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EVOLUTION

Approaches to Planetary Health Curriculum

Catherine Chen, MD, FACP Assistant Professor

Division of General Internal Medicine @catchenMD

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ROBERT WOOD JOHNSON MEDICAL SCHOOL JOINED IN DECEMBER 2021

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ALL PHRC 2022

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PHRC 2022

RWJMS Team:

Sukrut Sonty

Jeremy (Jake) Lessing Daniel Scalia

David Garyantes Julia Marx

Eric Muller Anisha Tyagi Jake Drobner

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CLIMATE CHANGE & HEALTH 3 PILLARS OF ACTION

CLIMATE & HEALTH IMPACTS

CLINICAL PRACTICE & CLIMATE ADAPTATION

HEALTH EQUITY

& ENVIRONMENTAL JUSTICE

HEALTHCARE WASTE & SYSTEMS

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FROM THE BEGINNING

Preclinical

  • Introduction of climate impacts on health with pathophysiology and Systems

Environmental History

  • Develop environmental history interview skills
  • Discuss Climate-health risk factors with patients

Clinical impact

  • Adaption & treatment for vulnerable patients
  • Health Equity Concepts in Clerkships

Systems based change

  • Sustainable Healthcare Delivery & HVC
  • Systemic change for Community health

M1

M2

M3

M4

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LONGITUDINAL CLINICAL INTEGRATION

Preclinical

  • Introduction of climate impacts on health with pathophysiology and Systems

Environmental History

  • Develop environmental history interview skills
  • Discuss Climate-health risk factors with patients

Clinical impact

  • Clinical Adaption & treatment opportunities
  • Health Equity Concepts in Clerkships

Systems based change

  • Sustainable Healthcare Delivery & HVC
  • Systemic change for Community health

M1

M2

M3

M4

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WHAT THAT PRACTICALLY MEANS FOR OUR STUDENTS

AY 2024-2025

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Embedded Planned This AY One-offs

Need to Address

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FLOODING HEALTHCARE ACCESS

RUTGERS NJ HEALTH AND MEDICAL LIFELINES FLOOD ANALYSIS

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Postcí Aít roí Social J"sticc - Ricaído Ḻc:i⭲s Moíalcs

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IN THE CLINICAL YEARS

FM

Psych

Neuro

EM

Embedded Planned This AY One-offs

Need to Address

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POSTGRADUATE & FACULTY EDUCATION

Clinical Practice

  • Hone environmental history interview skills
  • Discuss Climate-health risk factors with patients
  • Climate Adaptation for patients

Systems Based Practice

  • Health Equity
  • Population Health
  • Sustainable Healthcare Delivery & QI

Advocacy & Education

  • Systems changes
  • Advocacy
  • Resident as teacher

Continuing Medical Education

  • Faculty Education
    • Faculty Development DOM
    • All GME Grand Rounds
    • Quick talks
  • Advocacy

PGY1

PGY2

PGY3

+Beyond

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HIGH VALUE CARE EQUATION

Mortimer F, Isherwood J, Wilkinson A, Vaux E. Sustainability in quality improvement: redefining value. Future Healthcare Journal. 2018 Jun;5(2):88-93

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BUILDING SUSTAINABLE QI

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Learn about the issues

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Join an organization

GETTING • Clinicians for Climate Action

INVOLVED • Healthcare without Harm

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Talk to your society about Climate, Health & Healthcare

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CHANGE THE SYSTEM THROUGH EDUCATION

PITCH DECK

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  1. Understand Benefits, Harms, and Relative Costs of the intervention
  2. Decrease or Eliminate Interventions that provide no benefits and/or may be harmful
  3. Choose Interventions & Care settings to maximize benefits, minimize harms, and reduce costs
  4. Customize a care plan that incorporates patient values and concerns and complete a bias check-in
  5. Identify systems level opportunities to improve outcomes, minimize harms, and reduce waste

This Photo by Unknown Author is licensed under CC BY-NC

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TALK TO PATIENTS ABOUT HOW CLIMATE AFFECTS THEIR HEALTH

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  • Add impact from extreme weather to social history
  • Ask about triggers like heat

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“We are seeing more hot days because of climate change. This can affect people with asthma like you. I want to make sure you’re prepared for days like those. Can we talk about that?”

