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.
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