Empowering learners through student-led integration of environmental health into small group discussions

With ongoing climate change and other major human-induced changes to the biosphere, there is a greater need to improve future healthcare providers' environmental health (EH) literacy. As of 2022, 45% of U.S. MD programs lacked a required EH curriculum. A self-assembled group of four medical students conceptualized and planned this pilot study to characterize matriculating medical students' EH knowledge and attitudes. This group also developed EH content for integration into a preexisting 18-month Case-Based Learning (CBL) curriculum to enhance small-group discussion and learning. Matriculating medical students were invited to participate in an anonymous cross-sectional survey assessing EH literacy and the need for an EH-specific curriculum in August 2023. Concurrently, the student group analyzed 44 cases in the current CBL curriculum and searched PubMed and the PEHSU Climate Resources for Health Education for pertinent topics from the case review. The group then formulated learning objectives and discussion questions for the facilitator guide for 30 cases, with expert review by curriculum faculty members. 70 of 200 students (35%) fully completed a survey about EH literacy. Eighty percent of students reported no previous coursework pertinent to EH, with most students demonstrating a basic understanding of the concept. Students reported low confidence in counseling patients regarding pertinent EH matters and a limited understanding of social determinants of health pertinent to the local area. In 30 identified medical conditions across 10 disciplines, 57 new objectives were developed to address environmental exposures, infectious diseases, climate change, and local implications. Increasing EH literacy among medical students represents a high-impact educational need. This pilot study, conceived and led by medical students, successfully characterized the EH knowledge gap among medical students and integrated novel discipline-specific learning objectives and discussion points into a pre-existing CBL curriculum. This model may easily be adapted to other institutions' curricula.