Resident Physicians Can Promote Environmental Health and Climate-Informed Health Care Open Access

Awareness is growing within the medical community that a stable climate is fundamental to human health.¹  The term “environmental health” has been adopted to include aspects of human health that are impacted by natural and built environments.² 

Physicians have indicated they recognize the important role of climate change in the health of their patients.^3,4  However, they cite a myriad of barriers to engaging in environmental health, including lack of training, a need for concrete tools, and time constraints. Most current physicians were not exposed to environmental health content in their medical training, complicating their ability to incorporate it into their clinical work or teach learners on the topic.^3-5 

The current generations of medical students and resident physicians have a higher level of engagement with climate change than the generations that are teaching them.⁶  More than 90% of US medical students think that climate change is currently affecting public health, but only 13% believe they received adequate instruction on this subject.⁷  Medical students have played a major role in pushing its inclusion into undergraduate medical education (UME).⁸  Residency training lags behind UME in terms of incorporating environmental health education, as graduate medical education (GME) instead puts focus on required clinical experiences and specialty-specific competencies.

Many attending physicians do not have expertise in environmental health. Additionally, resident physicians must balance competing interests, including educational priorities and clinical duties. Given these barriers, what practical measures can residents take to promote environmental health in their day-to-day work? We put forth several scenarios whereby residents can achieve this through their everyday activities as clinicians, learners, educators, scholars, and leaders.

As trainees move from UME to residency, the focus of their learning transitions away from the classroom to the practice of medicine. We suggest high-value care, environmentally conscious care, and preventative medicine as strategies for residents to advance environmental health in their clinical practice (Table).

US health care per-capita spending and greenhouse gas emissions greatly exceed those of comparable health care systems around the world.²⁰  High-value care, the concept of simultaneously improving health, avoiding harm, and reducing wasteful practices, is an important component of residency education.^21,22  It may be underappreciated that when residents eliminate low-value testing and treatment, they maintain high-quality care while also reducing the environmental impact of health care delivery.

Residents can also familiarize themselves with environmentally conscious health care practices. When two clinical practices are otherwise equivalent in terms of health outcomes, choosing and advocating for the more environmentally friendly option reduces the footprint of their clinical work. These practices are often specialty-specific, with examples including using low-flow over traditional anesthetic gas delivery,²³  reusable over single-use surgical gowns,²⁴  and dry-powder over metered-dose inhalers.²⁵  Residents leading by example may shift practice patterns of a specialty over time.

Furthermore, residents practicing preventive medicine can reduce health care’s environmental footprint. Promoting cardiovascular and mental health in particular holds potential for aligning environmental and human health, as these efforts may prevent progression of chronic disease and decrease reliance on health care resources.²⁶  Alongside preventative medicine, residents can strengthen climate resilience in their patient population by screening for environmental exposures, cooling and heating access, and extreme weather preparedness.²⁷ 

By integrating these approaches into their daily clinical practice, residents not only improve patient outcomes but also contribute to the long-term sustainability of health care systems and environmental stewardship.

Currently, many residency programs do not include environmental health and climate change in their educational program, although there is growing interest within GME to do so.^5,28  While this curriculum is in development, there are several strategies residents can employ to further their education in this area, as learners and educators (Table).²⁹ 

As learners, residents can opt for electives in topics that align well with environmental health, such as preventative medicine or advocacy, integrating preexisting program requirements with environmental health interests.²⁹  Residents themselves can influence the inclusion of content in established department-wide educational activities (eg, grand rounds, morbidity and mortality conference),³⁰  as has been done previously for the rapid advancement of diversity, equity, and inclusion material in GME.³¹  Additionally, for conferences and presentations, there are repositories of ready-made slides that can be integrated into existing curriculum on numerous topics.³²  For aspiring physician leaders interested in deepening their learning, fellowships centered around climate research, health care sustainability, and community organizing are increasingly available across the country.³³ 

As educators, residents have the opportunity during team-based rounding to weave environmental health topics into their teaching, educating care members at all levels of training, and solidifying their own knowledge. For example, discussing etiologies of a patient’s presentation can include ecological risk factors (eg, current air quality as a possible trigger for a patient’s asthma exacerbation) or considering the environmental impact of a patient care plan.

Residents can integrate an environmental perspective into scholarly projects that fulfill program graduation requirements while contributing to this growing field of research (Table). Quality improvement projects can improve outcomes while reducing the environmental cost of health care delivery.³⁴  Alternatively, evidence-based interventions not primarily focused on sustainability can include environmental impact as a secondary outcome, such as antimicrobial stewardship initiatives that also consider the environmental impact of reducing unnecessary intravenous antibiotics.³⁵ 

For traditional research projects, residents can explicitly investigate environmental outcomes of health care practices, such as health care–associated methicillin-resistant Staphylococcus aureus contact precaution waste.³⁶  Additionally, projects may characterize any range of patient- or system-oriented outcomes associated with climate-related risk factors, such as the relationship between cardiovascular events after coronary artery bypass grafting and air pollution.³⁷  Residents may seek out mentors (even those without direct experience in this field) to help identify research opportunities and provide critical research support.

Within their own institutions, residents have opportunities to lead change that elevates the importance of environmental health (Table). Resident associations may establish a sustainability officer position to ensure that climate health issues are represented in agendas. A hospital-based sustainability committee that spans departments is another way to offer institutional continuity and outlast graduating residents. Additionally, this conveys a commitment to environmental health that may be appealing in recruitment efforts.

Residents can seek avenues to engage in advocacy beyond their immediate institutions, serving as expert and trusted voices to communicate the health implications of a changing climate. This work could be done through climate advocacy organizations, professional societies, or by partnering directly with frontline communities.³⁸  Professional societies are especially important as key creators of continuing medical education and policy statements.^2,28  Advocacy work allows residents to create systemic change and enables them to become physician leaders in the field.

The medical community’s response to climate change and environmental degradation is rapidly developing. Although medical education programs are beginning to integrate these topics into their curricula, the urgency of the need as well as the unique skills of trainees means there are many opportunities for resident-led involvement. We identified actionable opportunities for residents to promote environmental health and sustainability in their day-to-day activities, through patient care, education, research, and advocacy. We look forward to learning from trainees as they integrate environmental health into their medical education and help shape the practice of medicine for the era of the climate crisis.