Competencies and learning outcomes for healthcare professionals in climate change and sustainability: A protocol for a scoping review

Introduction

The planetary crisis, comprising climate change, biodiversity loss, and pollution¹, is recognised as a serious threat to human health^2,3. Impacts on human health include increases in vector-borne diseases, health-related illnesses and mental health conditions^4–6. Paradoxically, the healthcare sector responsible for treating these illnesses contributes to 4.4% to 5.2% of global greenhouse gas emissions^7,8. Healthcare systems have an important role in responding to the challenges of the planetary crisis (e.g. addressing the changing disease burden) and moving towards more sustainable ways of delivering care. Specifically, healthcare professionals have a pivotal role in adapting to, and mitigating against, the health impacts of this crisis.

To undertake this role, healthcare professionals must be equipped with knowledge, attitudes and skills in climate change and sustainability (CC&S). The knowledge, skills and attitudes required of healthcare professionals can be described in different ways, including as a framework of multiple competencies. A competency can be defined as “a learnable, durable, and measurable ability to execute a specific, integrative task that is a part of the full range of tasks that constitute the ... profession. It is a generalized ability that may vary somewhat, depending on the context”⁹. Competency frameworks outline what an individual is expected to be able to do in their practice¹⁰. Alternatively learning outcomes, which are defined as “broad statements of what is achieved and assessed at the end of a course of study”¹¹, may be used. Curricular frameworks include learning outcomes and more detailed information about content and approaches to curriculum delivery.

There have been several calls for the development of competency frameworks in CC&S across healthcare professions¹². In response to these calls, organisations have worked to define competencies and learning outcomes both for single healthcare professions and for all healthcare professionals. Examples include the Canadian Federation of Medical Students Health and Environment Adaptive Response Task Force (CFMS HEART)¹³ and the Sustainable Healthcare Education network¹⁴. With this increased body of work, there is a need to identify and synthesize the breadth of competencies, learning outcomes and curricular frameworks that have been developed internationally. The interprofessional nature of contemporary healthcare practice demands that the learning needs of the workforce to respond to the planetary crisis be considered as a whole. Without a comprehensive summary, there is a danger of duplication of efforts and missed opportunities to learn from best practices. A review would also help to identify gaps in the literature and areas for further development.

Previous reviews have aimed to summarise the literature in this area. A review by Parker et al.¹⁵ aimed to synthesise the literature on competencies in CC&S for all healthcare professionals. The review identified 23 articles conducted before 2018 that outlined suggested competencies for healthcare professionals. All included articles were conducted in four countries in the Global North and 70% of articles related to nursing and medicine. A recent review by Visser et al.¹⁶ summarised literature on planetary health in medical education only, categorising learning objectives in this area into eight themes as part of the review. The authors noted that most articles were published in 2020 or after and were predominantly conducted in North America and European countries. The authors recognised a limitation of their review as missing literature from other healthcare professions. Given the recent and rapidly-evolving nature of the literature, an up-to-date review focused on all healthcare professions is necessary. Furthermore, these reviews neglected to focus on the rationale and methods for the development of competencies and learning outcomes which would enable insight into their quality.

Review question

This scoping review will summarise the competencies, curricular frameworks and learning outcomes in climate change and sustainability that have been proposed internationally for healthcare professionals, as well as information on the rationale and processes involved in developing these competencies, frameworks and learning outcomes.

The primary research question is:

What competencies, curricular frameworks and learning outcomes in climate change and sustainability have been proposed internationally for all healthcare professionals?

The secondary research questions are:

Inclusion criteria

The Participants, Concept and Context (PCC) framework was used to develop the research question and to inform the inclusion and exclusion criteria¹⁷.

Methods

A scoping review was chosen as the most appropriate design for this study. As the review aimed to understand what competencies, curricular frameworks and learning outcomes are in existence and how they have been developed, a scoping review was deemed relevant over alternative review designs¹⁹.

The scoping review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews¹⁷. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews (PRISMA-ScR) will be followed when reporting the review²⁰. The review will follow the six-step methodology proposed by Arksey and O Malley²¹, with updates by Levac²². These steps are (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting the data, (5) collating, summarising and reporting the results, and (6) consultation exercise with stakeholders. This scoping review protocol was registered on the Open Science Framework (https://osf.io/vnx2g). The protocol was reported in line with the best practice guidance and reporting items for the development of scoping review protocols²³ (See Appendix 1 in Extended data).

Study status

At the time of publication, the review is at the full-text screening stage.

Discussion

This review will identify and synthesise the available evidence on competencies, curricular frameworks and learning outcomes in climate change and sustainability (CC&S) for healthcare professionals. This review will highlight gaps in the literature and highlight areas for future development. The findings will be used to inform the development of a set of core competencies in CC&S for all health professions. The strengths of this review include the comprehensive search strategy, methodological rigour and consultation with key stakeholders to ensure the relevance and applicability of the findings.

The findings of this review will be published in a peer-reviewed journal. We will disseminate the findings at national and international conferences and at knowledge-sharing events. We will also produce a summary of the findings for our key stakeholders.