Designing transformative sustainability education: a mixed methods study exploring the values and perspectives of medical students
4 affiliations
- 1Department of Surgery and Critical Care, University of Otago, Christchurch, New Zealand
- 2University of Dundee School of Medicine, Dundee, UK
- 3University of Dundee School of Humanities, Social Science and Law, Dundee, UK
- 4National University of Singapore, Singapore, Singapore
Abstract
Introduction: Education for Sustainable Healthcare (ESH) is a novel area of medical education and high-quality evidence to guide effective learning approaches is yet to be established. This study investigates the design of ESH in undergraduate medicine through the lenses of transformative learning, environmental value position and student-centred design.
Methods: A mixed methods approach was used. A questionnaire assessed the environmental value position and attitudes towards ESH of undergraduate medical students at the University of Dundee. Semi-structured interviews with a sub-group of these students further evaluated environmental perspectives and explored preferences for learning approaches for ESH.
Results: The questionnaire data indicated that the students had high levels of environmental concern, arising from an ecocentric value position. Ecocentrism correlated with support for the integration of ESH and sustainability in medicine. The qualitative findings from 10 interviews confirmed high levels of environmental concern and support for ESH but suggested a more complex underlying value basis. There was a disconnection between students’ environmental values and their engagement with sustainable medical practice, arising from conflict between their sense of medical professionalism and aspects of sustainable medical practice that were perceived to be at odds with providing optimal patient care. Regarding learning approaches, students highlighted the need to prioritise examined content, and reported a preference for small group, interactive learning, delivered by engaged tutors in an authentic and relevant way.
Discussion: It is important that the integration of ESH involves summative assessment; without this, students are unlikely to engage with the topic. ESH learning approaches should be designed in accordance with student preferences if they are to maximise impact: interactive, student-centred, experiential learning approaches are preferred. ESH should bridge the gap between students’ environmental attitudes and capacities for sustainable behaviour by empowering them to act sustainably through role modelling, skills acquisition, project work and critical reflection.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12909-026-09960-8.
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BibTeX
@article{smith2026designing,
title = {{Designing transformative sustainability education: a mixed methods study exploring the values and perspectives of medical students}},
author = {Tim Smith and Fiona Muir and Elizabeth Lakin and Shona Livingstone and Chantelle Rizan},
journal = {BMC Medical Education},
year = {2026},
month = jul,
doi = {10.1186/s12909-026-09960-8},
url = {https://doi.org/10.1186/s12909-026-09960-8},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Designing transformative sustainability education: a mixed methods study exploring the values and perspectives of medical students
AU - Tim Smith
AU - Fiona Muir
AU - Elizabeth Lakin
AU - Shona Livingstone
AU - Chantelle Rizan
PY - 2026
DA - 2026/07/31
JO - BMC Medical Education
DO - 10.1186/s12909-026-09960-8
UR - https://doi.org/10.1186/s12909-026-09960-8
AB - Introduction: Education for Sustainable Healthcare (ESH) is a novel area of medical education and high-quality evidence to guide effective learning approaches is yet to be established. This study investigates the design of ESH in undergraduate medicine through the lenses of transformative learning, environmental value position and student-centred design. Methods: A mixed methods approach was used. A questionnaire assessed the environmental value position and attitudes towards ESH of undergraduate medical students at the University of Dundee. Semi-structured interviews with a sub-group of these students further evaluated environmental perspectives and explored preferences for learning approaches for ESH. Results: The questionnaire data indicated that the students had high levels of environmental concern, arising from an ecocentric value position. Ecocentrism correlated with support for the integration of ESH and sustainability in medicine. The qualitative findings from 10 interviews confirmed high levels of environmental concern and support for ESH but suggested a more complex underlying value basis. There was a disconnection between students’ environmental values and their engagement with sustainable medical practice, arising from conflict between their sense of medical professionalism and aspects of sustainable medical practice that were perceived to be at odds with providing optimal patient care. Regarding learning approaches, students highlighted the need to prioritise examined content, and reported a preference for small group, interactive learning, delivered by engaged tutors in an authentic and relevant way. Discussion: It is important that the integration of ESH involves summative assessment; without this, students are unlikely to engage with the topic. ESH learning approaches should be designed in accordance with student preferences if they are to maximise impact: interactive, student-centred, experiential learning approaches are preferred. ESH should bridge the gap between students’ environmental attitudes and capacities for sustainable behaviour by empowering them to act sustainably through role modelling, skills acquisition, project work and critical reflection. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12909-026-09960-8.
SN - 1472-6920
ER -