Calling a Rapid Response on Environmental Racism: Medical Students Sound the Alarm.

A healthy lifestyle is fundamental for the prevention and treatment of cardiovascular disease and other noncommunicable diseases (NCDs). Investment in primary prevention, including modification of health risk behaviors, could result in a 4-fold improvement in health outcomes compared with secondary prevention based on pharmacological treatment. The American Heart Association (AHA) emphasized the importance of lifestyle in its 2020 goals for cardiovascular health promotion and disease reduction. In addition to defining “cardiovascular health” based on criteria for blood pressure and biochemical markers (lipids and glycemia), the AHA Strategic Planning Committee further identified lifestyle characteristics of central importance: nutrition, physical activity, smoking, and maintenance of a healthy body weight.1 The World Health Organization estimated that ≈80% of NCDs could be prevented if 4 key lifestyle practices were followed: a healthy diet, being physically active, avoidance of tobacco, and alcohol intake in moderation.2 To support healthy lifestyle initiatives, major changes are necessary at the societal level to improve population health. Numerous strategies might help to create a culture that promotes and facilitates healthy behaviors, including creating laws and regulations, mounting large-scale public awareness and education campaigns, implementing local community programs, and providing individual counseling.3 Physicians are uniquely positioned to encourage individuals to adopt healthy lifestyle behaviors: Approximately 80% of Americans visit their primary care physician at least once a year. Physicians directly communicate with their patients during clinical encounters across numerous settings, and research indicates that patients highly value recommendations provided by their physicians.4,5 However, data further indicate that lifestyle counseling does not routinely occur in physicians’ offices, thereby representing a lost opportunity. Physicians report that they perform lifestyle counseling during ≈34% of clinic visits.4 Patients, in turn, report an even lower frequency of physician lifestyle counseling. For example, obese patients reported receiving physical activity and …

CONTEXT: Structural factors are fundamental drivers of racial health inequity. Structural competency (SC) offers a paradigm for training health professionals to recognize and respond to the impact of structural factors. Despite national advocacy, curricula have been inconsistently implemented and evaluated. OBJECTIVE: To study the incorporation of Anti-Racism structural competency curricula and how it impacts Black, Indigenous, and people of color (BIPOC) vs non-BIPOC learners. STUDY DESIGN AND ANALYSIS: A cross-sectional mixed-methods study. Grounded theory analysis on the open-ended responses identified key themes. Both quantitative and qualitative analyses are by BIPOC vs non-BIPOC. SETTING: Pre and post survey was disseminated using Qualtrics in the 2021-2022 academic year. POPULATION STUDIED: All first year medical students at an academic medical teaching hospital. INTERVENTION: Adapted structural competency curriculum from Bay Area Working Group. Curriculum was delivered in six 2-hour teaching sessions, involving a mix of whole-classroom presentations and self-selected racial affinity small discussion groups, and were accompanied by pre-reading, follow-up informal discussion groups, and post-session written reflective assignments. OUTCOME MEASURES: Knowledge, attitudes, career choice, burnout, empowerment, and empathy. RESULTS: 182 completed surveys: PRE: 36 BIPOC and 48 Non-BIPOC and POST: 46 BIPOC and 52 Non-BIPOC. Both groups had similar knowledge and attitudes towards the SC curriculum. Regarding more time being dedicated to these topics, the percent who responded Strongly Agree for BIPOC and Non-BIPOC increased by 36% (33 to 69%) and 22% (42 to 64%) from pre to post surveys, respectively. BIPOC students reported an increase in commitment to medicine rather than a change in career choice, and Non-BIPOC students indicated the course helped them better understand their profession. Many students noted they entered medicine because of their values related to equity and justice, though BIPOC-identified students noted more often-feeling burnout. Non-BIPOC students reported awareness of their BIPOCs’ peer burnout. Finally, we found an increase in empathy for patients and in self-empowerment across both groups. CONCLUSIONS: SC curriculum at this scale and early in the curriculum remains critical to creating a community of practice addressing racial equity in medicine.

