Sarah Walpole

Challenges to professionalism: Social accountability and global environmental change

Abstract This article explores the concept of professionalism as it relates to social change and social accountability, and expands on them in the light of global environmental changes. Professionalism in medicine includes concepts of altruism, service, professional knowledge, self-regulation and autonomy. Current dialogues around social accountability suggest that medical schools should re-orientate their strategy and desired education, research and service outcomes to the health needs of the communities they serve.This article addresses the following questions: • How do we reconcile ideas of medical professionalism with the demands of creating a more equal, just, sustainable and socially inclusive society? • What new challenges do or will we face in relation to environmental degradation, biodiversity loss, ecosystem health and climate change? • How can medical schools best teach social and environmental responsiveness within a framework of professionalism? • How do medical schools ensure that tomorrow’s doctors possess the knowledge, skills and attitude to adapt to the challenges they will face in future roles?We offer ideas about why and how medical educators can change, recommendations to strengthen the teaching of professionalism and social accountability and suggestions about the contribution of an emerging concept, that of “environmental accountability”.

Exploring emerging learning needs: a UK-wide consultation on environmental sustainability learning objectives for medical education.

Objectives This study aimed to engage wide-ranging stakeholders and develop consensus learning objectives for undergraduate and postgraduate medical education. Methods A UK-wide consultation garnered opinions of healthcare students, healthcare educators and other key stakeholders about environmental sustainability in medical education. The policy Delphi approach informed this study. Draft learning objectives were revised iteratively during three rounds of consultation: online questionnaire or telephone interview, face-to-face seminar and email consultation. Results Twelve draft learning objectives were developed based on review of relevant literature. In round one, 64 participants’ median ratings of the learning objectives were 3.5 for relevance and 3.0 for feasibility on a Likert scale of one to four. Revisions were proposed, e.g. to highlight relevance to public health and professionalism. Thirty three participants attended round two. Conflicting opinions were explored. Added content areas included health benefits of sustainable behaviours. To enhance usability, restructuring provided three overarching learning objectives, each with subsidiary points. All participants from rounds one and two were contacted in round three, and no further edits were required. Conclusions This is the first attempt to define consensus learning objectives for medical students about environmental sustainability. Allowing a wide range of stakeholders to comment on multiple iterations of the document stimulated their engagement with the issues raised and ownership of the resulting learning objectives.

Building an environmentally accountable medical curriculum through international collaboration

Abstract Background: Global environmental change is associated with significant health threats. The medical profession can address this challenge through advocacy, health system adaptation and workforce preparedness. Stewardship of health systems with attention to their environmental impacts can contribute to mitigation of and adaptation to negative health impacts of environmental change. Medical schools have an integral role in training doctors who understand the interdependence of ecosystems and human health. Yet integrating environmental perspectives into busy medical curricula is not a simple task. Content: At the 2016 Association for Medical Education in Europe conference, medical educators, students and clinicians from six continents discussed these challenges in a participatory workshop. Here we reflect on emerging themes from the workshop and how to plan for curricular change. Firstly, we outline recent developments in environmental health and associated medical education. Secondly, we reflect on our process and outcomes during this innovative approach to international collaboration. Thirdly, we present learning objectives which cover core content for environmentally accountable medical curricula, developed through a reflective process of international collaboration integrating current literature and the workshop outcomes. Conclusions: International collaboration can bring together diverse perspectives and provide critical insights for the inclusion of environmental health into basic education for medical practitioners.

