Embedding planetary health concepts in a pre-medical physiology subject.

PURPOSE: There are increasing calls for planetary health (which includes sustainable healthcare) to be included in tertiary health professions education. With already busy curricula, particularly in medicine, educators need to find innovative ways of integrating these important concepts without adding to learners' workload. This study investigated whether planetary health concepts could be integrated into a Physiology subject as a stop-gap approach while longitudinal planning for longitudinal curriculum integration was underway. MATERIALS AND METHODS: Each week, a planetary health fact (Did you know?) with a corresponding link were embedded at the bottom of a relevant PowerPoint lecture slide to match the topic of the week in a health science and medicine Physiology subject. The embedded facts were a mix of effects on health and the environmental impacts of healthcare activities, such as medical imaging. No other formal planetary health teaching was conducted in the subject. At the end of the semester, 44% of 100 students completed a survey regarding their perceptions of the planetary health inclusions. RESULTS: Participants reported an appreciation of the facts, found them helpful for their overall learning, and were interested in learning about healthcare's large environmental footprint. Seventy-one percent were able to provide a reasonable definition of planetary health. Half of the participants reported their actions, behaviours, and thoughts had changed as a result of the planetary health inclusions. CONCLUSIONS: This study provides a relatively simple approach for individual educators to include planetary health concepts into existing health professions subjects until more longitudinal curriculum revisions can be undertaken. Based on our findings, we would, however, recommend providing students with a brief introduction in terms of why planetary health has been included either at the start of the first lecture or as a 10-min video.

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.

Symbols and rituals are alive and well in clinical practice in Australia: Perspectives from a longitudinal qualitative professional identity study.

PURPOSE: Many factors impact an individual's professional identity on their journey to becoming a doctor, including their experiences, the learning environment, role models, and symbols and rituals. Rituals and symbols associated with the medical profession have historically included wearing a white coat (now rare) and the stethoscope. This study explored two medical students' perspectives of symbolic identifiers in a six-year longitudinal study in Australia (2012-2017). METHODOLOGY: A 2012 qualitative cross-sectional qualitative professional identity study in an Australian five-year undergraduate medical programme was extended to a longitudinal study with annual interviews. A conversation about the symbolism of the stethoscope and other identifiers began in Year 1 and concluded when the students were junior doctors. FINDINGS: Symbols and rituals remain part of the 'becoming' and 'being' a doctor. In the context of Australian hospitals, the stethoscope appears to no longer be exclusively associated with the medical profession, with 'professional attire' distinguishing medical students and doctors from other team members (uniform). The study identified lanyard colour and design as a symbol and language as a ritual. CONCLUSIONS: Although symbols and rituals may change over time and across cultural contexts, some forms of treasured material possessions and rituals will persist in medical practice.[Box: see text].

Don't forget the veggies! Identifying and addressing a lack of vegetable education in physiology.

Ninety-five percent of Westerners do not consume the recommended daily vegetable intake, exacerbating the incidence of obesity, malnutrition, and nutritional deficiencies such as fiber. This article reviews the literature from PubMed, ERIC, and Web of Science, as well as Internet sites and government resources, to identify what should be considered important inclusions relating to dietary vegetable (including legumes and pulses) intake content in university physiology subjects. The primary aim is to advance the competency relating to good nutrition knowledge for future health professionals to enable them to guide and counsel patients and clients toward better health. A review of the literature provides scant nutritional content relating to vegetable intake, particularly across physiology subjects and health professional programs in general. A review of country dietary guidelines yielded discrepancies and ambiguity around recommended daily vegetable intake, including what constitutes essential vegetables. Educators responsible for embedding nutritional information in the curriculum would therefore be challenged to find reliable, evidence-based resources. Adding quality curriculum content on the importance of vegetable intake also promotes some of the Sustainable Development Goals (SDGs), including SDG 2 (Zero Hunger), thereby contributing to SDG 3 (Good Health and Well-Being). This article offers recommendations on how to embed content relating to the importance of dietary vegetables for good health and guidance for educators of health professions programs wanting to improve their curriculum content relating to adequate nutrition.NEW & NOTEWORTHY Is nutritional literacy an important concept in physiology? This article identifies a paucity of content and addresses the need for vegetable intake education.

Clinical supervision in podiatry in Australia and New Zealand: supervisor challenges in this role.

