The Climate Wise slides: An evaluation of planetary health lecture slides for medical education

Abstract

Educational Challenge

There is an urgent need for innovations in planetary health medical education. Physicians must be prepared to provide high-value, low-carbon healthcare for patients increasingly impacted by the health consequences of climate change.

Proposed Solution

The Climate Wise slides, an evidence-based, open-access pedagogical tool that provides didactic planetary health medical education organized by medical subspecialty, was developed and evaluated by a virtual lecture session that presented a subset of the slides to N = 75 Canadian medical students. Each participant completed a questionnaire before and after the Climate Wise virtual lecture that included multiple choice questions to assess their planetary health knowledge and a rating of their interest in including the Climate Wise slides in medical curricula.

Lessons Learned

Participants showed significantly improved planetary health knowledge scores (p < 0.0001) and increased interest in including the Climate Wise slides in medical curricula (p < 0.001) after the virtual Climate Wise lecture session. This study demonstrates that the Climate Wise slides are a valuable pedagogical tool to advance planetary health medical education.

Next Steps

Future directions include evaluating faculty perspectives on the Climate Wise slides, learning outcomes of the slides implemented longitudinally in medical curricula, and developing higher-order problem-based and simulation-based planetary health medical education resources. Given the urgent need for planetary health medical education, we recommend the global sharing of teaching resources to facilitate the rapid upscaling of validated pedagogical tools internationally.

Keywords:

• Climate change
• planetary health
• undergraduate medical education
• curriculum development

Educational challenge

Climate change is the greatest health crisis of the twenty first century. The growing frequency and severity of extreme weather events, prolonging allergy seasons, and shifting infectious disease distributions are eliciting significant climate-related sequelae on human health. Though necessary for patient care in a climate crisis, healthcare delivery is a significant contributor to climate change. Therefore, high-quality planetary health medical education is necessary to prepare physicians to provide environmentally-sustainable patient care that adapts to and mitigates the growing health impacts of the climate crisis.

Despite numerous calls for planetary health medical education, medical schools have been slow to teach planetary health due to competing demands from other content and the lack of faculty expertise. Planetary health curriculum development that addresses these barriers are required to facilitate rapid, transformative curriculum change. In this article, we present the Climate Wise slides as an open-access, evidence-based resource that integrates planetary health into existing didactic medical curricula and can be presented by non-expert faculty.

Proposed solution

There are a few published open-access planetary health medical education resources. The Brighton and Sussex Medical School developed an online ‘Climate Change and Sustainability in Clinical Practice’ learning module (Dunne et al. 2022). The Icahn School of Medicine at Mount Sinai integrated slides into existing preclinical lectures that are available open-access through the International Medical Education Collaboration on Climate and Sustainability at imeccs.org (Kligler et al. 2021). However, these approaches separated teachings on climate-related health impacts from clinically-actionable adaptation and mitigation approaches for physicians. In addition, as the climate crisis is not experienced equally across the planet, we felt that it was important to develop locally-relevant educational resources that prioritized Canadian research on climate-related health impacts to best prepare medical students to care for Canadian communities.

We designed the Climate Wise slides to implement the Canadian Federation of Medical Students (CFMS) Planetary Health Educational Competencies developed by Luo et al. (2021) through clinically-relevant didactic lecture content with a standardized format that provides teaching on: 1) climate change and human health links, and 2) what physicians can do to adapt to or mitigate these climate change-related health impacts. We believe that our approach to simultaneously present climate-related health impacts alongside climate action solutions would inspire action and mitigate eco-anxiety amongst learners. 45 slides were developed to be presented by non-expert faculty, and to be integrated into existing didactic lectures spanning the medical specialties and public health topics including climate justice and environmental advocacy (See Supplementary Table S1). All slides are available open-access to be downloaded as high-quality image files in English and French that can be inserted into existing lecture materials at: https://www.cwslides.com/slides, and were published online on May 30, 2022.

A selection of Climate Wise slides was presented by study authors to Canadian medical students through a virtual lecture on Zoom on April 22, 2023. Participants completed a questionnaire before and after the virtual lecture which included demographic questions (medical school, academic year, previous involvement in climate initiatives or exposure to the Climate Wise slides), 16 multiple choice questions assessing planetary health knowledge (see Supplementary Table S2) and indicated how valuable these slides were to medical curricula on a Likert Scale from 1–5, with 1 = little value and 5 = great value. Participation prizes were raffled to participants.

Statistical analysis and figure design was performed using R Studio and GraphPad Prism 6. Pre- and post-Climate Wise lecture planetary health knowledge scores and interest in including the Climate Wise slides in medical curricula and a planned subgroup analysis comparing participants with or without previous involvement in climate initiatives or exposure to the Climate Wise slides were analyzed with non-parametric two-sided paired Wilcoxon signed rank tests. A p-value of <0.05 was considered significant.

