Climate change, air pollution, and ecological degradation impact health through numerous, complex mechanisms. To train future physicians to understand these impacts, medical schools can deliver longitudinal climate curricula in undergraduate medical education, but the field remains nascent. This report describes the development, implementation, and evaluation of the longitudinal, integrated Climate Change, Environment, and Health curricular theme and novel competency framework at Harvard Medical School (HMS). A group of HMS students collaborated with faculty to integrate climate content into the pre-clerkship curriculum. The team subsequently pursued institutional recognition as a formal HMS curricular theme and created a new competency framework that guided curriculum integration mapping and evaluation tool development. The competencies cover the impact of climate change, air pollution, and ecological degradation on health in the context of historical and structural inequities and explore the role of healthcare in contributing to both climate change and solutions. A retrospective, eight-item survey using a seven-point Likert scale and two open-ended questions was administered at the end of the pre-clerkship curriculum. HMS approved a required, four-year Climate Change, Environment, and Health curricular theme in January 2023. Survey data from 100/134 (74.6%) study participants showed that most students agreed (somewhat agree/agree/strongly agree) the curricular theme was valuable (76.0%) and improved their understanding of the health impacts of climate change (80.0%). Most students agreed that their abilities in the five competencies improved because of exposure to the curricular theme. Qualitative comments indicated that students found the curriculum valuable, and also provided constructive feedback. Efforts to expand the curriculum to all four years of medical school and conduct further evaluation continue. Further scholarship is needed to present different curricular approaches and competency frameworks, which can ultimately support effective training of future physicians to understand and respond to the impacts of climate change on health and health equity.

The looming threat of climate change urgently calls for reimagining unsustainable systems and practices, including academia’s culture of emissions-intensive travel. Given that medical educators are uniquely invested in the future of the trainees they represent, this reimagination can and should begin with medical education. Making significant reforms to the application process has historically been challenging, but the COVID-19 pandemic catalyzed an abrupt shift from in-person to virtual interviews for medical school, residency, and fellowship. Programs and applicants alike demonstrated resilience, innovation, and satisfaction in adapting to virtual interviews during 2 full application cycles. This restructuring has prompted consideration of the necessity of environmentally costly, expensive, and time-consuming cross-country travel for single-day interviews. However, evolving conversations about the future of medical training interviews have not prioritized environmental impact, despite the sizeable historical emissions generated by interview-related travel and the incompatibility between ecological damage and population health. Beyond environmental impact, virtual interviews are more equitable, with significantly fewer financial costs, and they are more efficient, requiring less time off from school or work. Many concerns associated with virtual interviews, including interview inflation and limited applicant exposure to programs and their surrounding areas, can be addressed via creative and structural solutions, such as interview caps and in-person second-look programs. The medical training interview process underwent a forced restructuring due to the unprecedented disruption caused by COVID-19. This moment presents a strategic inflection point for medical education leadership to build on the momentum and permanently transform the process by focusing on sustainability and equity.

The surgical burden of neglected tropical diseases (NTDs) is set to rise alongside average temperatures and drought. NTDs with surgical indications, including trachoma and lymphatic filariasis, predominantly affect people in low- and middle-income countries where the gravest effects of climate change are likely to be felt. Vectors sensitive to temperature and rainfall will likely expand their reach to previously nonendemic regions, while drought may exacerbate NTD burden in already resource-strained settings. Current NTD mitigation strategies, including mass drug administrations, were interrupted by COVID-19, demonstrating the vulnerability of NTD progress to global events. Without NTD programming that meshes with surgical systems strengthening, climate change may outpace current strategies to reduce the burden of these diseases.

Surgery, anesthesia, and obstetric (SAO) care is quickly being recognized for its critical role in cost-effectively improving global morbidity and mortality. Six core indicators for SAO capacity were established in 2015 by the Lancet Commission on Global Surgery (LCoGS) and include: SAO provider density, population proximity to surgery-ready facilities, annual national operative volume, a system to track perioperative mortality rate, and protection from impoverishing and catastrophic expenditures. The surgical capacity of Kenya, a lower-middle-income country, has not been evaluated using this framework. Our goal was to review published literature on surgery in Kenya to assess the country’s surgical capacity and system strength. A narrative review of the relevant literature provided estimates for each LCoGS indicator. While progress has been made in expanding access to care across the country, key steps remain in the effort to provide equitable, affordable, and timely care to Kenya’s population through universal health coverage. Additional investment into training SAO providers, operative infrastructure, and accessibility are recommended through a national surgery, obstetric, and anesthesia plan. Key Findings While more than 90% of Kenya’s population lives within 2 hours of a health care facility, this statistic neglects reasons other than distance, such as socioeconomic factors, that prevent a patient from reaching timely surgical care, especially if nearby hospitals are not equipped for certain surgeries. Out-of-pocket expenses for perioperative needs, including transportation, food, and housing, as well as lost productivity for the patient and any caretakers, contributes to a persistently high risk of impoverishing or catastrophic expenditure for surgical patients. Key Implications A standardized, international framework with metrics that indicate success is needed for the evaluation of progress in surgery, obstetrics, and anesthesia infrastructure, but the incorporation of national priorities and measures of success is critical to achieve equitable development.

The establishment of the Global Programme to Eliminate Lymphatic Filariasis (GPELF) to stop the transmission of infection has significantly reduced the incidence of lymphatic filariasis, a debilitating mosquito-borne neglected tropical disease. The primary strategies that have been employed include mass drug administration (MDA) of anthelminthics and morbidity management and disability prevention (MMDP). While some countries have been able to reach elimination status in Africa, there is still active transmission of LF in Zambia. The nematode responsible for the disease is Wuchereria bancrofti, which is transmitted by Anopheles mosquitoes. To alleviate the suffering of those infected by the disease, the Zambian Ministry of Health launched a program to eliminate LF as a public health problem in 2003. This project reviewed the efforts to achieve the elimination of LF in Zambia, past and present government policies, and the anticipated challenges. MDAs have been conducted since 2014 and coverage has been between 87% and 92%. Zambia has now moved towards pre-transmission assessment surveys (PRETAS) and transmission assessment surveys (TAS). MMDP is a major priority and planned to be conducted between 2022 and 2026. COVID-19 presented a new challenge in the control of LF, while climate change, immigration, co-infections, and funding limitations will complicate further progress.

Zambia is among the countries making major progress in limiting cases of the neglected tropical disease lymphatic filariasis on the path to reaching global elimination targets. For this trend to continue, it is essential for strategies and policies targeting the disease in Zambia to be based on the most recent and relevant literature. The scope of research on lymphatic filariasis in the Zambian context is currently poorly understood. Therefore, this study describes a scoping review protocol which will be used to analyze the body of literature on lymphatic filariasis in Zambia. The scoping review protocol was developed following the PRISMA reporting guidelines for Scoping Reviews (PRISMA-ScR) and the JBI Scoping Review Methodology Group’s guidance on conducting scoping reviews. In consultation with a research librarian, these guidelines will be applied to a literature search of articles from peer-reviewed journals, or government and international regulatory bodies using PubMed, Embase, Web of Science, Cochrane CENTRAL, WHO ICTRP, Pan African Clinical Trials Registry, and ClinicalTrials.gov. Each record will be screened at the abstract and full-text level by two independent reviewers, and results reported via summary statistics. Understanding the current state of research on lymphatic filariasis in Zambia will identify major knowledge and intervention gaps in this context, and serve as a source of information for surrounding countries in the region. As the disease prevalence drops, efforts for elimination will require carefully targeted strategies which can be informed from the literature identified in this protocol.