My COVID 'planetary health' epiphany: restoration of our planet requires an Indigenous lens in health professions education and healthcare.

Background. Education about planetary health (PH) and sustainable healthcare (SH), or education for sustainable healthcare (ESH), enables health professionals to help protect public health and healthcare from climate change and environmental degradation. The Association for Medical Education in Europe Consensus (AMEE Consensus) Statement on Planetary Health and Education for Sustainable Healthcare has proposed a set of ESH learning objectives, activities and assessments for adaptation to different health professions education (HPE) contexts. The national audit phase of a mixed methods study in South Africa (SA) found that awareness of ESH and its curriculum development is emerging. The African Medical Education Directives for Specialists (AfriMEDS) is a competency framework for undergraduate medical students in SA that defines key competencies and enabling competencies related to seven roles of a health professional. Objectives. To recruit a national Delphi panel of health professions educators to assess the applicability of the AMEE Consensus learning objectives, activities and assessments to HPE in SA; to elicit panellists’ perceptions of the main barriers and opportunities for ESH in faculties; and to compare learning objectives recommended by AMEE and the panel for key competencies and enabling competencies within the AfriMEDS framework. Methods. Nine educators from three different disciplines and six national faculties of health sciences participated in two rounds of a Delphi process and in follow-up discussions. In round 1, they rated the AMEE Consensus learning objectives, activities and assessments, and proposed additional ones. In round 2, they rated the score-ranked AMEE lists, as well as relevant additions from round 1. All panellists participated in further discussions regarding applicability, and highlighted the potential barriers and opportunities for integrating ESH into their faculties. The lead author then matched the panel’s learning objectives with enabling competencies related to all seven health professional roles described by AfriMEDS. Results. All panellists recognised the importance of ESH in SA and the need for eco-ethical leadership by health professionals. All 13 AMEE Consensus learning objectives, as well as three additional objectives from the panel, were matched most frequently with AfriMEDS-enabling competencies related to the roles of leader and manager (n=9), communicator (n=8) and healthcare practitioner (n=7). Panellists highly ranked learning activities and assessments that are authentic, multiprofessional and require systems thinking. They perceived the lack of capable educators and curriculum overload to be the main barriers to integration of ESH, as well as the need for strong leaders, disciplinary champions and trained educators. Conclusions. Situating the selected learning objectives within the AfriMEDS competency framework provides a good basis for developing aligned learning activities and assessments of ESH. Strong leadership, capable educators and multidisciplinary collaboration are important enablers of integrating ESH into HPE in SA.

Integrating planetary health into clinical guidelines to sustainably transform health care

Over the past few centuries, human activity has wrought dramatic changes in the natural systems that support human life. Planetary health is a useful concept for health profession education (HPE) teaching and practice because it situates health within a broader understanding of the interdependent socio-ecological drivers of human and planetary health. It facilitates novel ways of protecting both population health and the natural environment on which human health and well-being depends. This paper focuses on the climate crisis as an example of the relationship between environmental change, healthcare, and education. We analyze how HPE can help decarbonize the healthcare sector to address both climate change and inequity in health outcomes. Based on the healthcare practitioner’s mandate of beneficence, we propose simple learning objectives to equip HPE graduates with the knowledge, skills, and values to create a sustainable health system, using carbon emission reductions as an example. These learning objectives can be integrated into HPE without adding unduly to the curriculum load.

