HEART

Major Reports

GHP Handbook 2012-2013

GHP Final Report 2012

Minutes

Aboriginal Health SWG - Minutes

Reports

CFMS Global Health Program September 2009 Report. CFMS Global Health Program, September 2009.

Update: IFMSA August Meeting 2009. Bev Wudel, Global Health Liaison, CFMS, August 2009.

CFMS Global Health Program April 2009 Report. CFMS Global Health Program, April 2009.

Update: IFMSA March Meeting 2009. Brianne Hudson, VP Global Health, CFMS, March 2009.

CFMS Global Health Program Report, January 2009. CFMS Global Health Program, January 2009.

Resource Documents

Preparing Medical Students for Electives in Low-Resources Settings: A Template for National Guidelines for Pre-Departure Training. AFMC Global Health Resource Group and CFMS Global Health Program, May 2008.

Global Health in Canadian Medical Education: Current Practices and Opportunities. Izadnegahdar et al., Academic Medicine, Vol 83, No. 2, February 2008.

Towards a Medical Education Relevant to All: The Case for Global Health in Medical Education. A Report of the Global Health Resource Group of the Association of Faculties of Medicine of Canada, April 2006.

Developing Global Health Curricula: A Guidebook for US Medical Schools. A Collaboration of AMSA, GHEC, IFMSA-USA, and R4WH. 2006.

Who is CFMS HEART?

The Health and Environment Adaptive Response Task force (HEART) is a group within the Canadian Federation of Medical Students (CFMS) that was established in 2016 to help coordinate advocacy efforts among Canadian medical students regarding current issues in environmental health and climate change. This has included:

Creating Canada’s first ever comprehensive set of curriculum competencies on planetary health and evaluating their integration across the country

Partnering with Project Green Healthcare to support student-led sustainable healthcare initiatives

Leading conversations on climate justice through speaker series, awareness initiatives, and direct action in political advocacy campaigns and protests

Building and sustaining an engaged community of healthcare learners passionate about building a healthy future for our patients and communities

2022-2023 HEART Committee Members:

Co-Chairs:

Julia Sawatzky (University of Alberta), Pardeep Gill (McMaster University)

Committee Members:

Emma McDermott (Dalhousie University), Sumara Stroshein (University of British Columbia), Ericka Iny (McGill University), Omar Salem Taboun (Western University), Alanna Jane (Queen’s University), Peri Ren (Western University), Jessica Chu (Western University), Helen Hsiao (University of British Columbia), Harry Wang (University of Ottawa), Alicia Follett (Memorial University of Newfoundland), Kaothar Koulmi (McGill University), Mahrukh Kaimkhani (University of Calgary), Hillary Hanna (Western University), Mia Wu (Queen’s University), Crystal Ma (University of British Columbia), Yina Shan (University of Toronto), Grace Kuang (University of Toronto).

Stay in touch with Us!

Instagram: @cfmsheart

Facebook: https://www.facebook.com/HeartCFMS

X (Formerly known as Twitter): @CFMS_HEART

Join our newsletter: https://forms.gle/u7HLQiQC3h9H1SBb7

HEART Report

HEART has been working since its inception to incorporate learning of the crucial links between planetary health and human health into medical curricula at all Canadian medical schools. HEART has partnered with the Association of Faculties of Medicine of Canada (AFMC) to incorporate planetary health teaching into all Canadian medical schools’ curricula by the upcoming 2025 curricula refresh nation-wide.

Developed a standardized set of curricular competencies on Planetary Health

The Planetary Health Curricular Competencies (last updated in 2021) are available here. The development process for the competencies is outlined in the infographic below, with the competencies having been modeled after the MCC competencies all Canadian medical schools must teach in order to receive accreditation and the CanMEDS roles for physicians.

Conducted semi-annual national evaluations on the state of Planetary Health Curricula at Canadian Medical Schools

The executive summary of our eight recommendations from the 2021 national re-evaluation can be found here (full report here), and its associated commentary, published in the Canadian Medical Education Journal, can be found here.

The CFMS HEART: National Report on Planetary Health Education 2019 can be found here, and its associated commentary, published in The Lancet Planetary Health, can be found here.

The most recent curriculum evaluation, The 2023 National Update on Planetary Health in Canadian Medical Schools, is available at the following links in English and French.

