator perspectives. BMJ Open 2023; 13:e067544. [PMID: 36639205 PMCID: PMC9843183 DOI: 10.1136/bmjopen-2022-067544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
AIMS Planetary health is a transdisciplinary field that explores the relationship between the escalating climate and environmental crises and human health. In light of the human health cost arising from planetary health issues, there is a need to educate future medical practitioners accordingly. This study investigates the factors influencing the integration of planetary health into undergraduate medical education at an Irish university and makes recommendations for future practice. METHODS A qualitative descriptive study design was employed. Twelve semi-structured interviews were conducted with academic staff actively involved in teaching on the undergraduate medical curriculum at Royal College of Surgeons in Ireland University of Medicine and Health Sciences. Both barriers and facilitators to integrating planetary heath into the curriculum were explored. Braun and Clarke's thematic analysis was used to analyse the findings. RESULTS Barriers to integration include: a lack of curricular space, a perceived lack of awareness among students and educators and a potential lack of knowledge among educators and senior management in relation to these issues. These barriers were tempered by significant facilitators suggesting a shifting paradigm within institutions, innovative approaches to content delivery and an increasing demand from undergraduate medical students. CONCLUSION This study found a demand from medical educators for the integration of planetary health topics into the medical curriculum. It is suggested that significant adaptation of existing medical curricula is required both in Ireland and further afield, to meet this need. Recommendations based on the barriers and facilitators that emerged during the analysis include: emphasising the clinical relevance of these topics, as suggested by the current evidence base; promoting senior and departmental leadership; and emphasising the potential for improvements in institutional prestige.
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Affiliation(s)
- Oisin Brady Bates
- Public Health and Primary Care, Trinity College Dublin, Dublin, Ireland
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Aisling Walsh
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Debbi Stanistreet
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
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21
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Cerceo E, Vasan N. Creating Environmental Health Leaders When Educators Are Learning Too. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231219162. [PMID: 38130832 PMCID: PMC10734366 DOI: 10.1177/23821205231219162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023]
Abstract
The climate crisis is upon us, already exacting a health cost, with likely acceleration over our lifetimes. Our existing medical curricula do not adequately prepare medical students to deal with climate health nor to be leaders in the public health sphere. Current faculty have themselves not often been exposed to climate health training nor often to leadership training. This affords a unique opportunity for creative implementation of strategies to educate both faculty and students on how leadership skill building can complement the science and policy of climate health.
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Affiliation(s)
- Elizabeth Cerceo
- Division of Hospital Medicine, Department of Medicine, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Nagaswami Vasan
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, New Jersey, USA
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Stanford V, Barna S, Gupta D, Mortimer F. Teaching skills for sustainable health care. Lancet Planet Health 2023; 7:e64-e67. [PMID: 36608951 DOI: 10.1016/s2542-5196(22)00330-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
In the context of accelerating concern regarding the climate and ecological crisis and the recognition of this crisis as a health threat, there is growing motivation among the health-care community to reduce the negative environmental impact of health care. Globally, the health-care sector is estimated to be the 5th largest carbon emitter. A health system that is socially, environmentally, and financially sustainable requires clinical leadership, yet few health-care workers possess the conceptual framework or practical skills for creating new models of care. Clinicians can protect planetary health as a core part of professional practice by integrating triple bottom line measures into quality improvement or quality management practices. Initial efforts to integrate sustainability into quality improvement teaching and training have been shown to transform learners' interest in quality improvement and environmental sustainability. Embedding sustainability principles and techniques into established quality improvement education and practice can operationalise planetary health, building the skills necessary for health-care system transformation at the speed and scale required.
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Affiliation(s)
| | - Stefi Barna
- Centre for Sustainable Healthcare, Oxford, UK
| | - Dhruv Gupta
- St George's, University of London, London, UK
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23
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Cunha MF, Pellino G. Environmental effects of surgical procedures and strategies for sustainable surgery. Nat Rev Gastroenterol Hepatol 2022; 20:399-410. [PMID: 36481812 PMCID: PMC9735025 DOI: 10.1038/s41575-022-00716-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2022] [Indexed: 12/13/2022]
Abstract
There is a bidirectional relationship between climate change and health care. Climate change threatens public health, and health care contributes to climate change. For example, surgery is the most energy-intensive practice in the health-care sector, and gastrointestinal conditions are responsible for a substantial environmental burden. However, environmental costs associated with health care are often overlooked. This issue has been examined more closely in current times. Emerging data are mainly focused on surgery, as the most resource-intensive practice. However, there is still a lack of global awareness and guidance on sustainable surgical practices. This Perspective aims to reassess the evidence on health care and surgery carbon footprints, focusing on gastrointestinal conditions, identify issues that need to be addressed to achieve a more sustainable practice and develop perspectives for future surgical procedures. The proposed framework to mitigate the environmental effects of surgery could be translated to other health-care sectors.
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Affiliation(s)
- Miguel F. Cunha
- grid.7157.40000 0000 9693 350XColorectal Surgery group - General Surgery Department, Algarve University Centre, Portimão, Portugal ,Algarve Biomedical Centre, Portimão, Portugal
| | - Gianluca Pellino
- grid.9841.40000 0001 2200 8888Department of Advanced Medical and Surgical Sciences, Universitá degli Studi della Campania ‘Luigi Vanvitelli’, Naples, Italy ,grid.411083.f0000 0001 0675 8654Colorectal Surgery, Vall d’Hebron University Hospital, Barcelona, Spain
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Pickard Strange M, Booth A, Akiki M, Wieringa S, Shaw SE. The role of virtual consulting in developing environmentally sustainable healthcare: a systematic literature review (Preprint). J Med Internet Res 2022; 25:e44823. [PMID: 37133914 DOI: 10.2196/44823] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Health systems globally need to rapidly set and achieve targets for reaching net zero carbon emissions. Virtual consulting (including video- and telephone-based consulting) is regarded as one means by which this might be achieved, largely through reduced patient travel. Little is currently known about the ways in which forms of virtual consulting might contribute to the net zero agenda or how countries may develop and implement programs at scale that can support increased environmental sustainability. OBJECTIVE In this paper, we asked, What is the impact of virtual consulting on environmental sustainability in health care? and What can we learn from current evaluations that can inform future reductions in carbon emissions? METHODS We conducted a systematic review of published literature according to PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) guidelines. We searched the MEDLINE, PubMed, and Scopus databases using key terms relating to "carbon footprint," "environmental impact," "telemedicine," and "remote consulting," using citation tracking to identify additional articles. The articles were screened, and full texts that met the inclusion criteria were obtained. Data on the approach to carbon footprinting reported reductions in emissions, and the opportunities and challenges associated with the environmental sustainability of virtual consultations were extracted into a spreadsheet, analyzed thematically, and theorized using the Planning and Evaluating Remote Consultation Services framework to consider the various interacting influences, including environmental sustainability, that shape the adoption of virtual consulting services. RESULTS A total of 1672 papers were identified. After removing duplicates and screening for eligibility, 23 papers that focused on a range of virtual consulting equipment and platforms across different clinical conditions and services were included. The focus on the environmental sustainability potential of virtual consulting was unanimously reported through carbon savings achieved by a reduction in travel related to face-to-face appointments. The shortlisted papers used a range of methods and assumptions to determine carbon savings, reporting these using different units and across varied sample sizes. This limited the potential for comparison. Despite methodological inconsistencies, all papers concluded that virtual consulting significantly reduced carbon emissions. However, there was limited consideration of wider factors (eg, patient suitability, clinical indication, and organizational infrastructure) influencing the adoption, use, and spread of virtual consultations and the carbon footprint of the entire clinical pathway in which the virtual consultation was provided (eg, risk of missed diagnoses from virtual consultations that result in the need for subsequent in-person consultations or admissions). CONCLUSIONS There is overwhelming evidence that virtual consulting can reduce health care carbon emissions, largely through reducing travel related to in-person appointments. However, the current evidence fails to look at system factors associated with implementing virtual health care delivery and wider research into carbon emissions across the entire clinical pathway.
