Medical students as advocates for a healthy planet and healthy people: Designing an assessment that prepares learners to take action on the United Nations Sustainable Development Goals.

PURPOSE: Health professionals are being called on to be advocates for the planet to ensure health and well-being for current and future generations. Clean air, flourishing ecosystems, a stable climate, and nutritious food are required for health and well-being. Considering the deteriorating state of our natural environment, today's health professionals need to be advocates for a healthy planet. This places an onus on tertiary institutions to prepare graduates to 'take action' for the planet and all of its inhabitants. MATERIALS AND METHODS: This report outlines the development of a team-based Planetary Health Assignment that equips learners to use at least two of the 2030 United Nations Sustainable Development Goals (SDGs). It was identified at the design stage that an effective planetary health educational intervention should not only encourage learners to take action, but also embed creativity, with the best products available for public scrutiny. Several pedagogical principles were used in the design (authentic assessment, learner-centredness, creativity, scholarship). RESULTS: During the first five years of implementation, minor refinements were made based on learner and academic feedback. The assignment criteria sheet was improved to the point that it encouraged thoughtful and reflective submissions, and tasked learners to provide achievable and realistic solutions to pressing environmental issues. The marking rubric was also developed to provide quality feedback and insights for students. CONCLUSIONS: The design of this assessment, framed by the SDGs, allows learners flexibility in their choices while still meeting the required learning outcomes. With the assignment underpinned by a robust design, it provides students with both knowledge and experiences about how they might take action on the SDGs and become advocates for a healthy planet.

An authentic learner-centered planetary health assignment: A five-year evaluation of student choices to address Sustainable Development Goal 13 (Climate Action).

A Code Red has been declared for the planet and human health. Climate change (e.g., increasing temperatures, adverse weather events, rising sea levels) threatens the planet's already declining ecosystems. Without urgent action, all of Earth's inhabitants face an existential threat. Health professions education should therefore prepare learners to not only practice in a changing world, but authentic educational activities should also develop competencies for global and planetary citizenship. Planetary health has been integrated across the five-year Bond University (Australia) medical curriculum. It begins in the second week of Year 1 and ends with a session on Environmentally Sustainable Healthcare in the General Practice rotation in the final year. The purpose of this article is to describe the outcomes of the first 5 years (2018-2022) of a learner-centered planetary health assignment, underpinned by the 2030 United Nations (UN) Sustainable Development Goals (SDGs), in the second year of a five-year medical program. Using systems and/or design thinking with a focus on SDG13 (Climate Action) plus a second SDG of choice, self-selected teams of 4-6 students submit a protocol (with feedback) to develop a deliverable "product" for an intended audience. Data analysis of the first 5 years of implementation found that the most frequently selected SDGs in addition to SDG13 were: SDG12 Sustainable Production and Consumption (41% of teams), mostly relating to healthcare emissions and waste; SDG3 Health and Well-being (22%), generally involving the impact of air pollution; and SDG6 Clean Water and Sanitation (15%). A survey at the concluding conference garnered student feedback across various criteria. The planetary health assignment is authentic in that teams provide solutions to address climate change. Where appropriate, final "products" are sent to local or federal ministers for consideration (e.g., policy proposals) or integrated into the curriculum (e.g., learning modules). We believe that the competencies, attitudes, and values fostered through engagement with planetary health. Throughout the medical program, as evidenced by their evaluations, stands students in good stead to be change agents, not only in clinical practice but in society. An awareness has been created about the need for planetary citizenship in addition to global citizenship.

Sharing stories about medical education in difficult circumstances: Conceptualizing issues, strategies, and solutions.

BACKGROUND: Global economic forces, political decisions, and natural disasters are only some of the factors that affect contemporary healthcare education. Given the centrality of health in all settings, the future of healthcare education depends on how we overcome these difficult circumstances. METHODS: Through a series of collaborative activities involving healthcare educators from around the world and their attempts to overcome these difficulties, the authors have developed a conceptual model centered around the people involved, the impact of culture, and organizations and systems. RESULTS: The model can help to frame discussions and develop strategies about how best we, as a community of health professionals and educators, collaborate and share wisdom, experiences and resources to assist colleagues who might be struggling to deliver education. What has clearly emerged from this work is the centrality of leadership and management in effectively challenging and addressing difficult circumstances. CONCLUSIONS: Contemporary health professions' education leadership needs to be inclusive, mindful, compassionate and caring; echoing and role-modeling how we expect our students to be with patients and colleagues. This means being willing to confront unacceptable behaviors and speak out and challenge authority when needed. It also requires awareness and understanding of the complex systems in which healthcare education is provided.