Adolescents aged 15 to 19 years have the second highest fatal drowning rate of any age group, second only to toddlers aged 12 to 36 months. This risk is amplified in black, indigenous, and people of color (BIPOC), and those of low socioeconomic status. Worcester, MA is a diverse city with over 40% of residents identifying as BIPOC and 20% living below the poverty line. The city has multiple natural bodies of water available for recreation, putting Worcester residents, particularly adolescents, at high risk of drowning. It is known that swimming lessons provided to adolescents significantly improve their swimming skills, however many programs are tailored to young children and are not appropriate for adolescents. Students from the University of Massachusetts T.H. Chan Medical School (UMass Chan), in collaboration with community partners, developed a water safety and swim education program tailored to Worcester adolescents as a means for an age-appropriate swim experience and education, community engagement, and injury prevention. Water Safe Worcester (WSW) was established as a city-wide injury prevention program that included swim lessons offered by medical students at the Central Community Branch YMCA in Worcester, MA. Instructors included UMass Chan medical students, graduate students, and staff. Adolescent YMCA members were invited to participate in lessons free of charge. Lessons were 90 min and emphasized a 3-fold approach: (1) expand knowledge of water safety and what to do in an emergency, (2) increase swimming skills, and (3) reduce fear of water. The overall attendance for the 2023 spring and summer sessions offered was 73 students, including multiple swimmers who attended more than one session. A total of 12 volunteers participated, which included 9 first-year medical students, one PhD student, one research assistant, and one surgery resident from UMass Chan. WSW demonstrated promising outcomes during its swim education classes, suggesting that WSW is a successful model to promote water safety, reduce the risk of drowning, and expand access to life-saving skills to Worcester's at-risk adolescents. This program serves as a critical step toward health equity while also providing an avenue for public health and injury prevention exposure for medical students.

IntroductionThe ability to utilize the electronic health record (EHR) without compromising the doctor-patient relationship (DPR) is an essential skill of all physicians and trainees, yet little time is spent on educating or assessing learners on needed techniques. To address this gap, we developed a conventional OSCE station coupled with a simulated patient chart within the Epic program in order to assess our students' skills utilizing the EHR during a patient encounter.MethodsOf third-year medical students, 119 were given full access to the patient's simulated chart 24 hours in advance of their OSCE to review clinical data. During an in-person OSCE with a standardized patient (SP), students performed a focused history and physical, using the EHR to verify allergies and medications. Students completed an electronic patient note graded by faculty. SPs evaluated the students on communication and interpersonal skills with specific rubric elements. Faculty graded the students' notes to evaluate their expression of clinical reasoning in the assessment and plan.ResultsTraining SPs and faculty to assess students on EHR skills was feasible. After implementation of a comprehensive curriculum focused on EHR and DPR, there was a significant difference on EHR-related communication skills (M = 76.4, SD = 17.6) versus (M = 37, SD = 28.9) before curriculum enhancement t (117.9) = −12.4, p <.001.DiscussionThe EHR OSCE station provided a standardized method of assessing students' EHR skills during a patient encounter. Challenges still exist in the technological requirements to develop and deliver cases in today's EHR platform.

Ours is an age of unprecedented levels of environmental alteration and biodiversity loss. Beyond the exposure to environmental hazards, conditions such as environmental degradation, biotic impoverishment, climate change, and the loss of ecosystem services create important health threats by changing the ecology of many pathogens and increasing the incidence and/or severity of certain noncommunicable conditions. They also threaten health in the future by weakening the Earth's life support systems.Although physicians remain one of the most often accessed and most trusted sources of information about the environment, there is currently little emphasis on educating medical professionals about these environmental issues. This lack of training reduces the ability of most physicians to be efficient science-public interfaces and makes them ineffective at contributing to address the fundamental causes of environmental problems or participate in substantive environmental policy discussions. This is an important challenge facing medical education today.To turn medical students into effective physician-citizens, an already-overwhelmed medical school curriculum must make way for a thoughtful exploration of environmental stressors and their impacts on human health. The overarching question before medical educators is how to develop the competencies, standards, and curricula for this educational endeavor. To this end, the authors highlight some of the critical linkages between health and the environment and suggest a subset of key practical issues that need to be addressed in order to create environmental education standards for the physician of the future.