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Affiliation(s)
- Martha Pickard Strange
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Amy Booth
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Melissa Akiki
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Sietse Wieringa
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- University of Oslo, Oslo, Norway
| | - Sara E Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Burch H, Beaton LJ, Simpson G, Watson B, Maxwell J, Winkel KD. A planetary health-organ system map to integrate climate change and health content into medical curricula. Med J Aust 2022; 217:469-473. [PMID: 36176203 PMCID: PMC9828644 DOI: 10.5694/mja2.51737] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/11/2022] [Accepted: 07/20/2022] [Indexed: 01/12/2023]
Affiliation(s)
| | | | | | | | | | - Kenneth D Winkel
- Centre for Health PolicyMelbourne School of Population and Global HealthUniversity of MelbourneMelbourneVIC
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Klünder V, Schwenke P, Hertig E, Jochem C, Kaspar-Ott I, Schwienhorst-Stich EM, Stauch L, Coenen M. A cross-sectional study on the knowledge of and interest in Planetary Health in health-related study programmes in Germany. Front Public Health 2022; 10:937854. [PMID: 36388321 PMCID: PMC9660317 DOI: 10.3389/fpubh.2022.937854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 10/13/2022] [Indexed: 01/25/2023] Open
Abstract
Planetary Health connects human health with the natural and anthropogenic systems on which it depends. Planetary Health education has been growing in a wide range of health-related disciplines, yet not been widely implemented in health-related university curricula. This cross-sectional study focused on students' knowledge of and interest in Planetary Health education in order to assess the relevance of Planetary Health and Planetary Health topics for university students and their fields of study. We surveyed 1,303 students enrolled in health-related programmes in Bavaria, Germany. Data was collected on students' previous knowledge of and interest in Planetary Health, as well as the relevance of different Planetary Health topics and students' willingness to select a Planetary Health elective within their study programmes. Descriptive statistics were calculated. The majority of participants (73.8%) had not yet heard of Planetary Health but were interested in learning more about this field (90.7%). Most participants considered Planetary Health as relevant to their field (81.6%) and would likely choose a Planetary Health elective (81.9%). Participants were most interested in topics about general associations between climate and health as well as its connections with mental health and (micro) plastics. There is an urgent need and high student interest to implement a Planetary Health module in health-related study programmes in order to move this topic more into focus for the next generation of students.
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Affiliation(s)
- Vera Klünder
- Institute for Medical Information Processing, Biometry, and Epidemiology–IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany,Pettenkofer School of Public Health, Munich, Germany
| | - Paula Schwenke
- Institute for Medical Information Processing, Biometry, and Epidemiology–IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany,Pettenkofer School of Public Health, Munich, Germany
| | - Elke Hertig
- Faculty of Medicine, Regional Climate Change and Health, University of Augsburg, Augsburg, Germany
| | - Carmen Jochem
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine, University of Regensburg, Regensburg, Germany
| | - Irena Kaspar-Ott
- Faculty of Medicine, Regional Climate Change and Health, University of Augsburg, Augsburg, Germany
| | - Eva-Maria Schwienhorst-Stich
- Department of General Practice/Family Medicine, University Hospital Würzburg, Würzburg, Germany,Teaching Clinic of the Faculty of Medicine and Institute of Medical Teaching and Medical Education Research, University of Würzburg, Würzburg, Germany
| | - Lisa Stauch
- Institute for Medical Information Processing, Biometry, and Epidemiology–IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany,Pettenkofer School of Public Health, Munich, Germany
| | - Michaela Coenen
- Institute for Medical Information Processing, Biometry, and Epidemiology–IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany,Pettenkofer School of Public Health, Munich, Germany,*Correspondence: Michaela Coenen
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Liu I, Rabin B, Manivannan M, Laney E, Philipsborn R. Evaluating strengths and opportunities for a co-created climate change curriculum: Medical student perspectives. Front Public Health 2022; 10:1021125. [PMID: 36353273 PMCID: PMC9638156 DOI: 10.3389/fpubh.2022.1021125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/07/2022] [Indexed: 01/28/2023] Open
Abstract
Introduction Medical trainees are front-line workers in our worsening climate and health crisis. A movement is underway to teach medical students essential climate change and health content. Few evaluations of climate and health curricula exist to support ongoing curricular development, innovation, and improvement. This study explores student perspectives on climate change and health content and delivery post-implementation of a climate change and health curriculum that was co-created by students and faculty and integrated across 16 months of pre-clinical coursework at Emory University School of Medicine. Methods The authors conducted focus groups with the inaugural cohort of students to receive the climate and health education content at the conclusion of their preclinical curriculum. The focus groups elicited student perspectives across four domains: (i) prior perceptions of climate change and health, (ii) current attitudes about climate change and health, (iii) reflections on the existing curriculum, and (iv) opportunities for the curriculum. In this qualitative evaluation, the authors coded focus group transcripts using an inductive content analysis approach. Results Out of 137 eligible students in the cohort, 13 (9.5%) participated in the focus groups. Implementation strategies that students valued included contextualization and integration of climate content within existing topics and student representation through the co-creation process. Students recommended bolstering small group sessions and case-based learning to build relevant history and physical examination skills as well as creating interprofessional and community-based opportunities. Discussion This evaluation offers in-depth student perspectives of our climate and health curriculum. Opportunities exist to synergize climate and health education with broader transformations in medicine toward health promotion and sustainable, climate-ready healthcare. From the input of focus groups, the authors derive a framework for strengthening and extending curricular content.
