Student participation in accelerated experience-based co-design for healthcare decarbonisation education: a focused ethnographic study

Abstract Background Pre-registration health professional students receive limited education on sustainable clinical practice within healthcare. Education on healthcare decarbonisation, a key strategy for reducing the environmental impact of healthcare delivery, also remains underdeveloped within many curricula. Co-designed e-resources offer a practical approach to help address this gap; however, their effectiveness depends on being relevant, engaging, and grounded in students’ experiences. This study aimed to co-design an e-resource on healthcare decarbonisation using an Accelerated Experience-Based Co-Design (AEBCD) approach with an embedded focused ethnography. Methods An adapted four stage AEBCD approach was used. Four co-design workshops were conducted over four months with interdisciplinary health profession students (nursing and pharmacy). An embedded focused ethnography captured social, cultural, and interactional dynamics through observational researcher field notes. Artefacts and post-workshop focus groups informed iterative development and explored participants experiences of co-design. Field notes were analysed using Rapid Qualitative Inquiry (RQI) and focus groups were analysed thematically. Results Fifteen pre-registration nursing and pharmacy students participated in the workshops. The co-design process resulted in a four-module gamified e-resource on healthcare decarbonisation. Three overarching themes were identified during post-workshop focus groups were: (1) increasing agency and confidence in action, (2) fostering interdisciplinary collaboration and shared purpose, and (3) the value of structured facilitation and tangible outputs. Students reported enhanced engagement, ownership, and perceived readiness to apply sustainability principles in future professional practice. Conclusion The AEBCD approach provided a robust and participatory framework for co-designing a learner-centred e-resource on healthcare decarbonisation. The integration of focused ethnography strengthened understanding of how co-design processes shaped engagement and decision-making, ensuring that stakeholder experiences directly informed both content and delivery. This combined methodological approach offers a transferable process for integrating AEBCD with focused ethnography, strengthening the visibility, reflexivity, and reproducibility of co-design in health professions education.