Student-led curricular change

in sustainable healthcare

Patel A*, Parveen T*, Vyas A,

North S, Gibbs R, Rodrigues V

Presented by:

Dr Adi Vyas MBBS MPH

Lecturer in Public Health

Norwich Medical School

NHS is the single

biggest emitter

of carbon in the

public sector

• UN declared 2005-2014 the decade of “Education for

Sustainability” (UNESCO)

• UK Higher Education Academy produced guidance for

higher education providers (HEA)

• Learning outcomes for sustainable healthcare

education already exist (Lancet, 2014, 384:1924)

• “Theory to practice” project run by the Centre for

Sustainable Healthcare (CSH) brought together 8

medical schools interested in increased SH teaching

Pedagogical precursors

• Aims

– To increase teaching on sustainable healthcare (SH) in

the core MBBS curriculum

– To include at least one SH teaching episode in each

module, each theme, and each year

• Strategic goals

1. Gain executive approval (students)

2. Analyse and understand the curriculum & local

context: PBL, LOs, assessments, engagement (teachers)

3. Approach key teachers (together)

4. Join a network of like-minded educators & students

Aims & Goals at Norwich

The curriculum: “vertical”

The curriculum: “vertical”

The curriculum: “vertical”

The curriculum: “horizontal”

Biomedical Sciences

Anatomy

Physiology

Genetics

Biochemistry

MicrobiologyImmunology

Nutrition

Pathology

Pharmacology

Social Sciences

Law

Ethics

Public Health

Sociology

Psychology

Health Economics

Clinical sciences

?

Theme by theme…Year Date Title

1 24/10/2016 Epidemiology of mortality

1 1/11/2016 What is health?

1 1/11/2016 Controlling infectious diseases

1 7/11/2016 Introduction to global health

1 8/11/2016 Myths and realities of immunisation

1 15/11/2016 What makes us sick and who is responsible?

1 15/11/2016 Environmental hazards to health

1 15/11/2016 Work and health: occupational medicine

1 18/11/2016 Healthy & sustainable NHS

1 21/11/2016 History & future of NHS

2 14/03/2017 Environment and disease

2 16/03/2017 Control of outbreaks of acute infections

2 28/03/2017 Preventing circulatory, respiratory and blood & skin

disease

3 24/10/2016 Work & health

3 28/10/2016 How to distribute resources from a public health

point of view

4 31/03/2017 Global health electives

Theme by theme…Year Date Title

1 24/10/2016 Epidemiology of mortality

1 1/11/2016 What is health?

1 1/11/2016 Controlling infectious diseases

1 7/11/2016 Introduction to global health

1 8/11/2016 Myths and realities of immunisation

1 15/11/2016 What makes us sick and who is responsible?

1 15/11/2016 Environmental hazards to health

1 15/11/2016 Work and health: occupational medicine

1 18/11/2016 Healthy & sustainable NHS

1 21/11/2016 History & future of NHS

2 14/03/2017 Environment and disease

2 16/03/2017 Control of outbreaks of acute infections

2 28/03/2017 Preventing circulatory, respiratory and blood & skin

disease

3 24/10/2016 Work & health

3 28/10/2016 How to distribute resources from a public health

point of view

4 31/03/2017 Global health electives

• Positive response: 7 out of 9 educators contacted

– Ethics: interested to develop new case studies

– Consultation skills: as above

– Module 1 (human lifecycle): new learning outcomes

– Module 6 (nephrology & endocrinology): utilised

“green nephrology” case study, independently

• Specific exclusions in biomedical sciences: anatomy,

biochemistry, physiology, genetics, pharmacology (!),

immunology, patient safety (!)

Results

• Negative response: 2 out of 9 educators contacted

– [social science]: longstanding “turf” issues

– [clinical science]: climate change as just a “fashionable”

topic; offended by student approach

• Solutions

– Pick your battles

– Educator to accompany students

• Why did some educators reject or neglect SH teaching?

– Lack SH knowledge & perceived relevance to

discipline?

– Students as educators; invitation to student society

events (indicator of esteem)

Results

1. Students are powerful partners in curriculum

development

– Students are increasingly vocal (Nat’l Student Survey)

– Good pedagogical practice: teaching should be

responsive to student needs

2. Promote the broader impact of your discipline

– Doctors are leaders and change agents, yet lack the

knowledge & tools for effective action

– Sustainable healthcare education can rectify this

3. Utilise the formal curriculum under your control

– Work within established structures; utilise formal

authority (e.g. curriculum development committee)

Recommendations

4. Present the “solution” along with the “problem” – we

provided busy educators with:

1. A contact person from the working group (student)

2. Resources in SH relevant to their discipline (CSH)

3. Examples of successfully incorporating SH into

teaching material at other schools (network)

5. Synergise with existing curricular elements

– Adding a few slides to microbiology lectures; co-

develop case studies for ethics & consultation skills

– Avoid increasing the teaching load; but need plenary

Recommendations

6. Responding to resistance from educators

– First line: students approach

– Second line: educator to educator

– Third line: approach MBBS course director

– Fourth line: extra-curricular approach (Medsin, HPUK)

7. Don’t forget the “low hanging fruit”

– Student selected components: flexible, fun, blueprint

– “Assessment drives learning”

8. Use your networks; identify your allies

– Sustainable Healthcare Education network (national)

– Monitor, share, and celebrate your progress

Recommendations

Students:

our heroes

Broader

impact

Plan for

resistance

Curriculum

Know your

allies

Problem &

solution

Under your

control