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Affiliation(s)
- Irene Liu
- Emory University School of Medicine, Atlanta, GA, United States
| | - Benjamin Rabin
- Emory University School of Medicine, Atlanta, GA, United States
| | | | - Emaline Laney
- Emory University School of Medicine, Atlanta, GA, United States,Department of Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Rebecca Philipsborn
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States,Gangarosa Department of Environmental Health, Rollins School of Public Health, Atlanta, GA, United States,*Correspondence: Rebecca Philipsborn
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28
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Spooner R, Stanford V, Parslow-Williams S, Mortimer F, Leedham-Green K. "Concrete ways we can make a difference": A multi-centre, multi-professional evaluation of sustainability in quality improvement education. MEDICAL TEACHER 2022; 44:1116-1124. [PMID: 35543345 DOI: 10.1080/0142159x.2022.2064737] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Quality improvement (QI) projects are a mandatory part of postgraduate medical training in the UK and graduating medical students must be competent in QI theory. We evaluated an educational toolkit that links concepts of sustainable healthcare with established quality improvement methodologies (the SusQI approach, available at www.susqi.org). The SusQI approach was implemented across a range of undergraduate and postgraduate nursing and medical education contexts. Educational strategies included guided online learning, live interactive webinars, small group activities and scaffolded project work. The evaluation strategy was informed by theories of academic motivation, educational value within communities of practice and behaviour change. A simultaneous nested design was tested using a mixed methods survey with input from learners and teachers. 177 survey responses were analysed to quantify and compare self-rated impacts of teaching across different audiences. Qualitative data were inductively coded into themes that were categorised according to above theoretical frameworks. Participants felt that this was 'time well spent' and many described transformative impacts that guided their daily professional practice beyond learning about QI. We suggest that meaningful space is found within both undergraduate and postgraduate healthcare curricula for SusQI, as a way of engaging and motivating learners to contribute to the creation of a sustainable healthcare system.
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Affiliation(s)
- Rosanna Spooner
- Department of Education, Centre for Sustainable Healthcare, Oxford, UK
- Department of Paediatrics, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Victoria Stanford
- Department of Education, Centre for Sustainable Healthcare, Oxford, UK
| | | | - Frances Mortimer
- Department of Education, Centre for Sustainable Healthcare, Oxford, UK
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Shehata MH, Prabu Kumar A, Al Ansari AM, Deifalla A, Atwa HS. Best Practices of the World Health Organization Collaborating Centres (WHOCCs) in the Eastern Mediterranean Region. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2022; 13:1199-1205. [PMID: 36212703 PMCID: PMC9532253 DOI: 10.2147/amep.s367834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/27/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND World Health Organization Collaborating Centres (WHOCCs) cooperate with the WHO on a range of strategic areas such as nursing, nutrition, mental health, chronic diseases, education, and health technologies, depending on their speciality areas. As of 2021, WHO has 47 CCs in the Eastern Mediterranean Region (EMR) collaborating on diverse areas. Four CCs in the EMR located in Egypt, Kingdom of Bahrain, Sudan, and Pakistan focus primarily on medical education (ME). OBJECTIVE The objective of this review of the literature is to describe the best practices in ME based on published research from the four WHOCCs in EMR. The secondary objective is to classify them based on the level of Kirkpatrick's model (KM) of educational outcomes. METHODS The contributions of WHOCCs are categorised in to five domains namely "Curriculum Development and Course Design", "Student Assessment", "Quality, Accreditation, and Program Evaluation", "Teaching and Learning" and "Innovation in Medical Education". Initial extraction yielded 96 articles for review, while the second level of analysis reduced the number of publications to 37 based on the date of publication within the last 5 years. Numerous best practices in ME emerged from the recently published works of these WHOCCs in the areas of learning and teaching, curriculum development, innovations in medical education, quality, and assessments in medical education. Literature from the WHOCCs on assessment and curriculum design are limited, possibly indicating opportunities for additional research. CONCLUSION The researchers conclude that the WHOCCs in the EMR show transformational impact on all principal areas of research and at multiple levels.
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Affiliation(s)
- Mohamed Hany Shehata
- Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
- Helwan University Faculty of Medicine, Cairo, Egypt
| | - Archana Prabu Kumar
- Medical Education Unit, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Ahmed Mohammed Al Ansari
- Medical Education Unit, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Abdelhalim Deifalla
- Department of Anatomy, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
- Faculty of Medicine, Suez Canal, University, Ismailia, Egypt
| | - Hani Salem Atwa
- Medical Education Unit, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
- Faculty of Medicine, Suez Canal, University, Ismailia, Egypt
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Gupta D, Shantharam L, MacDonald BK. Sustainable healthcare in medical education: survey of the student perspectives at a UK medical school. BMC MEDICAL EDUCATION 2022; 22:689. [PMID: 36151552 PMCID: PMC9508793 DOI: 10.1186/s12909-022-03737-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 08/08/2022] [Indexed: 05/28/2023]
Abstract
BACKGROUND It is now a General Medical Council requirement to incorporate education for sustainable healthcare (ESH) into medical curricula. To date, research has focussed on the perspectives of educators and which sustainable healthcare topics to include in teaching. Therefore, due to this gap in the literature, we have investigated the perspectives of medical students in the UK regarding current and future incorporation of ESH in medical education. METHODS A survey was circulated to 851 clinical year medical students and students intercalating after completing at least one clinical year in a London University. The anonymous survey consisted of sections on the environmental impact, current teaching and future teaching of ESH. RESULTS One hundred sixty-three students completed the survey. 93% of participants believed that climate change is a concern in current society, and only 1.8% thought they have been formally taught what sustainable healthcare is. No participants strongly agreed, and only 5 participants (3.1%) agreed, that they would feel confident in answering exam questions on this topic, with 89% agreeing that more ESH is needed. 60% believe that future teaching should be incorporated in both preclinical and clinical years, with 31% of participants preferring online modules as the method of teaching. CONCLUSION Our study has stressed the lack of current sustainable healthcare teaching in the medical curriculum. There is student demand for ESH, however, uncertainty remains regarding who is best placed to facilitate ESH, how it should be delivered, and whether there is a gender discrepancy regarding sustainable healthcare importance, emphasising the need to close the gap between educational rhetoric and action.
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Affiliation(s)
- Dhruv Gupta
- St George’s University of London, Cranmer Terrace, Tooting, London, SW17 0RE UK
| | - Lahvanya Shantharam
- St George’s University of London, Cranmer Terrace, Tooting, London, SW17 0RE UK
| | - Bridget K MacDonald
- St George’s University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT UK
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Dunne H, Rizan C, Jones A, Bhutta MF, Taylor T, Barna S, Taylor CJ, Okorie M. Effectiveness of an online module: climate-change and sustainability in clinical practice. BMC MEDICAL EDUCATION 2022; 22:682. [PMID: 36115977 PMCID: PMC9482263 DOI: 10.1186/s12909-022-03734-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 08/03/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Climate change has significant implications for health, yet healthcare provision itself contributes significant greenhouse gas emission. Medical students need to be prepared to address impacts of the changing environment and fulfil a key role in climate mitigation. Here we evaluate the effectiveness of an online module on climate-change and sustainability in clinical practice designed to achieve learning objectives adapted from previously established sustainable healthcare priority learning outcomes. METHODS A multi-media, online module was developed, and 3rd and 4th year medical students at Brighton and Sussex Medical School were invited to enrol. Students completed pre- and post-module questionnaires consisting of Likert scale and white space answer questions. Quantitative and qualitative analysis of responses was performed. RESULTS Forty students enrolled and 33 students completed the module (83% completion rate). There was a significant increase in reported understanding of key concepts related to climate change and sustainability in clinical practice (p < 0.001), with proportion of students indicating good or excellent understanding increasing from between 2 - 21% students to between 91 - 97% students. The majority (97%) of students completed the module within 90 min. All students reported the module was relevant to their training. Thematic analysis of white space responses found students commonly reported they wanted access to more resources related to health and healthcare sustainability, as well as further guidance on how to make practical steps towards reducing the environmental impact within a clinical setting. CONCLUSION This is the first study to evaluate learner outcomes of an online module in the field of sustainable health and healthcare. Our results suggest that completion of the module was associated with significant improvement in self-assessed knowledge of key concepts in climate health and sustainability. We hope this approach is followed elsewhere to prepare healthcare staff for impacts of climate change and to support improving the environmental sustainability of healthcare delivery. TRIAL REGISTRATION Study registered with Brighton and Sussex Medical School Research Governance and Ethics Committee (BSMS RGEC). Reference: ER/BSMS3576/8, Date: 4/3/2020.
