A “Climate +1” Approach to Teach Resident Physicians and Faculty the Effects of Climate Change on Patient Health Open Access

Climate change, per the World Health Organization, is the “biggest health threat facing humanity.”¹  Impacting patient and community health through a multitude of mechanisms,²  climate change disproportionately impacts the health risks already experienced by vulnerable communities and populations that most commonly are served by our residents, fellows, and faculty physicians. Yet, graduate medical education (GME) offers limited formal curricular content on the health effects of climate change and its implications on evaluation and management of disease, anticipatory guidance, and prevention in patient care. Obstacles to teaching about climate include: bloated curricula (eg, “We can’t stuff one more thing into our program.”); faculty knowledge gaps with limited time to learn (eg, “How do I teach about an area that’s new to me with no time to learn?”); and the rapidly evolving evidence in the field (eg, “How do I keep up?”).

“Climate +1” is a small and simple ask. Invite GME faculty to add just one slide or include one reading or case example highlighting climate-specific content to their existing teaching sessions. For example, for a presentation on chronic obstructive pulmonary disease (COPD), the instructor can add a slide that reviews: (1) increased exacerbation risk through the intersection of climate driven exposures (eg, heat, air quality factors like smoke or ground level ozone, pollen); (2) vulnerability (eg, exposure risk, sensitivity, adaptive capacity); and (3) anticipatory guidance for patients, giving learners actionable intelligence to improve care for their patients. To address faculty members’ limited knowledge base and time challenges, we collaborated with our librarians to develop a dedicated library request form that includes the presenter’s name and email, topic, and any previously identified relevant citations. It can be completed by an individual for a specific topic or allow for batched uploads for coordinators or curriculum leaders to submit multiple names by topic and email. Upon receipt of the form, librarians perform a targeted search, identify, and then email the requestor 2 to 3 key climate-related articles intersecting with the teaching topic.

Climate +1 slides have been incorporated into standard didactic lecture sessions in several Aurora Health Care residency programs to date including: family medicine (eg, gestational diabetes, dementia), obstetrics and gynecology (eg, preventative care), and now within their morbidity and mortality sessions. An internal medicine program has added Climate +1 slides focused on heat impacts into their grand rounds (eg, chronic kidney disease) and cardiology morning report (eg, stress cardiomyopathy). Quick resident surveys after each Climate +1 slide session revealed that our initial results have been very successful. Seventy three percent of residents (43 of 59) felt their ability to discuss the effects of climate on their patients’ health increased “moderately” (32 of 59, 54%) or “significantly” (11 of 59, 19%) after just one slide! Furthermore, residents overwhelmingly (49 of 59, 83%) recommended the Climate +1 slide approach to learn about the impacts of climate change on patients’ health and clinical care. Initial uptake of the library request form has been limited with presenters finding their own resources or contacting the library directly. Based on the success of our initial results, the approach is now being marketed widely to all GME programs at this sponsoring institution with clearer links to the library form (eg, a QR code) through our Graduate Medical Education Committee. We have 2 primary communication strategies: (1) presentation of a brief 8-minute PowerPoint orientation to faculty (and residents/fellows) who teach within our GME programs at various standing committee meetings, conferences, and work groups; and (2) one-on-one “asks” by a climate-knowledgeable faculty colleague in each of their respective programs. All strategies reference a SharePoint site for slide/case examples, resources, and a link to the library request form.