Health professionals must be prepared to address the health risks and impacts of climate change Between 2030 and 2050, climate change is expected to cause about 250 000 additional deaths per year.1 This does not include deaths from pollution, mental illness, extreme weather events and resultant migration and conflict, all of which carry significant morbidity and mortality risks. The medical profession has a responsibility to prepare practitioners and the health system for the escalating challenges of this health crisis. Even though planetary health frameworks, consensus statements, and early teaching experience have begun to be reported,2-10 persistent barriers to the implementation of planetary health concepts, including the health impacts of climate change and the principles of sustainable health care, are evident within medical education.11, 12 Consequently, the implementation of this content into predominantly biomedically focused curricula is frequently piecemeal, opportunistic, unidirectional and poorly related to clinical practice.13, 14 Internationally, the emerging curriculum principles to address this challenge align with global health priorities. Specifically, addressing the socio-economic and environmental determinants of health under the United Nations Sustainable Development Goals framework (https://sdgs.un.org/goals), indigenous eco-health-centric leadership, promotion of systems thinking and change, and experiential, practice-based learning that cultivates interprofessional teamwork, advocacy and leadership development.3-7, 9, 10, 15 A 2019 interactive perspective provides a useful open access resource in this direction.16 More recently, Emory University students and staff reported their experience in the incorporation of climate content into selected aspects of the pre-clinical curriculum.17 In Australia, Medical Deans of Australia and New Zealand (MDANZ) established a Climate Change and Health Working Group, which has proposed graduate outcome statements and learning objectives that incorporate the environment as a health determinant, health care sustainability, and the health effects of climate change.18, 19 At the time of publication, the Australian Medical Council is reviewing the accreditation standards of primary medical programs and has released updates to the National Framework for Prevocational Medical Training, strengthening a top-down national approach to producing climate-aware and prepared practitioners. There are many steps between developing new accreditation standards and actual delivery to learners. The three key strategies are: i) integrate climate change as a cross-cutting core theme, ii) facilitate educators and students sharing knowledge and teaching one another in this emerging field, and iii) relate learning to clinical practice.11 An intermediate step is to link existing organ systems focused preclinical studies with the impacts of climate change on the health of individual patients. In response to these challenges, students and faculty volunteers, all members of the Doctors for the Environment Australia at the University of Melbourne, collaborated to form the Planetary Health Curriculum Taskforce. This group was driven by student advocacy seeking to address a perceived gap in their curriculum. We contend that such cocreation is essential to accelerate the integration of such urgently needed curriculum content by adopting the highest level of pedagogical methods and to model the intergenerational collaboration required to address this "wicked" challenge. We sought to achieve three objectives (Box 1) and conducted our work in three phases (Box 2). First, student focus groups from all years of the medical school identified planetary health learning opportunities within the existing curriculum structure. DEA = Doctors for the Environment Australia. Second, we did a structured literature review, via two student and faculty workshops, to map climate change and health literature content and themes to the classical organ systems framework of first year medicine (Box 3). We incorporated the principles of sustainable health care, such as environmental footprint assessment and valuing the health cobenefits of decarbonisation, as well as the opportunities for medical students to learn applied skills and behaviour. Engagement with the First Nations health team helped us to incorporate Indigenous-led content, an identified area for further action by Australian and New Zealand public health and medical educators.12 WHO = World Health Organization. Source: Reproduced with permission from Burch et al.20 Phase three consisted of expert peer review by seven specialist, generalist and public health clinicians with teaching and research experience in climate change and health. Each clinician was allocated two organ system blocks and instructed to review and edit content for clinical relevance, strength of evidence, and quality of writing. The final synthesis, inclusion of images, figures and executive summaries were completed by the Curriculum Taskforce student members, with design support from Doctors for the Environment Australia. The outcome was an infographic-rich curriculum resource, a planetary health–organ system map,20 which is being used as a resource in first year medical teaching. Our systematic, student and faculty codeveloped process and clinical focus are an example to others seeking successful integration of planetary health into their curricula. Central to our approach was the application of the three selected models (Box 3). This process identified and explored the multidirectional relationships between broad public and planetary health content and person-centred biophysiological mechanisms. We achieved this by connecting literature content using Model 1 headings (eg, cardiovascular organ system) and Model 2 (relevant social determinants of health) and Model 3 content (relevant major consequences of climate change). As an example, Box 4 shows a mechanism for heatwave-associated acute myocardial infarction from the planetary health–organ system map. Source: Reproduced with permission from Burch et al.20 There is clear recognition by peak Australian medical bodies of the importance of climate change and our professions' role not just in preparing practitioners, but in advocating for climate-conscious health care and broader mitigation policies.21, 22 This has led to an emergent discussion about planetary health at all levels of Australian medical education. Our methodology and output may assist medical educators in addressing the challenges of integrating climate change education into their own teaching.11 For example, as this approach enables students to share their knowledge and experiences with teachers outside of formal classroom boundaries, it may support the evident lack of medical educators proficient in planetary health teaching. Empowering students as leaders and partners in learning and developing education material is known to improve their effectiveness as learners and confidence in teaching.23 It also explicitly promotes higher order relational and extended abstract reasoning by students (Blooms' revised taxonomy levels 4–6) — the ultimate task of any curriculum.24 Despite not being formally evaluated, we observed that the students involved in this project achieved the Association for Medical Education in Europe (AMEE) planetary health and education for sustainable health care consensus statement aims of "knowledge, skills, values, competence and confidence".9 Our mapping output also addresses the need for learning resources that are centralised, accessible and frequently peer reviewed. Our focus on clinical relevance helped narrow the scope of literature and developed the curriculum resource towards use in practice. This strategy connected theory with patient care in a way that ensured concepts could be translated into clinical skills. Even though it was designed for one context, the organ systems structure and clinical relevance also allow learning points to be drawn from this resource for prevocational, vocational and continuing professional development teaching. Our approach also aligns with recent understanding that planetary health is a theme akin to ethics or leadership that should spiral through the core curriculum.11 In this context, biomedical planetary health learning primes students for subsequent clinical training. Our initial successes, including deriving a climate change-themed tutorial from the map and precipitating a review of planetary health curriculum opportunities within the Doctor of Medicine (MD) program redesign, parallel those of the Emory student–staff collaboration.17 The process of expanding the map to cover more of the MD curriculum, regular peer review of emerging evidence and increasing interprofessional collaboration is ongoing and has garnered formal support through seed grant funding.25 We encourage the formal recognition of planetary health as core to any medical curriculum, with dedicated resourcing from the top-down and codesign from the bottom-up. We recognise and value the concurrent higher level advocacy of the MDANZ Climate Change and Health Working Group in supporting our grassroots project,18, 19 as well as allyship from our interprofessional and First Nations health colleagues.25 A remaining challenge, given the assessment-driven nature of medicine, is the development of "assessment for learning" inclusive of planetary health. We have not reviewed the assessment blueprint of the University of Melbourne MD program. However, we propose this as a valuable exercise, as assessment often strongly correlates with students' prioritisation of content.26 Ultimately, the role of medical professionals in providing leadership, advocating for sustainable health care and adopting evidence-based strategies for the management of planetary health-related risks has been widely acknowledged.9, 21, 22 Our methodology to generate the planetary health–organ system map presents a model for engaging learners through codevelopment of a novel learning resource. Our infographic-rich map also provides an example of systematic integration with existing curricula and an opportunity for strengthening planetary health leadership in medical education. We thank the members of Doctors for the Environment Australia (DEA) for their clinical and research expertise, and the organisation for its graphic support to produce our final curriculum mapping resource. Open access publishing facilitated by The University of Melbourne, as part of the Wiley - The University of Melbourne agreement via the Council of Australian University Librarians. No relevant disclosures. Not commissioned; externally peer reviewed.