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Affiliation(s)
- H Dunne
- Cambridge University Hospital, Cambridge, UK.
| | - C Rizan
- University Hospitals Sussex NHS Foundation Trust & Brighton and Sussex Medical School, Brighton, UK
| | - A Jones
- Brighton and Sussex Medical School, Brighton, BN1 9PX, UK
| | - M F Bhutta
- Brighton and Sussex Medical School & University Hospitals Sussex NHS Foundation Trust GB, Brighton, UK
| | - T Taylor
- University Hospitals Southampton, Southampton, SO16 6YD, UK
| | - S Barna
- Centre for Sustainable Healthcare, 291, Cranbrook house, 287 Bambury Rd, Summertown, Oxford, OX2 7JQ, England
| | - C J Taylor
- Brighton and Sussex Medical School, Brighton, BN1 9PX, UK
| | - M Okorie
- Brighton and Sussex Medical School & University Hospitals Sussex NHS Foundation Trust GB, Brighton, UK
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Carino S, Collins J, Malekpour S, Porter J. Harnessing the pillars of institutions to drive environmentally sustainable hospital foodservices. Front Nutr 2022; 9:905932. [PMID: 36172519 PMCID: PMC9511788 DOI: 10.3389/fnut.2022.905932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background The cultural-cognitive, normative and regulative pillars of institutions influence the ability of hospitals to change how they function at an organizational and operational level. As more hospitals and their foodservices instigate changes to address their environmental footprint and impact on food systems, they move through the “sustainability phase model” from no response through to high level action and leadership. The aim of this study was to describe and compare the pillars of institutions between hospitals in different stages of achieving environmentally sustainable foodservices (business-as-usual vs. exemplar hospitals). Methods For this qualitative inquiry study, interviews were conducted with 33 hospital staff from 3 business-as-usual hospitals in Melbourne, Australia and 21 hospital staff from 14 exemplar hospitals across 9 countries. Participants were asked questions about their perspectives on environmental sustainability in foodservices and the barriers, enablers and drivers they experienced. Each data set was analyzed thematically and then compared. Findings There was a clear and distinct difference in responses and behaviors within each pillar between the exemplar and business-as-usual hospitals. The cultural-cognitive pillar identified a similarity in personal belief in the importance of addressing environmental impacts of foodservices, but difference in how staff saw and acted on their responsibility to drive change. The normative pillar uncovered a supportive culture that encouraged change in exemplar hospitals whilst business-as-usual hospital staff felt disheartened by the difficult processes and lack of support. The regulative pillar reflected business-as-usual hospital staff feeling restricted by government policy vs. exemplar hospital participants who were motivated to internalize government policy in different ways and work with other hospitals to advocate for better policy. Interpretation These findings highlight strategies related to each of the three pillars of institutions that can be used to drive effective, sustainable long term change within hospitals. This includes staff education and training, revisiting hospital culture and values around environmental sustainability, embedding sustainable foodservices in internal policies, and a comprehensive government policy approach to sustainable healthcare.
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Affiliation(s)
- Stefanie Carino
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia
- Dietetics Department, Eastern Health, Box Hill, VIC, Australia
| | - Jorja Collins
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia
- Dietetics Department, Eastern Health, Box Hill, VIC, Australia
| | - Shirin Malekpour
- Monash Sustainable Development Institute, Monash University, Clayton, VIC, Australia
| | - Judi Porter
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
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Clery P, Embliss L, Cussans A, Cooke E, Shukla K, Li C. Protesting for public health: a case for medical activism during the climate crisis. Int Rev Psychiatry 2022; 34:553-562. [PMID: 36165750 DOI: 10.1080/09540261.2022.2093627] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Anthropogenic climate change and its sequelae are de-stabilizing our environmental, social, economical and political systems. Not surprisingly, the direct and indirect effects of disrupting these key determinants of health are profoundly detrimental to mental health and wellbeing. Psychiatrists feel compelled to speak out. However, decades of gentle persuasion have failed to invoke sufficient government action so many have turned to activism. Others doubt whether this is, or should be, within their scope of practice. In this article we present the case for medical activism. History has shown prominent activist medics and psychiatrists have been instrumental in creating social and cultural change. We propose that psychiatrists are well-placed to advocate for health issues that cross socio-politico-environmental boundaries. We suggest that, not only do we have a moral imperative to act for the wider determinants of health, but we are also advantageously positioned as trusted professionals with the necessary skills to articulate the problem and advocate for the most vulnerable in society. We call on our training and regulatory bodies to support health activism.
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Affiliation(s)
- Philippa Clery
- Department of Psychiatry, Camden and Islington NHS Foundation Trust, London, UK
| | - Liam Embliss
- Department of Psychiatry, East London NHS Foundation Trust, London, UK
| | - Amelia Cussans
- Department of Psychiatry, West London NHS Trust, London, UK
| | - Eleanor Cooke
- Department of Psychiatry, Camden and Islington NHS Foundation Trust, London, UK
| | - Kirsten Shukla
- Department of Psychiatry, MVZ Timmermann und Partner, Cuxhaven, Germany.,Department of Psychiatry, Oxford Health NHS Foundation Trust, Buckinghamshire, UK.,Planetary Health and Sustainability Committee, Royal College of Psychiatrists, UK
| | - Ching Li
- Planetary Health and Sustainability Committee, Royal College of Psychiatrists, UK.,Department of Psychiatry, Tavistock and Portman NHS Foundation Trust, London, UK
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Bakkum MJ, Richir MC, van Agtmael MA, Tichelaar J. Sustainable medicines use in clinical practice-It is time to help the teacher. Br J Clin Pharmacol 2022; 88:3030-3031. [PMID: 35384020 DOI: 10.1111/bcp.15340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/24/2022] [Accepted: 03/15/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Michiel J Bakkum
- Section Pharmacotherapy, Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Milan C Richir
- Section Pharmacotherapy, Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Michiel A van Agtmael
- Section Pharmacotherapy, Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Jelle Tichelaar
- Section Pharmacotherapy, Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
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Hampshire K, Islam N, Kissel B, Chase H, Gundling K. The Planetary Health Report Card: a student-led initiative to inspire planetary health in medical schools. Lancet Planet Health 2022; 6:e449-e454. [PMID: 35461572 DOI: 10.1016/s2542-5196(22)00045-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 02/03/2022] [Accepted: 02/14/2022] [Indexed: 06/14/2023]
Abstract
The warming of our planet and destruction of our ecosystems have created grave new threats to human health, such as food insecurity, physical and mental trauma from extreme weather events, and heat-related illness. In the 21st century, medical schools should be training physicians who, as researchers, can advance evidence-based linkages between environment and health; who, as clinicians, can recognise, prevent, and treat associated diseases; and who, as healers, can advocate for a healthy biosphere as an indelible precondition for a healthy humanity. To address the substantial gap between existing and needed curricular content that reflects the realities of the health impacts of environmental degradation, medical students have developed the Planetary Health Report Card (PHRC), a metric-based tool for evaluating and improving planetary health content in medical schools. The PHRC spans five topic areas-curriculum, research, community outreach and advocacy, support for student-led initiatives, and sustainability. Since its creation in 2019, the PHRC has expanded rapidly to evaluate more than 60 medical schools in five countries. Although evaluation results reveal inadequate engagement in all topic areas, application of the PHRC is already spawning transformative dialogue between students, faculty, and administrators, serving as a platform to advance the curricular innovations that will hopefully fulfil the learning needs of medical students in a rapidly changing world.