What do tomorrow’s doctors need to learn about ecosystems? – A BEME Systematic Review: BEME Guide No. 36

Abstract Background: Human health is fundamentally determined by the health of ecosystems. Guidance is lacking about how to address the topic of ecosystems within medical education. Aims: To determine the nature of discussions around ecosystems in the educational, medical and medical education literature. To identify learning needs of tomorrow’s doctors. Methods: A narrative synthesis approach was used. Systematic searches were completed in 14 databases. Two independent reviewers screened results. Preliminary synthesis included textual descriptions and quality appraisal. Data were analysed using the Education for Sustainable Healthcare framework and thematic analysis. Relationships between studies were explored. Best evidence synthesis, contacting authors of primary studies and critical reflection reinforced robustness. Results: Six thousand seven hundred and fifty-three abstracts and 123 full texts were screened. Twenty-seven studies were included. Many studies lacked clear reporting. Medical students and doctors displayed knowledge about ecosystems, but lacked confidence to enact sustainable practices. Education about causes and consequences of environmental change is required. Few studies proposed specific learning objectives. Conclusions: To prepare for roles as health care workers and leaders, medical students must learn about relationships between ecosystems, health and health care. The Education for Sustainable Healthcare framework outlines essential knowledge and attitudes but requires addition of practical competencies. Further research should explore the framework’s relevance in different contexts, in order to structure training accordingly.

Health informatics in UK Medical Education: an online survey of current practice

Objective Health informatics has growing importance in clinical practice with successive General Medical Council recommendations. However, prior data suggest that undergraduate medical education largely neglects this area. An up-to-date, UK-wide view of health informatics training in medical schools is required. Design An online survey was developed using current guidance and recommendations of UK professional bodies. Participants and Setting Senior academic staff and health informatics educators at all 34 UK medical schools were invited to complete the survey. Main outcome measures Quantitative and qualitative data regarding health informatics in the undergraduate medical curriculum. Results A total of 26/34 (76%) of UK medical schools responded and 23 provided full information. Aspects most frequently mentioned were literature searching and research governance. Seventeen per cent of respondents felt there was little or no HI training, although clinical record keeping was addressed by all medical schools. Pedagogies used to teach health informatics were self-directed learning (78%) to lecture based (70%), seminars (70%), informal teaching in clinical settings (57%) and problem-based learning (22%). Health informatics was usually integrated vertically and horizontally across the curriculum (76%). Assessment and updates of the health informatics curriculum are limited (57 and 41%, respectively). Thirty-two per cent of respondents reported a low level of confidence among students to use health informatics as doctors. In the most up-to-date survey of health informatics teaching in UK medical schools, there are three major findings. First, the proportion of health informatics in the medical undergraduate curriculum is low. Second, there was variation in content, pedagogy and timing across medical schools. Third, health informatics is rarely assessed and course content is not regularly updated. Conclusions There is a role for national guidelines and further research in this area of the curriculum which is rapidly gaining in prominence.

E-collaborating for Environmentally Sustainable Health Curricula

Purpose This chapter aims to demonstrate how medical educators can use e-collaborative tools to collaborating internationally and cross-institutionally towards designing environmental sustainability and health (ESH) education. The main focus of the chapter is on sustainable medical curricula.

Protecting Health from Climate Change Requires Concerted Action and Radical Approaches: A Discussion of Recent Progress in International Climate Negotiations

Correspondence to Andrew Punton, University of Dundee Medical School, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK E-mail: a.punton@ dundee.ac.uk Received: Dec 14, 2016 Accepted: Dec 14, 2016 Online First: Dec 18, 2016 Cite this article as: Punton A, Crossley EJ, Matthews NR, Walpole SC. Protecting health from climate change requires concerted action and radical approaches: A discussion of recent progress in international climate Negotiations. Int J Occup Environ Med 2017;8:1-6. doi: 10.15171/ijoem.2017.985 Protecting Health from Climate Change Requires Concerted Action and Radical Approaches: A Discussion of Recent Progress in International Climate Negotiations

A case of multiple cardiac calcified amorphous tumours

Cardiac calcified amorphous tumours of the heart are rare non-neoplastic cardiac masses that can present like a malignant mass or an intra-cardiac thrombus. We report an extremely unusual case of a 73 year old man who presented to hospital with dyspnoea and subsequent investigations revealed multiple cardiac CATs.