CanMEDS and Planetary Health: How to train a doctor

Originally published in The Sudbury Star and elsewhere Jan. 22, 2023 https://www.thesudburystar.com/opinion/columnists/blacklock-how-to-train-a-doctor-in-planetary-health

Last September, I drove to Kingston to give a presentation on Planetary Health to a gathering of fourth and fifth year post-graduate doctors training in the specialty of respirology. (For those not in the know, respirologists deal with lung ailments like asthma and COPD.)  The youngish docs in my audience were from training programs across Ontario. This was their annual CanMEDS conference, and I was their dinner-time speaker.

CanMEDS is a training framework, complete with a nifty visual resembling a flower, that describes the attributes and abilities of an effective physician. According to the model, competent physicians will behave in a professional manner. They will exhibit scholarship, and be skilled in communication, collaboration, leadership, and health advocacy. The centerpiece of the CanMEDS model is the integrating role known as “medical expert”. A CanMEDS conference is an opportunity for trainees to learn important aspects of being a physician, beyond mere medical knowledge. (There’s a Saturday morning session on the critical skill of OHIP billing, just for example.)

Medical educators are slowly coming to understand that global environmental issues like climate change have important implications for human health, but there is so much medical knowledge to impart, and it’s a struggle to find space in already jam-packed curriculums for a “new topic.” But although I’m obviously in favour of any efforts to educate physicians about Planetary Health, the inclusion of a lecture on the topic at a CanMEDS conference doesn’t seem quite right to me. It feels a bit like sticking a band-aid on the CanMEDS framework.

So as my audience munched on salad and other delectables, I began my presentation with a light-hearted comment: By the end of my presentation, I hope to convince you that Planetary Health is relevant to every aspect of the CanMEDS framework, including “medical expert.” Because what is Planetary Health, really? And where does it belong in the education of physicians?

In my view, Planetary Health is fundamentally a way of thinking; it starts with understanding that we are rapidly and seriously damaging our planet to the detriment of our own health and safety. From there, it’s easy enough to arrive at some implications for medical training. Physicians need to:

1)    understand the many physical and mental health threats that arise from climate change and environmental degradation, and the dramatic health co-benefits of action to mitigate the damage;

2)    recognize that the health care system itself is a substantial contributor to greenhouse gas emissions, air pollution, and other environmental damage; that this is harming the health of our patients, our communities, and people everywhere; that it’s our responsibility to consider the environmental impact of the clinical decisions we make, and work towards and advocate for sustainability;

3)    stop imagining Planetary Health as an optional band-aid crazy-glued on to the CanMEDS framework; instead envision the entire teaching framework steeped in Planetary Health principles;

4)    Practice our vocation, and teach our trainees, and care for our patients, with all this in mind.

My youthful audience in Kingston finished their dinner and listened to the remainder of my 1.5 hour presentation with relatively rapt attention (I could see only one cell phone in active use), and asked the inevitable question: what can we do? I explained my “three P’s” of action: Personal, Professional, and Political. And I wondered: Would their thinking be transformed at all? Would anything I’d taught them “stick”? Would they make changes in their practices? Would they pass on what they’d learned to more junior trainees? Would any of them become advocates or even activists? And above all, would this be their only exposure to Planetary Health during their two years of respirology training? Unfortunately, it might well be.

But the times they are a-changing, and at NOSM University, the new Class of ’26 were exposed to Planetary Health during their very first weeks of medical school! Now the work begins.