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Affiliation(s)
- Karly Hampshire
- University of California, San Francisco School of Medicine, San Francisco, CA, USA.
| | - Nuzhat Islam
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Bennett Kissel
- Department of Psychiatry, University of Hawaii, Honolulu, HI, USA
| | - Hannah Chase
- Medical Sciences Divisional Office, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Katherine Gundling
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
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Exploring, Diversifying and Debating Sustainable Health (Care) Approaches. SUSTAINABILITY 2022. [DOI: 10.3390/su14031698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Today’s sustainability challenges have major implications for human health and health care. At the same time, the way health care is organized and conducted has major sustainability implications. Sustainable health and sustainable health care approaches in research, which engage with health and sustainability as intertwined phenomena, feature increasingly prominently in various literatures, i.e. (i) literature based on the premise of ‘(un)healthy environments result in (un)healthy people’ (e.g., planetary health); (ii) literature on the implications of ecological change for the sustainability of healthcare systems; and (iii) literature on healthcare systems’ sustainability in view of a range of socio-economic factors. However, an integrative elaboration of the manifold relationships between health and sustainability challenges in these literatures is currently lacking. This review paper therefore maps how these three literatures represent intertwinements between health and sustainability challenges, as well as their suggestions to address these challenges. In addition, we explore which themes and questions are pertinent, meaning they have remained largely unaddressed. By performing a qualitative mapping review, we find that calls for structural attention to inequality, to in-and exclusion, and to stakeholder needs and perspectives cut across these three literatures. Furthermore, we identify three cross-cutting key questions that require future research attention. First, how do divergent ideas on what is and divergent ideas on how can that be known give rise to different health- and sustainability visions and pathways? Second, what do abstract problem statements and solutions presented in agenda-setting work look like in practice in specific and diverse empirical contexts across the globe? And third, how are diverse health and sustainability dynamics historically and spatially interconnected? Moreover, we observe that some voices have so far remained largely silent in scientific debates on health and sustainability intertwinements, namely non-expert voices such as patients and citizens, voices from a variety of social scientific and humanities disciplines, voices from relevant domains beyond (environmental) health, and voices from the global South (from non-experts, social scientific and humanities researchers and domains beyond health). We conclude that a focus on inclusive and equitable engagement with intertwined health- and sustainability challenges is imperative. This requires moving away from developing universal knowledge to address generic problems, to foregrounding plurality in terms of problem statements, knowledge, solutions, and the values embedded therein.
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Chase H, Hampshire K, Tun S. Improving the medical curriculum on planetary health and sustainable healthcare. BMJ 2022; 376:o209. [PMID: 35078768 DOI: 10.1136/bmj.o209] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Leblanc P, Occelli P, Etienne J, Rode G, Colin C. Assessing the implementation of community-based learning in public health: a mixed methods approach. BMC MEDICAL EDUCATION 2022; 22:40. [PMID: 35039020 PMCID: PMC8764809 DOI: 10.1186/s12909-021-03098-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 12/29/2021] [Indexed: 05/20/2023]
Abstract
BACKGROUND The French government has set up a community-based learning programme on health promotion for undergraduate health students to involve them in key public health objectives. At the University of Lyon, students first underwent formal instruction, including e-learning, lectures, and interactive seminars, and then became health educators for school pupils. The main objective of the present study was to assess the process of implementing this programme during the 2018-2019 academic year. METHODS The satisfaction and perception of medical and midwife students with community-based learning experiences were assessed by a questionnaire, semi-directive interviews, and observations. Replies to the questionnaire were described by median and interquartile range or by proportion. A paired Wilcoxon-Mann-Whitney test was used to compare self-evaluated students' competence scores before and after the seminars (alpha risk of 5%). Thematic analyses using grounded theory were performed on recorded and transcribed interviews, and on transcribed notes taken during the observations. RESULTS Over time the students have evolved from a negative perception of the community-based learning to a positive one. The students were mostly satisfied by interactive seminars that allowed them to gain confidence and competencies in health education. Their involvement in the programme increased their self-esteem. They became more aware of their educative responsibilities regarding public health issues as future professionals. CONCLUSIONS The students had a positive perception of the implementation of a community-based learning programme in our University, as it appeared a pertinent strategy to raise their awareness of prevention and health education issues.
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Affiliation(s)
- Pierre Leblanc
- Direction Qualité Usagers et Santé Populationnelle (DQUSP), Hospices Civils de Lyon, Lyon, France.
- Research On Healthcare Performance (RESHAPE), Université Claude Bernard Lyon 1, INSERM U1290, Lyon, France.
| | - Pauline Occelli
- Research On Healthcare Performance (RESHAPE), Université Claude Bernard Lyon 1, INSERM U1290, Lyon, France
- Pôle de Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - Jerome Etienne
- Faculté de Médecine Lyon Est, Université Claude Bernard, Lyon 1, Lyon, France
| | - Gilles Rode
- Faculté de Médecine Lyon Est, Université Claude Bernard, Lyon 1, Lyon, France
| | - Cyrille Colin
- Research On Healthcare Performance (RESHAPE), Université Claude Bernard Lyon 1, INSERM U1290, Lyon, France
- Service d'Evaluation Economique en Santé Pôle de Santé Publique, Hospices Civils de Lyon, Lyon, France
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Lateef F, Kiat KTB, Yunus M, Rahman MAA, Galwankar S, Al Thani H, Agrawal A. BRAVE: A Point of Care Adaptive Leadership Approach to Providing Patient-Centric Care in the Emergency Department. J Emerg Trauma Shock 2022; 15:47-52. [PMID: 35431488 PMCID: PMC9006722 DOI: 10.4103/jets.jets_138_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 10/09/2021] [Indexed: 11/23/2022] Open
Abstract
The practice of emergency medicine has reached its cross roads. Emergency physicians (EPs) are managing many more time-dependent conditions, initiating complex treatments in the emergency department (ED), handling ethical and end of life care discussions upfront, and even performing procedures which used to be done only in critical care settings, in the resuscitation room. EPs manage a wide spectrum of patients, 24 h a day, which reflects the community and society they practice in. Besides the medical and “technical” issues to handle, they have to learn how to resolve confounding elements which their patients can present with. These may include social, financial, cultural, ethical, relationship, and even employment matters. EPs cannot overlook these, in order to provide holistic care. More and more emphasis is also now given to the social determinants of health. We, from the emergency medicine fraternity, are proposing a unique “BRAVE model,” as a mnemonic to assist in the provision of point of care, adaptive leadership at the bedside in the ED. This represents another useful tool for use in the current climate of the ED, where patients have higher expectations, need more patient-centric resolution and handling of their issues, looming against the background of a more complex society and world.
