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PHRC and the GMC: A Planetary Health Agenda for Undergraduate UK Medical Education.
James Lee (PHRC Communications Chair), Hannah Chase (PHRC Interdisciplinary Coordinator). October 23rd 2023.
The PHRC have been collaborating with the General Medical Council after advocating for inclusion of planetary health in education policy documents within the UK. Here we describe the background to this work and where we have progressed to thus far.
The General Medical Council (GMC) is the UK regulatory body that oversees and sets the standards for healthcare professionals and medical education within the UK. The GMC’s ‘Outcomes for Graduates 2018’, outlines the expectations for all newly qualified doctors. The current edition does include the principles of sustainable healthcare as a component of undergraduate curricula, shown in figure 1, but does not acknowledge the vital inclusion of climate change and planetary health as key aspects of modernising medicine (General Medical Council, 2018, Tun, 2019). Additionally, despite the inclusion of sustainable healthcare, recent studies have identified teaching on this topic varies greatly, with some medical schools poorly integrating the outcomes (Bevan et al., 2022).
Figure 1: Excerpt from ‘Outcomes for Graduates 2018’. (GMC, 2018)
The Planetary Health Report Card (PHRC) identified that inclusion of planetary health concepts in curriculums of UK medical schools varied from 87.5% to just 25% across 22 metrics (Planetary Health Report Card, 2023). The PHRC is an international student advocacy group with student teams producing reports on planetary health education in 105 undergraduate health professional schools, in 13 countries. The report card has proven itself as an effective tool in empowering students to drive change at their institution, with mean scores in the UK improving from 47.6% (2021) to 59.8% (2023) and many other international successes (PHRC 2023, Hampshire et al., 2022, Chase et al., 2022, Nordrum et al., 2022).
In March 2022 the PHRC UK team wrote an open letter to the GMC outlining the importance of planetary health education, and the need for it to be included in an update of the Outcomes for Graduates, which was signed by over 100 medical students. Since then, the PHRC UK team have been working with the GMC’s Education Policy Team to discuss how we can move forward with the inclusion of these concepts. A really positive step was an in-person focus group at the GMC offices in London in March 2023. Ten members or associates of the PHRC attended the GMC offices to discuss what inclusion of planetary health might look like in an update to the ‘Outcomes for Graduates’ and also to draft a statement of purpose on behalf of the GMC, outlining what medical students want to see from the GMC on their stance on the importance of climate change and planetary health education.
In the workshop the PHRC team came up with three key priorities that should be included in the next iteration of the Outcomes for graduates:
The effects of climate change and ecological destruction on human health.
Healthcare’s contribution to climate change and ecological destruction.
Planetary Health thinking as a professional value and behaviour.
Updating the ‘Outcomes for Graduates’ is a significant undertaking and there are certain legal obligations which prevent the GMC updating their guidance too regularly. Additionally, the knock on effect on other policy documents such as ‘Good Medical Practice’ needs consideration (GMC, 2023). The recent publication of Good Medical Practice was heavily criticised for its lack of ambition around sustainability (Mulcahy & Smith, 2023). The GMC has however, specifically mentioned climate change in the ‘Physician associate and anaesthesia associate generic learning outcomes’ (General Medical Council, 2022) and does support the Medical Schools Council’s ‘Education for Sustainable Healthcare: A curriculum for the UK’ (Tun & Martin, 2022). This curriculum is currently listed as ‘additional reading’ by the GMC but without directly mandating the inclusion of this material, uptake from medical schools will be poor.
Both the drafted statement of purpose and concepts for Outcomes for Graduates are currently under review by the GMC, having been taken forward through internal audit processes. Despite repeated reminders that this will be a slow process, we are hopeful to see a published mission statement by the end of the year, which we are told is realistic.
We desperately need this education in our health professional schools. The regulatory bodies, both within healthcare and all fields, have a responsibility to ensure this material is included in their outcomes and standards. The PHRC will continue to advocate for the inclusion of this education internationally.
If you’d like to learn more about our work with the GMC you can tune into our upcoming talk at the Development Excellence in Medical Education Conference (DEMEC) this December or get in touch via our contact page.