**This page has not been updated since 2021. It is in the process of being updated. In the meantime, please contact the Director of Global Health at globalhealth@cfms.org if you have any questions about the global health portfolio**

FAQs written by: Arianne Cohen (University of Toronto), Finola Hackett (University of Alberta)

• What do we mean by planetary health?

By planetary health we envision a broad definition that includes more than just traditional environmental and occupational health. This idea was first published in a 2015 Lancet article by the Rockefeller Foundation. They define planetary health as “… the achievement of the highest attainable standard of health, well-being, and equity worldwide through judicious attention to the human systems—political, economic, and social—that shape the future of humanity and the Earth’s natural systems that define the safe environmental limits within which humanity can flourish. Put simply, planetary health is the health of human civilisation and the state of the natural systems on which it depends.”

In brief, planetary health is holistic. It looks beyond meteorological changes to populations, ecosystems, and the resilience of civilization. It demonstrates the importance of health promotion and protection regardless of social or political situations.

Whitmee S, Haines A, Beyrer C, Boltz F, Capon AG, de Souza Dias BF, Ezeh A, Frumkin H, Gong P, Head P, Horton R. Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation–Lancet Commission on planetary health. The Lancet. 2015 Nov 14;386(10007):1973-2028.

• Why should we learn about this if there’s no LMCC objective?

Planetary health intersects with medicine in many different and important ways. While not specifically addressed in all medical school curricula, it is important to understand the impacts of environmental issues like climate change for our patients. The health effects of climate change can be both direct (i.e. heat exhaustion, asthma from pollution) and indirect (i.e. PTSD from a natural disaster). It can also be socially mediated (i.e. population displacement from conflict).

As future physicians, we need to expect, prevent and manage these changes appropriately. According to the Lancet Commission on Planetary Health, health professionals have an essential role to integrate policies, tackle inequalities and reduce the environmental impacts of health systems while increasing resilience to change. It was also stated in a recent paper that “integrating climate change into medical education offers an opportunity for future doctors to develop skills and insights essential for clinical practice and a public health role in a climate-changing world.” It is therefore important for physicians to be aware of climate and the environment and do our part to provide a safe and sustainable future for all.

Note: there is an LMCC objective focused on traditional environmental and occupational health concepts: https://mcc.ca/objectives/expert/key/78-6/. However, note that this does not specifically refer to climate change and does not incorporate the holistic definition of planetary health described above.

• How can I advocate on climate change & environment in my medical school or community?

There are several ways to get more involved in your own communities. The first is by joining the HEART Network. This network comprises members of HEART and interested individuals, clubs and groups from medical schools across Canada. We send out a monthly newsletter with initiatives, updated articles and other relevant resources. We can also connect you with local representatives or other Network members at your school. If you would like to take on a more active role in this network, appointed committee positions for our task force are recruited in the fall of each school year through the CFMS.

You can sign up for the Network at this link: https://goo.gl/forms/r2CEYiuymbMsGilK2 And email heart.cfms@gmail.com if you have any questions!

If you have a great idea that you would like to plan yourself, the CFMS has excellent resources for first-time advocates. You can find our Advocacy Toolkits here: https://www.cfms.org/what-we-do/advocacy/advocacy-toolkit and https://www.cfms.org/what-we-do/global-health/advocacy-toolkit.html

• How might planetary health and climate & environment topics actually fit inside a medical school curriculum?

There are many ways these topics could fit into a curriculum, and each school’s integration may be unique depending on their existing sessions and teaching structure. For instance, HEART has created a case-based group learning module that will be integrated at the University of Alberta next year. It includes a pre-session survey and preparation that involves watching two short videos, two cases for discussion: one individual patient-based in family medicine setting, and one community-based in a public health consultancy setting, and finishes with a short wrap-up lecture. This is complemented by a separate stand-alone session, a two-hour didactic lecture on the health impacts of climate change.

Other options include adding a slide or two to existing sessions: such as links between air pollution and health in a lecture on pulmonary diseases, on climate related displacement and migration in a session on refugee and migrant health, on heat related illnesses or extreme disaster events in emergency medicine teaching… the possibilities are endless. Suggested links to existing topics or courses are highlighted in red within the competencies document.

• What’s already been done at different schools?

There are already some schools that either have already started teaching sessions on this topic, are looking to integrate them within the next year. Other schools have created specific portfolios who host non-mandatory student-run extracurricular sessions. Because the current status is so variable, HEART has conducted a national survey on the current status of each school in 2019, to be made available in the near future. You can continue to help with this, as we plan to re-survey each school in 2020! One curriculum assessment survey per school is to be completed, and you can work with other students and with faculty at your school in order to provide the most comprehensive and accurate responses.

