Eco-curriculum

On the morning of Sept. 9, 2020, medical student Ashley Jowell awoke, like others across the San Francisco Bay Area, to an eerie orange sky. The surreal phenomenon was brought on by a thick layer of smoke from massive California wildfires and a marine layer that combined to choke out the normal blue hue.

Now, as every wildfire season approaches, Jowell, a fourth-year Stanford School of Medicine student, experiences anxiety as more climate-related damage is laid bare.

That dread is lessened somewhat by Jowell’s knowledge that she is taking action: In 2019, she began co-leading a drive to weave information about climate change’s health impacts into medical education. She and her team were the first to bring the proposed changes to those responsible for overseeing the curriculum at the medical school. Jowell has been involved since the beginning.

“As future physicians, we need to be prepared to care for patients affected by climate change and also know how to help our patients adapt and respond with resilience to a changing environment,” Jowell said.

According to the World Health Organization, climate change is the biggest health threat facing humanity. From the exacerbation of asthma symptoms by wildfire smoke and pollution to the increased preeclampsia risk for pregnant women exposed to extreme heat, examples of the environment’s impact on health abound.

In 2019, Jowell co-founded the Stanford Climate and Health group, made up of students and faculty who organize symposiums and conduct community engagement events on climate change. She and three other medical students joined the group’s education subcommittee, aiming to enhance the school’s curriculum.

Daniel Bernstein, MD, the associate dean for curriculum and scholarship, joined the effort when Jowell approached him about proposed changes.

“Environmental change touches every single disease. Reflecting the pervasive nature of climate is paramount,” said Bernstein, the Alfred Woodley Salter and Mabel G. Salter Endowed Professor in Pediatrics. “We didn’t want a separate two-hour lecture on climate change. What we do is integrate it into each system course.”

As a first step, students evaluated and presented papers to Bernstein that could be added to the course slides. The biggest challenge, Jowell said, was folding new literature into already packed medical school curriculum materials — rather than creating new lectures — to ease adoption for lecturers.

“The students were methodical and gave the faculty the information and resources they would need to succeed,” said Barbara Erny, MD, a faculty adviser to the group and adjunct clinical associate professor of medicine.

Bernstein piloted the curriculum enhancement in the cardiology and pulmonary courses, adding content such as how heatstroke affects the cardiovascular system and how air pollution affects patients with asthma and chronic lung and heart diseases.

As the students’ team has grown, they have worked with faculty to expand the climate curriculum to 12 subject areas — including psychiatry, dermatology and neurology — and continue to evaluate and add content.

Though the students had no peer-reviewed climate-curriculum resource available when they launched their effort, that has changed. Now faculty can draw on standardized materials provided by Climate Resources for Health Education, a collaboration of several U.S. medical institutions.

The group is working to integrate these materials into every preclinical course along with clerkships and residencies.

The Stanford Climate and Health group’s success so far is a salve to Jowell’s eco-anxiety: “Channeling this concern into climate and health education has given me a tangible way to help address the climate crisis.”