Working in global health: A planning and implementation framework for international electives.

Purpose: Propose a framework for planning and undertaking an international elective. Methods: On returning from conducting maternal health and well-being research in several remote communities in India, two undergraduate medical students have reflected on and documented their experiences with the view to assisting other students (and their supervisors) considering undertaking an international elective. Results: A framework for undertaking clinical or research electives in remote or rural communities is presented. The framework comprises three distinct phases: Pre-departure planning and briefing, in-country experiences and returning from the elective and considers a range of factors to ensure that, as a minimum, visiting students "do no harm" and are themselves not harmed. Conclusions: Students' home institutions have a duty of care for preparing them for their international electives by providing pre-departure training, support during the elective and comprehensive de-briefing on their return. These electives should be evaluated (including by host communities) to ensure that exchanges are socially accountable, with no harm to the often-vulnerable communities in which students gain considerable experience. Also important is that future students build on the positive experiences of their predecessors to ensure sustainability of any interventions in host communities.

Muslim women's physician preference: beyond obstetrics and gynecology.

When Emirati (Muslim) women (n = 218) were asked about their preferred physician (in terms of gender, religion, and nationality) for three personal clinical scenarios, a female was almost exclusively preferred for the gynecological (96.8%) and "stomach" (94.5%) scenarios, while ±46% of the women also preferred a female physician for the facial allergy scenario. Only 17% considered physician gender important for the prepubertal child scenario. Just over half of the women preferred a Muslim physician for personal examinations (vs. 37.6% for the child). Being less educated and having a lower literacy level were significant predictors of preferred physician religion for some personal scenarios, whereas a higher education level was a significant predictor for physician gender not mattering for the facial allergy scenario. Muslim women's preference for same gender physicians, and to a lesser extent religion, has implications for health care services beyond obstetrics and gynecology.

Creating equal opportunities: the social accountability of medical education.

As new developments in medical education move inexorably forward, medical schools are being encouraged to revisit their curricula to ensure quality graduates and match their outcomes against defined standards. These standards may eventually be transferred into global accreditation standards, which allow 'safe passage' of graduates from one country to another [Educational Commission for Foreign Medical Graduates (ECFMG) 2010. Requiring medical school accreditation for ECFMG certification--moving accreditation forward. Available from: http://www.ecfmg.org/accreditation/rationale.pdf]. Gaining much attention is the important standard of social accountability--ensuring that graduates' competencies are shaped by the health and social needs of the local, national and even international communities in which they will serve. But, in today's 'global village', if medical schools address the needs of their immediate community, who should address the needs of the wider global community? Should medical educators and their associations be looking beyond national borders into a world of very unequal opportunities in terms of human and financial resources; a world in which distant countries and populations are very quickly affected by medical and social disasters; a world in which the global playing field of medical education is far from level? With medical schools striving to produce fit-for-purpose graduates who will hopefully address the health needs of their country, is it now time for the medical education fraternity to extend their roles of social accountability to level this unlevel playing field? We believe so: the time has come for the profession to embrace a global accountability model and those responsible for all aspects of healthcare professional development to recognise their place within the wider global community.

Developing a global health practitioner: time to act?

Although many health issues transcend national boundaries and require international co-operation, global health is rarely an integral part of the medical curriculum. While medical schools have a social responsibility to train healthcare professionals to serve local communities, the internationalisation of medical education (e.g. international medical students, export of medical curricula or medical schools) makes it increasingly difficult to define it as 'local'. It is therefore necessary to produce practitioners who can practice medicine in an ever-changing and unpredictable world. These practitioners must be clinically and culturally competent as well as able to use their global knowledge and experience to improve health and well-being, irrespective of where they eventually practice medicine. Global health practitioners are tomorrow's leaders, change agents and members of effective multiprofessional teams and so need to be aware of the environmental, cultural, social and political factors that impact on health, serving as advocates of people's rights to access resources, education and healthcare. This article addresses some of the difficulties of developing global health practitioners, offering suggestions for a global health curriculum. It also acknowledges that creating a global health practitioner requires international collaboration and shared resources and practices and places the onus of social accountability on academic leaders.

The pioneer cohort of curriculum reform: Guinea pigs or trail-blazers?

With curriculum reform, whether we admit it or not, the first cohort of students will be 'test-driving' the new programme. Not only are they the pioneers of a new curriculum, but as they progress through their studies, they experience each year of the innovation for the first time. As curriculum designers, we learn from their experiences and their feedback to improve the programme content and delivery, invariably for subsequent cohorts. A considerable onus therefore rests with this pioneer group, and their contribution to curriculum design, evaluation and programme revision should be valued.