BACKGROUND: Clinical supervisors play an integral role in preparing podiatry graduates for clinical practice. Not enough is, however, known about how prepared podiatry clinical supervisors are for this role, in terms of training received and the challenges they face in the role. Informed by previous qualitative research, this study extends our understanding of what it means to be a clinical supervisor in podiatry. METHODS: An online survey comprising closed and open-ended questions gathered data from 67 registered podiatrists who were also clinical supervisors. Descriptive analysis was undertaken. Chi-square analysis was used to test independence between preparedness for supervision and variables of interest (e.g. training received). Item analysis was assessed using Cronbach's alpha coefficients and Kendall's Tau to determine whether statistically significant associations existed across the broad challenges previously identified (i.e. supervisor-specific, curriculum and students). Open-ended comments were analysed using content analysis. RESULTS: Generally, most supervisors (64%, 43/67) initially felt " prepared" to supervise, despite the majority (58%, 39/67) not having received any training or educational support. Overwhelming, supervisors (97%, 65/67) considered universities responsible for ensuring quality clinical supervision. They perceived many of the previously identified supervisor-specific challenges (e.g. time-consuming), curriculum issues (e.g. limited hands-on patient contact in private practice placements) and student deficiencies (e.g. poor time management). Positive correlations were found across the three sets of challenges, with the strongest measure of association found between overall student deficiencies and overall curriculum issues (p < .001). CONCLUSION: These findings contribute to a deeper understanding of clinical supervision in podiatry. The study identified inconsistent support for clinical supervisors from partner universities. This study found a clear desire and need for supervisor training. A partnership approach is recommended in which universities work with clinical supervisors to address their overall challenges in terms of supervisor professional development, paying attention to curriculum issues, and improving student preparedness during placements.

Addressing Code Red for humans and the planet: We are in this together.

Climate change is one of the greatest threats to human health. It is not surprising that following one of the hottest years on record (2019) and wildfires on almost all continents that the 2021 Intergovernmental Panel on Climate Change and the 2021 Lancet Countdown on Climate Change identified a Code Red for humanity and for a healthy future. In addition, just prior to the November 2021 Conference of the Parties (COP26), the World Health Organization released its Special Report, The Health Argument for Climate Action, in which the global health community provided 10 recommendations for policymakers and governments for greener, cleaner and more sustainable action to ensure a healthy and just future. There is thus an urgent need for socially and environmentally accountable health professions education to pick up the pace in terms of climate change, planetary health and/or sustainable health care integration in curricula. Considerable work has already been undertaken by faculty and students. As we are in this together, students and faculty can collaborate and build upon the work already undertaken to ensure universities are social and environmentally accountable.

AMEE Consensus Statement: Planetary health and education for sustainable healthcare.

The purpose of this Consensus Statement is to provide a global, collaborative, representative and inclusive vision for educating an interprofessional healthcare workforce that can deliver sustainable healthcare and promote planetary health. It is intended to inform national and global accreditation standards, planning and action at the institutional level as well as highlight the role of individuals in transforming health professions education. Many countries have agreed to 'rapid, far-reaching and unprecedented changes' to reduce greenhouse gas emissions by 45% within 10 years and achieve carbon neutrality by 2050, including in healthcare. Currently, however, health professions graduates are not prepared for their roles in achieving these changes. Thus, to reduce emissions and meet the 2030 Sustainable Development Goals (SDGs), health professions education must equip undergraduates, and those already qualified, with the knowledge, skills, values, competence and confidence they need to sustainably promote the health, human rights and well-being of current and future generations, while protecting the health of the planet.The current imperative for action on environmental issues such as climate change requires health professionals to mobilize politically as they have before, becoming strong advocates for major environmental, social and economic change. A truly ethical relationship with people and the planet that we inhabit so precariously, and to guarantee a future for the generations which follow, demands nothing less of all health professionals.This Consensus Statement outlines the changes required in health professions education, approaches to achieve these changes and a timeline for action linked to the internationally agreed SDGs. It represents the collective vision of health professionals, educators and students from various health professions, geographic locations and cultures. 'Consensus' implies broad agreement amongst all individuals engaged in discussion on a specific issue, which in this instance, is agreement by all signatories of this Statement developed under the auspices of the Association for Medical Education in Europe (AMEE).To ensure a shared understanding and to accurately convey information, we outline key terms in a glossary which accompanies this Consensus Statement (Supplementary Appendix 1). We acknowledge, however, that terms evolve and that different terms resonate variably depending on factors such as setting and audience. We define education for sustainable healthcare as the process of equipping current and future health professionals with the knowledge, values, confidence and capacity to provide environmentally sustainable services through health professions education. We define a health professional as a person who has gained a professional qualification for work in the health system, whether in healthcare delivery, public health or a management or supporting role and education as 'the system comprising structures, curricula, faculty and activities contributing to a learning process'. This Statement is relevant to the full continuum of training - from undergraduate to postgraduate and continuing professional development.

