Shark Tanking Climate-Positive Innovations During Resident Orientation

Most recent medical school graduates have had some climate change–related education, but their ability to connect climate science to patient care is limited. For example, plastic material waste, mostly made up of fossil fuel–based chemicals, breaks down into microplastics and nanoplastics, becoming part of our environment and water supply. These microplastics and nanoplastics are now found throughout the human body and linked with toxicological effects.1 Yet instruction connecting climate change and health in graduate medical education (GME) is challenging nationally as most program faculty have limited climate science expertise and scheduling across program education is an ongoing challenge.Our team, composed of GME leadership and subject matter experts in climate science, identified resident orientation for Atrium Health Carolinas Medical Center as an optimal time to engage residents. We focused on 3 foundational knowledge areas where: (1) climate change affects patient care; (2) care delivery is contributing to emissions and waste that is harmful to health; and (3) these health impacts are disproportionately experienced by already vulnerable groups (eg, young, pregnant, people of color).We designed a 45-minute exercise to make explicit health care’s contributions to climate change and opportunities to reduce/repurpose waste. The session began with a request for residents to voluntarily complete an anonymous online baseline survey with items focused on their knowledge about health care’s contribution to climate change and their ability to initiate conversations with patients about climate-driven exposures to their health, prior climate education, and interest in the topic.During the remainder of the session, residents were divided into teams of 4 to 6 and tasked to propose how the displayed noninfectious hospital plastic waste (previously collected mostly from operating rooms) could be repurposed into something useful for their patients. Each team then presented their best idea in a “Shark Tank” style format to judges (eg, resident leadership, a physician with expertise in climate health impacts, Plastics Lab director at the Innovation Barn2). Ideas ranged from creating pill boxes to dinnerware for the hospital cafeteria. The winning team proposed creating a plastic prosthetic socket for patients with limb loss from the plastic waste. They noted that for residual limb volume changes and for children who are still growing, the socket often needs adjustments, and plastic can be used to create a temporary socket to achieve proper fit numerous times. A single climate item was included in the GME program’s voluntary and anonymous end of orientation evaluation.Resident attendees (62%, 65 of 105) from all 12 programs completed the baseline survey. Among respondents, 51% (33 of 65) felt very or extremely knowledgeable about how the environment in which people live, work, and play impacts health of certain communities disproportionately. However, most reported being less knowledgeable (ie, somewhat, minimally, or not knowledgeable) in several areas, including (1) how the health care industry’s carbon footprint and waste harms patient health (80%, 52 of 65); and their education/knowledge obtained during medical school on the impacts of (2) climate change on health care waste/sustainability and/or environment (75%, 49 of 65). A majority (78%, 51 of 65) were somewhat, very, or extremely interested in becoming more involved as a resident to address these issues. The overall orientation evaluation completion rate was 43% (45 of 105), with 93% (42 of 45) responding that the climate session and activities increased their understanding of the intersection of climate and health equity.By engaging residents in a creative, “gamified” process to discover solutions to improve climate-resilient patient care by “sharking” repurposed health care waste during orientation, we achieved our aims. While not all cities have an Innovation Barn, most have experts who can serve as judges, making this feasible for implementation in other sponsoring institutions and programs.