Climate and Health Education in Internal Medicine: Meeting Patients Where They Are

As internal medicine physicians, we are trained to recognize patterns, identify risk factors, and anticipate disease before it worsens. Yet one of the most significant health threats affecting our patients is still often missing from residency education: climate and environmental health.

For many residents, “climate change” can feel distant from day-to-day inpatient admissions or outpatient clinic visits. In reality, we already care for climate-related illness every day – we just may not label it that way. Heat-related illness, worsening COPD and asthma during poor air quality days, dehydration and acute kidney injury during extreme heat, vector-borne infections, mental health strain following natural disasters, and food or housing instability after severe weather events all intersect directly with internal medicine.

The challenge, of course, is residency itself. Internal medicine training is already dense, and adding another stand-alone lecture series may feel unrealistic. Fortunately, climate and health education does not need to compete with existing curriculum – it can be integrated into it. Kuczmarski and colleagues describe a practical approach of weaving climate-related concepts into preexisting subspecialty didactics rather than creating entirely new educational blocks. Pulmonary lectures can include air quality and respiratory exacerbations. Nephrology teaching can address dehydration and kidney injury during heat events. Infectious disease conferences can discuss changing vector-borne disease patterns. Gastroenterology discussions could incorporate food and water insecurity or disaster-related gastrointestinal illness.

This approach feels particularly relevant for residency because it mirrors how we actually practice medicine. Patients do not present with “climate disease.” They present with CHF exacerbations after prolonged heat exposure, worsening respiratory symptoms after wildfire smoke or poor air quality, medication access barriers after storms, or infectious exposures shaped by changing environments.

Importantly, climate and health education can strengthen resident confidence in patient counseling and community awareness. Recent residency-based educational efforts have demonstrated improved trainee confidence in recognizing climate-related health effects and helping patients navigate local risks and community resources after even brief educational sessions. Rather than asking residents to become environmental experts, these interventions emphasize practical clinical preparedness and anticipatory guidance.

For internal medicine residents, the goal is not perfection or added workload – it is awareness. A simple question about heat exposure, housing conditions, storm preparedness, medication refrigeration during power outages, air quality, or transportation barriers may become just as clinically relevant as asking about tobacco use or diet in certain settings.

Practical tools can also make climate-informed care easier to incorporate into everyday practice. Clinics and residency programs can provide simple patient handouts on heat safety, poor air quality, disaster preparedness, medication storage during outages, and local community resources for vulnerable patients. Free clinic-facing resources and patient education materials already exist and can be adapted to local community needs. Incorporating dot phrases or templated counseling language into the electronic medical record may also help residents efficiently document counseling and environmental risk factors while making climate-related anticipatory guidance easier to integrate into routine visits.

Ultimately, climate and health education belongs in residency training because it already belongs in patient care. As internists, we care for medically complex and vulnerable populations whose health is shaped not only by chronic disease but also by the environments in which they live.

References

Kuczmarski TM, Fox J, Katznelson E, et al. Climatizing the Internal Medicine Residency Curriculum: A Practical Guide for Integrating the Topic of Climate and Health Into Resident Education. Journal of Climate Change and Health. 2021;4:100067. doi:10.1016/j.joclim.2021.100067

Moon C, Braganza S, Bathory E. Incorporating Climate Change Education Into Residency: A Focus on Community Risks and Resources. Journal of Graduate Medical Education. 2024;16(6 Suppl):86-91. doi:10.4300/JGME-D-24-00061.1

Association of American Medical Colleges. Climate Change and Medical Education Resource Bundle.

Americares. Climate Resilience for Frontline Clinics Toolkit.