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Think about your strengths.

What barriers you may encounter and how we can overcome them

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5/18/2024

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Think about your strengths.

What barriers you may encounter and how we can overcome them

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Think about your strengths.

What barriers you may encounter and how we can overcome them

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Why?

  1. Highlight the role of health professionals and the urgency to act while contextualizing climate change in the broader field of planetary health
  2. Connect environmental sustainability content to broader education and professional

practice objectives

What?

  1. Prepare learners for the health impacts of climate change through exploring adaptation and mitigation strategies
  2. Inspire students with the health co-benefits of mitigation
  3. Embrace broad conceptualizations of professionalism incorporating environmental ethics, advocacy, and leadership
  4. Expand the biomedical approach to health by routinely considering environmental

determinants of health in all teaching

How?

  1. Collaborate through resource sharing, publishing and evaluating interventions
  2. Prioritize content for local relevance and professional utility
  3. Integrate environmental sustainability into core curriculum with increasing complexity and reinforcement throughout the course
  1. Teach knowledge, skills, and attitudes in environmental sustainability
  2. Assess learners through formative, portfolio-based and learner-led tasks that promote reflection
  3. Strive for progress with positivity and persistence

12 Tips for teaching

environmental sustainability to health professionals.

Schwerdtle et al. (2020) ‘12 tips for teaching environmental sustainability to health professionals’, Medical Teacher, 42:2, 150-155

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BARRIERS

CURRICULUM DIRECTOR

For the PHRC, if you have a director but there is not FTE There is no Curriculum Director

LACK OF TIME

Have students identify items for “cutting”

Micro integrations

Small extensions of existing curriculum

LACK OF STUDENT ENGAGEMENT

Name it. “Distinction”, “Scholar” etc.

EDUCATOR KNOWLEDGE

Leverage Student Energy

COURSE DIRECTOR RESISTANCE

Integrate & Negotiate by specialty/director interest

20XX

PITCH DECK

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Sample Curriculum Integration (CRHE)

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Neuro

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Psych

  • 9.1 Stroke risk factors (heat and PM 2.5)
  • 9.2 Heat and neurodegenerative disorders
  • 9.3 MS and thermal regulation of axonal transmission
  • 9.4 Hyperthermia: seizures, heat stroke/stress
  • 9.5 Cyanobacteria exposure from harmful algal blooms
  • 10.1 Anxiety
  • 10.2 Depression (solastalgia)
  • 10.3 Suicide (heat waves)
  • 10.4 PTSD (e.g. post disaster setting)
  • 10.5 Healthcare/frontline workers & burnout
  • 10.6 Climate change and children's mental health

Reproductive Health

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Pediatrics

  • 11.1 Pregnancy and heat stress (adverse outcomes)
  • 11.2 Pregnancy and air pollution (adverse outcomes)
  • 11.3 Climate change and intimate partner violence
  • 12.2 Development and air pollution
  • 12.3 Childhood leukemia and air pollution: Pathophysiology and clinical presentation
  • 12.4 Childhood leukemia and air pollution: Structural determinants of health

Heme/Onc

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Renal

  • 13.1 Particulate matter and lung cancer
  • 13.2 Primary prevention of cancer
  • 14.1 Heatstroke/stress and AKI
  • 14.2 Kidney stones
  • 14.3 CKD /CINAC
  • 14.4 Increasing temperature and kidney outcomes

Infectious Disease

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Occupational Health

  • 15.1 Hantaviruses
  • 15.2 Tick Borne diseases
  • 15.3 Vibrio vulnificus
  • 15.4 Arboviruses
  • 15.5 Malaria
  • 16.1 Primary prevention: workplace controls

