AMEE Consensus Statement: Planetary health and education for sustainable healthcare

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.

Faculty development and partnership with students to integrate sustainable healthcare into health professions education

There is an urgent need for health professionals to address the impacts of accelerating global environmental change. Healthcare faculty therefore have to educate the rising generation of health professionals in subjects unfamiliar to themselves, such as planetary health and sustainable healthcare. This creates a new paradigm where faculty have to learn a new subject area and incorporate and teach it within their own material. It is important to develop faculty knowledge and confidence to integrate education for sustainable healthcare into their educational practice, as faculty can rapidly acquire and build on these skills. Partnership between students and faculty can enhance this faculty development as students bring fresh ideas and possibly greater knowledge of the climate and ecological crisis. Under supervision, they can co-create the necessary new learning. Students can also act as partners in advocating for social and environmental fairness and systemic change toward a sustainable healthcare system. We summarize the impact of various activities of health professions students around the world which advocate for institutional change and enhance faculty development in education for sustainable healthcare. Through diverse case studies from different countries, we illustrate faculty development in education for sustainable healthcare, highlighting student involvement which has enhanced educators' learning.

Fulfilling a new obligation: Teaching and learning of sustainable healthcare in the medical education curriculum

Aims: Leading the growing international recognition of the need for sustainability in healthcare delivery, the UK medical regulator has mandated that newly qualified doctors must be able to apply the principles of sustainable healthcare to medical practice. This original research investigates how best to incorporate this new learning into the medical curriculum. Methods: Data from multiple sources were triangulated to generate themes through grounded theory. Meetings were held with representatives of key stakeholder organizations, relevant documents were reviewed and semi-structured interviews were conducted with diverse medical educators who teach sustainable healthcare. Results: There is continual pressure on space in the curriculum, and faculty lack the knowledge to teach this emerging subject, which is also difficult to examine. Students increasingly demand that sustainability be addressed in their education and future careers. Many sources of support and learning resources are available. Conclusions: Practical recommendations for implementation in any medical school include: teaching sustainability as a cross-cutting theme rather than a topic, clinicians and students learning from each other in this developing field, and embedding into assessment the wider determinants of disease. Sustainable healthcare emphasizes prevention rather than late intervention, with benefits to the environment on which health depends, healthcare systems and patients.

Neer Award 1999. Overuse activity injures the supraspinatus tendon in an animal model: a histologic and biomechanical study

Overuse activity has been implicated as an etiologic factor in injury to the rotator cuff and to the supraspinatus tendon in particular. Due in part to the lack of an appropriate animal model, expex85ental studies have not addressed this issue. With the use of a rat model, we measured the effects of an overuse running regimen on 36 Sprague-Dawley rats after 4 (n = 12), 8 (n = 12), or 16 (n = 12) weeks of exercise and compared them with a control group of rats (n = 10) who were allowed normal cage activity. The histologic characteristics, the gross morphologic characteristics, and the mechanical properties of the tendon tissue were evaluated. The supraspinatus tendons in the exercised animals demonstrated significant changes as a result of overuse at all time points compared with the normal group. There was an increase in cellularity and a loss of the normal collagen fiber organization consistent with what has been seen in human tendinopathy. The tendons from the exercise groups were larger than normal in cross-sectional analysis at 4 weeks (129% of control, P < .01) and continued to increase in size with time to 16 weeks (164% of control, P = .01). The mechanical properties of the tendons deteriorated in response to overuse exercise with a decreased modulus of elasticity ranging from 52% to 61% of control (P = .07 at 4 weeks, P < .05 at 8 and 16 weeks) and a decreased maximum stress of failure ranging from 51% to 63% of control (P < .007). These findings support overuse activity as an etiologic factor in the development of supraspinatus tendinopathy and begin to describe the changes in the tendons as a result of such activity. This model can now be used to study the effect of various treatment modalities on these injuries.