Rethinking health professions' education leadership: Developing 'eco-ethical' leaders for a more sustainable world and future.

In this commentary, we discuss health professions' education (HPE) leadership in relation to planetary health emergencies, suggesting that an 'eco-ethical leadership' approach is highly relevant. Building on both traditional and more contemporary leadership approaches and the need for HPE to be socially and environmentally accountable, we define the key features of eco-ethical leadership and its underpinning beliefs and values, then expand on these features in terms of leadership at intrapersonal, interpersonal, team, organisational and system levels. Eco-ethical leadership is needed to tackle a range of 'wicked' problems - a changing climate, environmental pollution, deforestation, all of which threaten global biodiversity and human civilisation. Such leadership requires passionate individuals to role model the behaviours and actions that are required to bring people along with them, not least the learners, many of whom are already concerned about their future. Eco-ethical leadership (and followership) offers an integrated approach for HPE, centred around sustainability, values, collaboration, justice, advocacy and, if need be, activism. The environment cannot not wait. Eco-ethical leaders already exist but their numbers are small. They are required in key positions in academia and healthcare to drive the agenda in partnership with learners, many of whom are already environmental advocates and activists.

Education for sustainable healthcare: A transdisciplinary approach to transversal environmental threats.

Global Environmental Changes are dynamic and complex, crossing disciplines, sectors, regions, and populations and shaping the health of current and future generations. GECs present an unprecedented challenge demanding a response of equal scale and complexity involving unfettered collaboration beyond disciplines with implications for global health. At this critical point, health professions' education should have moved on from building consensus about the relevance of education for sustainable healthcare (ESH) to active implementation. In this commentary, we discuss why transdisciplinary problem-solving and interprofessional education should be considered in education for sustainable healthcare. We review types of collaborative educational practices, outline opportunities, challenges, and resources to enable implementation.

Why use indicators to measure and monitor the inclusion of climate change and environmental sustainability in health professions' education?

Currently, health professionals are inadequately prepared to meet the challenges that climate change and environmental degradation pose to health systems. Health professions' education (HPE) has an ethical responsibility to address this and must include the health effects of climate change and environmental sustainability across all curricula. As there is a narrow, closing window in which to take action to avoid the worst health outcomes from climate change, urgent, systematic, system-level change is required by the education sector. Measuring, monitoring, and reporting activity using indicators have been demonstrated to support change by providing a focus for action. A review of the literature on the use of indicators in medical education for climate change and health, however, yielded no publications. The framework of targets and indicators developed for implementation of the Sustainable Development Goals (SDGs) by 2030 and the UNESCO initiative of the Education for Sustainable Development provide a guide for the development of indicators for HPE. Engaging stakeholders and achieving consensus on an approach to indicator development is essential and, where they exist, accreditation standards may have a supporting role. Creating capacity for environmentally sustainable health care at scale and pace should be our collective goal as health professions' educators.

Prehospital Blood Glucose Testing as a Predictor of Impending Hypotension in Adult Trauma Patients.

OBJECTIVE: Stress-induced hyperglycemia has been found to increase hemorrhagic shock, morbidity, and mortality in the trauma patient. The purpose of this study is to evaluate whether prehospital point-of-care glucose is an independent predictor of hypotension in the adult trauma patient transported by air ambulance to the receiving trauma center. METHODS: This retrospective chart review evaluated adult, nondiabetic trauma patients transported by air ambulance at 3 programs in the Midwest for the calendar year 2018. A total of 107 patients met the inclusion criteria. The primary analysis was the determination of an optimal cutoff for the blood glucose diagnostic for predicting a hypotensive outcome followed by chi-square incidence comparison. RESULTS: The optimal diagnostic cutoff point using Youden's index (J) was determined to be a blood glucose value of 220 mg/dL or greater. Initial glucose values were associated with an increased relative risk of a hypotension outcome (P = .040). Glucose dichotomy was also associated with a mean decrease in systolic blood pressure during transport (P = .016). CONCLUSION: The findings in this study indicate a point-of-care glucose measurement greater than 220 mg/dL should prompt prehospital clinicians to initiate aggressive balanced resuscitation before arrival at the receiving trauma center in order to prevent worsening hypotension and hemorrhagic shock.

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.

The Glucose Connection: Field Hyperglycemia as an Early Predictor of Hypotension in Trauma Patients.

