Doctors offer guide for teaching the health effects of climate change in medical residency

As massive wildfires, hurricanes, and record-breaking temperatures hit parts of the U.S., a group of doctors is urging medical residency programs to implement standardized curricula on the health impacts of climate change.

Their framework, published in a paper Wednesday in Academic Medicine, includes a breakdown of high-risk populations, including the elderly and low-income families, and a review of the current understanding on how climate impacts health — such as the relationship between air quality and respiratory illness. The framework also encourages consideration of the health impacts of displacement due to extreme weather events: Those who lose their home due to a hurricane, for instance, often develop post-traumatic stress disorder or face other mental health challenges; they are also at a higher risk for developing other conditions such as food insecurity that could in turn affect their physical and mental health.

“We wanted to link the content to what residents are supposed to learn anyway,” said Rebecca Philipsborn, a pediatrician at the Emory University School of Medicine and lead author of the new paper.

Physicians have been sounding the alarm on the health effects of climate change for years, and the need to train future physicians how to treat patients accordingly. In 2017, the American Medical Association and more than 25 other health organizations created the Medical Society Consortium on Climate and Health, which called climate change “one of the most important issues of our time.” And earlier this year, a group of medical students from more than 50 U.S. medical schools founded Medical Students for a Sustainable Future, an organization working to “recognize climate change as an urgent threat to health and social justice.”

The AMA passed a resolution last year that supported including climate change in medical training curricula at the undergraduate, graduate, and postgraduate levels. While there have been some efforts to offer climate change and health as an elective course at medical schools, the authors of the new paper argue that there still isn’t a standardized way that climate change is incorporated into medical training.

STAT spoke with Philipsborn to learn more about the new framework. This interview has been lightly edited for clarity and condensed.

What was the impetus for this framework?

We thought it was an important topic and one that is currently almost wholly lacking in medical school curricula. Right now, we can graduate doctors from medical school and residency programs without any mention of climate change, and yet climate change has been called the greatest threat of our time.

But I really didn’t hear [about any of this] during my clinical education. I’m a little bit of an outlier because I did a master’s in environmental science and policy, and climate change’s health impact was something I already had awareness of. On top of everyone’s minds right now are the wildfires in California and what that does for air quality. In medical school, we’re trying to train our physicians to practice anywhere but having this regional knowledge about the impact of these events will prepare our doctors to treat conditions they may see in local patients.

Have you seen examples of climate change’s impact in your own work?

This is something I see now in Georgia. One example is in student-athletes as they prepare to go back to high school. This year is different because of disruptions due to the pandemic, but every summer, there are heat-related illnesses and those seem to be happening more and more.

I talk to athletes during their sports physicals about the importance of hydration, if they’re on certain medication that could elevate their risk of heat intolerance, or even how they keep their medicines in the summer. They shouldn’t store albuterol for asthma in their car, for instance, because if the car temperature gets to be greater than 120 degrees Fahrenheit, it could cause the container to explode.

What does the framework involve?

The way we break it down is: How climate change harms health, how doctors can adapt clinical practice to health conditions and diseases that are worsened by climate change, and how climate change undermines and disrupts health care delivery. One example of this last category is hospital evacuation during extreme weather scenarios or shortages of critical medical supplies during Hurricane Maria in 2017.

We break it into categories and go into depth in each of those categories. It’s meant to serve as a template or guide for residency program directors. This is an important step, but first step, for figuring out how this will work in different rotations and different residency programs. Talking about air quality from wildfires, for instance, could come during community health rotations, or pulmonary/respiratory rotations or even primary care rotations. Many of these topics fit well into multiple areas and contextualizing those discussions for residents will be up to each program.

Has there really not been something like this before?

The gap we’re filling is that there’s no published curriculum that we could find. I hope that some schools are starting to implement and became aware of climate change and health curricula, but there’s no national or standardized curriculum for this topic. There may be other smaller endeavors, however.

Do you think climate change training ought to be just for residencies? And have schools expressed interest in adopting this framework?

I think it’s important across all levels of medical training, and it’s about continuing effort. This paper is specific to residency education, but there are learning points across all levels. Our hope is that this can serve as a starting point for residency program directors, as I think that inclusion of climate change-related content in the future is somewhat inevitable. What we want to do is prepare doctors who are graduating now, so we have also discussed offering this as part of continuing medical education for those who already have their degree.

The framework has not been disseminated widely yet, so we’re looking forward to hearing what our program director colleagues think.

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