Early Online 2024 Issue 1


health professions education
health sciences curriculum
education for sustainable healthcare
planetary health
sustainable healthcare

How to Cite

Early Online 2024 Issue 1: Education about planetary health and sustainable healthcare: A national Delphi panel assessment of its integration into health professions education in South Africa. (2023). African Journal of Health Professions Education, 15(3). https://doi.org/10.7196/


Background. Education about planetary health (PH) and sustainable healthcare (SH), or education for sustainable healthcare (ESH), enables health professionals to help protect public health and healthcare from climate change and environmental degradation. The Association for Medical Education in Europe Consensus (AMEE Consensus) Statement on Planetary Health and Education for Sustainable Healthcare has proposed a set of ESH learning objectives, activities and assessments for adaptation to different health professions education (HPE) contexts. The national audit phase of a mixed methods study in South Africa (SA) found that awareness of ESH and its curriculum development is emerging. The African Medical Education Directives for Specialists (AfriMEDS) is a competency framework for undergraduate medical students in SA that defines key competencies and enabling competencies related to seven roles of a health professional.

Objectives. To recruit a national Delphi panel of health professions educators to assess the applicability of the AMEE Consensus learning objectives, activities and assessments to HPE in SA; to elicit panellists’ perceptions of the main barriers and opportunities for ESH in faculties; and to compare learning objectives recommended by AMEE and the panel for key competencies and enabling competencies within the AfriMEDS framework. Methods. Nine educators from three different disciplines and six national faculties of health sciences participated in two rounds of a Delphi process and in follow-up discussions. In round 1, they rated the AMEE Consensus learning objectives, activities and assessments, and proposed additional ones. In round 2, they rated the score-ranked AMEE lists, as well as relevant additions from round 1. All panellists participated in further discussions regarding applicability, and highlighted the potential barriers and opportunities for integrating ESH into their faculties. The lead author then matched the panel’s learning objectives with enabling competencies related to all seven health professional roles described by AfriMEDS.

Results. All panellists recognised the importance of ESH in SA and the need for eco-ethical leadership by health professionals. All 13 AMEE Consensus learning objectives, as well as three additional objectives from the panel, were matched most frequently with AfriMEDS-enabling competencies related to the roles of leader and manager (n=9), communicator (n=8) and healthcare practitioner (n=7). Panellists highly ranked learning activities and assessments that are authentic, multiprofessional and require systems thinking. They perceived the lack of capable educators and curriculum overload to be the main barriers to integration of ESH, as well as the need for strong leaders, disciplinary champions and trained educators.

Conclusions. Situating the selected learning objectives within the AfriMEDS competency framework provides a good basis for developing aligned learning activities and assessments of ESH. Strong leadership, capable educators and multidisciplinary collaboration are important enablers of integrating ESH into HPE in SA.



Planetary Health Alliance. Planetary health. https://www.planetaryhealthalliance.org/planetary-health (accessed 23 June 2023).

Planetary Health Leadership Team. Planetary health report card 2022 - 2023. Summary report: An international health student initiative. https://phreportcard.org/wp-content/uploads/2023/04/PHRC-2023-Med-Summary- Report-FINAL.pdf (accessed 23 June 2023).

Walpole SC, Mortimer F, Inman A, et al. Exploring emerging learning needs: A UK-wide consultation on environmental sustainability learning objectives for medical education. Int J Med Educ 2015;6:191-200. https:// doi.org/10.5116/ijme.5643.62cd

Macpherson CC, Wynia M. Should health professionals speak up to reduce the health risks of climate change? AMA J Ethics 2017;19(12):1202-1210. https://doi.org/10.1001/journalofethics.2017.19.12.msoc1-1712

Berrang-Ford L, Sietsma AJ, Callaghan M, et al. Systematic mapping of global research on climate and health: A machine learning review. Lancet Planet Health 2021;5(8):e514-e525.

Association of Faculties of Medicine of Canada (AFMC) Declaration on Planetary Health Development Committee. Declaration on planetary health. https://www.afmc.ca/initiatives/planetaryhealthdeclaration/ (accessed 22 June 2023).

McKimm J, McLean M. Rethinking health professions’ education leadership: Developing ‘eco-ethical’ leaders for a more sustainable world and future. Med Teach 2020;42(8):855-860. https://doi.org/10.1080/0142159x.2020.1748877 8. Guarana CL, Hernandez M. Building sense out of situational complexity: The role of ambivalence in creating

functional leadership processes. Organ Psychol Rev 2015;5(1):50-73.

