Interview by Jamie Hansen, Global Health Communications Manager
Climate change is widely recognized as an urgent global health emergency that is already impacting patients through the stress of extreme heat, toxic smoke from wildfires, injury sustained during natural disasters, and more.
Ophthalmologist and Stanford alumna Barbara Erny, MD, was already advocating for doctors to adapt to the rapid changes wrought by climate change when she read an op-ed in Stat News by Stanford medical student Anna Goshua in 2019. The commentary called on medical schools to do more to prepare students to confront the health challenges of a warming world, including updating medical school curriculum.
Dr. Erny was inspired to support Goshua and other student leaders in their efforts to update curriculum and began advocating alongside them and Stanford faculty. Dr. Erny, a Global Health Faculty Fellow, has since joined Stanford as an adjunct clinical professor of medicine and is helping lead Stanford’s efforts to adapt medical education and delivery to the realities of climate change. She is also a founding member of the Stanford Clinicians’ Task Force for Climate, Health and Equity, serves on the Steering Committee for the Medical Societies Consortium on Climate and Health, sits on the editorial board of the Journal on Climate Change and Health, and is a member of the Climate Action Working Group of the International Agency for the Prevention of Blindness.
This Earth Day, Dr. Erny spoke with us about how to prepare the doctors of today and tomorrow to meet the shifting health needs wrought by climate change, pollution, and environmental degradation.
How did you develop your interest in incorporating climate change into medical education?
I believe that as physicians, regardless of specialty, we should all consider the greater good of public health. As I started to realize that climate change was the biggest threat to human health of our time, I got involved with the Bay Area Physicians for Social Responsibility’s Environmental Health Committee, and we began thinking about the need for education. Then, in 2019, I read Anna Goshua’s op-ed highlighting the absence of medical school curriculum addressing climate change and realized I wanted to do more.
I was just an alumna and not sure of my ability to influence change at Stanford. However, I met with Anna and Dr. Kari Nadeau, a leader in climate and medicine at Stanford. Together, we successfully advocated for an elective course, The Impact of Climate Change on Human Health (EMED 234), now in its fourth year. Since then, I’ve been increasingly involved in climate and medicine at Stanford and in my own professional ophthalmology society.
How have you experienced the impacts of climate change in your own specialty of ophthalmology?
There are many ways. Ocular allergies have increased in severity and longevity. These allergies used to be seasonal, but are now year-round in many cases. Air pollution is increasing eye irritation from dry eyes. Increased trauma from extreme weather events is impacting ours as well as almost every specialty. Trachoma and other infectious diseases of the eye are also expected to increase, with vectors like flies and mosquitoes thriving in warming climates.
Climate change impacts every specialty, from increases in injury and illness to the ways people access care during natural disasters. We have to find ways to adapt and address these challenges that are going to be happening with increasing frequency.
What change and progress have you seen since these efforts began in 2019?
Around the same time I was getting involved, a Stanford Climate and Health student group formed. I started advising students within that group who were interested in addressing medical education on how to integrate climate change into their curriculum. These students took one course at a time, painstakingly going through the slides of every lecture and finding places where climate change could be integrated. With passion and great effort, they have helped add information on climate change to several Stanford courses, from cardiology to women’s health. Daniel Bernstein, MD, Associate Dean for Curriculum and Scholarship, and Dr. Preetha Basaviah, MD, Assistant Dean of Pre-clerkship Education, were among the school of medicine leaders who were impressed by the students’ efforts and supported incorporating their suggestions into the curriculum.
Meanwhile, the Global Consortium on Climate Change and Health Education at the Columbia Mailman School of Public Health has created an incredible toolkit of educational materials, with objectives, references, and cases vetted by top professors from around the world. A student team and I, along with Clinical Assistant Professor of Radiology Dr. Preeti Sukerkar, are now making recommendations for how to integrate these materials into every preclinical course at Stanford — with the support of Stanford Medicine’s deans. We are really in the thick of it now — it’s very exciting.
How can climate change be incorporated into higher levels of medical education?
Climate change is so new in medical education that many professors simply didn’t learn about this during their training. In preclinical education, we can provide professors with slides and other resources on these topics, but it’s a more challenging culture shift for residencies and clerkships.
At Stanford, we’ve connected with a clerkship course that features lectures on special topics, and we’ll be providing an all-day course on climate and health on April 21. We’ve also worked with Dean Larry Katznelson to integrate climate change into residency programs, and several residents have taken on quality improvement projects related to sustainability. The Center for Innovation in Global Health is leading an initiative to develop clinical case studies on climate change in partnership with the University of Washington – a new project called “Medicine for a Changing Planet” that will be available soon.
One way we can support practicing physicians is through their professional organizations. Societies for various specialties can make statements on sustainability and offer resources to doctors. For instance, my specialty has created a website, EyeSustain.org, which offers resources to make ophthalmic care and surgery more sustainable. I also collaborated with the Center for Innovation in Global Health to create a web page with a wealth of sustainability resources for medical providers.
We can also include questions about climate change on board exams. Lisa Patel, MD, a Stanford pediatrician and national leader in climate change and medicine, has helped get questions about climate change onto pediatric recertification exams.
What’s your vision for how medical education will look five years from now, in regard to climate change?
Our goal is to integrate climate change and health and health equity into every preclinical course and every pre-residency program at Stanford and beyond. I’d like to see questions related to climate change on all board exams and every standardized test that physicians have to go through to be board certified. Until that happens, it won’t be taken seriously enough.
Physicians have an opportunity, as some of the most trusted voices out there, to be advocates for mitigating and adapting to climate change for the health of our patients. Here at Stanford, we’re making progress, but I’d love to see us become a national leader in climate change and health education — with a center or initiative to rival UC’s Center on Climate, Health, and Equity.
We’re well positioned to do so with the creation of the Doerr School of Sustainability, and I encourage anyone interested to get involved. Students can join the Climate and Health group. Faculty members can contact me to join Stanford’s Clinicians’ Task Force for Climate, Health, and Equity or explore the university-wide Human & Planetary Health Initiative. If you’re a medical professor, please integrate these topics into your courses and seek additional resources through organizations such as Physicians for Social Responsibility, The Global Consortium on Climate Change and Health Education, the Medical Society Consortium on Climate and Health, or your specialty’s professional organization.