The story of a small team motivated by a meaningful project that quickly managed to shake things up.

Dr Marine Sarfati, you are a rheumatologist and head of environmental health programmes at Lyon 1 University. You were behind the introduction of an environmental health module, which is set to become compulsory for all medical students from September 2023. Can you describe its content, educational objectives, format and philosophy?

Hello,

Yes, with the support of the Conference of Deans of the Faculties of Medicine in France, we have set up a nationwide digital teaching module which aims to present the key issues of medicine and environmental health. It is a relatively short module (6 hours of training, with about 20 videos of 15-20 minutes each), divided into 4 thematic sections. We wanted to provide a real introduction to medicine and environmental health, helping learners to understand the challenges of the current environmental crisis, both as citizens and as future healthcare providers.

The aim is to show that the current anthropocentric (human-centred) vision of the health system needs to shift towards a more global vision, in which human health is integrated into the animal environment and, more generally, into the planetary ecosystem.    For this purpose, we examine non-anthropocentric approaches to health (such as the "One Health" approach) and the major planetary limitations (climate change, biodiversity loss, pollution by new entities, etc.) as well as their link with human health. The aim is to demonstrate these interconnections, and therefore the importance of adopting a systemic vision. To provide a better understanding of the subject, we have also included videos on the history of human health and on environmental philosophy, for example. Finally, and this was specifically requested by the students, we have developed a section on levers for action which, once all the findings have been established, presents the key points for limiting one's environmental impact as a citizen and future healthcare provider. However, the intention is not to make students feel guilty and the closing video by a doctor in cognitive neuroscience explains the concepts of cognitive bias and the importance of the dynamics between individual and systemic factors.

This course is also suitable for students in other healthcare fields (pharmacy, maieutics, odontology, etc.) and will be offered to these students. Because of the global and widespread nature of the concepts, the course can also be extended to continuing education and to anyone wishing to learn about the links between health and the environment.

Let's take a look back at the conditions of success of this initiative, which was both set up very quickly and is highly ambitious in its objectives: the project did not come from institutions, as is usually the case, but rather from individual and citizen initiatives.

To go back to the roots of the project, we have to rewind to early 2020, when I joined a think tank working on the energy transition, The Shift Project, in the Health section. At the time, I was conducting a survey [1] to find out what is out there in terms of training in environmental issues for health students in France. Although some training courses exist, they are rare. At the same time, we interviewed nearly 3,300 health students in France (half of them in medicine) and their answers were quite clear: 84% of them want to be trained in environmental issues. To understand this discrepancy between the students' desire to be trained and the lack of existing courses, I interviewed experts in the field of health, including the outgoing president of the Conference of Deans at the time, Professor Jean Sibilia, the directors of studies at the public health schools in France (EHESP, ISPED), and people working on these subjects at the Ministry of Health and Research. I was very pleasantly surprised to discover that all these people wanted to see this type of training introduced in our curricula. They are convinced of the importance of these subjects and aware of the demand from students. The course even responds to a point of the PNSE/PRSE (National/Regional Environmental Health Plan).

However, environmental health is a complex field, which requires a multi-disciplinary approach, but also the decompartmentalisation of fields and the training of the teachers themselves. All these barriers make its implementation more complicated, in addition to the density of courses already in place.

Concerning the pedagogical format of the module, could you talk about the interest of this MOOC format mixing expert interventions and round table discussions? What difficulties and opportunities did you encounter in its implementation?

To counter these obstacles, we opted for a short (due to the already dense curricula) and digital format, to provide each faculty with a “turnkey” module directly available on the digital platform for health students (UNESS).

In order to make the user experience as “lively” as possible online, we have been careful to choose experts in each subject (and enthusiasts in general!), and to use a variety of formats: filmed, narrated PowerPoints, interviews, videos with educational animations and round table discussions. The round table discussions were chosen to embody the diverse range of profiles, backgrounds and points of view on the different issues. The goal was to present different proposals for sustainable and desirable futures and different approaches to medicine, so it made more sense in this form.

The pedagogical programme was developed in partnership with Raphaël Guttières, who has a PhD in Ecology and Biogeochemistry and works at the Institute for Environmental Transition at Sorbonne University. The complementarity created between a researcher and a doctor was, I think, beneficial in providing an overall view of the subject.

Another advantage was that we were supported by two Deans of Medicine, Professor Jean Sibilia (Dean of the University of Strasbourg) and Professor Gilles Rode (Dean of Lyon 1 University), as well as a team of pilot medical students (4 from Lyon 1 University, 2 from Sorbonne University, 1 from Paris Cité University) who helped us to create the programme and to check that we were meeting the expectations of the audience concerned.

In this context, the project was well received by the whole Conference of Deans of the Faculties of Medicine. We are now in the process of developing a University Network for Environmental Health (RUSE) in France, with one research professor per faculty to organise the dissemination of the environmental health module and approach in medical studies, on campus and in research.

The students will follow a MOOC that goes beyond the traditional framework of medical studies: it talks about the pollution of ecosystems by the molecules of the drugs we take and which end up in the water, the carbon emissions of hospitals, our philosophical relationship with the environment, the future of professions and practices in a world facing unprecedented challenges, etc. What was the goal?

As I said above, the field of environmental health is complex, because the environment can be seen schematically as constant interactions between the fields of biology, chemistry, physics, etc. The issues are global with multiple interconnections (for example, urbanisation and disruption of the water cycle, or deforestation, loss of biodiversity and climate change). To help understand this, we felt it was necessary to provide explanations from experts with different and complementary backgrounds. We therefore opted for a multidisciplinary approach to teaching with a variety of speakers (doctors, biologists, ecologists, urban planners, hydrologists, palaeontologists, engineers, doctors in management science, political science, etc.).

Experts are developing the concept of One Health, i.e. how human health is affected by and affects the health of other living beings. In concrete terms, what are the key issues of this concept and how could it be put into practice?

“One Health” is a concept developed in the early 2000s and particularly supported by veterinarians: it involves promoting a systemic and unified approach to animal, human and ecosystem health. These days, it would be wise for human health experts to adopt it too. The Covid-19 pandemic was in fact a good “advertisement” for the movement: scientists and the general public became convinced of the importance of taking ecosystems into account in order to avoid future pandemics (although the link between biodiversity loss and the emergence of pandemics is long established [1]). For example, one could imagine the creation or development of multidisciplinary veterinarian-doctor-ecologist teams to study pandemic “hot spots” and guide the human/animal health policies to be implemented accordingly.

A first session was inaugurated at the beginning of the year for students in Brest. How did this first group receive the new course?

More than 170 third-year medical students in Brest have completed the course to date. We are delighted with the initial feedback, which is very encouraging: “The speakers are clear and very interesting. The fact that they are not all from the health field is also very enriching and allows us to realise that we can take action as citizens and not only as doctors. I liked the format of debates or round table discussions” said one student.  The concept of “One Health” was appreciated by the students, 55% of whom had never heard of this concept before the training (24% were not sure and 21% said they had).

By including Environmental Health in all medical student curricula, we are taking the first step in developing the “One Health/Global Health” approach, which is a strong and encouraging signal to future health practitioners. However, the adventure must be continued and consolidated!

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Formation bientôt disponible en formation libre sur le site de l’UNESS : https://formation.uness.fr/ouverte/login/index.php 

Chaîne YouTube du module où sont hébergées les différentes vidéos :  https://www.youtube.com/@medecinesanteenvironnement

Site de la conférence des Doyens des Facultés de Médecine où figure notamment le programme : https://conferencedesdoyensdemedecine.org/lancement-du-module-pedagogique-de-medecine-et-sante-environnementale/