A Residency Elective in Sustainable Health Care Open Access

The climate crisis is a serious public health emergency, and the US health care sector itself produces 8% to 10% of US greenhouse gas emissions.¹  Experts have estimated that harm from these emissions is comparable to harm from medical errors and thus a safety and quality of care issue.²  Currently no standardized graduate medical education (GME) interventions for physicians exist that address the relationship between climate change, environmental sustainability, and quality improvement (QI). We describe a novel residency elective that shows how GME can advance health care sector decarbonization and improve quality of care by facilitating faculty-supported, resident-driven, environmental sustainability initiatives. This article focuses on a single case study of an emergency medicine (EM) resident who completed the elective virtually with the University of Colorado School of Medicine (CU) Climate and Health Program while fulfilling clinical requirements at their home institution.

The CU Climate and Health Program launched a climate medicine elective in 2021. Core competencies in climate change and health education along with a compendium of supporting learning objectives were collated from existing resources published by a variety of climate-focused organizations and subsequently revised and refined by program faculty. Interested residents apply for the elective on a rolling basis. Accepted residents meet with program directors, faculty, and fellows to further narrow scope, goals, and learning objectives based on their level of learning and expertise. The elective completed by the model EM resident focused specifically on environmentally sustainable health care. It was completed in October 2022 entirely remotely due its nonclinical nature, allowing for simultaneous fulfillment of clinical shifts at their home institution during the second year of residency. Based on learning objectives agreed upon with the resident, a variety of resources were utilized to deliver QI-targeted education in health care sustainability, including synchronous and asynchronous didactics, reading materials, virtual conferences, networking with subject matter experts, online modules, and weekly meetings to identify and define a QI project that served as a capstone deliverable (Table). Utilizing these resources, the resident independently designed and implemented a QI project to reduce insulin waste in their home institution’s emergency department.

This example highlights opportunities for GME to support learner-directed health care sustainability education that can help transform industry practices while fulfilling QI requirements set forth by the Accreditation Council for Graduate Medical Education. Elective and virtual format allows for geographical and temporal flexibility as well as adaptability tailored to individual knowledge base, skills, and personal interests. CU faculty designed the elective curriculum over a period of 6 months using existing climate health resources (Table). These resources can be utilized by GME faculty in any specialty. In our experience, a single faculty member can design and oversee this type of education but will need variable amounts of time to review existing topical literature and materials (Table) based on their preexisting knowledge base and comfort in teaching QI skills. Faculty will also need time to regularly meet and mentor learners developing QI projects. For faculty looking for continuing education on these topics, the Centre for Sustainable Healthcare in the United Kingdom provides the tuition-based courses on “How to Teach SusQI.”

In this case study, the participating resident successfully met the goals of the elective by planning, leading, and implementing a QI project focused on waste reduction and environmental sustainability. Integrating practical education about health care sustainability at the GME level can also empower physicians in addressing environmental determinants of health throughout their careers. Following the elective, the resident engaged in scholarly activity and professional development by presenting the QI project at multiple national conferences. The resident also pursued further physician-oriented education and career advancement in health care sustainability, as well as founded an Environmental Stewardship and Sustainability Committee at their home institution.