Shaw E, Walpole S, McLean M, et al. AMEE Consensus statement: Planetary health and education for sustainable

healthcare. Med Teach 2021;43(3):272-286. https://doi.org/10.1080/0142159X.2020.1860207

Tun S, Wellbery C, Teherani A. Faculty development and partnership with students to integrate sustainable healthcare into health professions education. Med Teach 2020;42(10):1112-1118. https://doi.org/10.1080/0142


Irlam J, Dreyer A, Filies G, et al. Education about planetary health and sustainable healthcare: A national audit of health professions education curricula in South Africa. Afr J Health Professions Educ 2023;15(4):e326. https:// doi.org/10.7196/AJHPE.2023.v15i4.326

Irlam JH, Scheerens C, Mash B. Planetary health and environmental sustainability in African health professions education. Afr J Prim Health Care Fam Med 2023;15(1). https://doi.org/10.4102/phcfm.v15i1.3925

Hampshire K, Islam N, Kisse B, et al. The planetary health report card: A student-led initiative to inspire planetary health in medical schools. Lancet Planet Health 2022;6(5):e449-e454. https://doi.org/10.1016/S2542- 5196(22)00045-6

Naidu C, Reid S, Burch V. Development of a CanMEDS-based instrument for evaluating medical students’ perceptions of the key competencies of a socially accountable healthcare practitioner. Perspect Med Educ 2020;9(2):98-106. https://doi.org/10.1007/s40037-020-00564-6

Health Professions Council of South Africa. Core competencies for undergraduate students in clinical associate, dentistry and medical teaching and learning programmes in South Africa. 2014. https://www.hpcsa-blogs.co.za/ wp-content/uploads/2017/04/MDB-Core-Competencies-ENGLISH-FINAL-2014.pdf (accessed 19 October 2023).

Frank JR, Danoff D. The CanMEDS initiative: Implementing an outcomes-based framework of physician competencies. Med Teach 2007;29(7):642-647. https://doi.org/10.1080/01421590701746983

Humphrey-Murto S, Varpio L, Gonsalves C, et al. Using consensus group methods such as Delphi and nominal group in medical education research. Med Teach 2017;39(1):14-19. https://doi.org/10.1080/014215 9X.2017.1245856

Walpole S, Vyas A, Maxwell J, et al. Building an environmentally accountable medical curriculum through international collaboration. Med Teach 2017;39(10):1040-1050. https://doi.org/10.1080/0142159X.2017.1342031 19. Tun S, Martin T. Education for sustainable healthcare ‒ a curriculum for the UK. 2022. https://www. medschools.ac.uk/media/2949/education-for-sustainable-healthcare_a-curriculum-for-the-uk_20220506.pdf

(accessed 19 October 2023).

Chase H, Hampshire K, Tun S. Improving the medical curriculum on planetary health and sustainable healthcare.

BMJ 2022;376:0209. https://doi.org/10.1136/bmj.0209

Tun S. Fulfilling a new obligation: Teaching and learning of sustainable healthcare in the medical education

curriculum. Med Teach 2019;41(10):1168-1177. https://doi.org/10.1080/0142159X.2019.1623870

Irlam J, Razzak Z, Parker Q, et al. Student knowledge and perceptions of climate change and environmental sustainability at the Faculty of Health Sciences, University of Cape Town, South Africa. Afr J Health Professions

Educ 2023;15(1):2-6. https://doi.org/10.7196/AJHPE.2023.v15i1.1659

Karliner J, Guenther R. Global green and healthy hospitals agenda: A comprehensive environmental health

agenda for hospitals and health systems around the world. Health Care Without Harm 2011.

GroundWork. The Global Green and Healthy Hospitals (GGHH) network in Africa. https://groundwork.org.za/

global-green-healthy-hospitals/ (accessed 22 June 2023).

Alsubaie MA. Hidden curriculum as one of current issue of curriculum. J Educ Prac 2015;6(33):125-128.

UNESCO International Bureau of Education. Hidden curriculum. https://www.ibe.unesco.org//en/glossary-

curriculum-terminology/h/hidden-curriculum (accessed 22 June 2023).

Prasad V, Thistlethwaite W, Dale W. Effect of clinical vignettes on senior medical students’ opinions of climate

change. South Med J 2011;104(6):401-404. https://doi.org/10.1097/SMJ.0b013e31821a841d

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Copyright (c) 2023 J Irlam, S reid, H-A Rother