Students report major success of new climate and health curriculum at Harvard Medical School
A 17-month evaluation of a new curriculum at Harvard Medical School (HMS) on climate change, environment, and health (CCEH) finds that medical students in the program significantly improved their self-perceived knowledge of climate-related health and equity topics. The study, out today in PLOS Climate, offers insights for other medical schools and programs looking to create impactful curricula to prepare medical students to more effectively deliver patient care in a changing climate.
Researchers from HMS and Harvard T.H. Chan School of Public Health evaluated the impact of the new curriculum by analyzing pre- and post- surveys of first-year HMS students who completed the new curriculum as part of their pre-clerkship education. Launched in the fall of 2023, the curriculum embeds into preexisting courses lessons about how climate change impacts health, health equity, and health care delivery; how the health system contributes to climate change; and how health professionals and institutions can play a role in climate solutions.
“Our hope is that these findings can help other schools develop and implement their own climate and health curricula and understand the significant impact it can have on how the next generation of health care providers can serve their patients,” said senior author and Harvard Chan C-CHANGE core faculty member Gaurab Basu, who is faculty director of the curriculum.
At the completion of the curriculum, students self-reported large knowledge gains across all 5 primary core competencies. Researchers also conducted pre- and post- surveys after each lesson integration to assess how each lecture, case-based learning session, small group discussion, and preparatory materials affected students’ understanding and confidence regarding climate health topics specific to each course. Students reported knowledge improvements in all lesson integrations, with 20 out of 29 (69.0%) showing statistical significance. Survey items widely showed large effect size, demonstrating the impact of the curriculum on knowledge gains.
“As the healthcare providers who will be on the frontlines of managing climate-related health challenges in the decades to come, students have been essential to pushing forward climate and health curricula at medical schools around the country,” said co-lead author Natalie Baker. “This study validates that well-integrated lessons can have a significant, positive impact on student learning.”
“Climate change introduces all kinds of new risks to patients—from extreme heat impacting certain medications to poor air quality from wildfire smoke worsening lung health,” added co-lead author Hugh Shirley. “It’s encouraging to see that this curriculum is helping future doctors feel more prepared to handle these challenges.”
According to the Association of American Medical Colleges (AAMC), while the percentage of medical schools with required climate and health curricula has grown in recent years, there is no standardized approach to doing so, and many schools only offer standalone lectures rather than fully integrated coursework like that developed by HMS.
This level of longitudinal evaluation for climate education is one of the most detailed assessments of a fully integrated, competency-based climate curriculum to date. A previous report in PLOS Climate details how students, faculty, and administration at HMS worked together to develop the four-year curricular theme on climate and health and provides a road map for other medical schools to do the same.
Key findings
- 87% of students who completed the post-survey found the curriculum valuable
- In the curriculum-wide competency-based survey, all 5 primary core competencies and 19/20 (95.0%) survey items showed statistically significant pre–post gains:
- Core competency 1 (“I can define the pathophysiological mechanisms by which climate change, air pollution and ecological degradation impact human health”) increased from 33% to 92%
- Core competency 2 (“I can apply knowledge of climate impacts on human health to the clinical care of patients including prevention, diagnosis, and risk reduction counseling”) increased from 19% to 92%
- Core competency 3 (“I can analyze the historical and structural causes of climate change, air pollution and ecological degradation and describe the ways in which it creates/exacerbates health inequity”) increased from 42% to 92%
- Core competency 4 (“I can describe the ways in which the health care system contributes to climate change and how health care delivery is vulnerable to climate-related events”) increased from 41% to 96%
- Core competency 5 (“I am prepared to explore roles health professionals and institutions can play in climate solutions”) increased from 72% to 96%
- All 29 course integrations showed knowledge gains, with 20 (69%) showing statistically significant gains. The largest gains were seen in:
- Improved confidence obtaining a basic environmental and occupational history from a patient (increased by 80%)
- Understanding the historical context of environmental racism (increased by 80%)
- Understanding the goals of environmental justice (increased by 76%)
- Understanding healthcare providers’ responsibility to address the health impacts of climate change (increased by 80%)
- Understanding the pathophysiology underlying the relationship between climate change and CKD (increased by 72%)
- How to sort waste in a hospital setting (increased by 72%).
- Some survey items assessing clinical readiness, such as counseling patients about air pollution exposure, showed moderate gains that did not reach statistical significance, suggesting a need for more hands-on training in applying CCEH knowledge in a clinical setting
Citation
Baker N, Shirley H, Kline MC, Malits J, Mandalapu A, Mazumder DR, et al. (2025) Evaluating the impact of a longitudinal, integrated climate change, health, and environment curriculum in undergraduate medical training at Harvard Medical School. PLOS Clim 4(12): e0000727. https://doi.org/10.1371/journal.pclm.0000727
