Development of a curricular thread to foster medical students' critical reflection and promote action on climate change, health, and equity.

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.

Department

Description

Provenance

Citation

Published Version (Please cite this version)

10.1371/journal.pone.0303615

Publication Info

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.

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.

Scholars@Duke

Mantri

Sneha Arun Mantri

Associate Professor of Neurology

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.

Kaplan

Samantha Kaplan

Prof Library Staff

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
Andolsek

Kathryn Marijoan Andolsek

Professor in Family Medicine and Community Health

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.

Lawson

Jennifer Mah Lawson

Clinical Associate in the Department of Pediatrics

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

Muzyk

Andrew Muzyk

Associate Professor of the Practice of Medical Education

Dr. Andrew Muzyk is an Associate Professor of the Practice of Medical Education at Duke University School of Medicine in Durham, NC and an Associate Professor in the Department of Pharmacy Practice at Campbell University College of Pharmacy and Health Sciences in Buies Creek, NC. Dr. Muzyk also holds a Clinical Associate appointment in the Duke University School of Nursing. Dr. Muzyk's responsibilities include teaching students across numerous health professions programs, rounding as a clinical pharmacist at Duke University Hospital, and conducting educational research.

Teaching
Dr. Muzyk is the director of pharmacology content and the course co-adminstrator for the Foundations of Patient Care II course, a semester long course that includes pharmacology, pathology, microbiology, immunology, and clinical medicine content. He teaches pharmacology to first-year medical students at Duke University School of Medicine with a focus on CNS medications. For five years, Dr. Muzyk served as the director for the Biological Psychiatry course for psychiatry residents in the Duke Department of Psychiatry and Behavioral Sciences.

At Campbell University College of Pharmacy and Health Sciences, he teaches pharmacy students about the treatment of psychiatric and substance use disorders and men's health. Dr. Muzyk is the course co-coordinator for the pharmacoepidemiology, health informatics, and neurology-psychiatry modules. He precepts fourth-year pharmacy students completing an internal medicine or psychiatry clerkship at Duke University Hospital.

He teaches students in other health professions programs at Duke and Campbell including doctor of osteopathy, physician assistant, and nursing. His teaching in these programs focuses on the management of psychiatric and substance use disorders. Dr. Muzyk serves as a mentor for graduate students enrolled in the University of Michigan Master of Health Professions Education program.

Clinical
Dr. Muzyk's clinical responsibilities include rounding at Duke University Hospital on the Medicine-Psychiatry inpatient service and providing consultation to the inpatient psychiatry unit and the opioid use disorder consult service. He is a clinical pharmacist in the Duke University Hospital Department of Pharmacy.

Research
Dr. Muzyk has over 70 publications from research projects focused on health professions student education and hospital based medication outcomes. His work has been published in journals including Academic Medicine, Substance Abuse, Psychosomatics, Academic Psychiatry, American Journal of Pharmaceutical Education, CNS Drugs, and Pharmacotherapy. He has received approximately $170,000 in grants to support his educational research developing an interprofessional substance use disorder course for health professions students and continuing education programs for healthcare professionals. Educational research support has come from Duke Academy for Health Professions Education and Academic Development, Duke Division of Addiction Medicine, Duke Bass Connections, the Josiah Charles Trent Memorial Foundation Endowment Fund, Duke-Southern Regional Area Health Education Center, and Campbell University College of Pharmacy and Health Sciences. Dr. Muzyk has given numerous presentations throughout the United States on topics related to psychiatric and substance use disorders and health professions education. He is a speaker for the North Carolina Area Health Education Centers (AHEC).

Awards 
Campbell University College of Pharmacy and Health Sciences Dean's Award for Excellence in Teaching; Association of American Medical Colleges (AAMC) Curricular Innovation Award (2020); Association for Multidisciplinary Education and Research in Substance use and Addiction (AMERSA), New Educator/Investigator award (2019); Campbell University College of Pharmacy and Health Sciences, Educator of the Year (2018); Duke University Hospital Department of Pharmacy, Educator and Researcher of the Year (2018); Duke Academy for Health Professions Education and Academic Development (Duke AHEAD), Interprofessional Excellence Award (2016); the Association of Academic Psychiatry (AAP), Psychiatric Education Award (2012); and, the North Carolina Association of Pharmacist (NCAP), Distinguished Young Pharmacist Award (2012).


Education
Dr. Muzyk received his Doctor of Pharmacy (PharmD) degree from Mercer University College of Pharmacy in Atlanta, GA. He completed two years of post-doctorate pharmacy residency training at DCH Health System in Tuscaloosa, AL and at UNC Medical Center in Chapel Hill, NC. His second year of residency training was focused on psychiatric pharmacy practice. Dr. Muzyk obtained a Master of Health Profession Education degree from University of Michigan. In 2023, he completed a year long Climate Health Organizing Fellowship through the Center for Health Equity Education and Advocacy at Harvard Medical School and Cambridge Health Alliance.




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