Cardio

  • 1.1: Primary prevention of cardiac disease
  • 1.2: Heat and cardiac morbidity and mortality
  • 1.3: Air pollution & cardiac morbidity and mortality
  • 1.4: Heat stress and heart failure
  • 1.5: Extreme weather and carbon monoxide poisoning

Respiratory

  • 2.1: COPD
  • 2.2: Asthma
  • 2.3: Environmental allergic dx & immuno (e.g. ragweed)
  • 2.4: Hypersensitivity pneumonitis
  • 2.5: Global health: indoor biofuel combustion & lung dx

Endocrine, Nutrition, Biochem

  • 3.1: Obesity & weight
  • 3.2: Metabolic dx: Type 2 DM & PM 2.5 inc risk
  • 3.3: Primary prevention: meat vs. plant based diet
  • 3.4: Nutritional content of food, agriculture, and food systems
  • 3.5: Global health: Food insecurity

Gastro

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Rheum

  • 4.1: Diarrheal dx and WASH infrastructure
  • 4.2: IBD flares and heat waves

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  • 5.1: Lupus flares, climate change, particulate matter

Surgery

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Radiology

  • 6.1: Extreme weather and traumatic/electric injury
  • 6.2: Vibrio vulnificus and necrotizing fasciitis

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  • 7.1: Sustainable diagnostic algorithm that optimizes ecological impact of radiological procedures

Dermatology

  • 8.1: Skin cancer, ozone w/ UV and inc temps
  • 8.2: Pemphigus & atopic dermatitis d/t PM exposure

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RESOURCES

Links

Resources

STUDENT PRESENTATION ON PHRC FOR CURRICULUM COMMITTEE

PHRC – ALL SUMMARIES PHRC – RWJMS DETAILED

CLIMATE RESOURCES FOR HEALTH EDUCATION PRACTICE GREENHEALTH

HEALTHCARE WITHOUT HARM HEALTHIER HOSPITALS

20XX

PITCH DECK

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Medical Education - GME

  • Climate Change and the Practice of Medicine: Essentials for Resident Education Philipsborn
    • https://journals.lww.com/academicmedicine/fulltext/2021/03000/climate_change_ and_the_practice_of_medicine_.23.aspx
  • Identification of core objectives for teaching sustainable healthcare education - Teherani
    • https://pubmed.ncbi.nlm.nih.gov/29025363/
  • Climatizing the internal medicine residency curriculum: A practical guide for integrating the topic of climate and health into resident education
  • Child-focused climate change and health content in medical schools and pediatric residencies – Nature Pediatric Research

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Useful Sites & Resources

  • Global Consortium for Climate Health Education
  • Climate Resources for Health Education https: /climatehealthed.org/
  • Center for Sustainable Healthcare: https: /sustainablehealthcare.org.uk/
    • Interesting projects & Teaching resources
  • CO2 calculator: https: /www.epa.gov/energy/greenhouse-gas- equivalencies-calculator
  • Can Sustainable Hospitals Help Bend the Health Care Cost Curve?
  • EPA Going Green in Mid Atlantic HealthCare Impacts

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Hospital / System Resources

  • Healthier Hospitals Initiative
  • Practice Green Health
    • https: /practicegreenhealth.org/gco
  • Healthcare Without Harm
    • https: /noharm-uscanada.org/
    • https: /www.greenhospitals.net/leadership/
  • Climate Health Connect: https: /climatehealthconnect.org/
  • Advisory Board
  • Target 100! University Washington
    • http: /t100.be.uw.edu/
    • http: /t100.be.uw.edu/TOL_DWN.php
  • UCSF
    • https: /sustainability.ucsf.edu/get_involved/getcertified
    • https: /www.youtube.com/watch?v=Yr-FrLom_3s