Evaluating the impact of a longitudinal, integrated climate change, health, and environment curriculum in undergraduate medical training at Harvard Medical School

Climate change, air pollution, and ecological degradation are defining public health and health equity challenges of our time. Efforts to integrate and evaluate climate change curriculum in medical education is still nascent. Herein, the authors presented findings of a longitudinal evaluation of such curriculum at Harvard Medical School (HMS). Authors designed and administered competency-based and course content-specific pre/post surveys to first-year HMS students to evaluate the impact of the climate change, environment, and health curriculum. Survey development used an adapted Delphi process to solicit feedback from experts at HMS, students, and the Office of Medical Education and included seven-point Likert scale questions (dichotomized and analyzed using Fisher’s exact test). Once data saturation was reached, we conducted a thematic analysis to identify key themes and selected illustrative quotes to support each theme. Surveys were administered to the first-year class of 134 HMS students from August 2023 to December 2024. Response rates varied from 21/132 (15.7%) to 119/134 (82.1%). Comparing pre-to post-course responses, competency-based surveys demonstrated statistically significant improvements in 19/20 items (95.0%) and course content-specific surveys showed statistically significant improvements in 20/29 items (69.0%). The vast majority of open-ended responses affirmed the curriculum’s value. This study demonstrated that the curriculum significantly improved medical students’ self-perceived competence in climate-related topics. While statistically significant improvements were observed, results are based on self-reported perceptions and may be subject to response bias due to response rate attrition during the study. No formal validation process was conducted during survey development. As climate and health equity education continues to expand rapidly, often with little standardization, these findings offer insight for other institutions seeking to build measurably impactful curricula, and ultimately prepare medical students to more effectively deliver patient care on a warming planet.