Designing transformative sustainability education: a mixed methods study exploring the values and perspectives of...

Education for Sustainable Healthcare (ESH) is a novel area of medical education and high-quality evidence to guide effective learning approaches is yet to be established. This study investigates the design of ESH in undergraduate medicine through the lenses of transformative learning, environmental value position and student-centred design.

A mixed methods approach was used. A questionnaire assessed the environmental value position and attitudes towards ESH of undergraduate medical students at the University of Dundee. Semi-structured interviews with a sub-group of these students further evaluated environmental perspectives and explored preferences for learning approaches for ESH.

The questionnaire data indicated that the students had high levels of environmental concern, arising from an ecocentric value position. Ecocentrism correlated with support for the integration of ESH and sustainability in medicine. The qualitative findings from 10 interviews confirmed high levels of environmental concern and support for ESH but suggested a more complex underlying value basis. There was a disconnection between students' environmental values and their engagement with sustainable medical practice, arising from conflict between their sense of medical professionalism and aspects of sustainable medical practice that were perceived to be at odds with providing optimal patient care. Regarding learning approaches, students highlighted the need to prioritise examined content, and reported a preference for small group, interactive learning, delivered by engaged tutors in an authentic and relevant way.

It is important that the integration of ESH involves summative assessment; without this, students are unlikely to engage with the topic. ESH learning approaches should be designed in accordance with student preferences if they are to maximise impact: interactive, student-centred, experiential learning approaches are preferred. ESH should bridge the gap between students' environmental attitudes and capacities for sustainable behaviour by empowering them to act sustainably through role modelling, skills acquisition, project work and critical reflection.