Attitudes of US Emergency Medicine Program Directors Towards the Integration of Climate Change and Sustainability in Emergency Medicine Residency Curricula

Background: Climate change affects hospital operations and the conditions and rates at which people seek treatment. Emergency physicians are relied upon to treat climate-related conditions and meet surges in demand. Educators have called for integrated education on climate change to better prepare physicians. However, the attitudes of United States (US) emergency medicine (EM) residency educators on climate change in the curriculum remains unknown. Methods: An initial pilot survey was developed and validated to assess US EM program directors’ attitudes towards the inclusion of sustainability and climate change in resident education. Likert scales were analyzed as a psychometric response to specific domains of residency directors’ attitudes towards climate change and sustainability importance and their inclusion in EM residency training. Concordance of Likert scores for questions on sustainability versus climate change were compared via Wilcoxon matched pairs signed rank test. Scores were compared across demographics, geographic location, political affiliation and self-reported knowledge of sustainability and climate change with one-way ANOVA analyses. Results: Seventy-five survey responses were received, with greatest representation from the Northeast and Great Plains/Midwest. Most participant's self-identified political leanings were liberal (43%). Respondents indicated that most programs do not include climate change education (90.3%). The median level of agreement with “climate change is an important issue for EM physicians” on the 9-point Likert scale was 6 (IQR= 1, 8) and for sustainability was 7 (IQR = 6, 9). The median level of agreement for “climate change should be included in EM curriculum” was 3 (IQR = 1, 6) and for sustainability was 6 (IQR = 5, 8). Responses were statistically different across political leanings and gender. Conclusion: While most program directors sampled believe that climate change and sustainability are important to EM, agreement with the importance of the inclusion of climate change in EM curricula was lower. Currently, climate change is not discussed in the majority of EM training programs across the United States. While low response rates limited generalizability, hypotheses were generated including potential differences in receptivity by educator age and gender.