James Bevan and Paul Roderick share how the University of Southampton School of Medicine is preparing medical students to practise sustainably

The climate emergency is a health emergency. This fact is now indisputable and it is common knowledge that climate change and environmental degradation pose an unprecedented threat to human health. Increasing intensity and frequency of extreme weather events, rising global temperatures and sea levels, pollution, and biodiversity loss contribute to considerable morbidity and mortality. The burden of disease will fall hardest on the most vulnerable people and will widen already existing global health inequalities and gaps in healthcare provision. 

The health sector has a considerable impact on the environment, contributing comparable greenhouse gas emissions to the airline or shipping industry and, consequently, exacting a paradoxical toll on global health. While last year marked the unveiling of the NHS’s Net Zero target, which is a great signpost of intent for a national health service, to create genuine change a major educational drive is required to alter behaviours and culture across healthcare. 

Considering these threats, the health workers of tomorrow need to be equipped with the tools to both deliver healthcare in a changing environment and to do so sustainably. Are medical schools currently preparing students for these challenges? 

At the University of Southampton School of Medicine, following a review of our curriculum, we realised we were falling short. While there were a few lectures with climate or sustainability content, we had no central strategy to deliver a comprehensive climate curriculum. The student timetable was already crowded with little space for new topics or lectures, so we have started to implement an adapted “Infusion” approach, which was originally developed at the Icahn School of Medicine at Mount Sinai.

This academic year we launched our “Southampton Medical School Medicine, Climate Change, and Sustainability Infusion Project.” The key principle is not to overwhelm students with excessive information they must learn, but to gently and continually reinforce the importance of climate change and sustainability in relation to health in a wide variety of contexts.  

We have introduced a climate curriculum spiral structure with three phases across the five year Bachelor of Medicine course: “Introducing Environmental Health” (years one and two); “Climate Change and Sustainability in Practice” (years three and four); and “Becoming a Sustainable Physician” (final year).

In the first phase, students get a grounding in environmental health, with the content infused into existing public health, physiology, and pathology lectures across the two preclinical years. We have identified existing teaching sessions where climate and sustainability related content or activities could be organically inserted and where they are most relevant. These have included, for example, asthma, nutrition, cardiovascular risk, and temperature regulation. In addition, basic concepts of planetary health and health related sustainability have been introduced in global public health lectures. These lectures are also used to introduce the infusion project and familiarise students with the slide template used for all infused content.

The second phase marks a more practical application of environmental health and sustainability. In year three, students already undertake a research project based on an interest so we are planning to provide an option for students to work on sustainability-related quality improvement or audit projects. As such, supervisors have been identified in both primary and secondary care who can guide enthusiastic students to both improve sustainability in the healthcare system and develop their research and evaluation skills, leading to an additional BMedSci qualification. In year four, students will also receive infused content into the clinical law and ethics module and their introductory lectures for each clinical placement across the specialties, including paediatrics, obstetrics and gynaecology, and psychiatry. 

In the third phase, there is a shift of focus from environmental health to becoming a sustainable clinician. As such the infused content for final year placements will reflect areas in which students can make their practice more sustainable. We have initiated this in primary care where students are encouraged to do a reflection on sustainability. We are looking to build this into surgery (including anaesthetics) and the assistantship in the coming years. This third phase also incorporates final year student electives. We have compiled and advertised a list of sustainability related electives to medical students, and we have one student due to be doing a placement at the Centre for Sustainable Healthcare this year.

Finally, in order to give this initiative further traction, we will introduce assessment throughout the course. We are also planning to launch a sustainability prize that will be awarded to the student who submits the most impressive portfolio of sustainability activities during their time at medical school.

So far we have been opportunistic in how we’ve implemented climate and sustainability topics, fitting them in where feasible. We are now in the process of reviewing our infused content against a range of learning outcomes, including those set out by the Centre for Sustainable Healthcare, which have been adopted by the GMC, and the planetary health curriculum metrics developed by the Planetary Health Report Card.

Throughout this process, we are being guided by a group of primary and secondary care physicians, public health experts, and medical students. In addition, we have been working in collaboration with Mount Sinai and several other medical schools as part of the International Medical Education Collaboration on Climate and Sustainability (IMECCS) to develop materials and guidance based on our collective experience. These materials are available open source for any medical student or faculty member to use so that they can hopefully easily implement a similar programme at their medical school. 

We hope that the implementation of a sustainability curriculum will educate and enthuse future doctors to recognise the interaction of climate change with the health of their patients and communities, to practise sustainably, and to be advocates for change at the individual and system level. 

James Bevan was previously a sustainability consultant and is now an academic foundation doctor at Southampton General Hospital. Twitter @jhjbevan

Paul Roderick is professor of public health at University of Southampton and lead for the undergraduate medical student teaching theme on public health. Twitter @paulrsoton

Competing interests: none declared.