This week, a medical student friend of mine presents a guest blog. As always, we welcome your comments and questions. We’d love to start a discussion about this topic.
SA is a second year medical student interested in global surgery. She is a native New Yorker and a proud graduate of Brooklyn College.
As a medical student cramming my brain with vast quantities of information on the fundamentals of the physical exam and how to take down medical history, I still have not gotten used to the idea of actually taking care of patients on my own. In between classes and research, I barely have enough time to sleep, let alone contemplate what it may actually look like to take care of patients on an everyday basis. But, for the past year of medical school, I have trained hard to learn the knowledge and skills I will need to address a multitude of increasingly complex health care issues that will inevitably affect the lives of my future patients.
Arguably one of the most pressing health care issues facing US patients is anthropogenic climate change, an impending public health crisis that threatens to disrupt food systems, exacerbate chronic disease conditions, and drive up rates of respiratory illnesses and vector-borne diseases globally. Climate change is already disproportionately impacting vulnerable communities, creating waves of “climate migrants” in the wake of floods, droughts, and other extreme weather events.
Along with multidrug resistance and lead contamination of public water supply systems in cities such as Newark, climate change is high on the list of public health threats I worry about. Regardless of whether I am prepared to confront the realities of being a care provider, I recognize that I will inevitably be forced to deal with the devastating repercussions of climate change at least once over the course of my medical career.
This is a grim realization, but it is one that is spurring students like myself into action. This past January, I was given the opportunity to meet with leading climate change experts and physician advocates at the New York Academy of Medicine’s 2019 Clinical Climate Change Conference. The faculty at the Icahn School of Medicine at Mount Sinai organized the conference. It provided a forum for physicians and allied health professionals to discuss the impact of anthropogenic climate change on patient health outcomes and ways to mitigate these adverse effects.
Similarly, as an organizer of the Advocacy in Medicine (AIM) Conference at the New York Academy of Medicine, I am facilitating a workshop for medical students on climate change and health. I chose to organize the AIM conference because I wanted to mobilize medical students to become effective future care providers, advocates, and educators in this realm. More recently, I co-authored a Health Affairs op-ed on the need for the Centers of Medicare and Medicaid Services (CMS) to mandate sustainability reporting for US hospitals. It’s a measure that I believe is essential: collecting baseline data on health systems’ environmental impacts. Without knowledge of what is currently happening, it is difficult to identify which areas need the most attention moving forward.
Still, organizing conferences and writing op-eds are insufficient ways of engaging and educating the nation’s future physician workforce on climate change. That is why we need broader institutional-level change, particularly in the form of US medical schools creating climate change-focused curricula.
This past June, the American Medical Association voted to create a baseline curriculum that physician educators can utilize to inform their students of the myriad impacts of climate change on patient health. Several schools, including the Icahn School of Medicine at Mount Sinai, University of California, San Francisco (UCSF), University of Minnesota Medical School, and University of Illinois College of Medicine at Urbana-Champaign are stepping up to the challenge.
For the past two years, Sinai has offered first year medical students the opportunity to work on a global health summer project focused on integrating clinically relevant material on climate change into course content related to medical microbiology and the social and environmental determinants of health.
UCSF has introduced elective courses covering food security and environmental sustainability. Encouragingly, 187 schools have joined Columbia University’s Mailman School of Public Health consortium to promote climate-focused curricula at their respective graduate programs. For physicians who are already practicing, the Yale School of Medicine offers a continuing education certificate and the University of Colorado School of Medicine offers a fellowship for emergency physicians interested in climate-related medicine.
While medical schools must take urgent action on this issue given the scale and magnitude of climate change, there are significant barriers to introducing climate-focused curricula. One challenge involves the breadth of material that medical students are already expected to learn in a very short period of time.
Medical schools boast overloaded, dense curricula and frequent examinations. Indeed, academic demands and the pressure to consistently perform on par with their peers adversely impact medical students’ mental health, leading to increased suicidal ideation, burnout, and elevated substance use amongst medical students.
Adding to an already arduous and time-consuming curriculum can be challenging. Secondly, the consequences of climate change are not yet tested on Step 1 of the United States Medical Licensing Exam (USMLE), which is perhaps the most important examination a medical student will take during medical school. In other words, there is little immediate incentive for medical students to master these concepts while in school. Given their time constraints, it is more likely that students will focus their energy on understanding elements that will be relevant for passing their Board exams.
Thirdly, in the clinical setting, there is a systemic lack of focus on communicating environmental concerns to patients. This type of inertia is difficult to overcome when there is very little training and infrastructure for physicians to address the environmental and psychosocial determinants of health. Meanwhile, primary care physicians are often allotted a mere 15 minutes to speak with each of their patients. Severe time constraints and increased administrative burdens leave little time for physicians to adequately address climate change in their discussions with patients.
And yet, all of these challenges are not insurmountable; they could be sufficiently addressed if medical education focused on producing more environmentally conscious and eco-literate physicians. After all, medical students need to know that they will be cogs in a health care system that is currently the world’s seventh largest producer of carbon dioxide emissions. In 2013, it released 614 million metric tons of carbon dioxide equivalents— other greenhouse gases (methane, nitrous oxide, water, etc.) measured in terms of how much Co2 is needed to produce the same greenhouse effect.
Board examinations should incorporate the health effects of climate change in order to incentivize students to learn this material for their future practice. Medical schools need to update their curricula to include the most clinically relevant information rather than a hodgepodge of basic science minutiae that will never even appear in Board-style questions.
For physicians who are already practicing, there should be increased pressure on administrators to provide avenues for more time with patients so physicians can discuss climate change in the clinical setting. Departments should allocate resources to adequately train physicians in proper and effective communication with their patients on climate change and other environmental and psychosocial determinants of health.
The time to act is now. Effective health care delivery in this country largely depends on training the next generation of care providers to understand the effects of climate change on patient health outcomes. And as future care providers, medical students must be committed to fighting climate change, just as they are committed to combating the spread of infectious diseases and the persistence of inequities as key drivers of human disease and suffering.