Medical studentś needs for an integration of climate change into the medical curriculum

Abstract Background The impacts of climate change (CC) on health comprise increased human morbidity and mortality. Consequently, physicians need to be systematically trained to address CC in their professional life. Due to lacking research on educational needs of medical students, we developed a survey instrument to assess studentś attitudinal and knowledge-based needs for the integration of CC into medical curricula and their readiness to learn. Methods Our survey was administered online to 788 students at the Medical Faculty of Heidelberg University between 06/2021 and 02/2022. Data analyses included descriptive statistics, reliability analyses as well as regression modeling with regard to readiness to learn. Results 214 students participated in the survey, 170 fully completed datasets were included in the analysis. A majority of students (72.35%) (strongly) agreed that doctors carry a responsibility to address CC in their work setting, while only 4.71% (strongly) agreed, that their current medical training had imparted them with enough skill to do so. Students showed both considerable knowledge and interest in the area of CC, its health impacts, vulnerabilities and clinical adaptation (70.09% correct answers). Knowledge gaps were identified in the areas of health co-benefits and sustainable healthcare (55.53% and 16.71% of correct answers). 79.42% of students want to learn about CC through the integration into existing mandatory courses. Conclusions Results encourage the integration of CC topics with a focus on knowledge and professional role development into existing mandatory courses of the medical curriculum. Specifically, they also pinpoint health impacts and adaptation as greatest areas of interest for students and at health co-benefits and sustainable healthcare as areas with least prior knowledge. Key messages Heidelberg medical students want to learn about CC in their curricula. They have decent knowledge about CC and health but knowledge deficits in the topic areas of health co-benefits and green health sector.

Exposure to air pollution is a known risk factor for asthma exacerbations, emergency attendances and hospitalisations. In Europe, the main source of air pollution is the transport industry, and so the COVID-19 transport restrictions provided an opportunity to examine if reduction in traffic had a demonstrable impact on ambient air quality and asthmarelated admissions. Routinely collected data was used to conduct a retrospective population cohort study. The Environmental Protection Agency provided daily nitrogen dioxide (NO2) and particulate matter (PM) concentrations for Dublin, and all asthma-related admissions were collected from the Hospital In-Patient Enquiry system. The two years prior to the pandemic were compared with the period of transport restrictions (from March 2020). During the period of restrictions, there was a significant reduction in the mean number of daily asthma admissions (2.8 v 4.5 admissions p < 0.001). There was also a significant decrease in mean daily concentrations in two pollutants: NO2 (16.7 v 24.0mg/m3 p < 0.001) and PM2.5 (7.8 v 8.9mg/m3 p = 0.002). Only NO2 had a statistically significant correlation with asthma admissions (r = 0.132 p < 0.001). Transport restrictions introduced to mitigate against COVID-19 led to improvements in air quality, as seen by the reductions in pollutant concentrations. Previously described associations between pollutants and asthma, would suggest that these improvements in air quality contributed to the reduction in asthma admissions. Whereas the primary source of NO2 is transport emissions, PM is made up of particles from multiple sources, which likely explains the lack of correlation between asthma admissions and PM. Public Health need to advocate for transport policies which can improve air quality, and as a result, public health. Key messages: Poor air quality poses a significant health challenge requiring public health input and advocacy. Reducing vehicle traffic can improve air quality which would have a positive impact on public health.

Background:
The impacts of climate change (CC) on health comprise increased human morbidity and mortality. Consequently, physicians need to be systematically trained to address CC in their professional life. Due to lacking research on educational needs of medical students, we developed a survey instrument to assess studentś attitudinal and knowledge-based needs for the integration of CC into medical curricula and their readiness to learn.

Methods:
Our survey was administered online to 788 students at the Medical Faculty of Heidelberg University between 06/2021 and 02/2022. Data analyses included descriptive statistics, reliability analyses as well as regression modeling with regard to readiness to learn. Results: 214 students participated in the survey, 170 fully completed datasets were included in the analysis. A majority of students (72.35%) (strongly) agreed that doctors carry a responsibility to address CC in their work setting, while only 4.71% (strongly) agreed, that their current medical training had imparted them with enough skill to do so. Students showed both considerable knowledge and interest in the area of CC, its health impacts, vulnerabilities and clinical adaptation (70.09% correct answers). Knowledge gaps were identified in the areas of health co-benefits and sustainable healthcare (55.53% and 16.71% of correct answers). 79.42% of students want to learn about CC through the integration into existing mandatory courses.