Lessons learned

N = 75 students from 13 of 17 Canadian medical schools participated in the study. Participants were mostly first- or second-year medical students, 44% and 47%, respectively, and most participants have not seen the Climate Wise slides nor been previously involved in climate initiatives (76%; Supplementary Table S3).

Participants showed significantly higher post-Climate Wise lecture planetary health knowledge scores (x¯ = 10.48 vs. 8.88, p < 0.0001; Figure 1A). In addition, there was a significant post-lecture increase in participant interest in including the Climate Wise slides in medical curricula (x¯ = 4.67 vs. 4.35, p < 0.001; Figure 1B). Significant improvement in planetary health knowledge scores and interest in including the Climate Wise slides in curricula were observed regardless of participant previous involvement in climate initiatives or exposure to the Climate Wise slides (See Supplemental Table S4).

Figure 1. Impact of the Climate Wise slides on planetary health knowledge and interest in their inclusion in medical curricula. Canadian medical students (N = 75) who participated in a virtual lecture of the Climate Wise slides showed A) improved post-lecture planetary health knowledge as assessed by a set of 16 multiple questions and B) increased post-lecture interest in the inclusion of Climate Wise slides in medical curricula. Data shown are mean ± SD, statistically significant differences are indicated by *p < 0.05.

These findings suggest that the Climate Wise slides improve planetary health knowledge amongst a diverse sample of Canadian medical students and validates the slides as an effective pedagogical tool for didactic teaching of planetary health material for undergraduate medical education. Participants showed a strong interest in including the Climate Wise slides into medical curricula, which reflects the growing student interest in planetary health learning opportunities.

The Climate Wise slides have already been incorporated into the preclinical medical curricula of the University of Calgary and McGill University. We believe that the Climate Wise slides can be seamlessly incorporated into medical education systems globally. We encourage global educators to adapt the Climate Wise slides with local research to prepare medical students to care for communities experiencing local climate-related health impacts. The adapted slides can be individually implemented by faculty into their lectures or can be longitudinally integrated into medical curricula, in keeping with the just-in-time learning model that integrates short snippets of information into existing curricula when it is professionally relevant to students.

Limitations of this study include its cross-sectional design with a short exposure to testing interval, which assesses immediate knowledge acquisition, rather than long-term information retention. In addition, our convenience sample of voluntarily-recruited participants has a high risk of selection bias for students that are more invested in planetary health content. However, our subgroup analysis demonstrated increased planetary health knowledge and interest in including the Climate Wise slides in medical curricula regardless of previous exposure to the slides and involvement in climate initiatives. Another limitation is that the Climate Wise slides were presented by resident and medical student presenters passionate about planetary health, instead of by non-expert faculty.

Next steps

Future directions to further validate the Climate Wise slides include assessing faculty perspectives on the slides, and evaluating the long-term learning outcomes of the Climate Wise slides as they are presented longitudinally in medical curricula by non-expert faculty.

We recognize that the didactic nature of the Climate Wise slides limits learners to engaging with planetary health content at the lower levels of remembering and understanding in Bloom’s taxonomy. Open-access resources for problem-based learning and simulation-based experiential learning are required to close the know-do gap in planetary health, with examples including a planetary health module with a mix of blended learning, flipped classrooms, and an integrative assignment to apply student learning developed by the University of Amsterdam medical school (Blom et al. 2023). Another example is the Project Green Healthcare/Projet Vert la Santé program that provides experiential-learning opportunities for medical students to launch healthcare sustainability quality improvement projects in Canadian health institutions in partnership with physicians and healthcare administrators (Luo et al. 2021). However, the successful implementation of higher order planetary health learning experiences for medical students requires faculty expertise in planetary health, which demands a greater emphasis on faculty development and continuing medical education on planetary health.

In conclusion, the Climate Wise slides are an effective approach to integrate planetary heath content into undergraduate medical curricula internationally. The continued sharing of teaching resources is necessary to rapidly upscale high-quality planetary health medical curricula in a climate crisis.

Acknowledgements

The authors would like to acknowledge the many medical student contributors to the Climate Wise slides.

Disclosure statement

The Climate Wise slides are funded by the CFMS Strategic Innovation Fund. The authors declare no conflicts of interest.

Additional information

Notes on contributors

Owen Dan Luo

Owen Dan Luo, MDCM, Department of Medicine, McGill University, Montreal, QC, Canada.

Candelaria Aristizabal Londono

Candelaria Aristizabal Londono, BKin, College of Medicine, University of Saskatchewan, Regina, SK, Canada.

Nicole Prince

Nicole Prince, MD, PhD, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.

Ericka Iny

Ericka Iny, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.

Tyler Warnock

Tyler Warnock, MD, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.

Kayla Cropper

Kayla Cropper, MSc, College of Medicine, University of Saskatchewan, Regina, SK, Canada.

Sam Girgis

Sam Girgis, BKin, College of Medicine, University of Saskatchewan, Regina, SK, Canada.

Celia Walker

Celia Walker, MD, MSc, Department of Medicine, University of Alberta, Yellowknife, NT, Canada.