Integrating planetary health into the continuing professional development and training in family medicine: Protocol for a scoping literature review

Key messages

Ethics

The study does not involve any primary data collection from human or animal subjects. As such, ethical approval is not required for this study.

Patient and Public Involvement

Patients or the public were not involved in the design, or conduct, or reporting, or dissemination plans of our research.

Transparency statement

The lead author confirms that this manuscript is an honest, accurate, and transparent account of the study being reported; no important aspects of the study have been omitted; and that any discrepancies from the study as originally planned have been explained.

Background

The Rockefeller Foundation-Lancet Commission first defined the term “Planetary Health” in 2015 as ‘The health of human civilization and the state of the natural systems on which it depends’¹. This is, and will continue to be, an essential component of the role of the General Practitioner (GP), from the move to reduce greenhouse gas emissions in healthcare to helping tailor patient care to changing climate patterns and increasing natural disasters. Nonetheless, despite the relevance of Planetary Health to General Practice, it remains a topic that is poorly integrated into postgraduate training and continuing professional development.

Although the potential human health cost in relation to unsustainable practice has been acknowledged for over a decade family medicine/general practice is well situated within the healthcare specialties to address these issues². Family medicine holds status within the community, has multiple strong relationships and a holistic approach to medical practice bestows it with a credible and impactful voice to advocate for positive planetary health. Whitmee et al., 2015 describe a ‘safeguarding’ role¹. GPs can engage in meaningful advocacy³ and can be catalysts for impactful change in the field of planetary health, particularly with a view to influencing policymakers; “While policymakers have the major role to play, we [family medicine] can still contribute to making our community and policymakers aware of the threat to health that climate change bring.“⁴. GPs can not only lobby politicians and policymakers but also advocate within the patient population⁵. The primary care relationship helps raise awareness on planetary health issues⁶.

In order to fulfill their role as planetary health advocates and to adopt positive planetary health practice, it is therefore imperative that family medicine physicians are adequately educated in regard to planetary health issues as part of their training and continuous professional development.

We seek to examine what resources are available for GPs and GP trainees that fit this brief. We envisage that this scoping review will outline a growing momentum in Planetary Health education, synthesise various opportunities to further increase their knowledge of Planetary Health and that our findings can be further utilised to inform the ongoing development and improvement of a live Planetary Health catalogue of information and resources hosted by the European Young Family Doctor’s Movement (EYFDM)⁷.

Methods

Stage 1: Identifying the research question

The purpose of this study is to identify the extent to which planetary health has been integrated into postgraduate family medicine training and continuous professional development curriculum, internationally.

Research question: To what extent are planetary health topics integrated into postgraduate GP training schemes and continuous professional development curriculum, internationally?

The question was framed using Population (postgraduate general practice trainees), Concept (planetary health curriculum) and Context (international) approach¹².

Stage 2: Identifying relevant studies

Stage 3: Study selection

The review process will involve two stages of screening: (1) a review of titles and abstracts and (2) a full-text review. During the first stage, two investigators will independently screen the titles and abstracts of all retrieved citations against the inclusion criteria. These criteria will be piloted on a subset of abstracts beforehand to ensure they are sufficiently robust to identify all relevant articles. Articles deemed relevant by either reviewer will proceed to the full-text review. In the second stage, a team of six international investigators will independently evaluate assigned portions of the full-text articles to determine whether they meet the inclusion and exclusion criteria. Rationales for exclusion of studies following the full text review will be carefully recorded. In the event of a disagreement, the adjudication of Reviewer DS will be sought to arrive at a final decision with respect to final study inclusion or exclusion. The eligibility criteria that will be applied when screening can be seen in Table 1. A comprehensive overview of the study selection protocol will be provided via the PRISMA flow diagram¹¹.

Stage 4: Data collection

Using microsoft excel, the research team will design a data collection instrument to capture essential study characteristics. The extracted study characteristics will encompass, but not be restricted to, the year of publication, publication genre (e.g., original research), study design, geographical location, characteristics of the planetary health content taught and theme of the planetary health content taught. Prior to implementation, this instrument will undergo review by the research team and will be pre-tested by all reviewers to ensure accurate capture of information. Data abstraction will be a collaborative effort involving all reviewers independently duplicating the extraction process for all encompassed studies.

Stage 5: Collating, summarising and reporting the results

The data will subsequently be collated to give an overview of the breadth of literature (recommended by Levac et al., 2010) with a summary of the main findings⁹. In light of the expected diversity in methodologies and study populations across the research encompassed within this scoping review, the interpretation of findings will depend upon the nature of the collected data.

Discussion

We envisage that the data analysis is likely to encompass a quantitative component for synthesizing the frequencies/demographics of studies, the sector of health education, the type of course, and the learning objectives/competencies addressed. In addition, a qualitative component will be used to delineate prevalent themes pertinent to planetary health within the realm of postgraduate family medicine education and training. When feasible, outcomes will be classified within the domains outlined by the Planetary Health Education Framework (PHEF), which integrates principles of systems thinking, social justice, and interconnectedness within nature as they relate to planetary health¹⁴.

Declarations