With thanks to the medical students who took part in our focus group: James Chu, Victoria England (PHRC UK Regional Lead 2022/23), Mahta Haghighat Ghahfaroki, Will Nash, Roshan Karthikappallil, Dhruv Gupta, Lauren Franklin (PHRC Analytics Lead), Brawin Kajenthra, Rhea Khosla, Juliette Goodwin.
References:
Bevan, J., Blyth, R., Russell, B., Holtgrewe, L., Cheung, A. H. C., Austin, I., Shah, V., Butler, M., Fraser, S. & Collaborating, A. (2022). Planetary health and sustainability teaching in UK medical education: A review of medical school curricula. Medical Teacher, pp. 1-10. Available from: https://www.tandfonline.com/doi/full/10.1080/0142159X.2022.2152190
Chase, H., Hampshire, K. & Tun, S. (2022). Improving the medical curriculum on planetary health and sustainable healthcare. Bmj-British Medical Journal, 376. Available from: https://doi.org/10.1136/bmj.o209
Elaine Mulcahy & Richard Smith. (2023). Good medical practice a missed opportunity to embed sustainability. BMJ. 382:p1956. Available from https://doi.org/10.1136/bmj.p1956
General Medical Council (2018). Outcomes for Graduates 2018. Available from: https://www.gmc-uk.org/-/media/documents/dc11326-outcomes-for-graduates-2018_pdf-75040796.pdf [Accessed: 18 Mar 2023]
General Medical Council (2022). Physician associate and anaesthesia associate generic and shared learning outcomes. Available from: https://www.gmc-uk.org/-/media/documents/pa-and-aa-generic-and-shared-learning-outcomes_pdf-87633490.pdf [Accessed: 18 Mar 2023]
General Medical Council (2023). Good Medical Practice. Available from: https://www.gmc-uk.org/-/media/documents/good-medical-practice—english-20200128_pdf-51527435.pdf [Accessed: 18 Sept March 2023]
Greener NHS (2020). Delivering a ‘Net Zero’ National Health Service. Available from: https://www.england.nhs.uk/greenernhs/publication/delivering-a-net-zero-national-health-service/ [Accessed: 18 Mar 2023]
Hampshire, K., Islam, N., Kissel, B., Chase, H. & Gundling, K. (2022). The Planetary Health Report Card: a student-led initiative to inspire planetary health in medical schools. The Lancet Planetary Health, 6(5), pp. e449-e454. Available from: https://doi.org/10.1016/S2542-5196(22)00045-6
Nordrum, O. L., Kirk, A., Lee, S. A., Haley, K., Killilea, D., Khalid, I., Perez, E. C., Waters, I., Yan, R., Zulfiqar, S. & Stanistreet, D. (2022). Planetary health education in medical curricula in the Republic of Ireland. Medical Teacher, 44(11), pp. 1237-1243.
Planetary Health Report Card (2023). International Summary Report 2022/23. Available from: phreportcard.org
Thompson, T., Walpole, S., Braithwaite, I., Inman, A., Barna, S. & Mortimer, F. (2014). Learning objectives for sustainable health care. The Lancet, 384(9958), pp. 1924-1925. Available from: https://doi.org/10.1016/S0140-6736(14)62274-1
Tun, S. (2019). Fulfilling a new obligation: Teaching and learning of sustainable healthcare in the medical education curriculum. Medical Teacher, 41(10), pp. 1168-1177. Available from: https://doi.org/10.1080/0142159X.2019.1623870
Tun, S. & Martin, T. (2022). Education for Sustainable Healthcare – A curriculum for the UK. Available from: https://www.medschools.ac.uk/media/2949/education-for-sustainable-healthcare_a-curriculum-for-the-uk_20220506.pdf [Accessed: 18 Mar 2023]
Walpole, S. C., Mortimer, F., Inman, A. C., Braithwaite, I. & Thompson, T. (2015). Exploring emerging learning needs: a UK-wide consultation on environmental sustainability learning objectives for medical education. International Journal of Medical Education, 6, pp. 191-200. Available from: https://doi.org/10.5116/ijme.5643.62cd
