June 19, 2024

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The Green Elephant in Medical School Classrooms

5 min read

Vora is a practicing internal medicine physician and infectious disease epidemiologist, and a policy fellow at Conservation International.

There is a health crisis expected to cause more than 14 million deaths by 2050. Millions more will suffer physical and mental illness each year as a result of this crisis. No person is immune, though the poorest among us are most susceptible. It is considered the single greatest threat to human health this century. Yet 85% of the world’s medical schools fail to incorporate it into their curricula.

Climate change is the elephant in our medical school classrooms. It’s time to address it.

On a moral level, I believe my fellow physicians should speak up on societal issues that affect the health of our patients. But even setting that obligation aside, medical educators are shirking their primary responsibility: preparing future doctors for the real world. In the coming months, more than 28,000 students will graduate from medical schools across the U.S., taking the next step toward becoming practicing physicians. But these doctors of tomorrow have been educated for the world of yesterday.

Our environment is changing rapidly, and medical education has yet to catch up. We just faced the hottest year on record in 2023, a foreboding glimpse of what life could look like at 1.5 degrees Celsius above pre-industrial levels. The health effects of the climate crisis are startling: Heat-related emergency department visits surged last summer; there’s a new crisis of kidney disease linked to extreme heat; and heat-related deaths in the U.S. have nearly doubled since 2010.

But acute heat emergencies are just the tip of the iceberg. In 2022, unprecedented flooding in Pakistan uprooted millions, killed over a thousand, and induced a perfect storm of disease — rampant outbreaks of malaria, cholera, starvation, and dehydration. More than a year later, over 1 million people were still displaced.

These once “unimaginable” disasters are growing horrifyingly normal.

Even when doctors aren’t responding to disasters, they can’t be sure what to test for anymore. Infectious diseases are popping up in new places. In one study, a medical school professor recalled seeing malaria outbreaks in places where, “according to the books, they shouldn’t have happened.” One such example is in Florida, where the U.S. recently documented its first locally acquired malaria cases in 20 years.

Changing medical school curricula may sound radical, but it’s a natural extension of existing requirements. The Liaison Committee on Medical Education, the pre-eminent accrediting body for medical schools, already mandates curricula include medical consequences from “common societal problems,” which can be anything from health disparities to substance use disorders. To me, this century’s greatest threat to human health — climate change — also qualifies as a societal problem, to say the least.

Students are not the impediment to change — quite the opposite. Student-led initiatives like Medical Students for a Sustainable Future are pressuring schools to act. In one study, an overwhelming majority of medical students said that climate change should be included in the core curriculum. Only 6% of these future doctors felt very prepared to discuss the simplest question: “How can climate change affect my health?”

It’s no surprise that curricula have been slow to evolve. Medical schools are rigid institutions — often for good reason. The path to becoming a physician is meticulously crafted to impart hundreds of years of knowledge in a short burst. Each lesson within each program of each school holds exorbitant weight. But these are exceptional times, and we cannot afford to delay any further.

To their credit, some are already trying. In 2019, the American Medical Association adopted a policy to ensure that medical students and physicians have access to educational materials about the intersection of climate and health. Columbia University hosts the Global Consortium on Climate and Health Education, which is trying to secure commitments from health professional schools globally to educate their students about the health effects of the climate crisis. The University of Colorado offers advanced training on climate and health for doctors who have already completed their residency. Though well-intentioned and useful, these efforts only skim the surface. Rather than allowing medical schools to opt in, we need to weave these ideas into the fabric of medical education.

One recent development intrigued me. Last year, Harvard Medical School added a “climate change and health” curricular theme. Students do not learn about climate during one discrete unit; instead, they are exposed to its impacts throughout their education. As a hypothetical example, when discussing dialysis, students could also learn how to respond to fatal interruptions in dialysis access caused by natural disasters.

That isn’t some far-flung theoretical: When Hurricane Maria hit the U.S. Virgin Islands in 2017, I oversaw delivery of essential services to a group of dialysis-dependent evacuees in Atlanta. For months, they were stuck in a hotel hundreds of miles from home because all dialysis centers on the islands had been wiped out, effectively rendering them climate refugees.

The only plausible way to ensure every aspiring physician is well-versed in situations like these is to test them on it. Adding climate-related scenarios to licensing and specialty board examinations can help ensure that medical knowledge is comprehensive and current.

Of course, something as rigid as a medical school education tends to be zero-sum — anything added necessitates something removed. Critics — many of whom pulled all-nighters cramming for anatomy and pathology exams, just like I did — might argue there is no content that can be spared. We need surgeons. We need neurologists. We need pediatricians. Some might ask: Do doctors really need climate expertise?

Damn right, we do. For decades, we have ignored the obvious connection between the planet’s health and human health, perhaps because it was still invisible to the privileged. No longer. For many people, the effects are hiding in plain sight. Friends who work in construction are hospitalized for heat stroke. Distance runners in the family suffer asthma attacks due to poor air quality. Beach-going peers acquire flesh-eating bacteria after a quick dip.

Will you be ready to help when your patients need you?

Neil Vora, MD, is a practicing internal medicine physician, an infectious disease epidemiologist, and a policy fellow at Conservation International. He previously served for nearly a decade with the CDC, including as an Epidemic Intelligence Service officer and a commander in the U.S. Public Health Service (USPHS).

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