INTRODUCTION: Trauma is the fourth leading cause of death overall for all ages and identifying a preemptive surrogate parameter that indicates impending shock would allow for optimization of prehospital care.Stress induced hyperglycemia (SIH) occurs secondary to critical illness or injury. Research indicates that SIH is a predictor of mortality in critically ill patients. Multiple studies have indicated a positive correlation between admission hyperglycemia and hypotension in trauma patients. The purpose of this retrospective chart review study is to evaluate the utility of prehospital point of care glucose as an independent predictor of hypotension in the adult trauma patient. METHODS: The primary study objective was to determine if point of care glucose measurement during prehospital transport is predictive of hypotension (systolic blood pressure < 90 mmHg) prior to arrival at the receiving trauma center. A total of 107 patients met inclusion criteria. The primary analysis was a receiver operating characteristics curve, (ROC curve) for the blood glucose diagnostic for predicting hypotension outcome with 95% confidence for the area under the curve and non-parametric comparison to 0.5. The optimal diagnostic cutoff point was determined using Youden's J and 95% confidence intervals for sensitivity and specificity. RESULTS: There were a total of 1623 trauma transports for the programs in 2018. Our final sample was 107 trauma patients. There were n=22 (20.6%) who had hypotensive systolic BP values (systolic BP < 90) upon arrival at the receiving facility. The ROC diagnostic determined that glucose >= 220 and had a 2.95 increased relative risk of hypotension if the patient's point of care glucose was >= 220. Patients with a glucose >= 220, the systolic blood pressure decreased an average of 13.5 mm Hg. A glucose < 220 demonstrated an increased systolic blood pressure of 0.26 mmHg. CONCLUSION: In prehospital trauma patients, point of care glucose measurements greater than 220 predicted a nearly threefold increase in hypotension prior to arrival at the trauma center. Prehospital point of care glucose measurements are simple, rapid, and inexpensive and may help to identify those patients requiring aggressive resuscitation prior to arrival to the receiving trauma facility.

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.

From being a nurse to becoming a 'different' doctor.

Using interpretative phenomenological analysis to make meaning of the experiences of three highly qualified registered nurses who had enrolled in an undergraduate medical programme, this study provides insight into their personal journeys of wanting to become 'different' doctors. In so doing, they conceptualised their future selves as adding clinical reasoning and diagnostic skills to the patient-centred caring ethic of their nursing practice, becoming a multi-skilled community member or helping to fix the health care culture. By customising their identities, e.g. by splinting (aligning with their stronger nursing identity), by enriching current nursing practice with newly acquired theory as medical students or by patching a perceived deficiency (i.e. patient-centredness) in medicine, they tailored their identities. Their journeys had, however, not been the natural progression they had anticipated, threatened by perceived and/or real intrinsic (e.g. working as nurses whilst studying medicine) and extrinsic (e.g. interprofessional rivalry) factors. Rather than being accepted as legitimate newcomers to the medical profession, the women sometimes felt like intruders. Some nursing colleagues accused them of desertion. In response, they generally withheld their identities as nurses or medical students, compartmentalising their group membership. This study has highlighted the role of personal (e.g. prior experience; agency; resilience; personality) and contextual factors in 'becoming' a doctor. A recommendation emerging from this study is the need for interprofessional learning in the medical curriculum to cultivate a health care culture of collaboration rather than competition. Future research is required in terms of how allied health professionals transition to medicine.

Applying positioning theory to examine interactions between simulated patients and medical students: a narrative analysis.

In their journey to becoming doctors, students engage with a range of teachers and trainers. Among these are simulated patients (SPs), who, through role-playing, assist students to develop their communication and physical examination skills, in contexts of formative and summative assessments. This paper explores the teaching and learning relationship between medical students and SPs, and considers how this might affect feedback and assessment. 14 SPs were interviewed on the subject of medical students' professional identity development in 2014. Data were examined using narrative analysis in conjunction with positioning theory to identify the positions that SPs assigned to themselves and to students. Narrative analysis yielded three interpretative positioning themes: Occupational, familial and cultural and discursive and embodied positioning. The interview process revealed that SPs adopt different positions intra-and interpersonally. SPs appear to hold dissonant perceptions of students in terms relating to their emerging professional identities, which may confound assessment and feedback. Training should include reflections on the SP/student relationship to uncover potential biases and positions, giving SPs the opportunity to reflect on and manage their individual and occupational selves.

Medical education in difficult circumstances: A global responsibility to contribute.

Medical and health professions' education is becoming increasingly standardized across the world in terms of core standards and competencies. Yet, the context in which education and training occurs is far from even. Many educators face challenges in providing health professions' education, ranging from individual challenges and organizational struggles, to working in countries experiencing major conflict or environmental disaster. This commentary sets the scene for an international discussion on might constitute "difficult circumstances" and invites educators from around the world to contribute to the discussion by sharing their stories and suggesting strategies and solutions in a themed issue of MedEdPublish, AMEE's (the Association for Medical Education in Europe) innovative online journal.