Climatizing internal medicine training: design, implementation, and evaluation of an environmental health curriculum...

Climate change poses an escalating threat to human health, yet graduate medical education has been slow to incorporate environmental health content into residency training. Internal medicine residents report low confidence in their ability to discuss environmental health topics, creating gaps in patient counseling and health advocacy. Despite position statements from major medical societies calling for environmental justice education in graduate medical education, few published curricula exist to guide internal medicine residency programs in this effort.

To describe the design, implementation, and preliminary evaluation of an interdisciplinary environmental health curriculum for internal medicine residents at a large university-affiliated residency program in the southern United States, informed by a formal needs assessment identifying specific knowledge gaps.

A seven-session environmental health curriculum was developed using a needs assessment-driven approach grounded in Bandura's self-efficacy theory and Kern's six-step framework for curriculum development in medical education. Twelve environmental health topics were assessed via a baseline confidence survey of 110 internal medicine residents. Curriculum content was prioritized based on the lowest-confidence domains and delivered through interactive didactic sessions led by content-area experts across disciplines including pulmonology, infectious disease, toxicology, and public health. Sessions covered climate change and human health, environmental justice, food security, endocrine disruptors, air pollution, emerging infectious disease, extreme weather, climate and cancer, and occupational lung disease. Post-curricular confidence surveys were administered to evaluate impact.

The baseline needs assessment (n = 62, 56% response rate) revealed a mean confidence score of 2.22 out of 5 across all environmental health topics. Hazardous waste, endocrine disruptors, water quality, toxicology, and environmental justice represented the lowest confidence domains. Seventy-one percent of residents reported no or slight confidence discussing environmental justice with peers. The curriculum was successfully integrated into existing didactic time across seven sessions from April through December 2024, with positive resident engagement and satisfaction. Post-curricular assessment data analysis is ongoing.

This article presents a replicable, needs assessment-driven model for embedding environmental health education into internal medicine residency training. By grounding curricular design in self-efficacy theory and leveraging interdisciplinary expertise, programs can systematically address the gap between the growing health impacts of climate change and physician preparedness to counsel patients and advocate for communities.