The purpose of this Consensus Statement is to provide a global, collaborative, representative and inclusive vision for educating an interprofessional healthcare workforce that can deliver sustainable healthcare and promote planetary health. It is intended to inform national and global accreditation standards, planning and action at the institutional level as well as highlight the role of individuals in transforming health professions education. Many countries have agreed to ‘rapid, far-reaching and unprecedented changes’ to reduce greenhouse gas emissions by 45% within 10 years and achieve carbon neutrality by 2050, including in healthcare. Currently, however, health professions graduates are not prepared for their roles in achieving these changes. Thus, to reduce emissions and meet the 2030 Sustainable Development Goals (SDGs), health professions education must equip undergraduates, and those already qualified, with the knowledge, skills, values, competence and confidence they need to sustainably promote the health, human rights and well-being of current and future generations, while protecting the health of the planet. The current imperative for action on environmental issues such as climate change requires health professionals to mobilize politically as they have before, becoming strong advocates for major environmental, social and economic change. A truly ethical relationship with people and the planet that we inhabit so precariously, and to guarantee a future for the generations which follow, demands nothing less of all health professionals. This Consensus Statement outlines the changes required in health professions education, approaches to achieve these changes and a timeline for action linked to the internationally agreed SDGs. It represents the collective vision of health professionals, educators and students from various health professions, geographic locations and cultures. ‘Consensus’ implies broad agreement amongst all individuals engaged in discussion on a specific issue, which in this instance, is agreement by all signatories of this Statement developed under the auspices of the Association for Medical Education in Europe (AMEE). To ensure a shared understanding and to accurately convey information, we outline key terms in a glossary which accompanies this Consensus Statement (Supplementary Appendix 1). We acknowledge, however, that terms evolve and that different terms resonate variably depending on factors such as setting and audience. We define education for sustainable healthcare as the process of equipping current and future health professionals with the knowledge, values, confidence and capacity to provide environmentally sustainable services through health professions education. We define a health professional as a person who has gained a professional qualification for work in the health system, whether in healthcare delivery, public health or a management or supporting role and education as ‘the system comprising structures, curricula, faculty and activities contributing to a learning process’. This Statement is relevant to the full continuum of training – from undergraduate to postgraduate and continuing professional development.