The Standing Committee of European Doctors urged to include training on the impact of climate change on health for health professionals. Currently, in the curriculum of most medical schools, the health-related impacts of climate change represent a peripheral part. The teaching of health effects of climate change should be made part of the training of health professionals and should be introduced in the curriculum of medical schools. ClimateMed is an Erasmus project that improves the curriculum and expands knowledge about the health effects of climate change at medical universities. The World Café method, based on round table discussions, was applied to assess the needs, summarize the proposals, and develop the necessary strategy. At the same time, a questionnaire was applied to those medical students from UMFST Targu Mureș who chose this subject as an optional subject. Students related the importance of understanding the diseases caused directly or indirectly by climate change, and reported what kind of topics should be included in a new course, in which semester/module and in what format it would be appropriate to teach it. The most frequently reported topics were: excessive heat and heat-related illnesses, extreme weather, vector-borne diseases, food safety, air pollution, and mental health. According to the goals of the project and students’ opinions, since 2023 medical students can choose Climate Change and Health Effects as an elective course. Based on the demand for medical universities to include in their curriculum knowledge related to the health effects of climate change, ClimateMed project can facilitate this integration and can promote the increase of teacher motivation and the development of methodological guidelines for university teachers. The project contributes to the preparation of some educational materials and the introduction of an optional subject in the training curriculum of the students of the Faculty of Medicine, UMFST Targu Mureș. Key messages • There must be made efforts to include training on the impact of climate change on health for health professionals, to introduce this subject in the curriculum of medical schools. • ClimateMed project can facilitate the integration of knowledge about the health effects of climate change into curriculum and can promote the practical use.

Climate change is a public health emergency.1Solomon CG LaRocque RC Climate change–a health emergency.N Engl J Med. 2019; 380: 209-211Crossref PubMed Scopus (75) Google Scholar Clinicians worldwide now face the reality of caring for patients during wildfires, heat waves, floods, and shifting infectious disease patterns. Health-care workers need better preparation to care for communities facing the health effects of climate change.2Salas RN The climate crisis and clinical practice.N Engl J Med. 2020; 382: 589-591Crossref PubMed Scopus (22) Google Scholar Medical students have been key advocates in these efforts, driving research, community partnerships, and education.3Goshua A Gomez J Erny B et al.Addressing climate change and its effects on human health: a call to action for medical schools.Acad Med. 2021; 96: 324-328Crossref PubMed Scopus (44) Google Scholar, 4Fadadu RP Jayaraman T Teherani A Climate and health education for medical students.Clin Teach. 2021; 18: 362-364Crossref PubMed Scopus (7) Google Scholar, 5Baker N Bromley-Dulfano R Chan J et al.COVID-19 solutions are climate solutions: lessons from reusable gowns.Front Public Health. 2020; 8590275Crossref Scopus (20) Google Scholar When we began medical school during record-setting Californian wildfires and a global pandemic, our curriculum did not address the effect of climate change on human health, nor the disproportionate effects on communities made vulnerable by racism and poverty. Here, we detail how we integrated the effects of climate change on health into more than a dozen courses at our institution, starting with the preclinical curriculum and then progressing through all levels of training. In this Comment, we use the example of reproductive health and obstetrics and gynaecology education to describe this longitudinal approach. Our student team first addressed the preclinical curriculum, highlighting the effect of climate change on disease pathophysiology across human health. We began with a review of our required preclinical curriculum, identifying areas of opportunity for integration on the basis of peer-reviewed literature. We worked closely with course faculty leads to incorporate climate topics into pre-existing course materials using an equity lens, emphasising the disproportionate health effects of climate change on low-resourced communities.4Fadadu RP Jayaraman T Teherani A Climate and health education for medical students.Clin Teach. 2021; 18: 362-364Crossref PubMed Scopus (7) Google Scholar, 5Baker N Bromley-Dulfano R Chan J et al.COVID-19 solutions are climate solutions: lessons from reusable gowns.Front Public Health. 2020; 8590275Crossref Scopus (20) Google Scholar, 6Nardone A Casey JA Morello-Frosch R Mujahid M Balmes JR Thakur N Associations between historical residential redlining and current age-adjusted rates of emergency department visits due to asthma across eight cities in California: an ecological study.Lancet Planet Health. 2020; 4: e24-e31Summary Full Text Full Text PDF PubMed Scopus (164) Google Scholar For example, we supplemented our reproductive health course with lecture slides identifying air pollution and heat exposure as environmental teratogens that increased the risk of adverse birth outcomes, especially for Black women and people with asthma.7Bekkar B Pacheco S Basu R DeNicola N Association of air pollution and heat exposure with preterm birth, low birth weight, and stillbirth in the US: a systematic review.JAMA Netw Open. 2020; 3e208243Crossref PubMed Scopus (257) Google Scholar Transitioning to clinical integration, our team expanded on knowledge gained in the preclinical setting to teach students how to identify climate-related disease pathology. In the obstetrics and gynaecology clerkship, we integrated climate and health effects into relevant didactic sessions and case presentations. For example, we highlighted how wildfire smoke contributes to preterm birth in our home state of California, USA.8Heft-Neal S Driscoll A Yang W Shaw G Burke M Associations between wildfire smoke exposure during pregnancy and risk of preterm birth in California.Environ Res. 2022; 203111872Crossref PubMed Scopus (37) Google Scholar Students also learned how to discuss climate-related topics in patient encounters. Lastly, we extended our efforts into the education of junior doctors, aiming to equip junior doctors with tools to counteract climate change's impacts on patients. These efforts emphasised how climate and health presentations are rooted in upstream factors that contribute to health inequities. For example, we developed a didactic session for the obstetrics and gynaecology junior doctor programme focused on taking environmental histories, providing climate-related patient education, and connecting junior doctors with advocacy resources.9Program on Reproductive Health and the EnvironmentPrenatal exposure to toxic chemicals and climate change.https://prhe.ucsf.edu/figoDate: 2022Date accessed: January 21, 2022Google Scholar Given the vital role that junior doctors play in medical student education, these efforts will not only provide junior doctors with tools to care and advocate for patients affected by climate change, but will also be passed down to medical students during clinical rotations. Although we use the obstetrics and gynaecology curriculum as an example of our longitudinal approach to climate and health education, our work has spanned across more than a dozen courses to date. Five best practices were crucial to our success: setting tangible education objectives as defined by the School of Medicine administration and relevant national climate educational efforts allowed us to develop targeted, effective educational interventions;10Fadadu R Hampshire K Ndovu A Medical students as agents of change in the climate crisis.Acad Med. 2022; 97: 1104-1105Crossref PubMed Scopus (3) Google Scholar soliciting iterative feedback from faculty and trainees enabled us to benchmark the school's progress in planetary health education; aligning with the Deans of Curriculum and Scholarship gave us a platform to directly interact with course faculty leads and integrate our research systematically; grounding our work in local effects and health equity by collaborating with at-risk community members ensured our educational materials were relevant to our patient population and showed how climate change is one of many social determinants of health; and connecting with national student and physician groups such as Medical Students for a Sustainable Future and Physicians for Social Responsibility enabled us to share resources, knowledge, and best practices. As climate change forces the world to grapple with a new understanding of normal, it is crucial that clinicians are prepared for the novel health effects that climate change will have on the communities they serve. A longitudinal approach to climate and equity education throughout medical training aims to not only build competency and awareness on the effects of climate change on health, but also provide an equity frame (figure). This approach empowers clinicians to effectively counsel patients within hospitals in addition to advocating for resources and policies outside clinical walls to best protect the health of their communities, ultimately preparing trainees for a career rooted in social justice and health equity. We declare no competing interests. AJ and AL contributed equally.

