Factors influencing medical students’ knowledge and attitudes toward climate change: A cross-sectional study

PLOS One | https://doi.org/10.1371/journal.pone.0330875 October 10, 2025 3 / 12 Worldwide, most medical schools have not formally included climate change in their curricula, relying instead on ini- tiatives led by individual student groups or faculty members [14]. A 2020 survey demonstrated that only 15% of medical schools worldwide teach climate change [15]. A recent review of global climate change curricula found only 2 studies that described experiential learning during clinical rotations [16]. Accordingly, in a study of 600 medical students across 12 hospitals in the United States, only 6.3% felt very prepared to discuss how climate change can affect health with a patient [17]. Curricular integration is even less common in medical schools in the Global South, despite the increasing frequency and severity of climate-driven extreme weather events in these regions over the past decade [8]. The effects of climate change are particularly pronounced in the arid and semi-arid regions of the Middle East and Northern Africa (MENA), where heat extremes, water scarcity, and air pollution pose major health risks to the population [18]. Studies show an increased mortality risk in the Middle East due to circulatory events associated with increased average daily temperatures [19]. It is currently estimated that two of every three deaths from heat in the Middle East are caused by human made global warming [20]. It is projected that by the end of the century, cities around the Arabian Gulf,

including Abu Dhabi and Dubai in the United Arab Emirates (UAE), could experience periods of intense heat that may make them unsuitable for human life [21]. Moreover, the MENA is among the regions with the lowest water availability in the world [18]. The water scarcity and high temperatures contribute to dust events, which increase risks of hospitalization and mortality due to respiratory and cardiovascular diseases [18]. However, there is limited published data on the atti- tudes, knowledge, or education of internationally educated physicians who are preparing to work in these regions. Iden- tifying gaps in knowledge and skills can help educators and policymakers develop and implement effective educational interventions tailored to student needs [22]. To address this gap, we conducted a survey of recently graduated medical students who received education from all over the globe and were seeking residency training in the UAE. The objectives of this study were to (1) assess the knowledge, attitudes, and prior education of medical graduates regarding climate change and its health impacts, and (2) identify factors associated with higher knowledge and more positive attitudes toward climate-related health issues. We hypothesized that prior exposure to climate change education would be associ- ated with greater knowledge and more favorable attitudes. Methods A cross-sectional survey study was conducted at two large academic medical centers in the UAE. The Checklist for Reporting Results of Internet E-Surveys (CHERRIES) was used to guide our reporting [23]. Survey development

The questionnaire was designed to assess climate change-related education in medical school curricula, participants’ knowledge of the effects of climate change on health, and their attitudes toward climate change. The survey questions were developed by a panel of medical educators and researchers after a review of the literature on climate change in medical education (S2 File). It was reviewed for content and accuracy by a public health specialist with expertise in cli- mate change. The survey was then piloted on 15 medical students for length and clarity, with minor modifications based on their feedback. These responses were not included in the data analysis. Internal consistency of knowledge and atti- tude of climate change were evaluated by computing Cronbach’s alpha. Cronbach’s alpha was 0.9 for attitude and 0.6 for knowledge. The Formsite (Vroman Systems, Inc.) survey tool was used to create the survey. All questions and responses were written in English, the primary language of medical education and healthcare delivery in the UAE. Each survey question allowed only one response, which could be changed until the survey was completed and submitted. A response to each question was needed to complete the survey. The final version of the survey (S3 File) consisted of four sections (demographics, education, knowledge, and attitude). After general demographic questions, participants were asked about formal education on climate change-related topics in medical school, with 7 questions on topics covered and 7 questions about teaching formats used. The following section