University of Bristol Medical School, Bristol, UK.
University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
BMC Med Educ. 2021 Oct 30;21(1):555. doi: 10.1186/s12909-021-02963-7.
The healthcare sector is a major contributor to climate change and there are international calls to mitigate environmental degradation through more sustainable forms of clinical care. The UK healthcare sector has committed to net zero carbon by 2040 and sustainable healthcare is a nationally mandated outcome for all UK graduating doctors who must demonstrate their ability to address social, economic, and environmental challenges. Bristol Medical School piloted successful Sustainability in Quality Improvement (SusQI) workshop, but identified challenges translating classroom learning into clinical practice. This paper aims to identify and address those challenges.
We conducted five focus groups that identified and iteratively explored barriers and facilitators to practice among medical students, comparing a range of experiences to generate a conceptual model. We then combined our findings with behaviour change theory to generate educational recommendations.
Students that applied their learning to the clinical workplace were internally motivated and self-determined but needed time and opportunity to complete projects. Other students were cautious of disrupting established hierarchies and practices or frustrated by institutional inertia. These barriers impacted on their confidence in suggesting or achieving change. A minority saw sustainable healthcare as beyond their professional role.
We present a series of theoretically informed recommendations. These include wider curricular engagement with concepts of sustainable clinical practice; supportive workplace enablement strategies such as workplace champions and co-creation of improvement goals; and time and headspace for students to engage through structured opportunities for credit-bearing project work.
医疗保健行业是气候变化的主要贡献者，国际社会呼吁通过更可持续的临床护理形式来减轻环境恶化。英国医疗保健行业承诺到 2040 年实现净零碳排放，可持续医疗保健是所有英国毕业医生的国家强制性要求，他们必须展示解决社会、经济和环境挑战的能力。布里斯托医学院成功试点了可持续性质量改进（SusQI）研讨会，但发现将课堂学习转化为临床实践存在挑战。本文旨在确定和解决这些挑战。
我们进行了五次焦点小组讨论，确定并迭代式探讨了医学生实践中的障碍和促进因素，通过比较各种经验来生成一个概念模型。然后，我们将研究结果与行为改变理论相结合，提出教育建议。
将学习应用于临床工作场所的学生具有内在动力和自我决定，但需要时间和机会来完成项目。其他学生则对打破既定的等级制度和实践感到谨慎，或对机构惰性感到沮丧。这些障碍影响了他们在提出或实现变革方面的信心。少数人认为可持续医疗保健超出了他们的专业角色。
我们提出了一系列有理论依据的建议。这些建议包括更广泛地在课程中参与可持续临床实践的概念；支持工作场所的赋能策略，如工作场所拥护者和共同制定改进目标；以及为学生提供时间和空间，通过结构化的项目工作机会获得学分。
