Karly Hampshire had just started medical school when historic wildfires ravaged Northern California during the fall of 2018.
Hampshire, now a fourth-year medical student at the University of California San Francisco (UCSF), was struck by the bright orange, dystopian sky on her commutes to class, wearing an N95 mask to protect herself from the smog.
The environmental stresses of day-to-day life became even more apparent in places where they weren't discussed -- in class.
"Even though we were walking to school every day in this awful hellscape ... our pulmonary block did not cover the health effects of air pollution," Hampshire told 番茄社区. "The reality of what was going on in our everyday life was so disconnected from what we were learning in the classroom."
While there has been a growing push to introduce climate-and-health curricula into medical schools, climate change courses are still not widespread. A recent survey conducted by the International Federation of Medical Students' Associations found that taught a climate-and-health curriculum.
However, while some believe that adding a climate component to medical education might make the curriculum too crowded, taking away from other clinical topics, climate and health advocates have pushed for an integrated approach, maintaining that climate change is a necessary core topic for physicians practicing in the 21st century.
"This is fundamental to the mission of medicine," Renee Salas, MD, MPH, MS, an emergency medicine physician at Massachusetts General Hospital in Boston, who researches climate change and health, told 番茄社区. "It is an obligation of medical schools and continuing education to ensure that we can optimally prepare individuals to practice in today's environment."
Slow Adoption, Growing Momentum
Hampshire's first year at medical school pushed her to get involved with efforts to create a climate-and-health curriculum at UCSF. She also wanted to find a way to encourage other schools to participate and to provide resources for incoming students to evaluate the climate change initiatives at different institutions.
Hampshire and colleagues created the in 2019, a tool that compiles data on medical schools' climate-related offerings. The database includes information on 87 member institutions in eight countries, rating schools based on their planetary health curriculum, interdisciplinary research, institutional support for student-led projects, community engagement and advocacy efforts, and campus sustainability.
It is difficult to assess exactly how many medical schools in the U.S. are offering a curriculum on climate change and health, because curricula are not publicly available. Hampshire noted that while adoption of climate-and-health curricula at medical schools nationwide is currently slow-going, there is a "tremendous momentum" to integrate this material into existing courses.
Within the next 5 or 10 years, Hampshire said, most schools will likely offer climate-and-health content.
"We're already seeing the health effects of climate change play out in our immediate surroundings and immediate communities," Hampshire said. "I think medical schools will start to feel like they're lagging behind if they don't address it in the curriculum."
Adding 'One More Thing'
The movement to include climate change and health education in medical school curricula has gained speed because of many grassroots movements piloted by medical students and trainees. However, medical schools often do not have the resources to teach climate courses.
According to Cecilia Sorensen, MD, the director of Columbia University's Global Consortium on Climate and Health Education, "there are tons of medical student groups who want this, but one of the big problems is that faculty don't have the expertise to teach it."
"There's just knowledge capacity gaps everywhere that we are trying to address," Sorensen told 番茄社区. The consortium has nearly 300 members in more than 50 countries, including programs that train physicians, nurses, public health professionals, and others, and offers resources to help schools develop a climate curriculum, as well as continuing medical education courses for faculty who are interested.
But aside from a lack of expertise, another barrier is simply a lack of resources, Sorensen said. "For a faculty member to be able to do this work, to integrate this into a very long-standing curriculum, that faculty has to be funded."
In addition to concerns about the availability of resources to develop and teach a climate-and-health curriculum, there is also the crammed schedule of the modern-day medical student to consider.
"I think that many people are concerned because medical curricula are already full of precious information," Salas said. "There's concern about how they can add one more thing."
An Integrated Approach
Medical schools have taken different approaches to offering climate-and-health education. Some schools offer semester-long courses on climate and health. Others choose a longitudinal approach, integrating climate change into their existing curriculum. Climate-and-health advocates have argued for an integrated approach to climate change education in medical school in order to address the concerns about taking time away from other necessary clinical topics.
James Sullivan, a medical student at the Cleveland Clinic Lerner College of Medicine in Ohio, and colleagues, proposed a model for , adding planetary health components to journal clubs, didactic sessions, problem-based learning, and clinical rotations.
For example, Sullivan's group recommended modified problem-based learning, adding questions about environmental triggers for cases of asthma. Additionally, they proposed updating content around clinical and communications skills, and modifying learning objectives to incorporate conversations about the history and risks of climate change during patient exams.
"This integrated approach, spanning all years of medical school and touching multiple aspects of existing curricula, can enhance -- rather than compete with -- other content and better represent the real-life problems clinicians will face in practice," Sullivan's group wrote.
While these integrated efforts are underway, there is significant room for growth in how medical schools teach students about climate. In the institutions where climate-and-health education does exist, for example, there is a wide variation in content, Sorensen said. Because climate-related content is not included on physician board exams, the material that schools teach is inconsistent.
"This is not something that is recognized as a universal competency for medical students," Sorensen noted. "Because of that, we see a wide variation in terms of what is actually being taught."
In addition to efforts to add climate questions to board exams and increase the number of faculty members who are trained to teach, Hampshire said she'd like to see further education on communicating about climate to patients. Physicians are in a unique position to engage with patients on an individual basis -- allowing them to communicate information not only about the intersections between climate change and health, but also patient-specific risk mitigation and adaptation strategies.
"Often, people think about climate change as happening to someone else, somewhere else," Hampshire said. "But when they realize that their health problems are directly related to climate change, that can maybe inspire broader change in our lives."
Update: This article has been updated to reflect additional data on the number of medical schools listed in the Planetary Health Report Card database.