RAMS Climate Change and Health Roadmap

Climate Change and Health A career in emergency medicine focused on climate change will give you the tools to advocate for patients and take steps to address the root causes of the problems they face from this global public health crisis.

MED STUDENT (MS3/4)

JUNIOR RESIDENT

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Senior RESIDENT

Resources

AUTHORS: Caitlin Rublee, MD, MPH; Caleb Dresser, MD; Hanna Linstadt, MD; Rachel Dahl, MS; Katelyn Moretti, MD, MS Contributors: Renee Salas, MD, MPH, MS; Jay Lemery, MD; Paul Auerbach, MD, MS; Jonathan Slutzman, MD Welcome to the Climate Change and Health Roadmap, your definitive step-by-step guide on how to succeed in Climate Change and Health at every training level. Don’t know where to start? Click on “Background” or select your training level above. A full list of fellowships, conferences, and podcasts can be found in “Resources.” For pearls of wisdom from faculty and residents in the trenches, click on “Insider Advice.”

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insider Advice

1 - SENIOR MEDICAL STUDENT M3/M4: Explore Climate Change and Health Given that the development of the role of academic physicians in climate change work is relatively new, medical students with a passion and motivation to pursue this track in their career may find few resources at their own school. But, this shall not discourage!

There is a global network of health professionals eager to have you join the team.

Becoming an active participating member in national organizations that allow exploration of the climate and health intersection can be beneficial for knowledge growth, networking, and residency application building. These groups have different opportunities and foci that can help identify areas of interest. The Medical Students for a Sustainable Future and its parent organization, the Health Care Without Harm Physician Network, emphasize the health sector’s role while the Medical Society Consortium on Climate and Health highlights health professionals as advocates for climate and health through state-based chapters and national activities. EMfocused groups, such as SAEM and the Climate Change and Health Interest Group, provide specific professional society education and research opportunities. Student memberships are often free or minimal cost and offer exposure to educational resources and networking with other trainees, physicians, and potential mentors.

Away rotations and other advanced electives offer opportunities to learn more about EM and to investigate the different career tracks offered through this specialty. With due diligence and preparation to the timeline prior to M4 interview season, students should take advantage of this time to schedule clerkships that allow them to develop and expand on interests. A myriad of topics overlap with climate change: disaster medicine, social emergency medicine, administration and operations, medical education, wilderness medicine and health policy. Mentors may be particularly helpful in identifying clerkships at programs where there are opportunities for a medical student to participate in projects with a climate change focus and to interact with physicians working in this track.

This time is also helpful for students to learn about the advantages and disadvantages of three and four-year residency programs and to determine what other program characteristics are most important to them, such as whether programs offer dedicated time and support for research, travel, and projects.

2 - JUNIOR RESIDENT PGY1/PGY2: You are in Residency! Now what?

As a first-year resident, you are going to be busy and your primary goal should be learning emergency medicine well. You can begin connecting with faculty mentors in your institution or department and getting to know other medical, public health, or policy professionals in your city who may be excellent partners for projects. Start planning your quality improvement project around a climate-related topic or a four-week elective experience in coming years. These early steps will help set you up for success during a busy time in training.

As you move through second year, continue to develop your climate and health lens. Need to do a lecture for a conference or write an article? Choose a climate topic that interests you. Look for opportunities to enhance your written and oral communication skills.

3 - SENIOR RESIDENT PGY3: Increasing your exposure to the field of climate and health will help you decide if you want to pursue this as a career. We recommend joining different local and/or national organizations depending on your interest. Many local regions have organizations for health care providers to learn about and act upon the health effects of climate change. Some larger hospitals and hospital systems have sustainability directors and/or departments which can be valuable resources if you are interested in exploring climate-smart health care. National groups like SAEM have interest groups to connect with members that share a similar interest in climate change and health. Notable groups to explore include the Medical Society Consortium on Climate and Health, Health Care Without Harm, and Practice Greenhealth, among others.