Background. Climate change and environmental degradation have severe public health impacts. Education about planetary health (PH) and sustainable healthcare (SH), or the interdependence of health and healthcare and planetary ecosystems, is developing globally to enable health professionals to protect public health from these threats, and to build sustainable healthcare systems. Objective. To assess the status of PH and SH in health professions education in South African (SA) faculties of health sciences as a foundation for future work. Methods. Educators at all 24 SA faculties of health sciences were surveyed regarding undergraduate and postgraduate faculty courses with PH- and SH-related learning objectives and outcomes, learning activities and assessments. Pivot tables were constructed to analyse their responses. Results. Forty-one responses were received, representing 9 health professions from 15 of 24 faculties of health sciences in SA (62.5%). More than half (53.7%) were unaware of any courses with PH and SH content at their faculties. Nineteen respondents from 11 faculties reported 44 courses and provided data on 18 non-duplicate courses. Learning activities included advising patients about environmental and health co-benefits of their lifestyle choices (33.3%); written assignments (38.9%); oral presentations (55.6%); and community-based research (38.9%). Nine courses (50%) reported PH- and SH-related assessments, most commonly oral presentations (88.9%); reflective essays (77.8%); multiple-choice or short assessment questions (55.6%); and research outputs (55.6%). Conclusion. Education about PH and SH is starting to develop in SA faculties, although with a limited variety of learning activities and assessments. This study provides a useful baseline for curriculum development and assessment of progress.

Planetary health: from concept to decisive action

Sustainable healthcare education: integrating planetary health into clinical education

There is an urgent need for health professionals to address the impacts of accelerating global environmental change. Healthcare faculty therefore have to educate the rising generation of health professionals in subjects unfamiliar to themselves, such as planetary health and sustainable healthcare. This creates a new paradigm where faculty have to learn a new subject area and incorporate and teach it within their own material. It is important to develop faculty knowledge and confidence to integrate education for sustainable healthcare into their educational practice, as faculty can rapidly acquire and build on these skills. Partnership between students and faculty can enhance this faculty development as students bring fresh ideas and possibly greater knowledge of the climate and ecological crisis. Under supervision, they can co-create the necessary new learning. Students can also act as partners in advocating for social and environmental fairness and systemic change toward a sustainable healthcare system. We summarize the impact of various activities of health professions students around the world which advocate for institutional change and enhance faculty development in education for sustainable healthcare. Through diverse case studies from different countries, we illustrate faculty development in education for sustainable healthcare, highlighting student involvement which has enhanced educators’ learning.

