Development of a curricular thread to foster medical students' critical reflection and promote action on climate change, health, and equity.
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2024-01
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Abstract
Introduction
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.Methods
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.Results
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.Conclusion
After participating in the curricular thread, most medical students reflected on cognitive, affective, and actionable aspects relating to climate change, health, and equity.Type
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Dalapati, Trisha, Emily J Alway, Sneha Mantri, Phillip Mitchell, Ian A George, Samantha Kaplan, Kathryn M Andolsek, J Matthew Velkey, et al. (2024). Development of a curricular thread to foster medical students' critical reflection and promote action on climate change, health, and equity. PloS one, 19(5). p. e0303615. 10.1371/journal.pone.0303615 Retrieved from https://hdl.handle.net/10161/31196.
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Scholars@Duke
Sneha Arun Mantri
I am a movement disorders specialist with a clinical practice focused on the care of people with Parkinson disease (PWP) and other movement disorders. I am interested in ways to improve the quality of care for patients with chronic neurodegenerative conditions, particularly translating clinically effective treatments and lifestyle modifications (e.g. exercise) into the “real world.” While a growing body of evidence demonstrates that physical activity, including high-intensity exercise, is feasible for PWP and leads to improved motor and non-motor outcomes, translating that knowledge into practice has been challenging. My research in this area focuses on the impact of patient/doctor communication and social determinants of health on promoting or preventing physical activity among PWP.
In addition to my clinical training, I hold a Master of Science in Narrative Medicine from Columbia University. This unique program, which grew out of the larger field of medical humanities, expands the conceptual framework of clinical medicine to incorporate patient perspective and social experience. I conduct mixed-methods research to design and implement interventions that are actually meaningful to the target population(s). As an example, in my study of Veterans with PD, I was able to conduct qualitative cluster analysis of Veterans’ self-reported barriers and motivators of adherence to exercise recommendations, reporting for the first time the unique barriers faced by this patient population. Additional funded projects using a narrative medicine approach have included (1) exploring the lexicon of burnout among clinical and non-clinical employees; (2) understanding the experience of fatigue and psychosis among PwP and their care-partners; (3) exploring the interactions between border-crossing in literature and border-crossing in medical education/practice.
In particular, narrative medicine offers guideposts toward a revitalized practice of medicine and medical education. In 2020, I was appointed Director of Medical Humanities at Duke, leading a team of clinician scholars in understanding moral injury and structural inequities in medicine. Under this umbrella, I co-direct the interprofessional course Moral Movements in Medicine; teach in the first-year Clinical Skills Immersion, the second-year Cultural Determinants of Health Disparities, and the fourth-year Medical Humanities courses; and mentor third-year students in the Medical Humanities study track.
Samantha Kaplan
Sami is the Research and Education Liaison Librarian to the School of Medicine. She offers research services to School of Medicine teaching faculty, staff, and students. She works to enable and promote evidence-based practice at Duke Health.
- PhD, UNC Chapel Hill School of Information and Library Science
- MLIS, University of South Carolina
- BA, University of Georgia
Kathryn Marijoan Andolsek
My career focuses on interprofessional medical education, and collaboration in community and population health. These are critically important areas with tremendous potential for creativity, innovation, and learning from one another. These are also strategic tools to advance health equity.
John Matthew Velkey
Jennifer Mah Lawson
Physician provides primary care services only. Interests include medical humanities, climate change and health, integrative medicine, transdisciplinary collaboration, underserved communities. Member of inaugural group of Climate Change Faculty Fellows, 2022
Andrew Muzyk
Dr. Andrew Muzyk is an Associate Professor of the Practice of Medical Education at Duke University School of Medicine and an Associate Professor in the Department of Pharmacy Practice at Campbell University College of Pharmacy and Health Sciences. He also holds a Clinical Associate appointment in the Duke University School of Nursing. His professional responsibilities span teaching across multiple health professions programs, serving as a clinical pharmacist on the Medicine–Psychiatry service at Duke University Hospital, and advancing scholarship in health professions education and clinical outcomes research.
Teaching
At Duke University School of Medicine, Dr. Muzyk directs pharmacology content and serves as course director for the Foundations of Patient Care II course, which integrates pharmacology, pathology, microbiology, immunology, and clinical medicine, in the first-year medical school curriculum. He lectures extensively in the first-year medical student curriculum, focusing on central nervous system pharmacology, and previously directed the Biological Psychiatry course for Duke psychiatry residents.
At Campbell University, he teaches pharmacotherapy with an emphasis on psychiatric and substance use disorders, men’s health, and neurology–psychiatry. He co-coordinates the Pharmacoepidemiology and Health Informatics modules and precepts pharmacy students in internal medicine and psychiatry clerkships at Duke University Hospital. Beyond these roles, he contributes to physician assistant, nursing, osteopathic medicine, and other health professions programs at Duke and Campbell, and he mentors graduate students in the University of Michigan’s Master of Health Professions Education program.
Clinical Practice
Dr. Muzyk practices as a clinical pharmacist in the Duke University Hospital Department of Pharmacy. He rounds on the Medicine–Psychiatry inpatient service and provides consultative expertise to the inpatient psychiatry unit and the opioid use disorder consult service.
Scholarship
Dr. Muzyk has authored more than 70 peer-reviewed publications addressing health professions education, psychopharmacology, and hospital-based medication outcomes. His research has appeared in journals such as Academic Medicine, Substance Abuse, Psychosomatics, Academic Psychiatry, American Journal of Pharmaceutical Education, CNS Drugs, and Pharmacotherapy. He has secured over $200,000 in research and educational funding, including support from the National Institute on Drug Abuse, Duke Academy for Health Professions Education and Academic Development, Duke Division of Addiction Medicine, Duke Bass Connections, the Josiah Charles Trent Memorial Foundation, and Campbell University. He is a frequent national speaker on psychiatric and substance use disorders and interprofessional education and regularly lectures for the North Carolina Area Health Education Centers.
Awards
Dr. Muzyk’s contributions have been recognized with numerous honors, including the Dean’s Award for Excellence in Teaching and Educator of the Year from Campbell University, the Association of American Medical Colleges Curricular Innovation Award, the Association for Multidisciplinary Education and Research in Substance Use and Addiction New Educator/Investigator Award, the Duke University Hospital Educator and Researcher of the Year Award, the Duke AHEAD Interprofessional Excellence Award, the Association of Academic Psychiatry Psychiatric Education Award, and the North Carolina Association of Pharmacists Distinguished Young Pharmacist Award.
Education and Training
Dr. Muzyk earned his PharmD from Mercer University College of Pharmacy and completed two years of residency training, culminating in a psychiatric pharmacy residency at UNC Medical Center. He received his Master of Health Professions Education from the University of Michigan and completed the Climate Health Organizing Fellowship through Harvard Medical School and Cambridge Health Alliance.
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