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Affiliation(s)
- Fatimah Lateef
- Department of Emergency Medicine, Singapore General Hospital, Singapore.,Duke NUS Graduate Medical School, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Lee Kong Chian Medical School, Nanyang Technological University, Singapore.,SingHealth Duke NUS Institute of Medical Simulation, Singapore
| | - Kenneth Tan Boon Kiat
- Department of Emergency Medicine, Singapore General Hospital, Singapore.,Duke NUS Graduate Medical School, Singapore
| | - Md Yunus
- Department of Trauma and Emergency Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | | | - Sagar Galwankar
- The Florida State University Emergency Medicine Residency Program, Sarasota Memorial Hospital, Sarasota, Florida, USA
| | - Hassan Al Thani
- Department of Surgery, Hamad Trauma Centre, Hamad General Hospital, Doha, Qatar
| | - Amit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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Wong YL, Noor M, James KL, Aslam TM. Ophthalmology Going Greener: A Narrative Review. Ophthalmol Ther 2021; 10:845-857. [PMID: 34633635 PMCID: PMC8502635 DOI: 10.1007/s40123-021-00404-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 09/28/2021] [Indexed: 11/30/2022] Open
Abstract
The combined effects of fossil fuel combustion, mass agricultural production and deforestation, industrialisation and the evolution of modern transport systems have resulted in high levels of carbon emissions and accumulation of greenhouse gases, causing profound climate change and ozone layer depletion. The consequential depletion of Earth's natural ecosystems and biodiversity is not only a devastating loss but a threat to human health. Sustainability-the ability to continue activities indefinitely-underpins the principal solutions to these problems. Globally, the healthcare sector is a major contributor to carbon emissions, with waste production and transport systems being amongst the highest contributing factors. The aim of this review is to explore modalities by which the healthcare sector, particularly ophthalmology, can reduce carbon emissions, related costs and overall environmental impact, whilst maintaining a high standard of patient care.
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Affiliation(s)
- Yee Ling Wong
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
| | - Maha Noor
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Katherine L James
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Tariq M Aslam
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,School of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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41
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Affiliation(s)
- Anna Moore
- Lewisham and Greenwich NHS Trust, London, UK
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42
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Anåker A, Spante M, Elf M. Nursing students' perception of climate change and sustainability actions - A mismatched discourse: A qualitative, descriptive exploratory study. NURSE EDUCATION TODAY 2021; 105:105028. [PMID: 34198158 DOI: 10.1016/j.nedt.2021.105028] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/27/2021] [Accepted: 06/14/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Climate change is described as the biggest global challenge for human health in the upcoming decade. Nurses play a central role in mitigating the effect of climate change on the healthcare sector and adapting to the phenomenon. Therefore, nursing students must be prepared for a new professional role keeping climate change in mind; consequently, it is important to study students' perceptions of climate change and sustainability. OBJECTIVES To explore nursing students' perceptions of climate change and sustainability and examine how they perceive their role as nursing students in working towards a more sustainable development within the healthcare sector. DESIGN It is a qualitative, descriptive exploratory study. SETTINGS A nursing program at a university in central Sweden. PARTICIPANTS Nursing students. METHODS Individual in-depth interviews and one group interview were conducted for the study. RESULTS The main findings revealed that students saw themselves living in a mismatched discourse. They perceived the future of humanity as gloomy but thought that sustainability is the society's joint obligation to achieve the right to a good life for all people equally. CONCLUSIONS Nursing students perceived themselves as important actors in the work of climate change and sustainability. Thus, nursing education needs to integrate the impact of climate change on healthcare and promote sustainability into the curriculum for preparing students to take responsibility for sustainability in society.
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Affiliation(s)
- Anna Anåker
- Dalarna University, School of Health and Welfare, Falun, Sweden.
| | - Marianne Spante
- Dalarna University, School of Health and Welfare, Falun, Sweden
| | - Marie Elf
- Dalarna University, School of Health and Welfare, Falun, Sweden
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Clery P, d'Arch Smith S, Marsden O, Leedham-Green K. Sustainability in quality improvement (SusQI): a case-study in undergraduate medical education. BMC MEDICAL EDUCATION 2021; 21:425. [PMID: 34384400 PMCID: PMC8358256 DOI: 10.1186/s12909-021-02817-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 06/01/2021] [Indexed: 05/04/2023]
Abstract
BACKGROUND There is a pressing need for more sustainable healthcare. UK medical graduates are required to apply social, economic, and environmental principles of sustainability to their practice. The Centre for Sustainable Healthcare has developed a sustainability in quality improvement (SusQI) framework and educator's toolkit to address these challenges. We aimed to develop and evaluate SusQI teaching using this toolkit at Bristol Medical School. METHODS We facilitated a SusQI workshop for all third-year Bristol Medical School students. We used mixed methods including questionnaires, exit interviews and follow-up focus groups to evaluate the outcomes and processes of learning. RESULTS Students reported: improvements in knowledge, confidence, and attitudes in both sustainable healthcare and quality improvement; increased self-rated likelihood to engage in SusQI projects; and willingness to change practices to reduce environmental impact in their healthcare roles. Factors for successful teaching included: interactivity; collaboration and participation; and real-life, relevant and tangible examples of projects delivered by credible role models. CONCLUSIONS Students reported that SusQI education supported by the toolkit was effective at building knowledge and skills, and reframed their thinking on sustainability in quality improvement. Combining the two topics provided enhanced motivation for and engagement in both. Further research is needed on the clinical impacts of SusQI learning.
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Affiliation(s)
- Philippa Clery
- Bristol Medical School, University of Bristol, 1-5 Whiteladies road, Clifton, Bristol, BS8 1NU, UK.
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
| | | | - Oliver Marsden
- Bristol Medical School, University of Bristol, 1-5 Whiteladies road, Clifton, Bristol, BS8 1NU, UK
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Exploring environmental sustainability in UK and US dental curricula and related barriers and enablers: a cross-sectional survey in two dental schools. Br Dent J 2021; 230:605-610. [PMID: 33990748 DOI: 10.1038/s41415-021-2942-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 10/04/2020] [Indexed: 11/08/2022]
Abstract
Introduction Very little is known about the knowledge and attitudes of dental students and educators regarding environmental sustainability in dentistry (ESD), the presence of ESD in dental curricula, and barriers and enablers to embracing ESD in dental education.Methods A cross-sectional survey using piloted online questionnaires for students and educators was carried out at the Institute of Dentistry, Queen Mary University of London and at Harvard School of Dental Medicine. Data analysis included descriptive statistics and thematic analysis.Results ESD does not exist formally in the dental curricula at either institution. Despite poor knowledge, students and educators had very positive attitudes to embracing ESD in the curricula. The most noted barriers were lack of knowledge about ESD, lack of time for preparing ESD content, lack of ESD educational materials and infection control regulations. Enablers included embedding ESD in UK and US dental education standards, having institutional backing and support in terms of providing training, educational materials, capacity and incentives, as well as adopting a critical evidence-informed approach in reforming current infection control regulations.Conclusions Dental education and infection control regulatory bodies, as well as dental institutions, can embed ESD in UK and US dental curricula by supporting the implementation of identified enablers.