University of Missouri—Kansas City School of Medicine

Emory University School of Medicine.

ObjectiveBoard examinations in undergraduate medical education are imperative for competency assessment and a standard licensure process. While the cost of attendance and mean indebtedness of medical students have been quantified, the financial burden experienced by medical students from board preparation and examination has never been quantified.Materials and methodsA total of 290 fourth-year osteopathic medical students from 38 osteopathic medical schools completed an anonymous survey that asked them to select the resources they had purchased for board preparation. Along with demographic information, respondents were asked which board examinations they had taken during their medical school education. The price for each resource was located by going to the resource website and finding the “list price” of a brand-new copy/version of that resource. If a price was not found, a current Amazon.com “list price” was utilized. These prices best approximate the maximum a student would spend per resource. Response and statistical analysis such as analysis of variance, post hoc comparison (Scheffé and Bonferronis test), and chi-square tests were conducted using the Statistical Package for Social Sciences (SPSS) Statistics, version 25.0 (IBM SPSS Statistics, Armonk, NY).ResultsThis study found that osteopathic medical students spent, on average, $7,499 (s.d.=$2,506) for board preparation and examination. This cost when isolated is $3,370 for the cost of taking board examinations and $4,129 for the cost of board preparation. Respondents from the West were found to spend most at $9,432, while students from the Northeast spent the least, $7.090. Additionally, non-traditional medical students, those who matriculated after the age of 30 were found to spend more than individuals who began when they were under the age of 25 or between the ages of 25-30. The two most commonly used resources for both Level 1/Step 1 and Level 2/Step 2 examinations were COMBANK and UWorld. Conclusions/relevanceThis study is the first of its kind to quantify the mean cost of board preparation and examination in undergraduate medical education at $7,499. When considering the mean indebtedness of the osteopathic graduating class of 2017-2018, 2.94% of medical education debt can be attributed to the cost of board preparation and assessments. As competitiveness for graduate medical education increases, individuals will spend more money to ensure a competitive board exam performance, a key selection factor. Stakeholders in undergraduate medical education are encouraged to further understand the interplay between medical student debt and the cost of board examinations and preparation.

