Table 1.

Student focus group evaluation: Perceptions of climate change and a co-created and disseminated pre-clinical climate change and health curriculum across four domains.

Themes	Codes	Quotations
Domain 1: Students' prior perceptions of climate change and health
Missing link between climate change & medicine	Knew the science	“Knew about the science of climate change…”; “I had a broad public health view.”
	Not patient health	“I don't think I knew as well about how it related directly to patient health.”
	Not an expected focus in the medical curriculum	“I expected to learn about social determinants of health…but I didn't expect climate change to be a part of that.”
	Important, but abstract	“I also thought of it very abstractly, almost in a different world to like, oh…worldly societal things that are important to me, and it was very separate.”
Variable level of engagement	Do one's part	“I did try to…do my part…reduce single-use products and not drive as much.”
	Reflecting prior exposure to sustainability	“As an undergrad…it was weaved into the curriculum or just the culture with peer health mentors that they had and a lot of sustainability efforts.“
	Not an advocate	“I wouldn't say I was super big into being an advocate.”
Domain 2: Current attitudes about climate change and health in terms of their careers as doctors
Believe that climate change matters for patients and counseling	Affects history-taking	“We need to be thinking about those questions when we're talking to a patient.”
	Context for exposures	“You have to take into the context what their exposures are on a daily basis.”
	Useful in an upstream way	“Informing people why the situation is the way it is, is upstream to helping them decide to make change later on through their voting.”
	Location/context matters	“I think just with being in the South…seeing some of the air quality difference…the warmer climate, it seems to be almost dramatic.”
Working through application of climate and health knowledge in future clinical practice	Convergence of work and life	“Thinking about caring for patients while processing that personal experience [with climate disasters], it is all coming together.”
	Frustration at individual limits	“One of my challenges is…I don't know if my actions will make a difference.”
	Uncertain how to apply	“But one piece that's missing for me for me is like, 'What does it mean that I know this now?”'
Perceive need to engage through non-clinical activities	Advocacy	“A lot of the big changes that we need to do to fix the issue won't really happen unless we do things on a policy level.”
	Research	“There's not decades or there's not centuries of research…on climate change.”
Domain 3: Reflections on the existing climate change and health curriculum
Enhanced awareness and applications in multiple domains	Medical waste	“The only one thing I can see after the case is… the post-surgery clean-up… [I] wouldn't have even looked at without…the lecture we have on how much medical waste is generated on a daily, annual basis.”
	Personal and professional growth	“…[Climate change] becomes something you consider in your daily practice, too, and hopefully moving forward as a physician.”
	Leadership	“It will be for the chance where we'll be in positions where we have opportunities to make an impact.”
	Patient health	“One of the biggest takeaways has been the application to patients.”
	Communication skills	“The most valuable part was how to talk about it.”
	Health equity	“When they showed the map with the red-lining, and how it overlapped perfectly with the map of the high incidence of heatstroke and the ambient temperature being higher, I think that really impacted me…”
Approach to content delivery matters	Meet the needs of different learners	“For 95% of the class, having key takeaway points is gonna do the trick …[but] one of the goals…is to inspire that 5% to do more…because we're gonna need that 5%, right?”
	Provide examples	“The more concrete an example or practical solution that they can give in those lectures is most meaningful.”
	Integrate seamlessly	“[When content] is weaved in and out through all the different lectures, it helps to kind of make it into more easily digestible bits. And also you can see more clearly how it impacts all these different areas of health.”
	Provide a frame/anchor	“It becomes a thing that helps you remember the other thing.”
	Faculty attitudes matter	“If the lecturer doesn't care, we can feel it.”
	Focus on facts rather than politics	“I really like how … it wasn't…there to sway people on climate change …instead…the focus of the lecture is more so like, this is climate change, this is why it's happening, this what we need to do.”
Perceived as more intuitive or deprioritized	Content is intuitive	“Part of it felt a little bit intuitive or kind of, ‘Oh, I probably know what they're gonna say,”'
	Traditional medical learning takes priority	“I care about this stuff, and…early on, when we were overwhelmed with anatomy, it was like, I am not even looking at this PowerPoint.”
Domain 4: Student-identified opportunities for the curriculum
Opportunities in non-didactic spaces	History and physical	“Maybe redoing how we take physical exams incorporating more questions…and incorporating more environmental risk factors in the questions we ask.”
	Translate to rotations	“If I'm a primary care doctor, how this gets integrated into my decision-making.”
	Case reports	“Having that tied to a case would be just engaging and nice.”
	Community learning	“Incorporating some opportunities…[with] organizations that might be doing this work.”
	Small group	“I would really like to see climate change being more integrated into a small group. I'm also not a lecture watcher.”
	Include students	“If you invited students to give presentations on topics they cared about…people would be more engaged.”
	Career development	“Things to think about when you're looking at a residency, or an employer down the line, about if these are really important values to you.”
Role and modalities of assessments	Reflections	“Reflections…would allow people to kind of explore what they find interesting...”
	Student motivation	“Including test questions would probably not really motivate people.”
	Perceived yield	“It's like, that's not gonna be on step, that's not gonna be on the test.”