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Ossebaard HC, Lachman P. Climate change, environmental sustainability and health care quality. Int J Qual Health Care 2021; 33:mzaa036. [PMID: 33693895 PMCID: PMC7197527 DOI: 10.1093/intqhc/mzaa036] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 03/25/2020] [Accepted: 04/01/2020] [Indexed: 12/20/2022] Open
Abstract
The challenges for health care continue to grow and in the 21st century healthcare policymakers and providers will need to respond to the developing impact of global warming and the environmental impact of healthcare service delivery. This cannot be viewed apart from the current Coronavirus disease (COVID-19) pandemic, which is likely to be linked to the climate crisis.
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Affiliation(s)
- Hans C Ossebaard
- National Health Care Institute, P.O. Box 320, 1110 AH Diemen, The Netherlands
| | - Peter Lachman
- International Society for Quality in Healthcare, ISQua, Ireland
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Shaw E, Walpole S, McLean M, Alvarez-Nieto C, Barna S, Bazin K, Behrens G, Chase H, Duane B, El Omrani O, Elf M, Faerron Guzmán CA, Falceto de Barros E, Gibbs TJ, Groome J, Hackett F, Harden J, Hothersall EJ, Hourihane M, Huss NM, Ikiugu M, Joury E, Leedham-Green K, MacKenzie-Shalders K, Madden DL, McKimm J, Nayna Schwerdtle P, Peters S, Redvers N, Sheffield P, Singleton J, Tun S, Woollard R. AMEE Consensus Statement: Planetary health and education for sustainable healthcare. MEDICAL TEACHER 2021; 43:272-286. [PMID: 33602043 DOI: 10.1080/0142159x.2020.1860207] [Citation(s) in RCA: 100] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The purpose of this Consensus Statement is to provide a global, collaborative, representative and inclusive vision for educating an interprofessional healthcare workforce that can deliver sustainable healthcare and promote planetary health. It is intended to inform national and global accreditation standards, planning and action at the institutional level as well as highlight the role of individuals in transforming health professions education. Many countries have agreed to 'rapid, far-reaching and unprecedented changes' to reduce greenhouse gas emissions by 45% within 10 years and achieve carbon neutrality by 2050, including in healthcare. Currently, however, health professions graduates are not prepared for their roles in achieving these changes. Thus, to reduce emissions and meet the 2030 Sustainable Development Goals (SDGs), health professions education must equip undergraduates, and those already qualified, with the knowledge, skills, values, competence and confidence they need to sustainably promote the health, human rights and well-being of current and future generations, while protecting the health of the planet.The current imperative for action on environmental issues such as climate change requires health professionals to mobilize politically as they have before, becoming strong advocates for major environmental, social and economic change. A truly ethical relationship with people and the planet that we inhabit so precariously, and to guarantee a future for the generations which follow, demands nothing less of all health professionals.This Consensus Statement outlines the changes required in health professions education, approaches to achieve these changes and a timeline for action linked to the internationally agreed SDGs. It represents the collective vision of health professionals, educators and students from various health professions, geographic locations and cultures. 'Consensus' implies broad agreement amongst all individuals engaged in discussion on a specific issue, which in this instance, is agreement by all signatories of this Statement developed under the auspices of the Association for Medical Education in Europe (AMEE).To ensure a shared understanding and to accurately convey information, we outline key terms in a glossary which accompanies this Consensus Statement (Supplementary Appendix 1). We acknowledge, however, that terms evolve and that different terms resonate variably depending on factors such as setting and audience. We define education for sustainable healthcare as the process of equipping current and future health professionals with the knowledge, values, confidence and capacity to provide environmentally sustainable services through health professions education. We define a health professional as a person who has gained a professional qualification for work in the health system, whether in healthcare delivery, public health or a management or supporting role and education as 'the system comprising structures, curricula, faculty and activities contributing to a learning process'. This Statement is relevant to the full continuum of training - from undergraduate to postgraduate and continuing professional development.
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Affiliation(s)
- Emily Shaw
- Newcastle University, Newcastle Upon Tyne, UK
| | - Sarah Walpole
- Newcastle University, Newcastle Upon Tyne, UK
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Centre for Sustainable Healthcare, Oxford, UK
| | - Michelle McLean
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia
| | | | - Stefi Barna
- Centre for Sustainable Healthcare, Oxford, UK
| | - Kate Bazin
- Department of Physiotherapy, King's College London, London, UK
| | - Georgia Behrens
- School of Medicine Sydney, The University of Notre Dame Australia, Sydney, Australia
| | | | - Brett Duane
- School of Dentistry, Trinity College Dublin, Dublin, Ireland
| | - Omnia El Omrani
- International Federation of Medical Students' Associations, Copenhagen, Denmark
| | - Marie Elf
- School of Education, Health and Social Studies, Department of Nursing, Dalarna University, Falun, Sweden
| | - Carlos A Faerron Guzmán
- Planetary Health Alliance, Harvard University T H Chan School of Public Health, Boston, MA, USA
| | | | | | - Jonny Groome
- Greener Anaesthesia & Sustainability Project, Great Ormond Street Hospital for Children, London, UK
| | - Finola Hackett
- University of Calgary, CFMS Health and Environment, Lethbridge, Alberta, Canada
| | - Jeni Harden
- University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | | | - Maca Hourihane
- Irish Society of Chartered Physiotherapists Special Interest Group for Healthcare Professionals in International Health and Development and Irish Red Cross Society, Dublin, Ireland
| | | | - Moses Ikiugu
- Occupational Therapy, University of South Dakota School of Health Sciences, Vermillion, SD, USA
| | - Easter Joury
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kathleen Leedham-Green
- Medical Education Research Unit, Imperial College London Faculty of Medicine, London, UK
| | | | - Diana Lynne Madden
- School of Medicine Sydney, The University of Notre Dame Australia, Sydney, Australia
| | - Judy McKimm
- Medical School, Swansea University, Swansea, UK
| | | | | | - Nicole Redvers
- Department of Family & Community Medicine, University of North Dakota School of Medicine & Health Sciences, Grand Forks, ND, USA
| | - Perry Sheffield
- Departments of Environmental Medicine and Public Health and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Judith Singleton
- Pharmacy, School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - SanYuMay Tun
- Imperial College London Centre for Environmental Policy, London, UK
| | - Robert Woollard
- Family Practice, The University of British Columbia, Vancouver, Canada
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Brand G, Collins J, Bedi G, Bonnamy J, Barbour L, Ilangakoon C, Wotherspoon R, Simmons M, Kim M, Schwerdtle PN. "I teach it because it is the biggest threat to health": Integrating sustainable healthcare into health professions education. MEDICAL TEACHER 2021; 43:325-333. [PMID: 33181038 DOI: 10.1080/0142159x.2020.1844876] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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.
