Mapping Greener HealthcareMapping Greener Healthcare

Summary

The University of Bristol Medical School has been running a student selected module in Sustainable Healthcare for the past five years. Although the content and structure has changed and adapted over this time, the course continues to have significant impact onstudents’ understanding of sustainability, and their role in creating sustainable healthcare systems. The course combines theoretical study, active learning and self-reflection to enable students to realise the practical implications of the concept of sustainable healthcare. The students have been taught by specialists from the Centre for Sustainable Healthcare and the NUS’ Department for Sustainability. Their learning is complemented by a placement in a local GP (general practice) surgery or NHS trust, where they deliver, monitor and evaluate a project designed to improve sustainability and quality of care, which may be linked to actions within the RCGP’s Green Impact for Health toolkit.

Course description

2nd year students are given the opportunity to engage in this student selected module which uses the SusQI framework for integrating sustainability in quality improvement and Green Impact for Health. The module engages students at the beginning of their career, enabling them to promote sustainable behaviours to contribute to a new, more sustainable culture in healthcare organisations.

The module gives students a background in sustainable healthcare, climate change, quality improvement and change management; issues that all practitioners in health and social care require an understanding of. Students are then placed within a healthcare organisation to develop and complete a project addressing an area that they feel particularly strongly about, using a simplified quality improvement approach. Projects have ranged from reducing disposable glove use, streamlining referral and support streams for obese children, establishing new exercise classes for social prescribing and creating awareness videos for patients about air quality.

Sustainability learning outcomes addressed:

• PLO 1 - Describe how the environment and human health interact at different levels
• PLO 2 - Demonstrate the knowledge and skills needed to improve the environmental sustainability of health systems
• Understand the wider concept of sustainability including social, economic and environmental sustainability and how it relates to healthcare
• PLO 3 - Discuss how the duty of a doctor to protect and promote health is shaped by the dependence of human health on the local and global environment

Of course, there are other lessons learnt and feedback from students suggests the module also enhances confidence, soft-workplace skills, change-make skills, systems-thinking and critical-thinking.

The details

• Teaching time has varied based on the medical school’s requirements. For the firstfour years the students had 30 hours spread across a ten-week period. Of these, 9 were used specifically for teaching and c. 8 were spent in practice. In the latest iteration of the module, students had 14 consecutive days to work on the module.

• 2-12 students have been taught per module although this could be extended to 20.

• The pedagogical format has been a mixture of lectures, seminars, community project visits, self-facilitated learning, peer-to-peer learning and a practice based project. A course handbook is also produced.

• Assessment for the module has varied across different years but has included verbal presentations, learning reflections, poster presentations and project reports.

• Impact assessment is undertaken with both the host GP practices as well as the students, so we can understand how the module is influencing activity, learning, and attitudes and behaviors relating to sustainable healthcare. Feedback from those involved also helps shape then next iteration of the module.

Lessons Learned:

• Using external experts to deliver the module (Charlotte Bonner from the National Union of Students and Dr Frances Mortimer from the Centre for Sustainable Healthcare) has presented both an opportunity and a challenge. The opportunity arises from their perspective and experience of practicing and teaching about sustainable healthcare; the challenge is ensuring alignment of their teaching both in terms of logistics and in terms of the aims and pedagogies of the module and the medical school.
• Student feedback suggests that students want to learn about sustainability if it is framed such that they can relate it to other core curriculum topics, particularly clinical care, and to their own personal interests, such as social justice and the future of the NHS.
• Tasks that seem doable to practitioners with experience of integrating sustainability into healthcare practice may be incredibly difficult for students just starting out on the journey – we have learned to reign in our expectations and take into account the other pressures students are experiencing! Similarly managing student expectations as to what is achievable in a few weeks needs to be done carefully.

Student feedback:

“This SSC was a great addition to my medical course, it was a lot of work at times, but I felt like I have really made a difference, and due to the nature of my project I felt like Iwas acting a professional in the NHS which was very exciting and rewarding.”

“This SSC has been a great opportunity...I have thoroughly enjoyed exploring a subjectoutside of the normal curriculum and it has been hugely valuable to experience thechallenge of making sustainable changes in the NHS.”

“Overall, I think the sustainability SSC offers a different but very relevant and animportant outlook on how healthcare is delivered.”

“I learnt a great deal within this course. I already had an understanding of sustainability but had not applied it to a healthcare setting.”

"The topic was very interesting and a good extra to our course as it is not covered but a vital part of working in the NHS and being a doctor. I believe it is a part of our educationthat is missing.”

“A doctor has a responsibility as someone who is respected by the community to pioneerchanges in practice and influence others to do the same...I think it will change the way Iwill practice medicine and will inform many decisions I make in the future.”

“I thought being a doctor was going into a surgery and talking to people but it’s helpedme realise that ... sustainability is a thing that as a doctor you can push forward and people will listen – you don’t realise how big your voice is until you use it. “