For years healthcare experts have sounded the alarm over the public health threat posed by climate change.
Now a new paper proposes what could be the first medical education curriculum designed to prepare future physicians for addressing climate change's impact on care delivery and health outcomes.
The proposal, published Wednesday in the journal Academic Medicine and written by physicians from six of the country's top medical school programs, offers guidance on teaching physician residents safer and more effective ways of providing care in the face of climate change.
"There have been calls to educate everyone across their medical careers from medical school to an experienced clinician and yet there's never been anything written about how to do it," said paper senior author Dr. Aaron Bernstein, interim director of the Center for Climate, Health, and the Global Environment at the Harvard T.H. Chan School of Public Health. "We recognize one of the major gaps in making this happen is that it turns out that most people who are educating residents from the case of our paper never learned about climate change."
Areas covered under the proposed curriculum include providing residents with more training in disaster response. Strategies that could be taught include chronic disease management of patients during extreme weather-related events like the wildfires currently raging in California and Oregon.
But clinicians also need to learn more about properly delivering care during less extreme, but potentially dangerous climate-related situations as well, like during hot days, Bernstein said. Since the 1960s heat waves have been occurring with more frequency in major cities, increasing from an average of two per year to more than six during the 2010s, according to U.S. Global Change Research Program. Between 2004-2018, the U.S. averaged 702 heat-related deaths annually, 415 with heat being the underlying cause and 287 with it being a contributing factor, according to the Centers for Disease Control and Prevention.
"You can imagine medications widely used to treat heart disease that lower blood pressure mixed with dehydration from heat exposure can result in landing in an emergency room," Bernstein said.
In addition to day-to-day clinical practice, the proposed curriculum also focuses on providing education on how climate change affects healthcare delivery. He said physicians need to know how to build more resilient clinical practices to be able to deliver care during emergencies when power lines might be knocked out or supply chains are disrupted.
The paper is the first to link learning objectives related to climate change to the core competencies set by the Accreditation Council for Graduate Medical Education, the organization responsible for accrediting all graduate medical training programs in the United States. Bernstein said the proposed curriculum was meant to be used in a way that includes it in the existing medical education framework.
Bernstein said the long-term goal is to create the next generation of physician leaders who can do more to make their healthcare organizations more environmentally sustainable and become louder voices in calling on lawmakers to develop more effective policies. Healthcare remains one of the world's leading polluters, responsible for nearly 10% of all U.S. greenhouse gas emissions.
"Once medical students and physicians are educated, they will ask questions of leadership of what healthcare's responsibility is to solve the problem [of climate change]," Bernstein said.