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Affiliation(s)
- Gabrielle Brand
- School of Nursing and Midwifery, Monash University, Frankston, Australia
- Monash Centre for Scholarship in Health Education, Monash University, Clayton, Australia
| | - Jorja Collins
- Department of Nutrition, Dietetics & Food, Monash University Australia, Notting Hill, Australia
- Dietetics Department, Eastern Health, Box Hill, Australia
| | - Gitanjali Bedi
- Monash Sustainable Development Institute, Monash University, Clayton, Australia
| | - James Bonnamy
- School of Nursing and Midwifery, Monash University, Frankston, Australia
| | - Liza Barbour
- Department of Nutrition, Dietetics & Food, Monash University Australia, Notting Hill, Australia
| | - Chanika Ilangakoon
- School of Nursing and Midwifery, Monash University, Frankston, Australia
| | - Rosie Wotherspoon
- School of Nursing and Midwifery, Monash University, Frankston, Australia
| | | | - Misol Kim
- Faculty of Engineering, Monash University, Clayton, Australia
| | - Patricia Nayna Schwerdtle
- School of Nursing and Midwifery, Monash University, Frankston, Australia
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
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Tweedie J, Wright HH, Palermo C, Pelly FE. Key concepts for dietetic curriculum: An observational study of Australian dietitians' perceptions. Nutr Diet 2021; 78:544-552. [PMID: 33501763 DOI: 10.1111/1747-0080.12654] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/29/2020] [Accepted: 11/24/2020] [Indexed: 11/29/2022]
Abstract
AIM A concept-based approach to dietetic curriculum design has been proposed to prevent content overload and promote critical thinking. Fifty-six concepts were identified in a previous study. The aim of the present study was to investigate whether the dietetic profession views these concepts as representative of current practice and key for nutrition and dietetics education, and identify any new or emerging concepts. METHODS Accredited Practising Dietitians (APDs) were invited to participate in a self-administered online survey that included scale responses on the relevance of the 56 concepts and open-ended suggestions of additional concepts. Respondent characteristics were also collected. RESULTS Ninety-eight APDs completed the survey. Greater than 65% of respondents agreed/strongly agreed that all 56 concepts were relevant. There was less agreement on the concepts of acid-base balance; leadership; management; physical activity, exercise and health; quality assurance and improvement; risk; safety; stakeholder; standards; sustainability; systems and technology and health informatics. Respondents working in regional, rural and remote areas were less likely to agree that leadership was a key concept (χ2 = 4.45, P = .035). Respondents working in teaching and education were more likely to agree that sustainability was a key concept (χ2 = 7.02, P = .008). No new concepts were identified. CONCLUSIONS The existing 56 concepts were considered key for nutrition and dietetics education. Although the respondents to this survey view these concepts as relevant to current practice, this may not represent the entire profession. It is yet to be determined if the concepts will meet future priorities for the dietetic workforce.
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Affiliation(s)
- Judith Tweedie
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Hattie H Wright
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Claire Palermo
- Monash Centre for Scholarship in Health Education, Monash University, Clayton, Victoria, Australia
| | - Fiona E Pelly
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
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Sherratt S. What are the implications of climate change for speech and language therapists? INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2021; 56:215-227. [PMID: 33258529 DOI: 10.1111/1460-6984.12587] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND The emerging global issue of climate change has large-scale effects on health and well-being, including communication disorders. The broad range of the speech and language therapy profession's scope of practice incorporates prevention, advocacy and equality in service delivery. These act as a springboard for involvement in climate change and health. AIMS This is an appeal to speech and language therapists (SLTs) to focus and take action on this issue and its considerable effects on communication and swallowing disorders. METHODS & PROCEDURES This article discusses the importance of taking a public health position on prevention and equality of services to manage environmental determinants of communication and swallowing disorders. It also describes the extent to which climate change affects these disorders and exacerbates the inequality of healthcare services in low- and middle-income countries. MAIN CONTRIBUTION Five strategies are provided for action on fulfilling therapists' roles in reducing the incidence, development and exacerbation of climate-related communication and swallowing disorders, as well as the role of SLTs in acting as advocates. The case is made for expanding the scope of services to focus on prevention and service equality so as to best meet the needs of the wider community. CONCLUSIONS & IMPLICATIONS Despite other challenges currently facing SLTs, climate change and its increasing effects on communication disorders and dysphagia is difficult to ignore. SLTs owe it to their clients, the wider community, low- and middle-income countries, the economy, and the future to take action. What this paper adds What is already known on the subject Multiple studies published in peer-reviewed scientific journals show that climate change is extremely likely to be due to human activities. The global effects will be higher temperatures, changes in precipitation, more droughts and heatwaves, stronger and more intense hurricanes, and a rising sea level which directly threaten the health of entire populations. Other health professions are beginning to take climate change into account in training and practice. What this paper adds to existing knowledge Many disorders of communication and swallowing are caused or exacerbated by the effects of climate change. Increasing temperatures, extremes of precipitation, population displacement and air pollution contribute to cardiovascular and cerebrovascular events, respiratory disease, malnutrition, premature birth, air- and water-borne diseases, and mental illness. These may affect the communication and swallowing abilities across the lifespan, but particularly those of children and older adults. What are the potential or actual clinical implications of this work? SLTs' roles in prevention, advocacy and education act as a starting point for involvement in climate change and health. Three practical strategies for action include educating SLTs and other health professionals on climate change and its effects on communication and swallowing, promoting awareness with clients and their families, and gathering and disseminating reliable data.
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Affiliation(s)
- Sue Sherratt
- Communication Research Australia, Rankin Park, NSW, Australia
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Hays RB, Ramani S, Hassell A. Healthcare systems and the sciences of health professional education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2020; 25:1149-1162. [PMID: 33206272 PMCID: PMC7672408 DOI: 10.1007/s10459-020-10010-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/27/2020] [Indexed: 05/02/2023]
Abstract
Health professions education is that part of the education system which applies educational philosophy, theory, principles and practice in a complex relationship with busy clinical services, where education is not the primary role. While the goals are clear-to produce the health workforce that society needs to improve health outcomes-both education and healthcare systems continue to evolve concurrently amidst changes in knowledge, skills, population demographics and social contracts. In observing a significant anniversary of this journal, which sits at the junction of education and healthcare systems, it is appropriate to reflect on how the relationship is evolving. Health professions educators must listen to the voices of regulators, employers, students and patients when adapting to new service delivery models that emerge in response to pressures for change. The recent COVID-19 pandemic is one example of disruptive change, but other factors, such as population pressures and climate change, can also drive innovations that result in lasting change. Emerging technology may act as either a servant of change or a disruptor. There is a pressing need for interdisciplinary research that develops a theory and evidence base to strengthen sustainability of change.
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Affiliation(s)
- R B Hays
- College of Medicine & Dentistry, James Cook University, Townsville, Australia.
| | - S Ramani
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - A Hassell
- School of Medicine, Keele University, Newcastle upon Tyne, UK
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