Climate Change in Undergraduate Medical Education: Gaps, Needs, and Opportunities for Curricular Reform

Background: Despite recognition of climate change as a key determinant of health, medical education on climate-health largely remains fragmented, elective-based, and focused more on knowledge than skills. At our institution, the Climate Change in Medicine elective course reaches only a small subset of students. To capture both course-specific outcomes and broader curricular needs, we paired an elective evaluation with a Community Strengths and Needs Assessment (CSNA) and subsequent focus groups. Methods: A mixed-methods study was conducted at a Mid-Atlantic medical school between September 2024 and May 2025. Pre- and post-course surveys were administered to students enrolled in a climate-health elective course to assess changes in knowledge, attitudes, and agency. A CSNA was distributed to the entire student body, and respondents subsequently participated in focus groups. Quantitative data were analyzed using paired t-tests and descriptive statistics; qualitative data were thematically analyzed. Results: Course participants (n = 14) demonstrated significant improvements across multiple domains. Self-reported knowledge increased from 4.21 to 5.28 on a 6-point Likert scale (p <0.001), while objective knowledge scores improved from 62.1% to 77.1% (p = 0.0025). Confidence in discussing climate-health during patient encounters rose from 3.50 to 5.07 on a 6-point Likert scale (p < 0.001), and confidence in advocating for community interventions increased from 3.57 to 4.93 (p < 0.001). Six months post-course students (n= 5) demonstrated persistence in students’ actions and self-efficacy regarding climate. The CSNA (n = 96) revealed limited prior exposure to climate-health education; only 38.5% of students reported at least some knowledge. However, 92.2% supported integrating climate-health into the medical curriculum. Reported barriers included lack of time (74.0%) and lack of confidence in discussing climate-health with patients (52.1%). Focus group participants (n = 14) emphasized the perceived clinical relevance of climate-health, the tension between individual and systemic action, and the need for equity-focused, clinically integrated curricula. Conclusions: This study demonstrates both the effectiveness of a climate-health elective in improving knowledge, confidence, and advocacy, and the significant unmet demand for broader curricular integration. Together, these findings highlight the potential of structured and accessible climate-health education to prepare future physicians.