An Interprofessional Approach to Prepare Medical Residents and Fellows to Address Climate- and Environment-Related Health Risks Open Access

At OHSU, we introduce climate and health topics through IPE in undergraduate medical education (UME) (see online supplementary data), with participation by faculty members across health care disciplines (family medicine, obstetrics, psychiatry, psychology, nutrition, public health, and nursing) and students from the Schools of Medicine, Nursing, Public Health, and Dentistry, as well as the College of Pharmacy.⁷  Collaboration with more than 10 instructors across professions and fields offers a novel and efficient approach to teach complex and wide-ranging material while modeling how teamwork is used to accomplish common goals. Weekly videoconference meetings enable further collaboration and opportunities for scholarship, grand rounds, and additional educational offerings. Throughout these endeavors, faculty mentors collaborate with upper-level medical students, residents, and fellows, providing additional training for emerging physician-leaders in climate and health; engagement in such mentored experiences has the added benefit of reducing burnout risk in residents and fellows by stimulating a sense of accomplishment and support at a critical time in their careers.⁹ 

Our students demonstrate understanding of climate health risks, synthesize knowledge, and communicate impacts through group poster projects and interactive blogs, where they explore how interprofessional teams can address climate and health issues collaboratively (see online supplementary data). Residents and fellows could further develop action-oriented solutions, aligned with their specialty, to address specific aspects of climate and health for improved patient care or climate change mitigation in clinical environments with emphasis on application to practice (Table). For example, anesthesiology residents and fellows could advocate for adoption of alternatives to volatile anesthetics to reduce greenhouse gas emissions.^10,11  Trainees in psychiatry may explore innovations in the composition and functioning of mental health interprofessional care teams, such as evaluating approaches that focus on wraparound services¹²  that might improve responsiveness to both acute and chronic climate-related health risks in vulnerable populations.

To accommodate scheduling needs of residents and fellows as they balance clinical duties, as well as those of faculty instructors, IPE modules can be offered in seminar- or workshop-style formats. Focused sessions could delve deeper into team-led case studies or simulations that provide rich, tailored learning experiences for training in identification and treatment of climate-related illnesses and conditions,^13,14  as well as documentation and communication of patient risk factors. For example, application of health informatics and advances in electronic medical records could help capture and integrate climate-related health risks.^15,16  The New England Journal of Medicine’s interactive climate tool is an excellent starting point to probe climate impacts on health for different specialties.¹⁷  Didactic sessions could be delivered in person or online by faculty with specific expertise from different disciplines/departments across the home institution, or by external collaborators, allowing course instructors to recruit specialists from a broader group of professionals and provide important networking opportunities for faculty and trainees. Focused, intensive sessions offer an opportunity to model and socialize the practice of preshift meetings (group huddles), which have been reported by residents as essential components of successfully working in interprofessional teams.¹⁸ 

Teamwork offers important benefits for physicians and their patients. Engagement in teamwork allows physician trainees to consider challenging issues with a broader perspective and to recognize their position in a larger system, showing them that they can—and should—lean on collaborators and colleagues to solve complex problems. In this sense, role-modeling teamwork across disciplines furthers development of professional identity and a shared community as physicians approach new challenges.¹⁹  IPE bolsters development of professional identity²⁰  by asking trainees to consider their individual and collaborative roles in the larger health care system. Importantly, teamwork and collaboration among medical professionals improves quality of care.²¹ 

Teamwork can benefit health care workers in supporting their efforts to uphold duty of care responsibilities²²  in the era of climate change. Advocacy (for patients, public health, and social responsibility) is associated with physician professional identity in the 21st century.²³  Health care workers have an important voice in climate change advocacy, including raising awareness of its health impacts,^24-26  working toward reduction in waste and emissions in health care settings, and calling for divestment from fossil fuels.^27-29  Climate change can be a politically charged topic,³⁰  with climate activism carrying personal and professional risks,³¹  including potential erosion of trust from patients with skeptical views about climate change or creation of workplace tension with colleagues who feel that physicians should remain impartial.^32,33  As such, climate activism can create a sense of isolation among medical professionals.³³ 

Interviews with climate change mitigation advocates in medical professions suggest that connecting with like-minded colleagues is a means to strengthen agency to effect change while lowering potential costs of activism³³  and engendering a sense of meaning in health care work, which has the benefit of reducing burnout risk.^34,35  Burnout is particularly severe among medical residents^36,37  and often accompanies a feeling of isolation.³⁸  Notably, reports of burnout tend to be lower among physicians who feel supported in collaborative teams,³⁹  further underscoring the importance of developing strong teamwork skills by residents and fellows. Education on team-oriented and collaborative approaches is an excellent opportunity to socialize the importance of support structures that promote physician well-being and thus physician retention.⁴⁰ 

The large number of climate-related health risks and impacts, and the complexity of potential solutions or mitigators, can be daunting to learners and challenging for instructors to cover in didactic content and clinical settings. Medical education must include both general and specific aspects of health impacts associated with climate change so that physicians are equipped to recognize and address health threats.⁴  The transition in scope and complexity from UME to GME is well suited to a scaffolding approach⁴¹  to efficiently teach cooperative and collaborative teamwork strategies⁴²  that support integration and application to clinical practice. Scaffolding is an instructional method that guides learning of complex topics through provision of organizational structures and frameworks^43,44 ; learners first identify structures and relationships (“structural skills”) before applying their knowledge across scenarios and in context (“dynamical skills”). This strategy is referred to as “future-scaffolding skills.”⁴⁵  To adequately prepare trainees, climate education should start during UME, with emphasis on awareness, foundational knowledge, systems thinking, and insight about where their career path could fit within environmental and climate sectors. As trainees advance to residency and fellowship programs, the foundational knowledge can be integrated, deepened, and applied through mentored experiences in clinical practice.

Graduate medical education must prepare physicians for a future in which health is strongly impacted by climate change, and must support them in serving patients and the community in a consistent and coordinated manner. These goals are best achieved through education and experience in teamwork and interprofessional skills. IPE is an efficient way to cover climate and health content in medical curricula, cultivate an atmosphere of collaboration and partnership, role model a collaborative approach, and equip trainees with essential knowledge and skills for their careers.

The authors would like to acknowledge the students and residents who contributed feedback during the development and evolution of the interprofessional education course in Climate and Human Health at Oregon Health & Science University, especially Dr. Shane Hervey. Support to implement the course came from the OHSU-PSU School of Public Health. They thank Elana Zuber, MBA, for her assistance and leadership in seeking course approval. The input and insights from course instructors were essential in creating comprehensive course content and establishing a strong and collaborative environment; special thanks to Dr. David Pollack, Dr. Kristy Lanciotti, Dr. Nicholas Gideonse, and Sara Mitenbuler for their contributions and collaborative efforts.

The online supplementary data contains further data from the study.