Safeguarding planetary health for southeast Asia's future children

BackgroundPlanetary Health studies the impact of the global environmental crisis on health. Urgent transdisciplinary, intersectoral, and holistic solutions adapted to local realities are needed. Designing training programs attuned to contextual needs of diverse groups and geographical areas is crucial. Planetary health programs are emerging worldwide, but little is known about their scope and learning outcomes. A systematic scoping review is needed to shed light on the state of planetary health education.ObjectivesThis review aims to identify existing frameworks, competencies, content, and teaching methods in planetary health education.MethodsFollowing PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines, we included studies targeting undergraduate and postgraduate students, focusing on skills, knowledge, and abilities related to planetary health, published in English or Spanish. No exclusions were made based on geographic area, study design, or publication period. Databases consulted were MEDLINE via PubMed, Scopus, Web of Science, and ProQuest. Selection and data extraction processes were conducted systematically.ResultsWe included 73 articles, with 88% from high-income countries and 49% focused on health professionals. Conceptual frameworks identified include "One Health," "Sustainable Development Goals," and the "Planetary Health Education Framework." Transversal skills (complex problem-solving, systemic thinking, collaboration, interdisciplinary) and specific competencies (understanding health interactions with climate change, pollution) were outlined in 45% of studies. Half of the studies described 23 general topics and 93 specific content areas. Teaching methods included in-person (59%), virtual (12%), and hybrid models (29%).ConclusionsThis review highlights the heterogeneity in conceptual frameworks, competencies, content, and teaching methods in planetary health education for health professionals. Future research should focus on developing and evaluating evidence-based educational models to address the evolving challenges of planetary health. Recommendations include enhancing collaboration among stakeholders and integrating innovative teaching methods to improve planetary health education.Trial registrationThe protocol has been registered in the Open Science Framework database (registration number: osf.io/h2b3j, March 2024).Clinical trial number: not applicable.

Embedding Indigenous knowledges and voices in planetary health education

Beyond tokenism: meaningful youth engagement in planetary health

Background Steering planetary and human health towards a more sustainable future demands educated and prepared health professionals. Aim This research aimed: to explore health professions educators’ sustainable healthcare education (SHE) knowledge, attitudes, self-efficacy and teaching practices across 13 health professions courses in one Australian university. Methods Utilising a sequential mixed-methods design: Phase one (understanding) involved an online survey to ascertain educators’ SHE knowledge, attitudes, self-efficacy and teaching practices to inform phase two (solution generation), ‘Teach Green’ Hackathon. Survey data was descriptively analysed and a gap analysis performed to promote generation of solutions during phase two. Results from the hackathon were thematically analysed to produce five recommendations. Results Regarding SHE, survey data across 13 health professions disciplines (n = 163) identified strong content knowledge (90.8%); however, only (36.9%) reported confidence to ‘explain’ and (44.2%) to ‘inspire’ students. Two thirds of participants (67.5%) reported not knowing how best to teach SHE. Hackathon data revealed three main influencing factors: regulatory, policy and socio-cultural drivers. Conclusions The five actionable recommendations to strengthen interdisciplinary capacity to integrate SHE include: inspire multi-level leadership and collaboration; privilege student voice; develop a SHE curriculum and resources repository; and integrate SHE into course accreditation standards.

Climate change is a public health crisis that health care professionals must be prepared to address. Academic programs for health professions have an opportunity to express commitment to addressing planetary health through website content. The purpose of this article is to describe how nursing and other health care education programs acknowledge planetary health on their websites. Nine website metrics were evaluated for top programs across 14 unique health care professions. Seventy university websites were reviewed. Nursing programs are most likely to share information about climate-related courses on their websites, but minimally include other metrics. Inclusion of website metrics for other health care professions varied greatly. Nurses are positioned to be leaders in planetary health. Without clear prioritization from institutions of higher learning, there remains a gap between patient needs and health care professionals' knowledge. Intentionally expressing a commitment to planetary health on websites can attract students who prioritize the issue, increasing the impact nurses and other health care professionals can have on planetary health.