Mapping Greener HealthcareMapping Greener Healthcare

Summary

“Introduction to sustainable health” is a 1.5 hour interactive workshop now scheduled for its second year in the Patients, populations, policy (P3) module. The workshop is a required experience for all first-year medical students (~200) and begins with a definition of environmental health, followed by an introduction to the overall causes, mechanisms and impacts of climate change.

Background

The faculty member who developed this session looked at the courses run by her department and identified those most amendable to climate-change topic related insertions. Because she has a relationship with her departmental colleagues, she was allowed to include these topics without adding substantially to the curriculum. Specific sustainability learning objectives were added to the P3 workshop, linked to the overall teaching goals of the course.

Course Description

The session addresses the following questions:

1. What are the mechanisms and impacts of climate change?
2. What are some of the barriers to implementing sustainable behavioral and institutional practices?
3. What are some commonly identified strategies to reduce greenhouse gas emissions?
4. What actions can doctors take to improve sustainability?
5. What effects does climate change have on air quality and by what mechanisms do increased temperatures affect air quality?
6. List common air pollutants. By what mechanism do they harm health?
7. What are the health effects/outcomes of air pollution?
8. Which populations are the most vulnerable and what environmental conditions increase individual vulnerability? How might lower SES influence exposure or susceptibility to air pollution?
9. What is the air quality in dc today and what does it mean? What advice would you give your 16-year-old asthma patient if the air quality index is 130? What are your options in counseling your vulnerable patients? How useful are face masks?

After listening to an introductory summary outlining the mechanisms and impacts of climate change, students identify their degree of concern about climate change through clicker voting, which is then compared to US percentages (‘6 Americas’) and their political affiliations, and discuss barriers to addressing climate change in their personal and professional lives.

Students also calculate their carbon footprint. They then are given a case study which links air pollution and climate change. The students form small groups to answer questions such as how to look up air quality, how to address the impact of air pollution on respiratory disease, what travel advisories would they give restricting travel to areas with high levels of pollution, and how to use an app to detect wildfires.

Year group taught: 1st years

Status of this teaching within the curriculum: Core

Curriculum area: P3 is an existing introductory course aimed at familiarising students with the US health care system (and comparing it with other systems), financial structures and health care coverage, and addressing issues important to population health, including a focus on social determinants of health.

Pedagogical format: lectures interspersed with interactive learning activities

Teaching time: 1.5 hours

Number of students taught: 200

Materials used: PowerPoint slides; background articles

Session dates: Takes place in October, has so far run in 2017 and will run in Fall, 2018

Sustainability learning outcomes addressed:

• PLO 1 - Describe how the environment and human health interact at different levels (“Explain the causal relationship between climate change & health”
• 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 (“Identify personal, professional and global solutions to atmospheric carbonization”)
• Other: Advise patients on monitoring air quality to minimize respiratory and cardiovascular effects of air pollution

Lessons Learned

• Based on reactions from students, the session lead found that to enhance effectiveness of the teaching, there needs to be more emphasis on solutions and more follow-up to support the learning. In the next iterations there will therefore be more focus on solutions available to students, and opportunities for follow-up will be provided e.g. research projects, service projects or support for advocacy.
• The educator recommends forming alliances with faculty in other departments and working with them to take a similar approach, consistent with previous recommendations on an integrated climate change curriculum.

An educator (small-group leader) new to teaching the course said:

“Yesterday's content on PCMH and community-focused/patient-centered care, using asthma as the example but then expanding the view by bringing in climate change and environmental impact on individual and community health is just plain genius. Over the course of the morning, the learning was just at optimal level. This session is a beautifully-designed flow and weave of content and teaching method.”