PGY4: If you are training in a four-year program, the last year provides you an opportunity to pursue a meaningful project and learn more about climate and health. You can assess the needs within your own community or healthcare system in order to decide if you can work with a group to improve the sustainability of your hospital or clinics. You can also develop and pursue a research project if an opportunity presents itself. The extra time allows an opportunity to learn more about climate change and health policy by reading resources like the Lancet Countdown, IPCC report, USGCRP Climate and Health Assessment and National Climate Assessment.

4 - FELLOWSHIP If you hope to pursue an academic emergency medicine career focused on climate change, you will benefit from the advanced training, networking, leadership and research opportunities that come with completion of a fellowship or advanced degree, although these are not mandatory for entering the field.

University of Colorado: In 2017, a graduate medical education (GME) fellowship for emergency medicine physicians was created through the University of Colorado School of Medicine, the first of its kind. The one-year fellowship provides emergency physicians with diverse leadership experiences and critical communication skills necessary to confront current and emerging environmental health threats with multiple stakeholders across academic departments, federal agencies, non-governmental organizations, professional societies, and private industries. Fellows partner with the University of Colorado Consortium for Climate Change and Health and the National Institute of Environmental Health Sciences. Fellows practice clinically ~6-8 shifts per month at the University of Colorado Anschutz Medical Campus.

There is no advanced degree at this time. Learn more here.

Beth Israel Deaconess Medical Center / Harvard Medical School: The Fellowship in Climate & Human Health at BIDMC/HMS is now in its second year. Fellows practice clinically ~ 8 shifts per month, and work with faculty at BIDMC, the Harvard Center for Climate, Health, and the Global Environment, and the Harvard FXB Center for Health and Human Rights. A two-year fellowship that includes a MPH from Harvard’s T.H. Chan School of Public Health is available.

University of Washington: The Section of Population Health in the Department of Emergency Medicine at the University of Washington has conducted extensive research on the health implications of climate change. Dr. Jeremy Hess has contributed to the Lancet Countdown on Health and Climate Change, and a physician fellowship focused on climate & health may be available soon. Read more here.

Columbia University: The Climate and Health Program at Columbia University, including a new Climate School, offers master’s and doctoral degrees in Climate & Health and related disciplines. While this is not a physician fellowship and clinical practice opportunities would have to be arranged separately, this may be a good option for those who want in-depth graduate-level research training in this field.

Learn more here.

Johns Hopkins University: While a physician fellowship is not offered, graduate students enrolled at the Bloomberg School of Public Health have the opportunity to complete a Climate and Health Certificate Program. Read more here.

Other institutions: Yale University hosts a Center for Climate Change Communication that offers seminar courses in climate change communication, and the center on Climate Change and Health pursues primary research. George Mason University’s Program on Climate and Health hosts the Medical Society Consortium on Climate & Health, and has an active research and education program.

Stanford University also has an active climate & environmental health program. At the federal level, NIEHS, CDC, NIOSH and other agencies have programs focusing on various aspects of climate and health. While none of these institutions currently offer physician fellowships, collaborative opportunities may exist. *Current as of December 2020

5 - BACKGROUND As an emergency physician, you will inevitably be involved in caring for patients affected by climate change. These will range from construction workers suffering from heatstroke to elders displaced by hurricanes who need to get back on their medication regimen and reestablish care. A career in emergency medicine focused on climate change will give you the tools to advocate for the needs of these patients and take steps to address the root causes of the problems they face from this global public health crisis.

Most academic emergency physicians who focus on climate change choose a combination of advocacy, organizing, writing, and research. Some focus on reducing greenhouse gas emissions from the healthcare industry or advocating for broader reductions; others focus on understanding and adapting to new hazards that will result from climate change, either for the wellbeing of patients in the community or for the functioning of health care systems.

The primary challenges facing a physician who wishes to focus on climate change are relatively sparse research funding, variable acknowledgement of this as a key focus area within the house of medicine, and the enormous scope of the problem. These challenges are also, however, opportunities. As a relatively new focus area, there are countless unaddressed research projects ready for your attention. You have the potential to become a leader early in your career. If the climate models continue as projected, your services will be more and more in demand over the course of your career.

