Overcoming Climate Apathy in Medical Education
Overcoming Climate Apathy in Medical Education
(Physicians for Human Rights Student Advisory Board, Climate Change Committee 2022-2023)
Jacqualine Ng, New York Institute of Technology College of Osteopathic Medicine
Kennedy Jensen, Geisel School of Medicine at Dartmouth
Arthur Bookstein, Keck School of Medicine of University of Southern California
Avi Borad, Medical University of South Carolina
Subjective: Chief Complaint
Today’s medical students, taught from our childhood the importance of sustainable practices and safeguarding the planet, are often more eager to discuss healthcare overspending or physician burnout than we are to discuss climate change, even as we near the attainment of our medical degrees and its consequent influence. What happened to our generation’s passion for the planet? Here, we break down the differential diagnosis of climate apathy to identify the origins of this learned helplessness and guide our reactions moving forward.
Objective: Vital Information
Most students begin their medical education with idealistic optimism, and lack understanding of the institutions and political inertia we face.(1,2) For those who attempt to instigate change, optimism erodes into helplessness as we learn more about the immense power of institutions and cynical outlooks of our colleagues.(3) Some resign themselves to this status quo, but a persistent few others forge onward — identifying areas they can influence, avenues of thoughtful engagement, and ways to pursue meaningful change.
Unfortunately, these aspiring changemakers face another challenge: as we grapple with the taxing nature of clinical practice, we are inundated with media coverage of global atrocities and humanitarian crises that deplete our emotional bandwidth. Compassion fatigue and declining empathy among medical trainees (4) can then compound with the aforementioned feelings of powerlessness.
This pattern is particularly salient among issues afflicted by the tragedy of the commons.(5) For problems that require immense levels of collaboration from both the people and their governments, we may feel absolved of the responsibility to do our part in spite of our awareness of the problem. This “collective bystander effect” is only exacerbated for medical trainees whose academic commitments alone are plenty overwhelming.
Assessment & Plan: What to do?
Climate apathy is pervasive, but not insurmountable. Already, recent global concerted efforts have taken steps to prevent climate catastrophes.(6) With both individual and collective efforts, we can reinvigorate and maintain motivation to protect the future of our planet. Here, we outline a few key principles to increase efficacy and odds of success.
Narrow Your Focus
Start locally with your medical institution: does your school have a human health and climate curriculum?(7) Free curricula, such as MS4SF’s “Climate & Health Curriculum Reform in Medical Schools”, are available online and could be utilized to start a climate and health elective. Look at your institution’s partner hospitals too: what efforts are they making to decrease their carbon footprint?(8) Whether you continue to build momentum on existing efforts or pioneer your own, commit to seeing it through.
Take a Detailed History
Understand what’s been done before and build upon previous successes. Reach out to sustainability advocates and researchers at your institution in to learn what progress has been made and what roadblocks they encountered. Avoid reinventing the wheel, and instead allocate your time and energy toward having an impact.
Speak the Language
Be strategic in how you frame your argument towards your audience. Some may not find environmental arguments compelling, but economic arguments rarely fail to garner interest. Fortunately, many sustainability-focused changes have financial benefits. In 2012, Boston Medical Center invested in clean energy and pioneering green campus projects, ultimately reducing their greenhouse gas emissions by 93% while saving $1.5 million in energy utilities annually. BMC’s annual utility expenditure of $17.2 million in 2011 was more than halved to an estimated $8.5 million by 2019.(9) Figures like these may appeal to hospital administrators interested in profit-based hospital policy, so do your research ahead of time.
Find Your Tribe
Collaborate with those who share your vision. Organizations like Medical Students for a Sustainable Future, Physicians for Social Responsibility and The Medical Society Consortium on Climate and Health are engaging clinicians and students across the nation. Collaborative efforts between hospitals and political advocacy organizations, such as the partnership between Dartmouth’s Alliance for Climate Change and the New Hampshire Physicians for Climate Action, attest to the fact that our impact increases exponentially when our efforts are magnified by others.