1) Project Green Healthcare/Projet Vert la Santé

Project Green Healthcare/Projet Vert la Santé (PGH/PVLS) is the first-of-its-kind national community of practice of medical student teams leading green change in the Canadian healthcare system. Founded in October 2020, selected teams receive funding and mentorship from physician and non-physician climate action leaders through the Canadian Association of Physicians for the Environment (CAPE) and the Canadian Coalition for Green Healthcare (CCGHC) to execute a needs assessment and quality improvement project to promote healthcare sustainability.

Projects can be in-hospital initiatives, community initiatives, or focus on medical education, so long as they contribute to the goal of net-zero healthcare in Canada. Our initiative is also an excellent opportunity to meet like-minded thinkers in the healthcare sustainability space; we host community of practice meetings at least three times a year with the entire PGH/PVLS cohort for you to learn from selected field experts and share project progress with other PGH/PVLS participants. Project Green Healthcare/Projet Vert la Santé is sponsored by the CFMS through the Strategic Innovation Fund. If you have any questions, please email us at projectgreenhealthcare@gmail.com. We highly encourage any medical student team to email us to inform us of your interest in applying; we would be more than happy to provide feedback and support to your applications.

2) Primer on Greening Healthcare for Healthcare Students

To aid healthcare trainees in developing high-impact, evidence-based quality improvement projects, we are pleased to make available our Primer on Greening Healthcare for Healthcare Students! In this document, you will find some background information on the environmental footprint of the Canadian and international healthcare systems, an extensive list of healthcare sustainability project ideas that are most amenable to trainee leadership, and a summary of essential steps to complete these projects successfully. We hope that this toolkit will be useful to prospective PGH/PVLS student teams and other stakeholders interested in reducing the environmental impact of their healthcare systems.

French version/version française: Primer du HEART de la FEMC sur l’écologisation des soins de la santé pour les étudiants en santé.

Applications for the 2022-2023 PGH cohort are now closed. Applications for the 2023-2024 PGH/PVLS cohort will open in Feb 2024.

2022-2023 Student Cohort

The 2022-2023 academic year was yet another excellent year for PGH/PVLS! Over the past year, we had 6 teams spanning spanning 5 Canadian provinces. Should you wish to contact any of these teams, please reach out to projectgreenhealthcare@gmail.com

Northern Ontario School of Medicine - Kapuskasing ON - Implementing PPE recovery boxes at Sensenbrenner Hospital.

"Our team worked with our clerkship community in Kapuskasing, ON over the last year to better understand the intersection of rurality, healthcare, and the climate crisis. We have been working to complete a carbon footprint analysis of rural surgical suites and have implemented a PPE recovery initiative to repurpose used PPE. Rural communities are disproportionately affected by the impacts of climate change, however, the majority of carbon footprint analyses and green healthcare initiatives do not take into account the unique demands imparted by these environments. Our goal is to develop a rurally conscious, place-based toolkit for clinicians practicing in remote and rural areas to enact climate conscious initiatives. Our team included Katie Zugic, Jamie Thompson, Kristiina Frechette, Martine Fecteau, and Sebastien Labelle."

University of Saskatchewan - Saskatoon SK - USask Green Team - Implementing PPE recovery boxes within the Saskatchewan Health Authority

"The team consists of two second-year medical students, a passionate pathologist and a family doctor eager to make an impact. The team has been working on a PPE recycling project with the hopes of decreasing our healthcare impact on the climate."

University of Ottawa - Ottawa, Ontario - Winchester District Memorial Hospital Green Team - Launching a green team at a rural hospital

"Medical student Valeria Dimitrova and past CFMS lead Nathan Chiarlitti are working with the Green Team at the Winchester District Memorial hospital to implement many different events and help reduce carbon emissions within the hospital"

University of Manitoba - Winnipeg, Manitoba - Manitoba Green Team - Pushing for green change in the Winnepeg hospital network

"Our team is made up of a group of medical students from the University of Manitoba who are dedicated to contributing to environmental sustainability. Our team’s overall goal is to push for green changes at our local hospitals and to contribute to the goal of net-zero healthcare"

Dalhousie University - Halifax, Nova Scotia - Dal Med Green Team - Establishing a green team network in Maritime hospitals (www.dmss.ca/green-team.html)