Conclusions:
Results encourage the integration of CC topics with a focus on knowledge and professional role development into existing mandatory courses of the medical curriculum. Specifically, they also pinpoint health impacts and adaptation as greatest areas of interest for students and at health co-benefits and sustainable healthcare as areas with least prior knowledge.

Background:
Climate change and its mitigation have significant health implications. Hence, medical associations call on physicians to inform the population about health risks of climate change and possible health co-benefits of climate action. However, so far it is unclear what preferences the general public has about climate-sensitive health counselling (CSHC). Therefore, we developed a survey tool to a) characterize experiences of CSHC, b) identify preferences about communication methods and themes, and c) determine associations of socioeconomic characteristics and climate change attitudes with CSHC preferences.

Methods:
The tool development for this cross-sectional online-based survey was embedded in a bigger research project on the conceptualization of CSHC, which follows an exploratory mixed-methods design. Results of preceding qualitative interviews about CSHC were integrated into the tool development.
After two pilot tests, the tool was administered from April to June 2022 through the population-based HeReCa panel (Health Related Beliefs and Health Care Experiences in Germany), comprising 3200 participants from 5 federal states. Sociodemographic data is available for all participants.

Results:
The final tool entails 46 items, sorted into 7 sections. Two sections serve as dependent variables for the association analysis: 13 items about the acceptability of different communicative approaches of CSHC and 18 items on preferences for themes in CSHC. Three sections serve as independent variables for the analysis: attitudes on climate change, level of engagement, and sociodemographic data. Two sections assess experiences with CSHC and preferred information channels to serve as descriptive results.

Conclusions:
A rigorous methodology proved helpful for survey development within a mixed methods study. In triangulation with qualitative data, results of the survey will help physicians to deliver CSHC tailored to the preferences of different sociodemographic groups.

Key messages:
We developed a survey tool to measure the general public's preferences regarding climate-sensitive health counselling (CSHC) of physicians. Our study will provide guidance for physicians on how to offer CSHC to specific patient subgroups based on socioeconomic characteristics and attitudes towards climate change.
Abstract citation ID: ckac130.070 The role of public health services in implementing heat health action plans in Germany

Background:
The rise in extreme heat periods is a major public health challenge of climate change and the World Health Organization therefore recommends the implementation of heat health action plans (HHAPs). In Germany, HHAPs are not implemented in a comprehensive manner nor nationwide. Public health authorities have been identified as key actors with regards to heat and health. This study aims at assessing the role of public health services in the implementation of HHAPs in Germany.

Methods:
First, a review of the scientific and grey literature on the role of public health services in heat adaptation in Europe was conducted. Second, a policy document analysis of the legislation of Germany's federal states for public health services and their potential role in the implementation of HHAPs was carried out. Finally, semi-structured interviews with selected experts from multiple sectors at the local, federal and national level on their perception of the role of public health services in the implementation of HHAPs in Germany were undertaken.

Results:
Preliminary findings show that the legal framework for public health services in the different federal states addresses environmental health and civil protection to varying extents, but that climate change-specific health risks are barely mentioned. The expert interviews revealed perceived barriers for the public health services to implement HHAPs, notably with regards to personnel (e.g. competencies, time), organizational structures (e.g. financial resources, administrative structures, legal mandates) and competing other tasks (e.g. COVID-19 response). Facilitators included motivated individuals, funding opportunities for cross-sectoral collaboration and political support.

Conclusions:
The role of public health services in HHAP implementation in Germany varies widely between the different geographic settings and is influenced by several factors at the individual, organizational and political level. Key messages: Public health services can play an important role in heat adaptation, for example through coordinating the implementation of heat health action plans. Strong legal frameworks, sufficient organizational structures and well-trained personnel are important preconditions for an effective response by public health services to climate change challenges.