Unite With Those Working on Related Issues
Find allies in unexpected places. Though fraught with frustrations, climate advocacy remains essential for protecting human health. From housing insecurity to displacement and migration, climate change exacerbates countless social justice challenges. Those who have been historically marginalized are those who are most negatively affected by the changing climate. For example, the uptick of natural disasters in recent decades have been directly correlated with climate change; does your school have a disaster medicine, global health, or refugee health organization that you can partner with to discuss this connection? Collaborate with classmates and organizations on how to protect individuals who are most vulnerable to the downstream consequences of climate change.
Extend Your Time Horizons
Finally, as with medicine, healing takes time. The climate risks we face today are centuries in the making; it will take generations to get back on track. We must accept that our work is planting seeds that will bear fruit we might not witness. Let us rest in the knowledge that our efforts now will have ripple effects for the collective future. For example, after much public attention surrounding environmental justice, the Inflation Reduction Act was signed in 2022 to invest in community-led projects that improve public health, reduce pollution, and revitalize marginalized communities to mitigate inequities.(10) Although this is one step of many needed to put us on track, we cannot overlook the decades of effort it took to be having conversations about climate action on such a large scale. Celebrate every success, no matter how small, with gratitude for those who paved the way.
This pattern of apathy is relevant to many of the complex problems our health systems face, not just climate change. Our prescription for this apathy, across all issues, is to take responsibility for our patients’ health and holistic well-being and reject cynicism. Develop your skills as an advocate, find opportunities to leverage your position, and be unrelenting in safeguarding patients and our collective future.
Follow-Up: Did this OpEd speak to you? Stay tuned to the Physicians for Human Rights Student Advisory Board for upcoming events and materials addressing climate change and related issues. Follow us at Instagram, Twitter, Facebook, or reach out to us at phr.sab@gmail.com.
1 Woloschuk, W., Harasym, P. H., and Temple, W. (2004). Attitude change during medical school: a cohort study. Med. Educ. 38, 522–534. doi: 10.1046/j.1365-2929.2004.01820.x
2 Morley, C. P., Roseamelia, C., Smith, J. A., and Villarreal, A. L. (2013). Decline of medical student idealism in the first and second year of medical school: a survey of pre-clinical medical students at one institution. Med. Educ. Online 18:21194. doi: 10.3402/meo.v18i0.21194
3 Mayer, A., and Smith, E.K. (2019). Unstoppable climate change? The influence of fatalistic beliefs about climate change on behavioural change and willingness to pay cross-nationally. Clim. Policy 19, 511–523.
4 Morley, C. P., Roseamelia, C., Smith, J. A., and Villarreal, A. L. (2013). Decline of medical student idealism in the first and second year of medical school: a survey of pre-clinical medical students at one institution. Med. Educ. Online 18:21194. doi: 10.3402/meo.v18i0.21194
5 Ansari, S. (Shaz), Wijen, F., & Gray, B. (2013). Constructing a Climate Change Logic: An Institutional Perspective on the “Tragedy of the Commons.” Organization Science, 24(4),1014–1040. http://www.jstor.org/stable/42002891
6 Wallace-Wells, D. (2022). Beyond Catastrophe: A New Climate Reality is Coming Into View. New York Times. Accessed:https://www.nytimes.com/interactive/2022/10/26/magazine/climate-change-warming-world.html?utm_sourc e=newsletter&utm_medium=email&utm_campaign=weekly-planet&utm_content=20221109&utm_term=The%20Week ly%20Planet
7 Kigler, S. K., Clark, L., Canyon, C. et al. (2021). Climate change curriculum infusion project: An educational initiative at one U.S. medical school. The Journal of Climate Change and Health. 4; 100065.
8 Sherman JD, Raibley LA 4th, Eckelman MJ. Life Cycle Assessment and Costing Methods for Device Procurement: Comparing Reusable and Single-Use Disposable Laryngoscopes. Anesth Analg. 2018 Aug;127(2):434-443. doi: 10.1213/ANE.0000000000002683.
10https://www.whitehouse.gov/briefing-room/statements-releases/2022/08/17/fact-sheet-inflation-reduction -act-advances-environmental-justice/