State University of New York Upstate Medical University College of Medicine

AAIM Recommendations to Promote Equity in the Clerkship Clinical Learning Environment

Climate change presents a significant health challenge, emphasizing the need for resilient healthcare systems. This study aimed to explore medical students’ knowledge, attitudes, and practices regarding the climate-health link and their curriculum preferences. Conducted from March to June 2023 at the Medical School of Bahçeşehir University, Turkiye, the cross-sectional study utilized an online questionnaire covering demographic data and climate change-related inquiries. Participation was open to all medical students without class-based distinctions. The response rate was 53.6%, with 439 medical students included (average age: 21.8 years). The majority (74.5%) acknowledged human-induced climate change, with over 87% expressing concerns about its impact on health. Nearly 70% emphasized the importance of physicians understanding climate change’s health effects, while 45.8% perceived a lack of information in their medical education. Most students (70.0%) supported integrating climate change’s health effects into medical education, rating its importance at 7.1 on a scale of 0 to 10. Preferences included electives, team-based learning, case-based learning, problem-based learning, clinical practice in climate-sensitive diseases, and theoretical courses on climate change in basic medical sciences. This study underscores the growing awareness among medical students regarding climate change’s health impact and the need for climate-integrated medical education, emphasizing its importance in preparing future physicians for climate-related health challenges and resilient healthcare systems.

BackgroundThe British medical student population has undergone rapid diversification over the last decades. This study focuses on medical students' views about their experiences in relation to ethnicity and gender during their undergraduate training within the context of the hidden curriculum in one British medical school as part of a wider qualitative research project into undergraduate medical education.MethodWe interviewed 36 undergraduate medical students in one British Medical School, across all five years of training using a semi-structured interview schedule. We selected them by random and quota sampling, stratified by sex and ethnicity and used the whole medical school population as a sampling frame. Data analyses involved the identification of common themes, reported by means of illustrative quotations and simple counts.ResultsThe students provided information about variations patterned by gender in their motivation and influences when deciding to study medicine. Issues in relation to ethnicity were: gaining independence from parents, perceived limitations to career prospects, incompatibility of some religious beliefs with some medical practices and acquired open-mindedness towards students and patients from different ethnic backgrounds. Despite claiming no experiences of gender difference during medical training, female and male students expressed gender stereotypes, e.g. that women bring particularly caring and sympathetic attitudes to medicine, or that surgery requires the physical strength and competitiveness stereotypically associated with men that are likely to support the continuation of gender differentiation in medical careers.ConclusionThe key themes identified in this paper in relation to ethnicity and to gender have important implications for medical educators and for those concerned with professional development. The results suggest a need to open up aspects of these relatively covert elements of student culture to scrutiny and debate and to take an explicitly wider view of the influence of what has sometimes been called the hidden curriculum upon the training of medical professionals and the practice of medicine.

We assessed associations of pediatrician demographic characteristics with patient satisfaction (PS) scores. We performed a retrospective analysis of PS scores among pediatricians at a single academic institution and their associations with individual demographic features including gender, race, and geographic location of medical school education. We analyzed PS survey results for 153 pediatricians, 48.4% of whom were female. Males received higher scores in 4 out of 10 questions including "Likelihood of your recommending this care provider to others" (P = .007). We observed similar findings for white pediatricians compared to Black, Indigenous, and People of Color (BIPOC) (P = .033) and US medical school graduates compared to international school graduates (P = .044). Overall, we observed that pediatricians who are female, BIPOC, or international medical school graduates receive lower PS scores than their counterparts. The impact of potential survey responder bias should be acknowledged when interpreting PS scores for pediatricians.