Advocating for planetary health in medical education

Adding to the huge response to Dr Ladouceur’s editorial on climate change,¹ we wish to emphasize one further role for family physicians in planetary health (PH) promotion: leadership in medical education.

Replies have highlighted the importance of this issue to learners as expressed by the International Federation of Medical Students² and more locally the efforts of the Canadian Federation of Medical Students,^3,4 which include student contributions to resources developed by the Canadian Association of Physicians for the Environment (CAPE.ca). To respond to these calls, family physicians need to equip themselves with strong foundational knowledge about PH and lead through example. As the largest single group of physicians in Canada, we have the greatest front-line advocacy effect, not only with patients but with our learners, too. All medical schools in Canada have a department of family medicine, and family physicians are influential across the continuum of medical school and in undergraduate, postgraduate, and continuing medical education. Here we outline some ways family physicians can advocate for PH in medical education.

With students: PH training can and should take place in family medicine (FM). Family medicine clerks at the University of Calgary in Alberta participate in a workshop that focuses on PH foundational knowledge. This includes encouraging students to think proactively about meaningful change they can offer patients, communities, and society. Our focus is on empowering students to promote eco-action rather than to graduate eco-anxious, despondent doctors.

Within the school: Embedding FM representation in other medical school courses provides opportunities to advocate for inclusion of PH concepts along with FM principles in these typically “organ-centric” courses. This integration of PH and FM with other courses, in turn, informs the other physician educators within an institution. And we are excited that Canadian Federation of Medical Students has been invited to develop LMCC (Licentiate of the Medical Council of Canada) questions on PH.

With our preceptors: We should focus on greening our patient medical homes. Practically, we can green our teaching clinics to lead by example—many others have contributed excellent ideas regarding approaches to this.^1,5 We can engage our inspiring and motivated medical student trainees to help drive sustainable change across the primary care landscape. Faculty development is a great opportunity to equip preceptors with foundational language and expertise by providing evidence-based interactive practical workshops.

Finally, the challenges of the Canadian Resident Matching Service are already a topic of nationwide interest.⁶ We query the carbon footprint generated by thousands of medical students as they travel back and forth across Canada. Can family medicine lead the way in reducing the planetary effects of postgraduate program selection?

Canadian family physician educators are well positioned to take leadership on PH education within medicine, similar to initiatives in the United Kingdom, and by the United Nations Education, Scientific and Cultural Organization and the World Organization of Family Doctors.^7–9 Long have family doctors been the stalwarts of the medical system with our compassion, our holistic approach, and our focus on relationships. It is time to apply that lens to the biggest community we serve: the planet of which we are a part. Family medicine in Canada has a history of innovation and global effects in medical education; let’s continue to lead that tradition and help our communities—and our Earth—flourish together.