Effective mentorship is essential at every level of training if you plan to develop an emergency medicine career focused on climate change. You should seek out a mentor who is well connected to other people in the field and can help you navigate a highly crossdisciplinary academic landscape. An ideal mentor will be able to guide you through public health aspects of climate change, governance and policy issues, and key research questions in both adaptation and mitigation, and connect you with experts who are focusing on these topics.

6 - RESOURCES Organizations to become involved with: Medical Students: •A merican Medical Student Assocation Environmental Health Action Committee •M edical Students for a Sustainable Future • I nternational Federation of Medical Students Fellows/Residents/Medical Students: • SAEM Climate Change and Health Interest Group • Health Care Without Harm • The Medical Society Consortium on Climate Change and Health

Conferences for abstract submission and meeting climate change physician experts: • SAEM: Look for Climate Change and Health sponsored events and meetings.

• American College of Emergency Physicians (ACEP): Check out your local chapter.

Rhode Island ACEP hosts a climate change and health committee with physicians active in climate change and health.

• CleanMed: Leading conference for experts in healthcare sustainability • The Medical Society Consortium on Climate and Health Annual Meeting

Information regarding fellowships: •U niversity of Colorado Climate and Health Science Policy Fellowship •B eth Israel Deaconess Medical Center / Harvard Medical School Climate and Human Health Fellowship

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Funding opportunities: •h ttps://www.epa.gov/research-grants/climate-change-research-grants •h ttps://www.saem.org/saem-foundation/grants •h ttps://www.greenclimate.fund/ •h ttps://www.niehs.nih.gov/research/supported/centers/climate/index.cfm

Articles, books, and more: • Lemery, J and Auerbach, P. (2017). Enviromedics: The Impact of Climate Change on Human Health. Lanham, Maryland: Rowman & Littlefield.

•U S Lancet Countdown on Health and Climate Change Policy Brief •U .S. Global Change Research Program (USGCRP) •C limate Change and Human Health Literature Portal • I ntergovernmental Panel on Climate Change (IPCC) •C limate Nexus •M ore book recommendations

Podcast links: • https://www.hsph.harvard.edu/news/podcast-series-climate-change-health/

Must attend conferences for education and networking: • Annual Meeting

Others to consider: • American Geophysical Union • American Meteorological Society • Consortium of Universities for Global Health • United Nations Climate Change Conference of the Parties (COP)

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7 - INSIDER ADVICE Renee Salas, MD, MPH, MS is an Assistant Professor of Emergency Medicine at Harvard Medical School and lead author for the Lancet Countdown on Health and Climate Change U.S. Brief.

“The climate crisis touches all of our patients, everything we do as doctors, and the ability for our health care systems to deliver care. Making these connections helps decision makers realize that climate action is actually just a prescription for health and resilient health care.”

Jay Lemery, MD is a Professor of Emergency Medicine at the University of Colorado School of Medicine, Section Head of Wilderness and Environmental Medicine, and Climate and Health Science Policy Fellowship Director.

“Find a mentor-- anyone who’s a few years ahead who understands how to grow a career and can offer perspective on wellness, reputational growth, and impact. Think hybrid connections: look for partners in affiliate fields in environmental justice, conservation, clean energy etc. Often they’re looking for a ‘health’ impact on the work that they’re doing, and your advice can be invaluable to them, and offer you novel niches to develop and grow. Develop a really good lecture-- vetted and practiced-- that you know very well. Make that your way to show the world how smart you are and to spread your knowledge.”

Paul Auerbach, MD, MS is the Redlich Family Professor Emeritus in the Department of Emergency Medicine at Stanford University School of Medicine.

“Learn about climate change and human health. Form an opinion and then voice it with a group for which you have respect and can hopefully influence.”

Jonathan Slutzman, MD, BSE is an Instructor in Emergency Medicine at Harvard Medical School and former civil and environmental engineer.

“Find your people – an organization, network, institution – where you can learn and do what fulfills you.

Look beyond medicine to learn the science and engineering behind your climate and health niche.”