Every medical school should have a planetary health teaching fellowBMJ 2023; 382 doi: https://doi.org/10.1136/bmj.p2026 (Published 08 September 2023) Cite this as: BMJ 2023;382:p2026
- James HJ Bevan,, planetary health senior teaching fellow, specialty registrar in public health1,
- Kalyanaraman Kumaran,, professor of public health & epidemiology, lead for population and planetary health1,
- Inna V Walker,, specialty registrar in public health, deputy lead for population and planetary health123,
- Jane Wilkinson,, associate dean of medical education, respiratory consultant1
- 1Faculty of Medicine, School of Primary Care, Population Science and Medical Education, University of Southampton, UK
- 2Health Institute for Health and Care Research Coordinating Centre (NIHRCC), University of Southampton, Southampton, UK
- 3Health Education England Wessex, NHS England, South East Region, Winchester, UK
Are medical students being prepared for the global health crisis due to the climate emergency? The evidence becomes more sobering and visceral each year. Unless we keep global temperatures below 1.5°C compared to pre-industrial levels, unprecedented environmental shocks will increase in intensity and frequency taking a great toll on all life on Earth.12 The heatwaves that we have experienced recently around the world, which will likely cause thousands of excess deaths, are a stark reminder of the fragility of human health in the context of more extreme climatic conditions. In recent years there has been considerable academic momentum behind planetary health and healthcare sustainability. However, medical students often receive little or no education on these important topics.345
Planetary health is a relatively new concept and refers to the interconnectedness between human health and the health of the planet’s living and non-living systems.6 Healthcare sustainability has been gathering traction for well over a decade, but it is only recently that it has become part of common medical discourse. There is typically a 17 year lag between medical research and clinical practice.7 With business as usual, healthcare sustainability and planetary health could perhaps not be part of doctors’ core knowledge until 2032. Given the scale of the crisis such a lag is unjustifiable, yet there are substantial barriers to these topics being taught at medical schools. While many educators are enthusiastic, most will have no prior experience or education in these disciplines. As a result, few have the confidence to deliver dedicated teaching.8910 Even fewer are likely to have the capacity to adapt their existing teaching or curricula without additional resources.
In 2020 and 2021, we audited our undergraduate medical curriculum at the University of Southampton and discovered we were not providing enough education on these topics.5 Our response to this was to adopt an “infusion” approach, first developed at the Icahn School of Medicine at Mount Sinai in New York.11 Recognising the demands of a densely packed medical curriculum, we sought to infuse planetary health and sustainability teaching into already existing sessions.12 We anticipated some pushback from educators, but instead found overwhelming support for the initiative and relatively easy integration of topics across the curriculum. We have now successfully infused content across all years of study.
In a bid to ensure this change is sustained, in 2022 the Faculty of Medicine rebranded our “Public Health” education theme to “Population and Planetary Health” and created a planetary health teaching fellowship. The creation of the substantive part time position has been transformative for the development of a planetary health and sustainability curriculum. It has enabled further infused content and engagement with educators across a diverse range of topics from cardiology to nutrition to ophthalmology to primary care. The fellow also delivers two core lectures on sustainable health systems and sustainable surgery to final year students. In addition to formal teaching the fellowship has also allowed us to involve interested students in both developing and evaluating our curriculum as well as delivering sustainability related academic and quality improvement projects. In the next academic year, the fellow will also support student run planetary health events, engage in various community projects, and continue to evaluate our progress.
The Planetary Health Report Card is a student-led initiative that assesses medical schools’ performance against a variety of planetary health metrics. Its 2022-23 summary report is out now and includes 96 universities from 11 countries.13 Most participating medical schools received a “C” grade or below for curriculum, on a scale of A-F, and only four were awarded “A” grades in this category. Nine months after the creation of the planetary health teaching fellowship, we were thrilled to achieve an “A” grade for our curriculum. Without the faculty’s dedicated action and employment of a planetary health teaching fellow, it would not have been possible to overcome the barriers to curriculum change so quickly. However, we are certainly not perfect and now we are turning our attention to the areas where we are falling short. The curriculum was our initial priority, but much remains to be done on our planetary health related community engagement, as well as research and student-led initiatives.
There is an urgent need to teach doctors about the oncoming planetary health challenges as they will be on the front line of the developing crisis. Medical schools worldwide have a duty to equip their students with the knowledge necessary to be effective practitioners of the future, in which it will no longer be possible to ignore planetary health. If all medical schools had a planetary health teaching fellow, could we quickly create a global workforce of doctors who are prepared for the health challenges, drivers for sustainable change and builders of environmentally resilient healthcare systems?
We hope other medical schools will follow what we have done at Southampton and encourage anyone considering doing the same to reach out. We are all in this together.
Competing interests: none declared.
Provenance and peer review: not commissioned, not peer reviewed.