"The Dal Med Green Team is in its third year of the PGH Program and has grown to include 13 Dalhousie Medical Students in both Nova Scotia and New Brunswick. Please don't hesitate to reach out if you are looking to connect with low carbon healthcare initiatives in the Maritimes"

Memorial University - St. John’s, Newfoundland - MUN Medicine Code Cycle Team - Promoting and supporting active transport in Newfoundland

“We are MUN Medicine's Code Cycle team for PGH. Our team is working towards reducing Newfoundland's carbon footprint by promoting human-powered active transportation, such as biking and walking, among the healthcare sector in the City of St. John's. We have organized two annual car-free weeks to the hospital and medical school.”

2021-2022 Student Cohort

We are incredible proud of our 2021-2022 cohort! Please see below for the project descriptions of the 11 teams spanning 9 medical schools across 7 Canadian provinces that have participated in our program during that year. Should you wish to contact any of these teams, please reach out to projectgreenhealthcare@gmail.com.

Dalhousie University - Halifax, Nova Scotia - Dal Med Green Team - Establishing a green team network in Maritime hospitals (www.dmss.ca/green-team.html)

"The Dalhousie Medicine Green Team was founded by Dalhousie University medical students with a shared interest in environmental health and sustainability. We designed this network with the intention of promoting green health care initiatives within our learning and working environments across our Maritime provinces. We hope to bridge connections between students, healthcare providers, and other stakeholders who are eager to participate in healthcare sustainability projects. Through interprofessional collaboration we hope to inspire change at all levels of health care both locally and regionally."

Memorial University - St. John’s, Newfoundland - MUN Medicine Code Cycle Team - Promoting and supporting active transportation in healthcare

“We are MUN Medicine's Code Cycle team for PGH. Our team is working towards reducing Newfoundland's carbon footprint by promoting human-powered active transportation, such as biking and walking, among the healthcare sector in the City of St. John's.”

McGill University - Montreal, Quebec - Inspire Sustainability - Launching an environmental sustainability website for healthcare trainees (www.inspire-sustainability.com/)

"Inspire Sustainability provides medical students with a centralized website containing: easy-to-use resources, educational modules, a database of climate action champions in clinical and research fields, and advocacy tools regarding planetary health.”

McGill University - campus Gatineau - Gatineau, Québec - CHLSD Community Garden - Creation of a community garden in a long term care home

"EnviroSanté, the Outaouais Campus branch of the McGill Medical Students’ Society (MSS) Sustainability Committee, implemented a community garden at a local long-term care home (CHSLD). Inspired by the hardships faced by CHSLD residents during the pandemic, along with the desire to create a foundation for sustainability initiatives, this project was created. Supported by Projet Vert la Santé, the community garden aims to mobilize students and healthcare professionals alike in greening practices."

Université de Montréal, campus Mauricie - Trois-Rivière, Québec - Compostage collectif du Comité MedVert - Implementation of a collective compost system

"The Trois-Rivière town does not offer municipal compost, so we decided to implement a collective compost system for medical students on campus since the latter is directly adjoined to the hospital and most students' housing. By partnering with a local compost firm and by enabling structured training on composting and compost use, we were able to implement a sustainable system. We hope to further expand the project with the hospital and community garden in the future."

University of Ottawa - Ottawa, Ontario - The Ottawa Hospital Green Team - Hospital carbon footprint analysis

“The healthcare sector is a large contributor of GHG emissions, exacerbating chronic health conditions. Our project quantifies the annual amount of GHG produced by TOH's General Hospital and makes recommendations to mitigate our output.”

University of Ottawa - Ottawa, Ontario - Children’s Hospital of Eastern Ontario Green Team - Waste audit in a Pediatric Emergency Department

“We are one of Project Green Healthcare’s University of Ottawa teams. With Dr. Curtis Lavoie and help with Environmental Services, we’re creating a new waste management strategy for CHEO’s emergency department. We are using evidence-based strategies to implement new signage and recycling stations to reduce contamination, increase recycling and reduce waste. We expect to calculate how our strategy will reduce CHEO’s contribution to greenhouse gases as well as make our strategy easy for other hospitals to implement when looking to reduce their carbon footprint!”

