Environmental sensitization, advocacy and resource-management training in a resource-limited paediatric surgical educational setting

Aim A policy framework for Paediatric surgical training to address sustainable surgical resource utilization and environmental-disease interplay in a low-to-middle income country (LMIC) setting is presented. Methods Using the United Nations Educational, Scientific and Cultural Organization (UNESCO) Education Pillars for Sustainable Development (EPSD), existing and potential integration of environmental education in undergraduate and postgraduate paediatric surgical training is described at an LMIC academic hospital, in conjunction with a narrative review of environmental underpinnings of existing paediatric surgical English literature. Pedagogical techniques are conceptualized to demonstrate the 3-way interactions between paediatric surgical services and social/ built, economic and natural/ climactic environments, on individual and community level. This is illustrated by the context of the surgically managed congenital abdominal wall defect gastroschisis, amongst other examples. Results Gastroschisis is a Paediatric Surgical key topic that highlights the imperative for comprehensive environmentally sensitive patient-orientated care. Some curricular content and LMIC situational awareness already exists in our setting regarding resource stewardship, environmental teratogens and socioeconomic interactions. The local surgical procedure-related carbon footprints and interaction with socio-economic factors are inadequately researched to inform resource management and educational content. Topical paediatric surgical literature and local knowledge, attitude, skills and participation have significant gaps on individual, institutional and community levels, aggravated by a circular interplay between these UNESCO EPSD. Potentially feasible Paediatric Surgery curricular changes to increase environmental focus include explicit standard pedagogical content, behaviour modelling/ modulation and interdisciplinary engagement. Conclusions Paediatric Surgery curriculum and educational and healthcare culture currently convey little environmentally implicit or explicit pedagogical content, and require teaching of skills for critical thinking, research, resource management and organized advocacy.