Duke University School of Medicine, Durham, NC, United States of America.
Program in Medical Humanities, Trent Center for Bioethics, Humanities & History of Medicine, Duke University School of Medicine, Durham, NC, United States of America.
PLoS One. 2024 May 30;19(5):e0303615. doi: 10.1371/journal.pone.0303615. eCollection 2024.
Due to the health consequences arising from climate change, medical students will inevitably interact with affected patients during their training and careers. Accordingly, medical schools must incorporate education on the impacts of climate change on health and equity into their curricula. We created a curricular thread called "Climate Change, Health, and Equity" in the first-year preclinical medical program to teach foundational concepts and foster self-reflection and critical consciousness.
The authors developed a continuum of practice including administrators, educators and faculty members, students, and community partners to plan and design curricular activities. First-year medical students at Duke University School of Medicine participated in seven mandatory foundational lectures and two experiential learning opportunities in the local community. Following completion of activities, students wrote a critical reflection essay and completed a self-directed learning exercise. Essays were evaluated using the REFLECT rubric to assess if students achieved critical reflection and for thematic analysis by Bloom's Taxonomy.
All students (118) submitted essays. A random sample of 30 (25%) essays underwent analysis. Evaluation by the REFLECT rubric underscored that all students were reflecting or critically reflecting on thread content. Thematic analysis highlighted that all students (30/30, 100%) were adept at identifying new areas of medical knowledge and connecting concepts to individual experiences, institutional practices, and public health and policy. Most students (27/30; 90%) used emotionally laden words, expressing negative feelings like frustration and fear but also positive sentiments of solidarity and hope regarding climate change and effects on health. Many students (24/30; 80%) expressed actionable items at every level including continuing self-directed learning and conversing with patients, minimizing healthcare waste, and advocating for climate-friendly policies.
After participating in the curricular thread, most medical students reflected on cognitive, affective, and actionable aspects relating to climate change, health, and equity.
由于气候变化带来的健康后果，医学生在培训和职业生涯中不可避免地会与受影响的患者接触。因此，医学院校必须将气候变化对健康和公平的影响教育纳入其课程。我们在第一年的临床前医学课程中创建了一个名为“气候变化、健康和公平”的课程，以教授基础知识，并培养自我反思和批判意识。
作者与行政人员、教育工作者和教师、学生以及社区合作伙伴一道，开发了一条贯穿始终的实践路径，以规划和设计课程活动。杜克大学医学院的一年级医学生参加了七次必修的基础讲座和两次在当地社区的体验式学习机会。在完成活动后，学生撰写了一篇批判性反思文章，并完成了一项自我指导学习练习。文章采用 REFLECT 量表进行评估，以评估学生是否实现了批判性反思，并按照布鲁姆的教育目标分类法进行主题分析。
所有学生（118 人）都提交了文章。对 30 篇（25%）文章进行了随机抽样分析。REFLECT 量表的评估强调，所有学生都在反思或批判性地反思课程内容。主题分析突出显示，所有学生（30/30，100%）都能够识别医学新知识领域，并将概念与个人经验、机构实践以及公共卫生和政策联系起来。大多数学生（27/30；90%）使用了情感化的词语，表达了对气候变化及其对健康影响的负面情绪，如沮丧和恐惧，但也表达了团结和希望等积极情绪。许多学生（24/30；80%）在各个层面都提出了可采取的行动，包括继续自我指导学习和与患者交流、尽量减少医疗废物以及倡导有利于气候的政策。
参与课程后，大多数医学生反思了与气候变化、健康和公平相关的认知、情感和可操作方面。