Queen's University - Kingston, Ontario - Queen’s Medicine Environmental Advocacy in Medicine Interest Group - Promoting active transportation in healthcare

“The PGH Team at Queen’s University has recently launched our first initiative, the Active Transportation Campaign. Our campaign involved the promotion of biking and walking to work for surrounding hospitals, including Kingston General Hospital, Hotel Dieu Hospital, and Providence Care Hospital. We have also created and disseminated infographics that explain the benefits of active transportation on health, the environment, and climate change.”

Western University - London, Ontario - Western Green Team - Improving waste management in the PICU

“We are second year med students at Western working on a project streamlining waste management in a Pediatric Unit. By placing recycling bins and educational posters on the hospital floor, we hope to serve as a model for others to improve green habits.”

University of Manitoba - Winnipeg, Manitoba - Manitoba Green Team - Reducing waste in the operating room

“"Our team is made up of a group of medical students from the University of Manitoba who are dedicated to contributing to environmental sustainability. Our team’s overall goal is to push for green changes at the Health Sciences Centre (HSC), the largest hospital in Winnipeg, and to contribute to the goal of net-zero healthcare. Our team is currently tackling multiple potential avenues for achieving these goals. So far, these include setting up PPE recycling bins, reprocessing single use medical equipment, recycling PVC plastics, educating staff on what things are recyclable, and reducing natural gas usage. We are currently discussing with various sustainability leads and attendings throughout the hospital to determine which of these are most feasible and how to best proceed with implementing these plans. We are also in communication with multiple companies that specialize in recycling medical supplies in order to establish the necessary industrial partnerships for rolling out our plans."

University of British Columbia - Vancouver, British Columbia - Planetary Healthcare Lab - Developing climate-centered resource stewardship modules for internists and surgeons

“Over ordering of medical investigations directly impacts the triple bottom line of healthcare systems: it increases costs, causes patient inconvenience and at times harm, and contributes to the considerable environmental footprint of hospitals. Our team hopes to create accessible, innovative, and evidence-based educational resources focusing on the environmental footprint of inappropriate testing. These resources will then be integrated into the curricula and provide standard training in the basics of the climate impacts of healthcare delivery and tailored content on appropriateness of care and stewardship. Using the expertise of our team members, we will be focusing on general surgery and internal medicine to start. While these resources will initially be introduced at UBC, we plan on creating material that can be disseminated to other medical schools in Canada and beyond.”

2020-2021 Student Cohort

We are incredibly proud of our inaugural 2020-2021 PGH/PVLS cohort, which included over 50 medical students distributed across 6 medical schools in 5 Canadian provinces. Please see below for an infographic summarizing the projects developed by our 7 PGH/PVLS teams during the years of 2020-2021. Should you wish to contact any of these teams, please reach out to projectgreenhealthcare@gmail.com

Publications

Our teams' initial progress has been featured in the CFMS 2021 annual review. Click this link to access our article, found on pages 12 and 13. Our work has also been featured in the Hospital News.

We have also provided guidance for meaningful healthcare trainee engagement to achieve net-zero in healthcare in The Lancet Planetary Health and the Journal of Climate Change and Health

Resources from PGH/PVLS Teams

1) McMaster University Greener Gases website: https://www.greenergases.ca/

- Details the environmental impacts of anesthesia and includes an open-access starter pack to building local campaigns to reduce the carbon footprint of anesthetic gases including an infographic, white paper, powerpoints, and anesthesia machine labels.

2) University of Toronto Choosing Wisely in Primary Care Module: See here for their module PDF

- An online module detailing the environmental co-benefits of implementing the Choosing Wisely Canada Primary Care guidelines to reduce unnecessary, low-value laboratory investigations, imaging, pathology and treatments.

3) University of Calgary X McGill University Climate Wise slides: https://www.cwslides.com/

- A set of open-access slides that summarize the health impacts of climate change and document evidence-based opportunities for healthcare professionals to engage in climate change adaptation and mitigation and promote planetary health.

4) McGill University Inspire Sustainability website: https://inspire-sustainability.com/

- A centralized website containing: easy-to-use healthcare sustainability resources, educational modules on healthcare sustainability, a database of climate action champions in clinical and research fields, and advocacy tools regarding planetary health.

5) Queen’s Medicine Environmental Advocacy in Medicine Interest Group Active Transportation Infographics:

Contact

We look forward to building this national network with you and contributing to making a more environmentally sustainable future!

Please contact us at: projectgreenhealthcare@gmail.com

If you are a CAPE physician or CCGHC health sector leader and are interested in participating in or learning more about this project, please fill in this google form.